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152 Cards in this Set
- Front
- Back
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What is a "personality"?
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Set of stable, predicted emotional and behavioral traits |
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What are "personality disorders"? |
Deeply ingrained, inflexible patterns of relating to others that are maladaptive and cause significant impairment in social or occupational functioning |
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How do patients with personality disorders feel about their problems? |
- They lack insight about their problems; symptoms are either ego-syntonic or viewed as immutable - Rigid view of themselves and others and around their fixed patterns have little insight |
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What axis do personality disorders fit under? |
Axis II |
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Many people have odd tendencies and quirks, what makes them part of a "personality disorder"? |
If these are pathological and cause significant distress or impairment in daily functioning |
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What mnemonic can be used to remember the criteria for a personality disorder? |
CAPRI (need 2 or more): - Cognition - Affect - Personal Relations - Imuplse control |
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What are the DSM-IV criteria for personality disorders? |
1. Pattern of behavior / inner experience that deviates from the person's culture and is manifested in 2 or more of the following ways: CAPRI (need 2 or more): - Cognition - Affect - Personal Relations - Imuplse control
2. Pattern is: - Pervasive and inflexible in a range of situations - Stable and has an onset no later than adolescence or early adulthood - Leads to significant distress in functioning - Not accounted for by another mental/medical illness or by use of a substance |
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What are the DSM-IV criteria for the pattern of a personality disorder? |
- Pervasive and inflexible in a range of situations - Stable and has an onset no later than adolescence or early adulthood - Leads to significant distress in functioning - Not accounted for by another mental/medical illness or by use of a substance |
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How prevalent are personality disorders internationally? |
6% |
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How are personality disorders divided? |
3 clusters: - Cluster A: schizoid, schizotypal, paranoid - Cluster B: antisocial, borderline, histrionic, narcissistic - Cluster C: avoidant, dependent, obsessive-compulsive |
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What personality disorders and cluster are characterized by eccentric, pecculiar, or withdrawn patients; familial association with psychotic disorders? |
Cluster A - Schizoid - Schizotypal - Paranoid |
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What personality disorders and cluster are characterized by emotional, dramatic, or inconsistent patients; familial association with mood disorders? |
Cluster B: - Antisocial - Borderline - Histrionic - Narcissistic |
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What personality disorders and cluster are characterized by anxious or fearful patients; familial association with anxiety disorders? |
Cluster C: - Avoidant - Dependent - Obsessive-compulsive |
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What personality disorders do not fit into the clusters ("unspecified personality disorders")? |
- Passive-aggressive PD - Depressive PD |
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There is what familial association for schizoid, schizotypal, and paranoid PDs? |
Psychotic disorders |
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There is what familial association for antisocial, borderline, histrionic, and narcissistic PDs? |
Mood disorders |
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There is what familial association for avoidant, dependent, and obsessive-compulsive PDs? |
Anxiety disorders |
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What factors contribute to the etiology of personality disorders? |
Following factors during childhood and adolescence: - Biologic - Genetic - Psychosocial |
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How does the prevalence of personality disorders compare for monozygotic twins vs dizygotic twins? |
Higher prevalence in monozygotic twins |
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Why are personality disorders hard to treat? |
Patients are rarely aware that they need help; disorders tend to be chronic and lifelong
Pharmacologic treatment has limited usefulness (some individual exceptions) except in treating co-existing symptoms of depression, anxiety, etc |
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What are the most helpful treatment modalities for personality disorders? |
Psychotherapy and group therapy |
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What are the characteristics of cluster A personality disorders? |
- Eccentric, peculiar, or withdrawn / hermetic - May have sx that meet criteria for psychosis |
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What are the cluster A personality disorders? |
- Paranoid PD - Schizoid PD - Schizotypal PD |
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Which PD is characterized by a pervasive mistrust and suspiciousness of others; often interpreting motives as malevolent; blame their problems on others; seem angry/hostile; pathologic jealousy, making them believe their partners are cheating on them? |
Paranoid PD |
