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Flashcards in Personality Disorders Cluster A + Borderline Deck (34):
1

What is a general personality disorder Criteria A?

An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture.

2

General Personality Disorder Criteria A is manifested in two (or more) of the following areas:

1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
3. Interpersonal functioning.
4. Impulse control.

3

What is general personality disorder criteria A,B,C,D,E,F?

A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture.
B. inflexible and pervasive across a broad range of personal and
social situations.
C. leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. stable and of long duration, and Its onset can be traced back at least to
adolescence or early adulthood.
E. is not better explained as a manifestation or consequence of another mental disorder.
F. is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

4

Personality traits are ______

enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts

5

The personality traits that define these disorders must also be distinguished from:

characteristics that emerge in response to specific situational stressors or
more transient mental states (e.g., bipolar, depressive, or anxiety disorders; substance intoxication).

6

The clinician should assess the stability of personality traits ____

over time and across different situations.

7

ego-syntonic

not be considered problematic by
the individual

8

Some types of personality disorder
(notably,________) tend to become less evident or to
remit with age, whereas this appears to be less true for some other types (e.g.,______)

1. antisocial and borderline personality disorders

2. obsessive compulsive
and schizotypal personality disorders

9

For a personality disorder to be diagnosed in an individual younger than 18 years, ______The one exception to this is______

1. the features
must have been present for at least 1 year

2. antisocial personality
disorder, which cannot be diagnosed in individuals younger than 18 years.

10

Culture and Gender issues with personality disorder diagnosis

must take into account the individual's ethnic, cultural, and social background. Personality disorders should not be confused with problems associated with acculturation following immigration or with the expression of habits, customs,
or religious and political values professed by the individual's culture of origin.

personality disorders (e.g., antisocial personality disorder) are diagnosed more
frequently in males. Others (e.g., borderline, histrionic, and dependent personality disorders)
are diagnosed more frequently in females. Must be cautious of over diagnosis and gender stereotypes

11

Differential Diagnosis for personality disorder

PSYCHOTIC disorders. For the three personality disorders that may be related to the psychotic
disorders (i.e., paranoid, schizoid, and schizotypal), there is an exclusion criterion
stating that the pattern of behavior must not have occurred exclusively during the course
of schizophrenia, a bipolar or depressive disorder with psychotic features, or another psychotic
disorder. When an individual has a persistent mental disorder (e.g., schizophrenia)
that was preceded by a preexisting personality disorder, the personality disorder should
also be recorded, followed by "premorbid" in parentheses.
ANXIETY AND DEPRESSIVE disorders. The clinician must be cautious in diagnosing personality
disorders during an episode of a depressive disorder or an anxiety disorder, because
these conditions may have cross-sectional symptom features that mimic personality
traits and may m^ke it more difficult to evaluate retrospectively the individual's long-term
patterns of functioning.
POST TRAUMATIC STRESS DISORDER. When personality changes emerge and persist after an
individual has been exposed to extreme stress, a diagnosis of posttraumatic stress disorder
should be considered.
SUBSTANCE USE disorders. When an individual has a substance use disorder, it is important
not to make a personality disorder diagnosis based solely on behaviors that are consequences
of substance intoxication or withdrawal or that are associated with activities in
the service of sustaining substance use (e.g., antisocial behavior).
Personality change due to another MEDICAL CONDITION. When enduring changes in personality
arise as a result of the physiological effects of another medical condition (e.g.,
brain tumor), a diagnosis of personality change due to another medical condition should
be considered.

12

Personality disorders must be distinguished from personality traits that do not reach
the threshold for a personality disorder. Personality traits are diagnosed as a personality
disorder only when _____

they are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.

13

Paranoid Personality Disorder Criteria

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts as 4 or more of the following:
1. suspects, w/out sufficient basis, that others are exploiting, harming, or deceiving them
2. preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. reluctant to confide in others bc of unwarranted fear that the information will be used maliciously against them
4. reads hidden demeaning or threatening meaning into benign remarks or events
5. Persistently bears grudges(unforgiving of insults/slights)
6. perceives attacks on character or reputation that are not apparent to others and is quick to react angrily/ counterattack
7. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
B. Does not occur exclusively during the course of schizophrenia , a bipolar disorder, or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition

14

Paranoid Personality Disorder *note*

if criteria are met prior to the onset of schizophrenia, add
"(premorbid)" to the diagnosis

15

What Paranoid Personality disorder may look like "associated features" and co-occur with

