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Flashcards in Personality Disorders Deck (47):
1

How are personality disorders defined?

- enduring pattern of inner experience or behavior that deviates from expectations of culture, manifested in 2 or more of the following:
cognition (perception of self, others)
affectivity (intensity, range of emotions)
interpersonal fxning
impulse control***
- pts are egosynotic and lack insight regarding their problems.
- enduring pattern leads to distress, impairment in impt areas of fxning, pattern is stable, can be traced back to childhood, and it can't be due to substance abuse or medical condition

2

Personality disorders have been linked to?

- mortality
- heart disease
- decreased life satisfaction and well-being
- personality problems are costly to society

3

How does tx personality disorder and axis 1 pathology turn out?

- tx axis 1 pathology typically doesn't help the personality disorder
- tx personality disorder typically does help axis 1 pathology

4

What is most common PD dx?

- personality disorder NOS

5

6 types of PDs - based on trait criteria for DSM 5?

- antisocial
- avoidant
- borderline
- narcissistic
- obsessive-compulsive
- schizotypal

6

Classification of personality disorders?

- cluster A (odd or eccentric-mad): paranoid, schizoid, schizotypal
- cluster B (dramatic, emotional, erratic - bad): antisocial, bordeline, histrionic, narcissistic
- cluster C (anxious or fearful- sad): avoidant, obsessive-compulsive, dependent

7

What are high treatable PDs? Low?

- high - dependent, histrionic, OCPD, avoidant
- low - paranoid, antisocial (refuse tx or will be court ordered)

8

Traits of Cluster A personality disorders?

- paranoid, schizoid and schizotypal personality disorders
- marked by eccentricity, odd behavior, not psychosis
- share a superficial similarity with schizophrenia
- social detachment w/ unusual weird behavior

9

What is paranoid personality disorder?

- lack of trust in others
- fear that friends may be disloyal, unfaithful
- being hypersensitive, overly suspicious, perceived as hostile
- no hallucinations

10

DSM-5 criteria for paranoid PD?

- pervasive distrust, suspicion of others, and 4 of the following:
- suspects, w/o basis, that others are exploiting, harming and deceiving
- preoccupied with unjustified doubts of loyalty or trustworthiness of people
- is reluctant to confide in others
- reads hidden, demeaning, threatening meaning into benign actions
- persistently bears grudges
- perceives attacks on reputation
- has unjustified suspicions about fidelity of others

11

How common is paranoid personality disorder? Tx?

- affects 0.5-2.5% of population
- 10-30% among inpts
- 2-10% among outpts
- more common in men

- Tx: CPT -psychotherapy is key, use antianxiety meds (SSRIs) or antipsychotics to decrease paranoia or for transient psychosis

12

Paranoid PD - co-occuring disorders?

- generalized anxiety disorder
- panic disorder: palpitations, sweating, shaking, feeling of choking, SOB, fear of dying
- delusional disorder - nonbizarre delusions
- other PDs: BPD, APD, NPD

13

DSM-5 criteria for schizoid PD?

- detachment from social relationships, restricted emotions, as indicated by 4 or more of the following:
- neither desires nor enjoys social relationships
- prefers solitary activities
- has little interest in sexual experiences
- gets pleasures from few activities
- lacks close friends
- appears indifferent to praise or criticism
- shows emotional coldness, detachment, flat affect

*males affected 2x as much as females
*least commonly dx PD

14

DDx for schizoid PD?

- paranoid PD
- schizotypal PD
- schizophrenia
- autism

15

Tx for schizoid PD?

- aren't likely to seek help
- social skills training
- low dose antipsychotics or antidepressants

16

DSM-5 criteria for schizotypal PD?

- acute discomfort with social relationships, eccentric behavior, and 5 or more of the following:
-ideas of reference: things happen specifically for that person - people on radio talking about them
-odd beliefs
-unusual perceptual experiences
-odd speech
-suscipicousness or paranoid ideation
- inappropriate or constricted affect
- odd or eccentric appearance and behavior
- lack of close friends
- excessive social anxiety

* of the of all PDs this is the one that is most likely going to progress to schizophrenia

17

DDx for schizotypal PD?

- other PDs in cluster A: paranoid, schizoid
- psychotic disorders: personality disorder must have been present b/f the onset of psychotic sxs and persist when psychotic sxs are in remission
psychotic disorders are all characterized by period of persistent psychotic sxs

18

tx for schizotypal PD?