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What are the defining features of Paranoid PD? |
- Pervasive distrust and suspiciousness of others - Often interpret motives as malevolent - Blame their problems on others - Seem hostile and angry - Pathologic jealousy, making them think their partners are cheating on them |
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What are the DSM-IV criteria for Paranoid PD? |
Requires a general distrust of others, beginning by early adulthood and present in a variety of contexts
At least 4 of the following: 1. Suspicion (without evidence) that others are exploiting or deceiving him or her 2. Preoccupation with doubts of loyalty or trustworthiness of acquiantances 3. Reluctance to confide in others 4. Interpretation of benign remarks as treatening or demeaning 5. Persistence of grudges 6. Perception of attacks on his or her character that are not apparent to others; quick to counter-attack 7. Recurrence of suspicions regarding fidelity of spouse or lover |
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How prevalent is Paranoid PD? Males vs females? |
0.5-2.5% Males > Females |
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Who is more likely to have Paranoid PD? |
Patients with a family member with schizophrenia Males |
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In what patient populations is Paranoid PD often misdiagnosed? |
- Minority groups - Immigrants - Deaf people |
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What is the differential diagnosis for Paranoid PD? |
- Paranoid schizophrenia - Social disenfranchisement and social isolation |
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How do you distinguish Paranoid PD from paranoid schizophrenia? |
- Unlike pts with schizophrenia, pts with Paranoid PD do not have any fixed delusions and are not frankly psychotic - They may have transient psychosis under stressful situations though |
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How do you distinguish Paranoid PD from social disenfranchisement and social isolation? |
Without a social support system, persons can react with suspicion to others. The differential in favor of Paranoid PD can be made by the assessment of others in close contact with the person, who identify what they consider as excess suspicion. |
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What is the course and prognosis of Paranoid PD? |
- Some may eventually be diagnosed with schizophrenia - Disorder usually has a chronic course, causing lifelong marital and job-related problems |
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How do you treat Paranoid PD? |
- Psychotherapy is treatment of choice - Pts may also benefit from anti-anxiety meds or short course of anti-psychotics for transient psychosis |
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Which PD is characterized by a lifelong pattern of social withdrawal; often perceived as eccentric and reclusive; quiet and unsociable with a constricted affect; no desire for cloes relationships and prefer to be alone? |
Schizoid PD |
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How do you distinguish Schizoid PD from Avoidant PD? |
Pts with Schizoid PD prefer to be alone |
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What are the characteristics of Schizoid PD? |
- Lifelong pattern of social withdrawal - Perceived as eccentric and reclusive - Quiet and unsociable with constricted affect - No desire for close relationships - Prefer to be alone |
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What are the DSM-IV criteria for Schizoid PD? |
Pattern of voluntary social withdrawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts
At least 4 of the following: 1. Neither enjoying nor desiring close relationships (including family) 2. Generally choosing solitary activities 3. Little (if any) interest in sexual activity with another person 4. Taking pleasure in few activities (if any) 5. Few close friends or confidants (if any) 6. Indifference to praise or criticism 7. Emotional coldness, detachment, or flattened affect |
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How prevalent is Schizoid PD? Men vs women? |
7% Men 2x women |
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How does the incidence of schizophrenia in a family impact the prevalence of Schizoid PD? |
No increased incidence of Schizoid PD in families with a hx of schizophrenia |
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What is the differnetial diagnosis for Schizoid PD? |
- Paranoid Schizophrenia - Schizotypal PD |
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How do you distinguish Schizoid PD from paranoid schizophrenia? |
Unlike pts with schizophrenia, pts with Schizoid PD do not have any fixed delusions, although these may exist transiently in some pts |
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How do you distinguish Schizoid PD from Schizotypal PD? |
Pts with Schizoid PD do not have the same eccentric behavior or maigcal thinking seen in pts with Schizotypal PD
Schizotypal pts are more similar to schizophrenic pts in terms of odd perception, thought, and behavior |
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What is the course/prognosis of Schizoid PD? |
Chronic course, but not always lifelong |
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How do you treat Schizoid PD? |
Similar to paranoid PD: - Psychotherapy is the tx of choice - Group therapy is often beneficial - Low-dose antipsychotics (short course) if transiently psychotic, or antidepressants if comorbid MDD is diagnosed |
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Which PD presents with a pervasive pattern of eccentric behavior and peculiar thought patterns; often perceived as strange and eccentric? |
