Personality Disorders

What is a personality disorder

An enduring pervasive and inflexible pattern of inner experience and behavior that deviates from cultural expectations and causes distress or impairment

When do personality disorders generally begin

Adolescence or early adulthood

What 4 areas can show the abnormal pattern in a personality disorder

Cognition / affectivity / interpersonal functioning / impulse control

How many of the 4 general personality areas must be affected

At least 2

What does pervasive mean in personality disorder

The pattern occurs across a broad range of personal and social situations

What does inflexible mean in personality disorder

The person has difficulty adapting the pattern to different situations

What duration pattern is required for personality disorder

The pattern is stable and long lasting

What conditions must not better explain a personality disorder

Another mental disorder / substance effects / another medical condition

What are ego syntonic personality traits

Traits the person experiences as natural or consistent with the self and may not recognize as problematic

Why can collateral information be especially useful when assessing personality disorders

The person may not recognize their longstanding traits as problematic

What should clinicians assess before diagnosing personality disorder

Long term functioning across different situations rather than behavior during one episode

Why should personality disorders be diagnosed cautiously during depression anxiety or substance use

Temporary symptoms may resemble enduring personality traits

Can personality disorders be diagnosed before age 18

Yes in unusual cases when traits have persisted at least 1 year and are not developmental

What personality disorder cannot be diagnosed before age 18

Antisocial personality disorder

Why is culture important in diagnosing personality disorders

Behavior must be judged relative to cultural social and contextual expectations

What are the 3 personality disorder clusters

Cluster A / Cluster B / Cluster C

What disorders are in Cluster A

Paranoid / schizoid / schizotypal personality disorders

What general description fits Cluster A

Odd or eccentric

What disorders are in Cluster B

Antisocial / borderline / histrionic / narcissistic personality disorders

What general description fits Cluster B

Dramatic emotional or erratic

What disorders are in Cluster C

Avoidant / dependent / obsessive compulsive personality disorders

What general description fits Cluster C

Anxious or fearful

Are the personality disorder clusters absolute diagnostic categories

No / people can have traits or disorders across multiple clusters

What is paranoid personality disorder

Pervasive distrust and suspiciousness in which other peoples motives are interpreted as malevolent

How many paranoid personality disorder criteria are required

At least 4 of 7

What are the 7 paranoid personality disorder features

Unfounded suspicion of exploitation or harm / doubts about loyalty / reluctance to confide / hidden threatening meanings / grudges / perceiving character attacks / unjustified jealousy

What relationship belief is central to paranoid personality disorder

Others are likely to exploit harm deceive or betray the person

Why may someone with paranoid personality disorder avoid confiding in others

Fear that information will be used maliciously against them

How may benign comments be interpreted in paranoid personality disorder

As hidden insults threats or attacks

How do people with paranoid personality disorder respond to perceived insults

They may hold grudges or react angrily and counterattack

What romantic relationship symptom may occur in paranoid personality disorder

Unjustified recurrent suspicion of partner infidelity

How does paranoid personality disorder differ from psychotic disorders

Pervasive suspicious personality traits occur without the persistent delusions or hallucinations characteristic of psychosis

How does paranoid personality disorder differ from schizotypal personality disorder

Schizotypal also includes cognitive or perceptual distortions magical thinking and eccentricity

How does paranoid personality disorder differ from avoidant personality disorder

Paranoid avoids trust because others may be malicious / avoidant holds back because of fear of rejection or humiliation

What is schizoid personality disorder

Pervasive detachment from social relationships with restricted emotional expression

How many schizoid personality disorder criteria are required

At least 4 of 7

What are the 7 schizoid personality disorder features

No desire for close relationships / solitary activities / little sexual interest / little pleasure / few close friends / indifference to praise or criticism / emotional coldness

Do people with schizoid personality disorder generally want close relationships

Usually no

What activity pattern is common in schizoid personality disorder

Strong preference for solitary activities

What is the typical emotional presentation of schizoid personality disorder

Cold detached or restricted affect

How does schizoid personality disorder respond to praise or criticism

Often with apparent indifference

How does schizoid personality disorder differ from avoidant personality disorder

Schizoid generally lacks desire for relationships / avoidant wants relationships but fears rejection

How does schizoid personality disorder differ from paranoid personality disorder

Schizoid detachment is not primarily caused by pervasive suspicion

How does schizoid personality disorder differ from schizotypal personality disorder

Schizotypal includes odd beliefs perceptual distortions and eccentric behavior

What is schizotypal personality disorder

Pervasive social and interpersonal deficits with cognitive or perceptual distortions and eccentric behavior

How many schizotypal personality disorder criteria are required

At least 5 of 9

What are the 9 schizotypal personality disorder features

Ideas of reference / magical thinking / unusual perceptions / odd speech / suspiciousness / constricted affect / eccentric behavior / few close friends / unusual social anxiety

What are ideas of reference

Incorrectly interpreting ordinary events as having special personal meaning without full delusional conviction

What is magical thinking in schizotypal personality disorder

Beliefs in unusual powers or phenomena outside cultural norms such as telepathy or clairvoyance

What perceptual symptoms can occur in schizotypal personality disorder

Unusual perceptual experiences or bodily illusions

What speech pattern may occur in schizotypal personality disorder

Vague circumstantial metaphorical overelaborate or stereotyped speech

What kind of social anxiety occurs in schizotypal personality disorder

Anxiety that persists despite familiarity and is often linked to paranoid fears

How does schizotypal personality disorder differ from schizophrenia

Schizotypal lacks the persistent full psychotic syndrome required for schizophrenia