-problems with close relationships
-excessive suspiciousness and hostility
may be expressed in overt argumentativeness, in recurrent complaining, or by quiet,
apparently hostile aloofness.
-may act in a guarded, secretive, or devious manner and appear to be "cold" and lacking in
tender feelings.
- appear to be objective, rational, and unemotional, but
more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating
-may elicit a hostile response in
others, which then serves to confirm their original expectations
-need to be self-sufficient and a strong sense of autonomy; control over others; rigid, critical, and unable to collaborate
-frequently involved in legal disputes (blame others/counterattacks)
-may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of
power and rank, negative stereotypes (other groups)
-form groups of "fanatics"/cults
-brief (min/hours) psychotic episodes
- may develop major depressive
disorder and at increased risk for agoraphobia and obsessive-compulsive disorder.
-Alcohol and other substance use disorders frequently occur.
-The most common cooccurring
personality disorders appear to be schizotypal, schizoid, narcissistic, avoidant,
and borderline

16

Paranoid personality disorder; development and course

-first in childhood w/ solitary, poor peer relations, social anxiety, school underachievement, idiosyncratic fantasies, appear odd or eccentric
-more diagnosed in males

17

paranoid personality; cultural issues

Members of minority groups, immigrants, political and economic refugees, or
individuals of different ethnic backgrounds may display guarded or defensive behaviors because of unfamiliarity (e.g., language barriers or lack of knowledge of rules and regulations)
or in response to the perceived neglect or indifference of the majority society. These behaviors can, in turn, generate anger and frustration = cycle of mutual mistrust. Some ethnic grps display misinterpreted behaviors that look paranoid

18

Paranoid Personality Differential Diagnosis

OTHER PSYCHOTIC SYMPTOMS
distinguished from delusional disorder, persecutory type; schizophrenia; and a bipolar or
depressive disorder with psychotic features because these disorders are all characterized by a
period of persistent psychotic symptoms (e.g., delusions and hallucinations)
-additional diagnosis of paranoid personality disorder to be given, the personality disorder must have
been present before the onset of psychotic symptoms and must persist when the psychotic
symptoms are in remission
MEDICAL CONDITION. must be distinguished from personality change due to another medical condition, in
which the traits that emerge are attributable to the direct effects of another medical condition on the central nervous system.
SUBSTANCE USE DISORDERS distinguished from
symptoms that may develop in association with persistent substance use.
PHYSICAL HANDICAPS. distinguished from paranoid traits associated with the development of physical handicaps (e.g.,
a hearing impairment).

19

personality traits that paranoid personality disorder shares with other personality disorders

SCHIZOTYPAL= suspiciousness, interpersonal aloofness, and paranoid ideation, but schizotypal personality
disorder also includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech
SCHIZOID =
often perceived as strange, eccentric, cold, and aloof, but
they do not usually have prominent paranoid ideation
BORDERLINE/HISTRIONIC =
react to minor stimuli with anger; not necessarily pervasive suspiciousness
AVOIDANT =
reluctant to confide, but more out of fear to be inadequate and not malicious intent
ANTISOCIAL =
antisocial behavior may be present in some individuals with paranoid personality, but not motivated by personal gain like in antisocial more likely for revenge
NARCISSISTIC =
sometimes display suspicion, social withdrawal, or alienation, but mostly bc of fear that flaws will be revealed
***Paranoid must only be diagnosed when traits are inflexible, maladaptive and cause sig functional impairment or subjective distress (might be adaptive in some circumstances)

20

Schizoid Personality Disorder Criteria

A. pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts as indicated by 4 or more of the following:
1. neither desires nor enjoys close relationships, including being a part of a family
2. almost always chooses solitary activities
3. has little if any interest in having sexual experiences with another person
4. takes pleasure in few activities, if any
5. lacks close friends or confidants other than first degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affectivity
B. not exclusively during schizophrenia, bipolar, or depressive w/ psychotic features, or autism spectrum, and is not attributable with physio effects of medical bond
*note*if met prior to onset of schizophrenia add (premorbid) after disorder

21

What Schizoid Personality disorder may look like "associated features" and co-occur with

-"loner" hobbies, mechanical or mathematical games,
-if comfortable may acknowledge painful feelings about social settings
-difficulty expressing anger, "drift in goals," don't respond appropriately to important life events, passive, not married, don't date
-might do well in social isolation
-brief (min/hours) psychotic episodes -- might be premorbid to delusional disorder or schizophrenia
-most often co-occurs with schizotypal, paranoid, and avoidant personality disorders

22

Schizoid development and course

childhoos - solitary, poor peer relations, underachievment in school, "different", teased

23

Schizoid - culture and gender issues

-more impairment in males
-ex. = rural to metro areas may have "emotional freezing" = solitary, constricted affect, communication deficits
-ex - immigrants = mistaken as cold, hostile, or indifferent

24

Schizoid - differential diagnosis

OTHER DISORDERS WITH PSYCHOTIC SYMPTOMS
-distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder
with psychotic features because these disorders are all characterized by a period of
persistent psychotic symptoms (e.g., delusions and hallucinations).
-additional diagnosis = must have been present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission = (premorbid)
AUTISM
-confused with mild autism - differentiated by more impaired social interaction and stereotyped behaviors/interests
MEDICAL COND.

