Term
| Deeply ingrained, inflexible patterns of relating to others that are maladaptive and cause significant impairment in social and occupational functioning |
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Definition
| Personality disorder
-patient lack insight about their sxs
-sxs are ego-syntonic
-Axis II dx's |
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Term
| What are the DSM criteria for personility disorders |
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Definition
1. Pattern of behavior or inner experience that deviates from the person's culture and is manifest in 2 or more of these domains: "CAPRI"
-cognition
-affect
-impulse control
-personal relationships
2. The pattern is:
-pervasive and inflexible
-stable (onset no later than early adulthood or adolescence)
-leads to distress in functioning
-Is not accounted for by another medical/substance/psych illness |
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Term
| What personality disoders are cluster A? |
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Definition
"MAD"
Schizoid, schizotypal, paranoid
-familial association with psychotic diseases |
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Term
| What are cluster B personality disorders? |
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Definition
"BAD"
antisocial, histrionic, boderline, narcissitic
-Familial association with mood disorders
-Patients seem emotional, dramatic, inconsistent |
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Term
| What are cluster C personality disorders? |
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Definition
"SAD"
-avoidant, dependent, OCPD
-Patients are anxious or fearful
-Familial association with anxiety disorders |
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Term
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Definition
Most are difficult; patients often unaware of the problem, so dz is often chronic and lifelong
-Tx other comorbidities (anxiety, depression)
-Psycotx and group tx may be useful |
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Term
| 30 year-old man says wife has been cheating on him because he does not have a good enough job to provide for her needs. He also says that he was fired from a previous job because he did a better job than his boss |
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Definition
Paranoid PD
-DSM IV criteria:
Distrust of others beginning by early adulthood and present in a variety of contexts. Must also have 4 of the following:
1. Suspicion
2. Preoccupation with doubts of loyalty
3. Reluctance to confide in others
4. Interpretation of bening remarks as threatening or demeaning
5. Persistence of grudges
6. Perception of attacks on his or her character that are not apparent to others; quick to counterattack
7. Recurrence of suspicions re: fidelity of spouse or lover
-more common in men, family members of schizophrenics
-ddx: paranoid schizophrenia
-Tx: psychotherapy
-Prog: Some pts with PPD may be diagnosed with schizophrenia; disorder is usually chronic--> multiple job and personal problems |
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Term
| How do you differentiate PPD, SPD from paranoid schizophrenia? |
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Definition
| PPD/ SPD patients do not have any frank psychosis (no fixed delusions) though they may have transient psychosis during periods of stress |
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Term
| 45 year-old scientist works in the lab most of the day and has no friends. He expresses no desire to make friends and is content with his single life. He has no evidence of a thought disorder. He was this way during his childhood as well. |
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Definition
| Schizoid PD
-DSM IV criteria:
A pattern of VOLUNTARY social withdrawl beginning by early adulthood and present in a variety of contexts. Must have 4 or more of the following:
1. Neither enjoying or desiring close relationships
2. Generally choosing solitary activities
3. Little (if any) interest in sexual activity with another person
4. Taking pleasure in few activities
5. Few close friends or confidants
6. Indifference to praise or criticism
7. Emotional coldness, detachment, or flat affect
-7% of the population
-No increased incidence in pts. with family hx of schizophrenia
-usually chronic
-Tx: psychotherapy; low-dose antipsychotics if transient psychosis; tx of other comorbid psych conditions |
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Term
| How do you differentiate between schizoid and schizotypal personality disorders? |
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Definition
| Patients with schizoid PD do not display the kind of eccentric behavior or magical thinking seen in patients with schizotypal PD. |
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Term
| A 35 year-old man dresses in a space suit 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. |
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Definition
Schizotypal PD.
-Pervasive pattern of eccentric behavior and peculiar thought process
-DSM IV criteria: A pattern of social defecits marked by ECCENTRIC behavior, cognitive or perceptual distortions, and discomfort with close relationships beginning by early adulthood. Must have 5 or more of the following: 1. Ideas of reference (thinking things are referring to them) 2. Odd beliefs or magical thinking 3. Unusual perceptual experiences 4. Suspiciousness 5. Inappropriate or restricted affect 6. Odd or eccentric personality or appearance 7. Few close friends or confidants 8. Odd thinking or speech 9. Excessive social anxiety -Course: chronic; pts may eventually develop schizophrenia -Tx: Psychotherapy, Lange says that low-dose traditional antipsychotics often useful |
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Term
| What disorder do patients with antisocial personality disorder need to have had as a child? |
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Definition
| Conduct disorder -may have a history of being abused, hurting animals, starting fires |
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Term
| 30 y.o. 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. |
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Definition
| Antisocial Personality Disorder
-DSM IV criteria:
Pattern of disregard for others and violation of the rights of others since age 15; must be at least 18 y.o for dx and must have met criteria for conduct d/o as a child. Must also have 3 of the following:
1. Failure to conform to social norms by committing unlawful acts
2. Deceitfulness/repeated lying/ repeated manipulation
3. Impulsivity
4. Irritability
5. Recklessness
6. Irresponsibility/ failure to honor financial obligations or sustain work
7. Lack of remorse for actions
-Patients often appear charming and normal to those who meet them for the first time
-Often concomittant drug addiction (if started using before antisocial behavior may be attributed to drugs)
-Tx: psychotherapy |
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Term
| 23 year-old student attempted to slit her wrists because things a guy she was seeing for 3 weeks broke up with her. She states that all guys are jerks and "not worth her time". She often feels that she is "alone in this world". |
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Definition
| Borderline Personality Disorder
-DSM IV criteria:
Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors present by early adulthood and predominant in many different contexts. 5 of the following must be present: "IMPUSIVE"
