What is a personality d/o?
CAPRI
Personality d/o = deeply ingrained, inflexible pattern of relating to others that is maladaptive and causes sig. impairment
-axis II diagnosis
Pattern of behavior/inner experience which deviates from culture, 2+ (CAPRI)
- cognition
- affect
- personal relations
- impulse control
Cluster A d/o
(a) list from most to least severe
(b) gender difference
(c) mainstay of treatment
Cluster A: ‘mad’ or ‘weird’
-eccentric, peculiar, withdrawn
(a) Most severe: paranoid PD > schizotypal > schizoid
- schizoid has no ideas of reference (no loss of reality) while the other 2 do
(b) all 3 cluster A are more common in males
(c) psychotherapy for all 3 + pharmacotherapy PRN
Symptoms of schizoid personality d/o
Schizoid personality disorder
- *prefer to be alone
- no desire for close relationships
- take pleasure in few activities
- indifferent to criticism
- emotional coldness, detachment, flat affect
- choose solitary activities, gravitate to solitary jobs
- *no loss of reality (no ideas of reference)
Symptoms of schizotypal personality d/o
Schizotypal personality d/o
- *magical thinking: think their thoughts can have special powers on others
- odd, eccentric behaviors, habits, or thinking
- excessive social anxiety
- unusual perceptive experiences
- *ideas of reference
Symptoms of paranoid personality d/o
Paranoid personality d/o
- hostile, angry
- preoccupied w/ trustworthiness/loyalty of others
- reluctance to confide in anyone
- recurrent suspicious of infidelity of spouse
- *ideas of reference
Differentiate paranoid personality disorder from schizophrenia paranoid type
Paranoid PD: ideas of references but NOT DELUSIONS
-while scz paranoid type, paranoia comes w/ delusions (false fixed believes)
Cluster B d/o
(a) Name 4
(b) treatment
Cluster B d/o: ‘bad’ ‘wild’
-emotional, dramatic, inconsistent
(a) Histrionic, narcissistic, antisocial, borderline
(b) Psychotherapy + pharmacotherapy PRN for all 4
Epidemiology of paranoid personality d/o
- males
- minorities, immigrants
- relatives of schizophrenics
Symptoms of histrionic personality d/o
Histrionic personality d/o
- *theatrical expression of emotion: temper tantrums
- *uncomfortable when not the center of attention
- inappropriate provocative, often uses physical appearance to gain attention
- easily influenced by others
- constant need for praise
- use regression as defense mechanism
- speech is impressionistic, lacks details
ex: Dani Warren? boobs out, emotionally theatrical, easily influenced
Histrionic personality d/o
(a) prevalence
(b) gender
(c) associated w/ what type of relationships
(d) common comorbidities
Histrionic personality d/o
(a) 2-3%
(b) females
(c) Superficial relationships
(d) Comorbid w/ somatization and depression
Symptoms of narcissistic personality d/o
Narcissistic PD
- *lack of empathy
- *sense of superiority
- *takes advantage of others for self gain
- preoccupied w/ unlimited wealth, power, success
- envious of others, believes others are envious of them
- believes they are special => only can associate w/ high-status ppl
- inflated sense of entitlement
Differentiate pt’s motivation for taking advantage of others in
(a) narcissistic PD
(b) antisocial PD
Motivation for taking advantage of others
(a) Narcissistic PD: for self-gain, for status and recognition
(b) Antisocial PD: for material gain or subjugation of others
Describe the way that each of the 4 cluster B personality disorders deal w/ time
Histrionic: show less symptoms w/ age
Narcissistic: handle aging poorly
Antisocial: only a diagnosis after 18, symptoms since age 15, history consistent w/ CD. Course may increase or decrease w/ age
Borderline: ppl get worse w/ age (burnout)
Symptoms of antisocial personality d/o
- *NO REMORSE for harmful actions
- wont conform to society => violates laws
- irritability, aggression
- *Charming when first encountered, manipulative: con men, intelligent
Why be careful when treating anxiety in ppl w/ antisocial personality d/o
Caution due to addictive personality
Symptoms of borderline personality disorder
IMPULSIVE I- impulsive: sex, substance, spending M- moodiness** P- paranoid or disassociation under stress U- unstable self image** L- labile interpersonal relationships** S- suicidal gestures or self-harm** I- inappropriate anger V- vulnerability to abandonment => desperately avoid real or perceived abandonment** E- emptiness (feelings of)
Epidemiology of borderline personality do
- 2-3% prevalence
- 2:1 female
- women: 3-10x likely to be victim of incest
- 10% suicide
Cluster C personality d/o
(a) treatment
(b) Name 3
Cluster C personality d/o: ‘sad’ ‘wimpy/worried’
-anxious, fearful
(a) psychotherapy and pharmacotherapy in all
- individual psychotherapy for dependent
- encourage interaction for avoidant
- group therapy for obsessive compulsive
(b) Cluster C: dependent, avoidant, obsessive-compulsive
Symptoms of dependent personality d/o
- *want others to make decisions
- feel helpless when alone
- difficulty initiating projects on their own
- urgently seek new partner if one is lost
- poor self-confidence and fear separation
Symptoms of avoidant personality d/o
- *wants friendships, just hard to form
- *fear of rejection
- unable to interact unless assured that person will like them
- avoid situations in which they may be rejected, seek jobs w/ little interpersonal contact
- hypersensitivity
- feelings of inadequacy
Fear of what in avoidant personality d/o vs. agoraphobia
Avoidant personality d/o- fear of rejection
Agoraphobia- fear of embarrassment
Risk factors for avoidant personality d/o
- common in timid infants
- genetic predisposition
-prone to depression
Symptoms of OCPD
Obsessive compulsive personality d/o
- *preoccupation w/ details such that main point of activity is lost
- perfectionism detrimental to completing task
- will not delegate tasks
- rigid, serious, formal
- workaholic
- hoard meaningless objects
Differentiate obsessive compulsive and narcissistic personality d/o in ppl that overwork themselves
OCPD- workaholic, motivated by the activity itself
Narcissistic- workaholic, motivated by the success