SUBSTANCE USE

25

personality traits that schizoid personality disorder shares with other personality disorders

*if individual has personality features that
meet criteria for one or more personality disorders in addition to schizoid personality disorder,
all can be diagnosed
*social isolation and restricted affect seen in:
SCHIZOTYPAL
-distinguished by lack of cognitive and perceptual distortions
PARANOID
-lack of suspicious and paranoid ideation
AVOIDANT
-not attributed to fear of being embarrassed or rejection
OCD
- have an underlying capacity for intimacy - social iso due to devotion to work and discomfort with emotions
***must be inflexible, maladaptive, and cause sig distress = schizoid

26

Schizotypal Personality Disorder Criteria

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort
with, and reduced capacity for, close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, beginning by early adulthood and present in
a variety of contexts, as indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or
“sixth sense”: in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate,
or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.
*note = met prior to onset of schizophrenia add "(premorbid)" after disorder

27

What Schizotypal Personality disorder may look like "associated features" and co-occur with

-seek treatment for the associated
symptoms of anxiety or depression
-brief (min/hours) psychotic episode (insufficient in duration
to warrant an additional diagnosis such as brief psychotic disorder or schizophreniform
disorder)
-concurrent diagnosis of major depressive disorder when admitted to a clinical setting (50% at least 1 depressive episode) There is considerable co-ocurrence with schizoid, paranoid, avoidant, and borderline personality disorders

28

Schizotypal development and course

-only small portion go on to develop schizophrenia or psychotic disorder
-childhood - solitary, poor peer relations, social anxiety, academic underachievement, HYPERSENSITIVITY, PECULIAR THOUGHTS AND LANGUAGE, BIZARRE FANTASIES, appear odd or eccentric, teased

29

Schizotypal: culture and gender

Cognitive and perceptual distortions must be evaluated in the context of the individual's
cultural milieu. Pervasive culturally determined characteristics, particularly those regarding religious beliefs and rituals, can appear to be schizotypal to the uninformed outsider (e.g., voodoo, speaking in tongues, life beyond death, shamanism, mind reading, sixth
sense, evil eye, magical beliefs related to health and illness
-more common in males

30

Schizotypal: Differential diagnosis

OTHER PSYCHOTIC DISORDERS
NEURODEVELOPMENTAL DISORDERS
MEDICAL CONDITION
SUBSTANCE USE

31

personality traits that schizotypal personality disorder shares with other personality disorders

-PARANOID and SCHIZOID personality disorders
may also be characterized by social detachment and restricted affect, schizotypal
personality disorder can be distinguished from these two diagnoses by the presence of
cognitive or perceptual distortions and marked eccentricity or oddness
-Close relationships
are limited in both schizotypal personality disorder and AVOIDANT personality disorder;
however, in avoidant personality disorder an active desire for relationships is
constrained by a fear of rejection, whereas in schizotypal personality disorder there is
a lack of desire for relationships and persistent detachment
NARCISSISTIC - also display suspiciousness, social withdrawal, or alienation, but in narcissistic personality disorder these qualities derive primarily from fears of having imperfections or flaws revealed.
BORDERLINE PERSONALITY -
also have transient, psychotic-like symptoms, but these are usually more closely related to
affective shifts in response to stress (e.g., intense anger, anxiety, disappointment) and are
usually more dissociative (e.g., derealization, depersonalization; whereas schizotypal more likely to have enduring psychotic-like symptoms that may worsen under stress but are less likely to be invariably associated with pronounced affective symptoms social isolation may occur in borderline personality
disorder, it is usually secondary to repeated interpersonal failures due to angry outbursts
and frequent mood shifts, rather than a result of a persistent lack of social contacts and desire
for intimacy; schizotypal do not
usually demonstrate the impulsive or manipulative behaviors of the individual with borderline **high rate of co-occurance btwn these two!
-Schizotypal features
during adolescence may be reflective of transient emotional turmoil, rather than an enduring
personality disorder.

32

Borderline PD Criteria

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal
or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or selfmutilating
behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

33

Culture and gender issues with Borderline PD

adolescents and young adults with identity problems (esp with SU) may look like BPD = looks like existential dilemmas emotional instability

34

Diff Diagnosis Borderline PD

DEPRESSIVE AND BIPOLAR - both can be diagnosed; Borderline must have early onset and long standing course!
HISTRIONIC - attention seeking too, but BPD = self destructive and angry in relations and chronic emptiness
PARANOID/Schizotypal - both have illusions, but BPD = reactive and transient based on relations
PARANOID/ NARCISSTIC - all have angry reactions to minor stim. but BPD = self destructive and abandonment concerns
APD - manipulative to gain profit and BPD to gain caretaker concern
DEPENDANT - both fear abandonment, but BPD = emotional emptiness, rage, but Dep. = appeasement and submission
GMC/ SUD