Term
| How is a "personality disorder" defined? |
|
Definition
When person's habitual style is "inflexible and maladaptive, and causes either significant functional impairment or subjective distress."
- Revolve around Cognition, Emotion Regulation, Behavior/impulsivity and Interpersonal relations |
|
|
Term
| What are the 3 important diagnostic elements in all personality disorders? |
|
Definition
1) Early onset
2) Relative consistency over time
3) Pervasive impairment across multiple life functions |
|
|
Term
True or False.
Temperament is the biologic component of personality, usually genetics |
|
Definition
True!
"Character" is reserved for traits related to social/cultural moral values |
|
|
Term
"Temperament" vs. "Character"?
1) Processing
2) Development
3) Regulation
4) Consciousness
5) Pathology
6) Cloninger classifications |
|
Definition
Temperament
1) Pre-conceptual
2) Present in childhood
3) Limbic/striatum
4) Unconscious
5) Acquired (trauma)
6) Novelty-seeking, harm avoidance, reward dependent
Character
1) Conceptual/insight-learning
2) Matures in adulthood
3) Neocortex, hippocampus
4) Conscious
5) Interpersonal problems (psychological trauma)
6) Self-directeness, Cooperativity, Self-transcendence |
|
|
Term
What is the biological basis of regulation of Temperament vs. Character?
What about pathology? |
|
Definition
1) Temperament is regulated by Limbic/Striatum, while Character is regulated by Neocortex/Hippocampus
2) Temperament (unconscious) involves acquired deficits via physical trauma, while Character (conscious) involves interpersonal problems via psychological trauma. |
|
|
Term
Match each of the following personality symptom with their appropriate NT
1) Emotional reactivity, arousal, extroversion
2) Inhibition of impulse/affect
3) Lethargy//depression, decreased exploration
4) Novelty-seeking, Histrionic traits |
|
Definition
|
|
Term
| How does 5-HT interact with NE to regulate arousal and reactiveness? |
|
Definition
In the presence of High NE
1) High 5-HT inhibits, leading to reactive anxiety, avoiding, dependent, phobic, anxious personality traits
2) Low 5-HT "dis-inhibits" leading to reactive impulsivity, external aggression, novelty seeking, risk taking, dramatic, sensitive to criticism
When NE is Low
1) Low 5-HT causes "disinhibition" of NE effects, with depressive, self directed aggression and suicide
2) High 5-HT leads to inhibition of NE effects, with withdrawn, ruminative, obsessional behavior |
|
|
Term
What personality traits will you see if NE and 5-HT are both low?
What types of PDs fit this profile? |
|
Definition
1) Low NE leads to withdrawn and un-reactive behavior
2) Low 5-HT wil cause "dis-inhibition" of NE effects, causing depressive feelings, self-direction aggression and suicide.
Anxious Fearful Cluster (C)
- fear of rejection, avoidance, submissive, excessive inhibition and self-control |
|
|
Term
What personality traits will you see if NE and 5-HT are both high?
What types of PDs fit this profile? |
|
Definition
1) High NE leads to arousal and reactive behavior
2) High 5-HT causes inhibition of NE effects, causing reactive anxiety, avoidant behavior and dependent, phobic, anxious personality traits.
Anxious Fearful Cluster (C)
- fear of rejection, avoidance, submissive, excessive inhibition and self-control |
|
|
Term
What personality traits will you see if NE is high but 5-HT is low?
What types of PDs fit this profile? |
|
Definition
1) High NE leads to aroused, reactive behavior
2) Low 5-HT leads to "disinhibition" of NE activity, leading to reactive impulsivity, external aggression, novelty-seeking and risk taking
Probably Dramatic Cluster (B) (Perhaps Borderline)
- Emotional lability, impulsiveness, irritability, lacking empathy |
|
|
Term
What personality traits will you see if 5-HT is high but NE is low?
What types of PDs fit this profile? |
|
Definition
1) Low NE leads to withdrawn and unreactive behavior
2) High 5-HT leads to inhibition of NE, causing withdrawn, ruminative and obsessional behavior.
Sounds like Obsessive-Compulsive Personality disorder from Cluster C |
|
|
Term
| What are Personality disorders so important to study? |
|
Definition
1) Prevalent- 10-14% lifetime (OC, paranoid and schizoid most common)
2) Disabling (determined by PD)
3) Lethal (10% of borderline PD complete suicide)
4) Predictive (co-morbidity predicts axis 1 refractoriness (e.g major depression and Adherence likelihood) |
|
|
Term
| What are the 3 personality disorders in the "Odd-Eccentric Cluster" (A)? |
|
Definition
Some Days Sally Does Dishes
- social withdrawal
- detachment from others
- suspiciousness
- distrust
- discomfort with closeness
1) Paranoid- Suspicious (unjustified), sensitive to threats, grudges, projection as defense
2) Schizoid- little emotion, indifferent, little sexual interest, no close friends, "Loners"
3) Schizotypal- Psychotic-like cognitive/perceptual distortions (mild thought disorder), odd beliefs, constricted affect, illusions (vs, Schizophrenia) |
|
|
Term
| What are the 4 personality disorders in the "Dramatic" Cluster (B)? |
|
Definition
All Share
- Emotional lability
- Intense, unstable
- Behavioral impulsiveness
- Irritability and Manipulative
- Sensitive to withdrawal of attention
1) Antisocial- lack of empathy/remorse/responsibility
- impulsive with no empathy or guilt
- excessive need for stimulation
2) Borderline- affective lability/cognitive distortion-paranoid ideation/sensitive to rejection/
**Self-destructive-mutilation
3) Narcissistic
- demand for attention, entitled, self-important
4) Histrionic
- Excessive emotional lability, manipulation, compulsive lieing, seduction, provocation, little empathy |
|
|
Term
| When should be be sure to refer cases of Dramatic personality disorders? |
|
Definition
Remember, Antisocial, Borderline, Histrionic and Narcissistic
1) Suicidal behavior
2) Self-mutilation
3) Impulsivity
4) Aggression |
|
|
Term
| Why are personalty disorders so concerning clinically? |
|
Definition
- Suicide risk (9-28% of completed suicides!)