Schizotypal PD |
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What are the characteristics of Schizotypal PD? |
- Pervasive pattern of eccentric behavior and peculiar thought patterns - Often perceived as strange and eccentric - D/o was developed out of the observation that certain family traits predominate in 1st degree relatives with schizophrenia |
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What are the DSM-IV criteria for Schizotypal PD? |
Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships, beginning by early adulthood and present in a variety of contexts
At least 5 of the following: 1. Ideas of reference (excluding delusions of reference) 2. Odd beliefs or magical thinking, inconsistent with cultural norms 3. Unusual perceptual experiences (such as bodily illusion) 4. Suspiciousness 5. Inappropriate or restricted affect 6. Odd or eccentric appearance or behavior 7. Few close friends or confidants 8. Odd thinking or speech (vague, stereotyped, etc) 9. Excessive social anxiety
Magical thinking may include belief in clairvoyance or telepathy, bizarre fantasies or preoccupations, or belief in superstitions
Odd behaviors may include involvement in cults or strange religious practices
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What type of magical thinking may be seen in pts with Schizotypal PD? |
- Belief in clairvoyance or telepathy - Bizarre fantasies or preoccupations - Belief in superstitions |
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What is the prevalence of Schizotypal PD? |
3% |
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What is the differential diagnosis for Schizotypal PD? |
- Paranoid schizophrenia - Schizoid PD |
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How do you distinguish Schizotypal PD from paranoid schizophrenia? |
Unlike pts with schizophrenia, pts with Schizotypal PD are not frankly psychotic (though they can become transiently so under stress), nor do they have fixed delusions |
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How do you distinguish Schizotypal PD from Schizoid PD? |
Pts with schizoid PD do not have the same eccentric behavior seen in pts with Schizotypal PD |
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What is the course/prognosis for Schizotypal PD? |
- Course is chronic or pts may eventually develop schizophrenia - Short course of low-dose antipsychotics if necessary (for transient psychosis) - Antipsychotics may help decrease social anxiety and suspicion in interpersonal relationships |
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What are the characteristics of cluster B personality disorders? |
- Emotional - Impulsive - Dramatic |
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What are the types of cluster B personality disorders? |
- Antisocial PD - Borderline PD - Histrionic PD - Narcissistic PD |
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What PD is characterized by superficial conformity to social norms; exploitation of others; breaking rules to meet personal needs; lack of empathy and compassion; lack of remorse for their actions; impulsive, deceitful, and often violating the law; skilled at reading social cues and appear charming and normal to others who meet them for the first time and do not know their hx? |
Antisocial PD |
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What are the characteristics of Antisocial PD? |
- Superficial conformity to social norms - Exploitive of others - Break rules to meet personal needs - Lack empathy and compassion - Lack remorse for their actions - Impulsive, deceitful, and often violate the law - Skilled at reading social cues and appear charming to others who meet them for the first time and do not know their hx |
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What mnemonic can be used to remember the symptoms of Antisocial PD? |
CONDUCT: - Capraciousness - Oppressive - Non-confrontational - Deceitful - Unlawful - Carefree - Temper |
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What are the DSM-IV criteria for Antisocial PD? |
Pattern of disregard for others and violation of the rights of others since age 15
Pt must be at least 18y old for this diagnosis; hx of behavior as a child/adolescent must be consistent with Conduct Disorder
At least 3 of the following: 1. Failure to conform to social norms by committing unlawful acts 2. Deceitfulness, repeated lying, and manipulating others for personal gain 3. Impulsivity and failure to plan ahead 4. Irritability and aggressiveness / repeated fights or assaults 5. Recklessness and disregard for safety of self or others 6. Irresponsibility / failure to sustain work or honor financial obligations 7. Lack of remorse for actions |
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What is the prevalence of Antisocial PD? Men vs. women? |
- Men: 3% - Women: 1% |
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Who is more likely to be diagnosed with Antisocial PD? |
- Higher incidence in poor urban areas - Higher incidence in prisoners - No racial difference - 5x higher in first-degree relatives of Antisocial PD - Men 3x more prevalent than women |
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How does Antisocial PD present in childhood? |
Conduct Disorder (<18y) - Pt may have a hx of being abused (physically or sexually) as a child or a hx of hurting animals or starting fires - It is often associated with violations of the law |
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What is the differential diagnosis for Antisocial PD? |
Drug abuse |
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How do you distinguish Antisocial PD from drug abuse? |
