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Flashcards in Personality Disorders Deck (47)
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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


Personality disorders have been linked to?

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


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


What is most common PD dx?

- personality disorder NOS


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

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


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


What are high treatable PDs? Low?

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


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


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


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


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


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


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


DDx for schizoid PD?

- paranoid PD
- schizotypal PD
- schizophrenia
- autism


Tx for schizoid PD?

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


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


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


tx for schizotypal PD?

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


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


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


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


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


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)


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


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


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


Comorbidity of BPD pts?

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


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


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


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