How does schizotypal personality disorder differ from paranoid personality disorder

Schizotypal adds magical thinking unusual perceptions odd speech and eccentric behavior

How does schizotypal personality disorder differ from borderline personality disorder

Schizotypal psychotic like experiences are more enduring / borderline experiences are usually transient and stress related

What is antisocial personality disorder

Pervasive disregard for and violation of the rights of others beginning by age 15 and continuing into adulthood

How many antisocial personality disorder behavioral criteria are required

At least 3 of 7

What are the 7 antisocial personality disorder features

Repeated unlawful behavior / deceitfulness / impulsivity / aggression / reckless disregard for safety / irresponsibility / lack of remorse

What minimum age is required for antisocial personality disorder

Age 18

What childhood history is required for antisocial personality disorder

Evidence of conduct disorder beginning before age 15

Can criminal behavior alone establish antisocial personality disorder

No

What is the deceitfulness criterion in antisocial personality disorder

Repeated lying aliases or conning for personal profit or pleasure

What is the irresponsibility criterion in antisocial personality disorder

Repeated failure to sustain work behavior or honor financial obligations

What is lack of remorse in antisocial personality disorder

Indifference to or rationalization of harming mistreating or stealing from others

How does antisocial personality disorder differ from conduct disorder

Antisocial personality disorder requires age 18 plus conduct disorder before age 15

How does antisocial personality disorder differ from narcissistic personality disorder

Antisocial includes deceit aggression impulsivity and conduct disorder history while narcissistic centers on grandiosity admiration and entitlement

How does antisocial personality disorder manipulation differ from borderline manipulation

Antisocial manipulation usually seeks profit power or material gain / borderline behavior more often seeks care or prevents abandonment

What is borderline personality disorder

Pervasive instability in relationships self image and emotion with marked impulsivity

How many borderline personality disorder criteria are required

At least 5 of 9

What are the 9 borderline personality disorder features

Abandonment fears / unstable relationships / unstable identity / damaging impulsivity / suicidal or self injurious behavior / mood reactivity / emptiness / intense anger / stress related paranoia or dissociation

What abandonment behavior occurs in borderline personality disorder

Frantic efforts to avoid real or imagined abandonment

What relationship pattern is characteristic of borderline personality disorder

Unstable intense relationships alternating between idealization and devaluation

What is identity disturbance in borderline personality disorder

Markedly and persistently unstable self image or sense of self

How much impulsivity is required for the borderline impulsivity criterion

At least 2 potentially self damaging areas

What are examples of borderline impulsivity

Reckless spending / unsafe sex / substance misuse / reckless driving / binge eating

What self harm criterion occurs in borderline personality disorder

Recurrent suicidal behavior threats gestures or self mutilation

What mood pattern occurs in borderline personality disorder

Markedly reactive moods often lasting hours and rarely more than a few days

What chronic internal feeling is common in borderline personality disorder

Emptiness

What anger pattern occurs in borderline personality disorder

Intense inappropriate anger or difficulty controlling anger

What psychotic like symptoms can occur in borderline personality disorder

Transient stress related paranoid ideation or severe dissociation

How does borderline personality disorder differ from bipolar disorder

Borderline mood shifts are often rapid and interpersonal stress reactive while bipolar episodes persist as distinct mood episodes

How does borderline personality disorder differ from histrionic personality disorder

Borderline has greater self destructiveness abandonment fear identity disturbance emptiness and angry relationship disruption

How does borderline personality disorder differ from dependent personality disorder

Borderline responds to abandonment with rage emptiness and instability / dependent responds with submission and urgent pursuit of another caregiver

Is suicide risk important in borderline personality disorder

Yes / recurrent suicidal and self injurious behavior is a major clinical feature

What is histrionic personality disorder

Pervasive excessive emotionality and attention seeking

How many histrionic personality disorder criteria are required

At least 5 of 8

What are the 8 histrionic personality disorder features

Needs center of attention / inappropriate seductiveness / shallow shifting emotion / appearance used for attention / impressionistic speech / theatrical emotion / suggestibility / overestimates intimacy

What happens when someone with histrionic personality disorder is not the center of attention

They often feel uncomfortable or unappreciated and may seek attention dramatically

What type of emotional expression occurs in histrionic personality disorder

Rapidly shifting shallow and exaggerated emotional expression

What speech pattern occurs in histrionic personality disorder

Impressionistic speech lacking detail

What relationship perception occurs in histrionic personality disorder

Relationships are often viewed as more intimate than they actually are

How does histrionic personality disorder differ from narcissistic personality disorder

Histrionic seeks attention broadly / narcissistic particularly seeks admiration confirming superiority

How does histrionic personality disorder differ from dependent personality disorder

Histrionic is flamboyant dramatic and attention seeking / dependent is submissive and primarily seeks caregiving

What is narcissistic personality disorder

Pervasive grandiosity need for admiration and lack of empathy

How many narcissistic personality disorder criteria are required

At least 5 of 9

What are the 9 narcissistic personality disorder features

Grandiose importance / fantasies of success or power / special status beliefs / excessive admiration / entitlement / exploitation / lack of empathy / envy / arrogance

What is grandiosity in narcissistic personality disorder

Exaggerated sense of importance superiority ability or achievement

What fantasy pattern is common in narcissistic personality disorder

Fantasies of unlimited success power brilliance beauty or ideal love

What does special status mean in narcissistic personality disorder

Belief that only special or high status people can understand or associate appropriately with the person

What is entitlement in narcissistic personality disorder

Unreasonable expectation of favorable treatment or automatic compliance