Personality Disorders

Question 1

When is the onset for personality disorders?

Answer 1

adolescence or early adulthood

Question 2

Do personality disorders tend to be stable over time?

Answer 2

yes

Question 3

Why might there be dilemmas in making distinctions between the personality disorders and other diagnoses?

Answer 3

High rate of comorbidity with other psychiatric disorders

Question 4

How are the Three clusters of personality disorders grouped?

Answer 4

according to common symptomatology

Question 5

What is Cluster A?

Answer 5

• Paranoid, schizoid, and schizotypal personality disorders

- characterized by odd or peculiar behavior

Question 6

What is Cluster B?

Answer 6

• Antisocial, borderline, histrionic, and narcissistic personality disorders
• present with flamboyant or dramatic behavior

Question 7

What is Cluster C?

Answer 7

• Avoidant, dependent, obsessive-compulsive personality disorders
• characterized primarily by anxiety or fear

Question 8

Etiology of personality disorders is a combination of what?

Answer 8

• Genetic factors affecting serotonin system and stress reactions
• Deficits in function of the prefrontal cortex & structures related to emotion and impulse control
• Structural and functional deficits especially in limbic and paralimbic brain areas, and the cognitive-executive brain regions
• Parental influences—parents with anhedonia more likely to have children with Personality disorders
• Childhood trauma; and adverse experiences in adolescence
• Exaggerated defense mechanisms
• Avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal PD strongly correlated with comorbid depression
• Comorbidity: major depression, anxiety disorders, substance use disorders, worse outcome

Question 9

Which is the most severe personality disorder cluster and how are these people perceived?

Answer 9

A-most resistant to treatment

perceived as self-centered, negatively affecting their social relationships

Question 10

What do individuals with paranoid personality disorders experience?

Answer 10

• sense of being threatened or persecuted
• Others are suspected of intent to harm the individual
• Jealousy and suspicion characterize most relationships
• Individual is isolated, few friends/close relationships
• Argumentative and withdrawn
• Hypercritical of others, respond poorly to any criticism

Question 11

What is paranoid personality disorder thought to be a milder manifestation of?

Answer 11

characteristics of paranoid schizophrenia

Question 12

Characteristics of Schizoid Personality Disorder?

Answer 12

• Detachment from social relationships
• Limited expression of emotions in interpersonal relationships
• Little interest in sexual experiences
• Lack of pleasure in activities
• Emotional coldness, detachment or flattened affect

Question 13

What may Schizoid Personality Disorder be related to?

Answer 13

• May be a spectrum disorder with schizophrenia

- May be related to early attachment difficulties

Question 14

What is Schizotypal Personality Disorder defined by?

Answer 14

• Schizoid plus the following distorted thinking and behavior:
• Fear & anxiety with relationship
• Cognitive distortions, eccentric behavior, peculiar perceptual experiences, odd thinking and speech, paranoia
• Flat affect; social isolation
• Psychological defense mechanisms associated with schizotypal personality disorder include passive-aggression, devaluation, rationalization, isolation, splitting

Question 15

What is Cluster B of personality disorders characterized by?

Answer 15

• emotional instability
• disruptive and erratic interpersonal relationships
• restricted affect
• lack of empathy and insight

Question 16

What is Cluster B personality disorder thought to be a result of?

Answer 16

• deficient or abusive parenting that results in emotional dysregulation
• Evidence for an inherited component for these disorders

Question 17

What is the criteria for antisocial personality disorder?

Answer 17

Disregard for the rights of others (usually violent behavior) for at least three years in an individual at least 18 years old

Question 18

Prior to 18 years old, what would a person presenting with symptoms of antisocial personality disorder be diagnosed with?

Answer 18

a conduct disorder

Question 19

What are signs and symptoms of antisocial personality disorder?

Answer 19

• Failure to conform to lawful behavior; deceitfulness
• Impulsivity, aggressiveness, failure to plan ahead
• Irresponsibility, disregard for the safety of others
• Lack of remorse
• Splitting, denial, projection, acting out
• High risk in legal activities; money problem

Question 20

What diagnosis (diagnoses) must be ruled out before a diagnosis of antisocial personality disorder?