1. Desparate efforts to avoid abandonment
2. Unstable, intense personal relationships
3. Unstable self image
4. Impulsivity in at least 2 potentially harmful way (spending, sex, substance use)
5. Recurrent suicidal threats or attempts or self-mutilation
6. Unstable mood/affect
7. General feelings of emptiness
8. Difficulty controlling anger
9. Transient stree-related paranoid ideation
-Tx: psychotherapy
-these patients are shown to respond better than all other PD patients to pharmacotx
-commonly use "splitting" defense mechanism |
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Term
| A 49 year-old woman comes to your office in a boustierre and thong and complains that her fever feels like she's "burning in hell". She vividly describes how the fever has affected her work as a teacher. |
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Definition
| Histrionic PD
-excessive attention-seeking behavior and excessive emotionality + flamboyant, dramatic, and extroverted behavior--> failure to establish long-lasting meaningful relationships
-DSM IV criteria:
Pattern of excessive emotions and attention-seeking present by early childhood and in a variety of contexts
1. Uncomfortable when not center of attention
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 then they acutally are
-Tx: pharmacotx |
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Term
| Differentiating Histrionic PD from BPD |
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Definition
| patients with BPD are more likely to suffer from depression and attempt suicide. HPD pts are generally more functional. |
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Term
| A 48 y.o. 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" |
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Definition
| Narcissitic Personality Disorder
DSM IV criteria:
Pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts. Must have 5 or more of the following:
1. Exaggerated sense of self-importance
2. Preoccupied with fantasies of unlimited money, success, brilliance
3. Believes they are "special" or unique and can only associate with other high-status persons
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 beleives others are envious of him or her
9. Arrogant or haughty
Tx: psychotherapy |
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Term
| Differentiating antisocial PD from narcissistic PD |
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Definition
| Antisocial personality disorder patients want material gain or to subjugate others by their exploitation of them, while narcissitic PD patients exploit for recognition and status |
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Term
| A 30 y.o. postal worker rarely goes out with her coworkers and often makes excuses not to go out with them because she's afraid they will not like her. She wishes to go out, deeply, but according to her, she's "too shy". |
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Definition
| Avoidant personality disorder
-DSM IV criteria:
A pattern of social inhibition, hypersensitivity, and feelings of inadequacy since early child hood with 4 of the following:
1. Avoids occupation that involves interpersonal contact due to fear of criticism and rejection
2. Unwilling to interact unless certain of being liked.
3. Cautious of interpersonal relationships
4. Preoccupied with being criticised or rejected in social situations
5. Inhibited in new social situations because he or shee feels inadequate
6. Believes he or she is socially inept and inferior
7. Reluctant to engage in new activities for fear of embarrassment
-Tx: psychotherapy, betablockers for autonomic sxs of anxiety |
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Term
| What is on the differential for a person with suspected avoidant PD? How can you distinguish between similar entities? |
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Definition
1. Schizoid PD
-Avoidant PD patients want social interaction, but can't do so, whereas schizoid, are indifferent
2. Social phobia-
Sxs since early adulthood and before, think avoidant PD. Social phobia is driven by fear of embarrassment in a specific setting (i.e. speaking in public), whereas avoidant PD is an overall fear of rejection
3. Dependent PD
-avoidant PD patiens cling to relationships like dependent PD patients, b ut avoidant patients are slow to get involved whereas dependents actively and aggressively seek relationships |
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Term
| A 40 y.o. man lives with his parents and has trouble deciding how to have his car fixed. He calls his father at work several times to ask very trivial things. He has been unemployed for 3 years. |
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Definition
| Dependent Personality Disorder
-DSM IV criteria:
A 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 life
3. Cannot express disagreement because of fear of loss of approval.
4. Difficulty in 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. Pre-occupied with fears of being left to take care of self.
-Tx: psychotherapy |
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Term
| Differential diagnosis for dependent PD and differentiating |
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Definition
1. Avoidant
Avoidant PD patients depend on others but are more reserved in relationships and reluctant; dependents are voraciously seeking new relationships
2. Borderline
Patients with dependent PD maintain longer relationships while patients with borderline have short, intense relationships |
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Term
| 40 year-old secretary has been recently fired because of her inability to prepare some work projects in time. According to her, they were not in the right format and she had to revise them six times which led to the delay. This happened before but she feels she is not given enough time |
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Definition
| Obsessive-Compulsive Personality Disorder
-DSM IV criteria:
Pattern of preoccupation orderliness, control, and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts. Also must have four of the following:
1. Preoccupation with details, rules, lists and organization such that the major points of the activity is lost
2. Perfectionism that is detrimental to the completion of a task
3. Excessive devotion to work
4. Excessive conscientiousness about morals and ethics
5. Will not delegate tasks
6. Unable to discard worthless objects
7. Miserly (stingy)
8. Stubborn and rigid
-ego-syntonic=patients unaware of their problem
Tx: psychotherapy |
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Term
| Personality disorder not otherwise specified |
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Definition
Reserved for PDs not fitting into the
A,B,or C categories. Includes Passive aggressive personality disorder, sadomasochistic disorder, and sadistic PD. |
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Term
| An obese woman starts a diet, loses 5 lbs. and then says she's taking a "break" from the diet because she hasn't been feeling well |
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Definition
| Passive-aggressive Personality Disorder
-stubborn, inefficient procrastinators
-alternate between compliance and defiance and passively resist fulfillment of tasks
-They frequently make excuses and lack assertiveness
-manipulate others, and complain about their own misfortunes
Tx: psychotherapy |
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