- increased by comorbidity with other known risk factors
- best predictor of repeat attempt is history of prior attempt |
|
|
Term
| What are the 3 personality disorders in the "Anxious Fearful" Cluster (C)? |
|
Definition
All share
- Fears of rejection and social disapproval
- Avoidance
- Submissive dependence
- Excess of inhibition and self-control
1) Avoidant- painfully shy, fear of criticism, rejection
2) Dependent- feelings of inadequacy, fear of rejection, specialize in submission
3) Obsessive-Compulsive- Inhibited emotionally, preoccupied with issues of control over affect, highly judgmental/rigid, perfectionistic |
|
|
Term
| When should be be sure to refer cases of Anxious Fearful Cluster personality disorders? |
|
Definition
1) Social inhibitions
2) Social phobia
3) Obsessions or Compulsive rituals |
|
|
Term
| How do you treat the Cognitive-Perceptual cluster (A) of personality disorders? |
|
Definition
Anti-psychotics (neuroleptics)
- Suspicious/paranoid
- Odd communication
- Dissociation/hallucinations |
|
|
Term
| How do you treat the Affective cluster (B) of personality disorders? |
|
Definition
- Emotion dysregulation, intense anger, rejection sensitivity, chronic emptiness
1) SSRI/Anti-psychotic
2) SSR/MAOIs |
|
|
Term
| How do you treat the Impulsive-Behavioral (C) of personality disorders? |
|
Definition
1) SSRIs, Lithium, antipsychotics, MAOIs, anticonvulsants
Sensation-seeking
Cognitive impulsivity
Aggressive
Binges
Suicide/self-mutilation |
|
|
Term
An example of a personality disorder in the “odd/eccentric” cluster would be:
a. Paranoid
b. Avoidant
c. Dependent
d. Obsessive-compulsive |
|
Definition
|
|
Term
The biological component of personality is usually called:
a. Character
b. Temperament
c. Biobehavior
d. None of the above |
|
Definition
|
|
Term
Which personality disorder would be most likely to cause a person to display impulsive, potentially self-injurious behavior?
a. Borderline
b. Schizotypal
c. Schizoid
d. Obsessive-Compulsive |
|
Definition
|
|
Term
The DSM-IV approach to diagnosing personality disorders may be best described as:
a. Dimensional
b. Etiological
c. Categorical
d. Functional |
|
Definition
|
|
Term
All of the following are features of narcissistic personality disorder EXCEPT:
a. Exaggerated sense of self-importance
b. Excessive demand for attention
c. A sense of entitlement
d. Circumstantial thinking |
|
Definition
|
|
Term
Management approaches to the patient with borderline personality disorder and self-injurious behavior would include all of the following EXCEPT:
a. High-dose opiate agonists
b. Careful assessment of risk/safety
c. Referral to specialized psychiatric services
d. Aggressively treating comorbid psychopathology |
|
Definition
|
|
Term
Which statement best describes aspects of character, as opposed to temperament:
a. Mediated primarily by limbic structures, character formation occurs preconceptually
b. Character traits include novelty-seeking, harm avoidance, and persistence.
c. Character traits are learned, mature in adult, and are maintained in conscious awareness.
d. Neurobiological and genetic forces are the strongest influence on character development. |
|
Definition
|
|
Term
A patient comes to office, presenting as highly aroused, reactive, and impulsive, saying that he loves to hang-glide and exceed the speed limit when driving. What neurotransmitter profile might best explain this personality profile?
a. High NE, low 5HT
b. High NE, high 5HT
c. Low NE, low 5HT
d. Low NE, high 5HT |
|
Definition
|
|
Term
Which personality disorder is most commonly observed in community samples?
a. Schizoid
b. Borderline
c. Antisocial
d. Obsessive-Compulsive |
|
Definition
|
|
Term
Which personality disorder should be considered highest in the differential when an adolescent presents with signs of possible early psychosis (delusions, hallucinations):
a. Avoidant
b. Schizotypal
c. Histrionic
d. Schizoid |
|
Definition
|
|
Term
| What notable co-morbidities occur with Dramatic personality disorders? |
|
Definition
1) Depression
2) S/A
3) Suicide attempt
4) Self injury
5) Impulsivity and Aggression |
|
|