- similar to schizoid
- social skills training
- low dose antipsychotics or antidepressants

19

Similarities and differences b/t schizoid and schizotypal PDs?

- similarities: inability to initiate or maintain relationships (both friendly and romantic)
- differences: schizotypal pts avoid social interation b/c of fear of people
schizoid individuals feel no desure to form relationships

20

What are the Cluster B personality disorders?

- antisocial, BPD, histrionic, and narcissistic personality disorders
- dramatatic, emotional and erratic
- being self-absorbed, prone to exaggerate importance of events
- having difficulties maintaining close relationships
- usually higher fxning

21

DSM-5 criteria for antisocial PD?

- pattern of disregard for rights of others since age 15, as indicated by 3 or more of the following:
- failure to conform to social norms, respect lawful behavior
- deceitfulness, lying, conning others for profit or pleasure
- impulsivity, failure to plan ahead
- irritability, aggressiveness, repeated fights
- reckless disregard for safety of others
- consistent irresponsibility, failure to honor obligations
- lack of remorse
- individual is at least 18 yo
- evidence of conduct disorder b/f 15
- occurrence not exclusively during course of schizophrenia, or a manic episode

22

What pops - more commonly have antisocial PD?

- 2.5-3.5% of pop
- more common in men
- highest prevalence in men 25-44 yr old
- familial pattern
- higher rates in prisons, forensic settings and substance abuse tx programs, more common in urban areas

23

Tx of antisocial PD?

- usually is court ordered
- anger management (harm reduction)
- med to tx impulsivity, aggressiveness, explosiveness and violence
- group therapy (w/ other APD pts, not mixed)

24

Characteristics of BPD?

- enduring pattern of thinking, behavior that involves:
- instability of mood, self-image, interpersonal relationships
- frantic efforts to avoid real or imagined abandonment
- unrealistically positive or negative opinions about others (intense relationships or nonexistence)
- dx more often in women
- threats/actions of self-harm are common
- black and white thinking
- 8-10% commit suicide
- 60-70% make attempts

25

What PDs are more common in men? Women?

men: antisocial, schizoid, paranoid
women: borderline, histrionic, dependent

- be careful not to overdx or underdx just b/c of this fact - can go either way

26

How is amygdala-prefrontal cortex affected in BPD?

- normal: prefrontal cortex - inhibitory control over amygdala
- in BPD: absence of normally tight coupling so leads to disconnect b/t orbital frontal cortex and amygdala - failure to downregulate amygdala in response to aversive stimuli

27

Comorbidity of BPD pts?

- 84.5% of pts meet criterial for axis 1 disorders:
mood disorders
anxiety disorders
substance use disorders

28

DSM-5 criteria for BPD?

- instability in relationships, self-image, marked impulsivity, and five or more of the following:
1. frantic efforts to avoid real or imagined abandonment
2. pattern of unstable, intense relationships
3. identity disturbance
4. impulsivity in 2 or more areas that are self-damaging
5. recurrent suicidal behavior, gestures, threats
6. affective instability - labile: crying and then laughing
7. chronic feelings of emptiness
8. inappropriate intense anger
9. transient, stress-related paranoid ideas

29

Tx of BPD?

- meds to tx target sxs: antipsychotics in addition to psychotherapy yield better results - prozac to improve mood, lithium or valproate can be used as mood stabilizer, benzos should only be used short term
- acute inpt psych
- DPT - in group and individual basis is tx of choice
- cognitive behavioral therapy

30

What is histrionic personality disorder?

- enduring pattern of thinking, behavior characterized by excesive emotionality and attention seeking behavior
- person is typically self-centered, vain, demanding
- appears in 2-3% of pop
- person dresses eccentrically, seductively
- somatization and substance use disorders are common

31

DSM-5 criteria for histrionic PD?

- excessive emotionality, attention seeking, and 5 or more of the following:
1. being uncomfortable when not center of attention
2. interactions characterized by provocative, sexually seductive behavior
3. rapidly shifting and shallow moods
4. consistently uses physical appearance to draw attention to self
5. style of speech is excessively impressionistic and lacking in detail
6. shows self-dramatization, exaggerated expression of emotion
7. is suggestible, easily influenced
8. considers relationships more intimate than they are

32

Tx of histrionic PD?

