what percent of the population has personality disorders?
what is ecosyntonic?
acceptable to the go
which pts are more likley to refuse txment and deny their problems?
pts with axis II conditions
what is the definition of personality disorders?
enduring subjective experiences and behavior that deviate from cultural standards, are rigid and stable through time
commonly have adolescent or early adulthood onset
often lead to unhappiness and impairment
what do you use to help understand a person's personality disorder?
what is concerning about labeling ppl with personality disorders?
the label is stigmatizing and follows them around for life
which personality disorders are part of cluster A?
which personality disorders are part of cluster B?
which personality disorders are part of cluster C?
what are characteristics of paranoid PD?
long-standing suspiciousness and mistrust of ppl in general
hostile, irritable, angry
may have disdain for ppl who are weak, sickly or impaired
how is paranoid PD different from delusional disorder?
there are not fixed delusions
how is paranoid PD different from schizophrenia ?
there are no hallucinations or formal thought problems
what are common relational problems that paranoid PD ppl have?
medications may be used to calm pts anxiety
what are characteristics of schizoid disorder?
1. pattern of social withdrawal
2. isolated/lonely, uncomfortable with human interaction
3. seem lost in daydreams, but are connected to reality
4. no delusions/hallucinations
what are DDx of schizoid-type behaviors?
how do you treat schizoid PD?
what are characteristics of schizotypal PD?
1. odd, strange, bizarre behavior and thinking
2. magical thinking
3. vivid imagery, clairvoyance, child-like fantasies
4. may decompensate and develop psychosis
what is DDx of schizotypal-type behaviors?
schizophrenia (no psychosis)-may develop into this
what is an important risk to consider with schizotypal PD?
more likely to commit suicide
how do you treat schizotypal PD?
may use antidepressants
what are characteristics of antisocial PD?
1. against society
2. can not experience empathy
3. often a/w criminal behavior
4. lack of remorse (no conscience)
what is a common progression of antisocial PD?
onset before age 15
starts as ODD, then conduct disorder, then ASPD
strong genetic component
how would an antisocial PD patient present in the clinic?
may appear charming, persuasive, and have a mask of sanity
often very intelligent
what is DDx of ASPD type behaviors?
how do you treat ASPD?
firm limits are essential
challenge them to deal honestly with ppl
medications may be used
be cautious of drug abuse
what are chacteristics of borderline PD?
1. unstable affect, mood, behavior and self-image
2. always in a state of crisis
3. repetitive self-destructive acts including suicidal gestures
4. feel both hostile and dependent, cannot tolerate being alone, chronic feelings of emptiness
5. ppl are either all good or all bad
what is DDx of borderline PD?
schizophrenia (no prolonged psychotic episodes)
how do you treat borderline PD?
1. difficult (regressive behavior, acting out, hostility)
2. good to stay reality based, give feedback on their behavior
3. hospitalizations are common
4 medications (antipsychotics, antidepressants, benzos)
what are characteristics of histrionic PD?
1. dramatic attention-seeking behavior, very colorful language
2. unable to maintain deep, long-lasting relationships
3. temper tantrums, tears, accusations are common, may be coy or flirtatious
4. have trouble explaining their motivations
what is DDx of histrionic type behaviors?
decreased sxs with age (less energy to put into their exaggerations)
how do you treat histrionic PD?
focus on clarifying their inner feelings
meds can help tx borderline-type sxs
what are characteristics of narcissistic PD?
1. heightened sense of self importance and grandiose feelings of uniqueness
2. unrealistic sense of omnipotence, beauty, talent
3. do not handle criticism (everyone is an idiot)
4. fragile relationships, follow their own rules, commonly exploit others, incapable of empathy
what is DDx of narcissistic PD?
can be seen in cluster B disorders
lack suicidal gestures present in other disorders
how do you treat narcissistic PD?
difficult (they have to renounce their narcissism in order to make progress)
aging is difficult for pts
group therapy may be helpful
antidepressants and mood stabilizers
what are characteristics of avoidant PD?
1. extreme sensitivity to rejection leading to social withdrawal
2. interviewing reveals anxiety and vulnerable to comments or criticism
3. seek employment away from ppl
what is DDx of avoidant type behaviors?
schizoid (wanting to be alone)
can maintain family relationships that are safe
how do you treat avoidant PD?
trust and acceptance are essential
pts are encouraged to take risks
group therapy can be helpful
meds to manage anxiety and depression
what are characteristics of dependent PD?
1. subordinate their needs to the needs of others
2. lack self confidence and uncomfortable when left alone
3. pervasive pattern of dependent, submissive behavior
4. cannot make decisions w/o lots of information, advice and reassurance
what is DDx of dependent type behaviors?
histrionic and borderline (no long term relationships)
how do you treat dependent PD?
1. require constant supervision, have trouble working independently
2. insight oriented therapies
3. teach how to become more assertive and self reliant
4. be careful about txment engaging primary relationships
5. meds used to manage anxiety, depression
what are characteristics of OCPD?
1. emotional constriction, orderliness, stubbornness
2. extreme perfectionism and inflexibility
3. controlling, preoccupied with rules, regulations, details
4. few friends b/c of imposing rules on others
5. lack sense of humor
how do you distinguish between OCPD and OCD?
OCD has recurrent obsessions and compulsions
OCPD can develop into OCD or sxs may go away
how do you treat OCPD?
1. long and complex
2. group and behavior therapy
3. meds for anxiety and depression