Answer 20

Bipolar-Manic must be ruled out

Question 21

What are the signs and symptoms of borderline personality disorder?

Answer 21

• Unstable interpersonal relationships- characterized by alternating idealization and devaluation
• Self-image problems characterized by uncertainty about sexual orientation, long-term goals, or values
• Inappropriate affect- anger; Impulsivity
• Efforts to avoid abandonment
• Suicidal or self-harm behavior

Question 22

What diagnosis (diagnoses) must be ruled out before a diagnosis of borderline personality disorder?

Answer 22

Depression

bipolar disorder

other personality disorders

Question 23

What are frequent commodities of borderline personality disorder?

Answer 23

Depression

PTSD

substance abuse

Question 24

What is Cluster C of personality disorders characterized by?

Answer 24

• anxiety and fear

- Avoidant PD, Dependent PD, Obsessive-compulsive PD

Question 25

What is the most common Cluster C disorder?

Answer 25

Obsessive-compulsive personality disorder

Question 26

What are Cluster C disorders as a group highly correlated with?

Answer 26

major depressive disorder and the anxiety disorders

Question 27

What do theories for the development of Cluster C disorders include?

Answer 27

speculation about attachment difficulties, traumatic life events, and psychological stress and dysfunction

Question 28

What is the diagnostic criteria for Avoidant Personality Disorder?

Answer 28

- Social inhibition - Feelings of inadequacy and sensitivity leading to avoidance of activities that require social interaction, restraint in intimate relationships - Fear of criticism or rejection - Self-perception of social inadequacy - Avoid interaction, and often experience significant loneliness

Question 29

What is the diagnostic criteria for dependent personality disorder?

Answer 29

- Excessive need to be taken care of resulting in submissive and clinging behavior and fear of separation - Difficulty making independent decisions; excessive need for reassurance; unwillingness to assume responsibility - Difficulty expressing differences of opinion, and a feeling of helplessness when alone - May have deficits at certain skills - More likely to experience physical illness and to make use of the health care system than is true for the general population

Question 30

What is the diagnostic criteria for obsessive-compulsive personality?

Answer 30

- Preoccupation with order and perfectionism - Lack of flexibility and preoccupation with details - Rigidity and stubbornness - Task completion is problematic due to spending too much time in details - Decision making is difficult- unable to evaluate choices and act - Judgmental and moralistic- have difficulty expressing warmth - Difficulty forming warm relationships - Mild form in the OCD spectrum

Question 31

What is the prognosis for personality disorders?

Answer 31

-Behaviors associated with them tend to be fairly ingrained and pervasive—ways of being in the world as opposed to discrete symptoms Individuals often externalize their problems, blaming others when life does not go as they wish -Some evidence that individuals with personality disorders can change

Question 32

Underlying issues for all personality disorders implicating for OT?

Answer 32

- Inaccurate perceptions of self and others - Inadequate social skills - Poorly developed personal values and goals - Poor self-esteem

Question 33

What kind of group/cooperative activities may be helpful for those with PD?

Answer 33

- Planning a social event; Social skills training - Interpreting accurately what others say and developing empathy; consistent, clear, and nonjudgmental feedback from the therapist and from other group members may assist in accomplishing this goal - Must learn to make an active effort to show regard for or understanding of the feelings of others

Question 34

What are the implications for OT for each cluster of PD?

Answer 34

- Cluster A: sensory integrative interventions - Cluster B: behavioral approaches - Cluster C: social skills training

Question 35

What are the implications for OT in terms of occupational engagement for those with PD?

Answer 35

- Tendency to choose socially disapproved occupation to cope - Sports- serve as an outlet- nothing to do with social - Self-care/ meal preparation- meaningless, tedious, seek approval - Avoid social interaction at workplace

Question 36

What are the lifespan considerations for those with PD?

Answer 36

- Personality disorders tend to emerge in adolescence - Need to differentiate from normal adolescent behavior - B/b these are persistent disorders, often seen in older adults, although symptoms of may lessen over time (notably antisocial PD)

Question 37

What are some interventions an OT may use for someone with a PD?

Answer 37

- Opportunities for realistic self-appraisal through occupation - Opportunities to build self-esteem - Behavior modification