Necessary to ascertain which came first. Pts who began abusing drugs before their antisocial behavior started may have behavior attributable to the effects of their addiction. |
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What is the course / prognosis for Antisocial PD? |
- Usually chronic course, but some improvement of sx may occur as they age - Many have multiple somatic complaints, and coexistance of substance abuse and/or major depression - Increaesd morbidity from substance abuse, trauma, suicide, or homicide |
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How do you treat Antisocial PD? |
- Psychotherapy is generally ineffective; dialectical behavior therapy (DBT) and behavioral therapy best choice - Pharmacotherapy may be used to treat sx of anxiety or depression, but use caution due to high addictive potential of these patients |
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What PD presents with unstable moods, behaviors, and interpersonal relationships; fear abandonment and have poorly formed identity; relationships begin with intense attachments and end with slightest conflict; aggression is common; impulsive and may have hx of SA or gestures/episodes of self-mutilation; they have higher rates of childhood physical, emotional, and sexual abuse than general pop.? |
Borderline PD |
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What are the characteristics of Borderline PD? |
- Unstable moods, behaviors, and interpersonal relationships - Fear abandonment and have poorly formed identity - Relationships begin with intense attachments and end with the slightest conflict - Aggression is common - Impulsive - May have hx of repeated SA or gestures/episodes of self-mutilation - Higher rates of childhood physical, emotional, and sexual abuse than general population |
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How often do patients with Borderline PD report no hx of childhood physical, emotional, or sexual abuse? |
Only 25-35% |
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What is the mnemonic to remember the symptoms of Borderline PD? |
IMPULSIVE: - Impulsive - Moody - Paranoid under stress - Unstable self-image - Labile, intense relationships - Suicidal - Inappropriate anger - Vulnerable to abandonment - Emptiness |
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What are the DSM-IV criteria for Borderline PD? |
Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early adulthood and in a variety of contexts
At least 5 of following: 1. Desperate efforts to avoid real or imagined abandonment 2. Unstable, intense interpersonal relationships (eg, extreme love-hate relationships) 3. Unstable self-image 4. Impulsivity in at least two potentially harmful ways (spending, sexual activity, substance use, binge eating, etc) 5. Recurrent suicidal threats or attempts or self-mutilation 6. Unstable mood / affect 7. General feeling of emptiness 8. Difficulty controlling anger 9. Transient stress-related paranoid ideation or dissociative sx |
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What defense mechanism do borderline pts commonly use? |
Splitting - they view others as all good or all bad (e.g., "You are the only doctor who has ever helped me. Every doctor I met before you was horrible.") |
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What is the prevalence of Borderline PD? Men vs women? |
1-2% overall Women 2x men |
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What is the suicide rate in Borderline PD? |
10% |
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What is the differential diagnosis for Borderline PD? |
- Schizophrenia - Bipolar II |
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How do you distinguish Borderline PD from schizophrenia? |
Unlike pts with schizophrenia, pts with BPD do not have frank psychosis (may have transient psychosis, however, if decompensate under stress) |
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How do you distinguish Borderline PD from bipolar II disorder? |
Mood swings experienced in BPD are moment-to-moment reactions to perceived environmental triggers. They also are not characterized by spending excess amounts of money or heightened sexual activity. |
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What is the course / prognosis for Borderline PD? |
- Usually stable, chronic course - High incidence of co-existing major depression and/or substance abuse - Increased risk of suicide (often because pts will make suicide gestures and kill themselves by accident) |
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Why is the term "borderline" used for patients with Borderline PD? |
Comes from the patients being on the borderline of neurosis and psychosis |
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How do you treat Borderline PD? |
- Psychotherapy (DBT) is the treatment of choice - behavior therapy, cognitive therapy, social skills training, etc - Pharmacotherapy to treat psychotic or depressive sx as necessary |
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For which personality disorder is pharmacotherapy most effective? |
Borderline PD |
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Which PD is characterized by attention-seeking behavior and excessive emotionality; dramatic, flamboyant, and extroverted but are unable to form long-lasting, meaningful relationships; often sexually inappropriate and provocative? |
Histrionic PD |
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What are the characteristics of Histrionic PD? |
- Attention-seeking behavior - Excessive emotionality - Dramatic, flamboyant, and extroverted - Unable to form long-lasting meaningful relationships - Often sexually inappropriate and provocative |
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What are the DSM-IV criteria for Histrionic PD? |
Pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts
At least 5 of the following: 1. Uncomfortable when not the center of attn 2. Inappropriately seductive or provocative behavior 3. Uses physical appearance to draw attention to self 4. Has speech that is impressionistic and lacking in detail 5. Theatrical and exaggerated expression of emotion 6. Easily influenced by others or situation 7. Perceives relationships as more intimate than they actually are |
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How prevalent is Histrionic PD? Women vs men? |
2-3% Women > Men |
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What is the differential diagnosis for Histrionic PD? |
Borderline PD |
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How do you distinguish Histrionic PD from Borderline PD? |
Pts with BPD are more likely to suffer from depression, brief psychotic episodes, and to attempt suicide. HPD pts are generally more functional. |
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What is the course / prognosis for Histrionic PD? |
Chronic course, withs me improvement of symptoms with age |
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How do you treat Histrionic PD? |
- Psychotherapy is the treatment of choice - Pharmacotherapy to treat associated depressive or anxious symptoms as necessary |
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What defense mechanism is common among patients with Histrionic PD? |
Regression - revert to childlike behaviors |
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Which PD is characterized by a sense of superiority, need for admiration, and a lack of empathy; consider themselves "special" and will exploit others for their own self gain; despite grandiosity they often have fragile self-esteem? |
Narcissistic PD |
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What are the characteristics of Narcissistic PD? |
- Sense of superiority - Need for admiration - Lack of empathy - Consider themselves "special" and will exploit others for their own gain - Despite grandiosity, often have fragile self-esteem - Inflated sense of entitlement - Fish for compliments - Become irritated and anxious when they are not at the center of attention |
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What are the DSM-IV criteria for Narcissistic PD? |
Pattern of grandiosity, need for admiration, and lack of empathy beginning by early childhood and present in a variety of contexts
At least 5 of the following: 1. Exaggerated sense of self-importance 2. Preoccupation with fantasies of unlimited money, success, brilliance, etc 3. Believes that he or she is "special" or unique and can associate only with other high-status individuals 4. Needs excessive admiration 5. Has sense of entitlement 6. Takes advantage of others for self-gain 7. Lacks empathy 8. Envious of others or believes others are envious of him / her 9. Arrogant or haughty |
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How prevalent is Narcissistic PD? |
<1% |
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What is the differential diagnosis for Narcissistic PD? |
Antisocial personality disorder |
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How do you distinguish Narcissistic PD from Antisocial PD? |
Both types of patients exploit others, but Narcissistic PD pts want status and recognition while Antisocial PD pts want material gain or simply the subjugation of others. Narcissistic pts become depressed when they don't get the recognition they think they deserve. |
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What is the course / prognosis for Narcissistic PD? |
- Chronic course - Higher incidence of depression and midlife crises since these pts tend to put such a high value on youth and power |
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How should you treat a patient with Narcissistic PD? |
- Psychotherapy is the treatment of choice. Group therapy may help these patients learn empathy. - Antidepressants or lithium may be used as needed (for mood swings if a comorbid mood disorder is diagnosed). |
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What are the characteristics of cluster C personality disorders? |
They appear anxious and fearful |
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What are the types of cluster C personality disorders? |
- Avoidant - Dependent - Obsessive-Compulsive |
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Which PD is characterized by a pervasive pattern of social inhibition and an intense fear of rejection; avoid situations in which they may be rejected; fear of rejection is so overwhelming that it affects all aspects of their lives; avoid social interactions and seek jobs in which there is little interpersonal contact; they do desire companionship but are extremely shy and easily injured? |
Avoidant PD |
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What is the most common phobia in Avoidant PD? |
Social phobia |
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What are the characteristics of Avoidant PD? |
- Pervasive pattern of social inhibition and intense fear of rejection - Avoid situations in which they may be rejected - Fear of rejection is so overwhelming that it affects all aspects of their lives - Avoid social interactions and seek jobs in which there is little interpersonal contact - They DESIRE companionship but are extremely shy and easily injured |
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What are the DSM-IV criteria for Avoidant PD? |
Pattern of social inhibition, hypersensitivity, and feelings of inadequacy since early adulthood