- CBT
- group therapy

33

DSM-5 criteria for narcissistic PD?

- grandiosity is fantasy and behavior, need for admiration, lack of empathy, and 5 or more of the following:
1 - has grandious sense of self-importance
2 - is preoccupied with fantasies of power, success, love
3 - believes he or she is special or unique
4 - requires excessive admiration
5 - has sense of entitlement
6 - takes advantage of others to achieve own needs
7 - lacks empathy
8 - is often envious of others
9 - is arrogant, haughty

34

Tx of narcissistic PD?

- anger management
- psychotherapy (for axis 1)
- group therapy: works b/c improves ability to empathize, peer rather than therapist feedback is better for the pt

35

What are cluster C personality disorders?

- avoidant, obsessive compulsive, and dependent
- people are sad, have anxiety and fear - whiny, and dependent

36

What is avoidant personality disorder?

pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivty to negative eval indicated by 4 or more of the following:
- avoids occupational activities that involves significant interpersonal contract, b/c of fears of criticism, disapproval or rejection
- unwilling to get involved with people unless certain of being liked
- shows restraint with intimate relationships b/c of the fear of being shamed or ridiculed
- is preoccupied with being criticized or rejected in social situations
- is inhibited in new interpersonal situations b/c of feelings of inadequacy
- views self as socially inept, personally unappealing or inferior to others
- is unusually reluctant to take personal risks or to engage in any new activities b/c they may prove embarrassing

37

DDx of APD?

- social phobia: co-morbid with APD, fear of social situations
- schizoid PD and schizotypal PD: APD want to have relationships with others, schizoid and schizotypal prefer isolation

38

Tx of APD?

- CBT
- group therapy
- social skills training
- SSRIs

39

DSM-5 criteria for OCPD?

- preoccupied with details, rules, lists, order, organization, or schedules to extent that major pt of activity is lost
- shows perfectionism that interferes with task completeion
- is excessively devoted to work and productivity to the exclusion of leisure acitivities and friendships
- is overconscientious, scrupulous and inflexible about morality, ethics or values
- unable to discard worn out objects that have no sentimental value (hoarding - own DSM-V)
- reluctant to delegate tasks or do work with others unless they submit to exactly his or her way of doing things
- adopts a miserly spending style toward both self and others: money is viewed as something to be hoarded for future catastrophes
- rigid and stubborn

40

Prevalence of OCPD?

- one of the most prevalent PDs in the general pop ranging from 2.1%-7.9%
- 3 and 10% of clinical settings

41

DDx of person with OCPD sxs?

- hoarding: extreme hoarding
- OCDP: orderliness, perfection, and control, tx is psychotherapy
- OCD: recurrent obsessions (thoughts) or compulsions (act) that are recognized by the individual as unreasonable. Tx is meds and therapy

42

Tx of OCPD?

- they seek tx due to anxiety attacks, sexual dysfxn, fatigue or at request of family members
- CBT
- no research which meds work

43

What is dependend personality disorder (DPD)?

five or more of the following:
- has difficulty making everyday decisions w/o an excessive amt of advice and reassurance from others
- needs others to assume responsibility for most major areas of his or her life
- has difficulty expressing disagreement with others b/c of fear of loss of support or approval
- has difficulty initiating projects or doing things on his or her own
- goes to excessive lengths to obtain nurturance and support from others, to the pt of volunteering to do things that are unpleasant
- feels uncomfortable or helpless when alone b/c of exaggerated fears of being unable to care for self
- urgently seeks another relationship as a source of care and support when a close relationship ends
- is unrealistically preoccupied with fears of beign left to take care of self

44

Co-morbid conditions assoc with DPD?

- social phobia
- PTSD
- generalized anxiety disorder

45

Tx of DPD?

- med for specific sxs (usually on axis 1 - eating disorders, anxiety disorders and obesity)
- CBT
- psychodynamic

46

Essential features of a personality disorder?

- impairments in personality (self and interpersonal) fxning and the presence of pathological personality traits

47

To dx a personality disorder, what criteria must be met?

- A: significant impairments in self (identity or self-self direction) and interpersonal (empathy or intimacy) fxning
- B: one or more pathological personality trait domain(s) or trait facet(s)
- C: the impairments in personality fxning and the individual's personality trait experssion are relatively stable across time and consistent across situations