At least 4 of the following: 1. Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection 2. Unwilling to interact unless certain of being liked 3. Cautious of interpersonal relationships 4. Preoccupied with being criticized or rejected in social situations 5. Inhibited in new social situations because he or she feels inadequate 6. Believes he or she is socially inept and inferior 7. Reluctant to engage in new activities for fear of embarrassment |
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What is the mnemonic to remember the symptoms of Avoidant PD? |
AFRAID: - Avoids occupation with others - Fear of embarrassment and criticism - Reserved unless they are certain they are liked - Always thinking rejection - Isolates from relationships - Distances self unless certain they are liked |
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How prevalent is Avoidant PD? Men vs women? |
1-10% Sex ratio is unknown |
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What is the differential diagnosis for Avoidant PD? |
- Schizoid PD - Social phobia (social anxiety disorder) - Dependent PD |
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How do you distinguish Avoidant PD from Schizoid PD? |
Pts with Avoidant PD desire companionship but are extremely shy, whereas pts with Schizoid PD have no desire for companionship |
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How do you distinguish Avoidant PD from social phobia? |
- Both disorders involve fear and avoidance of social situations - If sx are an integral part of pt's personality and have been evidence since before adulthood, personality disorder is more likely - Social phobia involves a fear of embarrassment in a particular setting (e.g., speaking in public, urinating in public, etc) - Avoidant PD is an overall fear of rejection and a sense of inadequacy - A pt can have both disorders concurrently and should carry both diagnoses if criteria for each are met |
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How do you distinguish Avoidant PD from Dependent PD? |
- Avoidant PD pts cling to relationships, similar to Dependent PD pts - Avoidant PD pts are slow to get involved, whereas Dependent PD pts actively and aggressively seek relationships |
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What ist he course / prognosis of Avoidant PD? |
- Course is chronic - Particularly difficult during adolescence, when attractiveness and socialization are important |
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What is there a high incidence of in pts with Avoidant PD? |
High incidence of associated anxiety and depressive disorders |
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What is a pt with Avoidant PD susceptible to if their support system fails? |
Depression, anxiety, anger |
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How do you treat Avoidant PD? |
- Psychotherapy, including assertiveness training, is most effective - Beta blockers may be used to control autonomic sx of anxiety - SSRIs may be prescribed for MDD |
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Which PD is characterized by poor self-confidence and fear separation; excessive need to be taken care of and allow others to make decisions for them; feel helpless when left alone? |
Dependent PD |
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What are the characteristics of Dependent PD? |
- Poor self-confidence - Fear separation - Excessive need to be taken care of and allow others to make decision for them - Feel helpless when left alone |
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What is the mnemonic to remember the symptoms of Dependent PD? |
OBEDIENT: - Obsessive about approval - Bound by others decisions - Enterprises are rarely initiated due to their lack of self-confidence - Difficult to make their own decisions - Invalid feelings when alone - Engrossed with fears of self-reliance - Needs to be in a relationship - Tentative about decisions |
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What are the DSM-IV criteria for Dependent PD? |
Pattern of submissive and clinging behavior due to excessive need to be taken care of
At least 5 of the following: 1. Difficulty making everyday decisions without reassurance from others 2. Needs others to assume responsibilities for most areas of his or her life 3. Cannot express disagreement because of fear of loss of approval 4. Difficulty initiating projects because of lack of self-confidence 5. Goes to excessive lengths to obtain support from others 6. Feels helpless when alone 7. Urgently seeks another relationship when one ends 8. Preoccupied with fears of being left to take care of self |
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How prevalent is Dependent PD? Men vs women? |
~1%
Women > Men |
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What is the differential diagnosis for Dependent PD? |
- Avoidant PD - Borderline PD - Histrionic PD |
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How do you distinguish Dependent PD from Borderline and Histrionic PDs? |
- Pts with Dependent PD usually have a long-lasting relationship with one person on whom they are dependent - Pts with Borderline PD and Histrionic PD are often dependent on people, but they are unable to maintain a long-lasting relationship |
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What is the course / prognosis of Dependent PD? |
- Usually chronic - Often symptoms decrease with age and/or therapy |
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What are pts with Dependent PD at increased risk for? |
Depression, particularly after loss of person on whom they are dependent
Difficulties with employment since they cannot act independently or without close supervision |
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Many people with debilitating illness can develop dependent traits, why are they not diagnosed with Dependent PD? |
Features need to manifest early in adulthood |
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How do you treat Dependent PD? |
- Psychotherapy, particularly groups and social skills training, is the treatment of choice - Pharmacotherapy can be used to treat associated sx of anxiety or depression |
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Which PD is characterized by a pervasive pattern of perfectionism, inflexibility, and orderliness; they get so preoccupied with unimportant details that they are often unable to complete simple tasks in a timely fashion; appear stiff, serious, and formal with constricted affect; often successful professionally but have poor interpersonal skills? |
Obsessive-Compulsive PD |
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What are the characteristics of Obsessive-Compulsive PD? |
- Pervasive pattern of perfectionism, inflexibility, and orderliness - Preoccupied with unimportant details that they are often unable to complete simple tasks in a timely fashion - Appear stiff, serious, and formal, with constricted affect - Often successful professionally but have poor interpersonal skills |
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What are the DSM-IV criteria for Obsessive-Compulsive PD? |
Pattern of preoccupation with orderliness, control, and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts
At least 4 of the following: 1. Preoccupation with details, rules, lists, and organization such that the major point of the activity is lost 2. Perfectionism that is detrimental to completion of task 3. Excessive devotion to work 4. Excessive conscientiousness and scrupulousness about morals and ethics 5. Will not delegate tasks 6. Unable to discard worthless objects 7. Miserly 8. Rigid and stubborn |
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How prevalent is Obsessive-Compulsive PD? Men vs women? |
Unknown prevalence Men > Women |
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Who is more likely to get Obsessive-Compulsive PD? |
Oldest child; males; increased in first-degree relatives |
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What is the differential diagnosis for Obsessive-Compulsive PD? |
- OCD - Narcissistic PD |
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How do you distinguish OCPD from OCD? |
- Pts with OCPD do not have the recurrent obsessions or compulsions that are present in OCD - Sx of OCPD are ego-syntonic rather than ego-dystonic (as in OCD) - OCD pts are aware they have a problem and wish their thoughts and behaviors would go away |
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How do you distinguish Obsessive-Compulsive PD from Narcissistic PD? |
Both personalites involve assertiveness and achievement, but Narcissistic PD pts are motivated by status whereas OCPD patients are motivated by the work itself |
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What is the course / prognosis for Obsessive-Compulsive PD? |
- Unpredictable - Some pts later develop OCD, some develop schizophrenia, or MDD, and others improve or remain stable |
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How do you treat Obsessive-Compulsive PD? |
- Psychotherapy is the treatment of choice. Group therapy and behavior therapy may be useful. - Pharmacotherapy may be used to treat sx as necessary (- SSRIs often decrease the invasive thoughts associated with OCD) |
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What are the types of personality disorders not otherwise specified? |
- Passive-Aggressive PD - Depressive PD - Sadomasochistic PD - Sadistic PD |
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What are the characteristics of passive-aggressive PD? |
- Stubborn - Inefficient procrastinators - Alternate between compliance and defiance - Passively resist fulfillment of tasks - Frequently make excuses for themselves and lack assertiveness - Attempt to manipulate others to do their chores, errands, etc - Frequently complain about their own misfortunes - Psychotherapy is the treatment of choice |
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What are the characteristics of depressive PD? |
- Lifelong traits of depressed-like state. - Pessimistic, self-doubting, chronically unhappy, and distressed. |
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Case: 30yo man says his wife has been cheating on him because he does not have a good enough job to provide for her needs. He also claims that on his previous job, his boss laid him off because he did a better job than his boss. Refuses couples therapy because he believes the treater will side with his wife. Believes neighbors are critical of him.
What is the most likely personality disorder? |
Paranoid PD |
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Case: 45-yo scientist works in the lab most of the day and has no friends, according to his coworkers. Has not been able to keep his job because of failure to collaborate with others. He expresses no desire to make friends and is content with his single life. He has no evidence of a thought disorder.
What is the most likely personality disorder? |
Schizoid PD |
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Case: 35-yo man dresses in a spacesuit every Tuesday and Thursday. He has computers set up in his basement to "detect the precise time of alien invasion." He has no evidence of auditory or visual hallucinations.
What is the most likely personality disorder? |
Schizotypal PD |
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Case: 30 yo unemployed man has been accused of killing three senior citizens after robbing them. He is surprisingly charming in the interview. In his adolescence, he was arrested several times for stealing cars and assaulting other kids.
What is the most likely personality disorder? |
Antisocial PD |
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Case: 23 yo medical student attempted to slit her wrist because things did not work out with a man she had been dating for 3 weeks. She states that guys are jerks and "not worth her time." She often feels that she is "alone in this world."
What is the most likely personality disorder? |
Borderline PD |
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Case: 33 yo scantily clad woman comes to your office complaining that her fever feels like she is "burning in hell." She vividly describes how the fever has affected her work as a teacher.
What is the most likely personality disorder? |
Histrionic PD |
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Case: 48 yo company CEO is rushed to the ED after an automobile accident. He does not let the residents operate on him and requests the chief of trauma surgery because he is "vital to the company." He makes several business phone calls in the ED to stay on "top of his game."
What is the most likely personality disorder? |
Narcissistic PD |
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Case: Mr. Harris is a 35yo man w/ no prior psych hx who was arrested for assaulting his pregnant gf. While in jail, he reports feeling depressed, and you are called for psych eval. He is cooperative and presents as friendly and likable. Reports he is innocent of charges and expresses feeling sad and tearful since incarceration 2 days ago. Requests you transfer him to mental health unit at correctional facility. You perform a thorough eval and do not find his sx suggestive of a mood or psychotic disorder. When asked if he has been incarcerated before, he reports a hx of multiple arrests and convictions for robbery and gun possession. He reports he is unemployed because he has been "in and out of jail" during past 5 years. He provides explanations of his limited involvement in these past crimes and does not appear remorseful.
He reveals a pattern of repeated fights since childhood and says he quit school while in 9th grade after being suspended for smoking pot on school grounds. He reports during childhood he bullied others and laughs when recounting an episode during which he threw his cat against the wall to see it bounce back. Denies family hx of psych illnesses but reports his father is currently incarcerated for drug trafficking.
What is his axis II diagnosis? |
Antisocial PD - History shows a pervasive pattern of disregard for and violation of others since age 15y - Evidence of conduct disorder with onset before age 15y - Although it is common, not all criminals have antisocial PD |
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Case: Mr. Harris is a 35yo man w/ no prior psych hx who was arrested for assaulting his pregnant gf. While in jail, he reports feeling depressed, and you are called for psych eval. He is cooperative and presents as friendly and likable. Reports he is innocent of charges and expresses feeling sad and tearful since incarceration 2 days ago. Requests you transfer him to mental health unit at correctional facility. You perform a thorough eval and do not find his sx suggestive of a mood or psychotic disorder. When asked if he has been incarcerated before, he reports a hx of multiple arrests and convictions for robbery and gun possession. He reports he is unemployed because he has been "in and out of jail" during past 5 years. He provides explanations of his limited involvement in these past crimes and does not appear remorseful.
He reveals a pattern of repeated fights since childhood and says he quit school while in 9th grade after being suspended for smoking pot on school grounds. He reports during childhood he bullied others and laughs when recounting an episode during which he threw his cat against the wall to see it bounce back. Denies family hx of psych illnesses but reports his father is currently incarcerated for drug trafficking.
What are some associated findings? |
- More prevalent in males - Associated with low socioeconomic background - Genetic predisposition - Children of parents with antisocial PD have increased risk for antisocial personality disorder, somatization disorder, and substance related disorders |
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Case: 26 yo man has a history of multiple criminal arrests and is the son of two alcoholic parents. His brother recalls him setting their pet dog on fire as a kid.
What should you be thinking? |
Antisocial PD - Person violates rights of others without showing guilt - Men, especially those with alcoholic parents, are more likely than women to have this condition |
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Case: 30 yo postal worker rarely goes out with her coworkers and often makes excuses when they ask her to join them because she is afraid they will not like her. She wishes to go out and meet new people but, according to her, she is too "shy".
What is the most likely personality disorder? |
Avoidant PD |
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Case: 40 yo man who lives with his parents has trouble deciding on how to go about having his car fixed. He calls his father at work several times to ask very trivial things. He has been unemployed for the past 3 years.
What is the most likely personality disorder? |
Dependent PD |
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Case: 40 yo secretary has been recently fired because of her inability to prepare some work projects on time. According to her, they were not in the right format and she had to revise them 6 times, which led to the delay. This has happened before but she feels that she is not given enough time.
What is the most likely personality disorder? |
Obsessive-Compulsive PD |
