psych week 7

What is personality?

One's way of thinking, feeling, and relating to others and the environment.

How stable are personality traits over time?

They are relatively stable, particularly after early adulthood, but may gradually change throughout the lifespan.

What defines a personality disorder?

An enduring, inflexible pattern of thinking, feeling, and behaving that deviates from cultural expectations (but and causes distress or functional impairment) . Geneerally goes throughotu life without wavering.

Personality disorder patterns occur across what settings?

Multiple personal and social contexts.

Are personality disorders generally ego-syntonic or ego-dystonic?

Ego-syntonic.

What does ego-syntonic mean in personality disorders?

The individual generally views the traits/behavior as consistent with themselves rather than recognizing them as abnormal.

What does alloplastic mean in personality disorders?

The person tries to alter the environment rather than themselves in order to adapt. Acting like the victim so not taking responsibility fro their own circumstances.

What insight pattern is common in personality disorders?

Limited insight with externalization of blame.

Why may patients with personality disorders be reluctant to seek treatment?

They often have limited insight and do not perceive their own personality patterns as problematic.

What areas of functioning are commonly impaired by personality disorders?

Social and occupational functioning.

Personality disorders consume substantial resources in what areas?

Community services (b/c theyre often not able to function on their own), social welfare benefits, public health, and prison resources.

Why is evaluation and management of personality disorders difficult?

Personality is difficult to reduce to discrete symptoms/criteria, research is difficult, and patients often have traits of multiple disorders.

Why can personality disorders be difficult to fit into discrete DSM categories?

Individuals frequently exhibit traits of more than one disorder and can overlap.

What criticism has been made of the traditional personality disorder classification system?

It may fail to appreciate the multidimensional nature of personality disorders.

Were the major proposed DSM-5 Personality Disorders Workgroup changes adopted as DSM-5 criteria?

No; they were considered too radical a leap for clinical use.

Is diagnosing personality disorders considered an entirely settled area of psychiatry?

No; it remains controversial.

Approximately what percentage of the general population has a personality disorder?

10-20%.

Approximately what proportion of psychiatric patients have a personality disorder?

About 50%.

How do monozygotic twins raised separately compare with monozygotic twins raised together regarding personality disorders?

They have similar rates.

What EEG finding has been documented in some personality disorders?

Slow-wave activity.

Which personality disorders are particularly associated with documented EEG slow-wave changes in the lecture?

Antisocial and borderline personality disorders.

What general model explains the etiology of personality disorders?

Interaction of genetic/temperamental vulnerability with environmental influences.

What childhood experiences may increase the risk of personality pathology?

Abuse/neglect, caregiver disruption or abandonment, inconsistent/maladaptive parenting, and trauma.

What is Reich's concept of "character armor"?

Rigid psychological defenses that become incorporated into personality.

According to Reich's theory, how can early experiences contribute to personality pathology?

Early experiences shape defense mechanisms and coping patterns; repeated defenses become ingrained into character/personality.

How can psychological defenses eventually become maladaptive personality patterns?

Repeated defenses become rigid and ingrained into personality.

Why is Reich's "character armor" theory relevant today?

It was historically influential in the development of modern psychodynamic concepts.

What disorders/symptoms are frequently comorbid with personality disorders?

Substance use, suicidality, mood disorders, eating disorders, and anxiety disorders.

What is the usual time course of personality disorders?

Chronic, often lasting decades.

How can personality disorders affect treatment of comorbid conditions?

They frequently interfere with treatment.

What is the overall prognosis of personality disorders?

Variable; many can be lifelong.

Why do patients with personality disorders seldom independently recognize their illness?

Traits are usually ego-syntonic and supported by defense mechanisms.

What generally brings a patient with a personality disorder into treatment?

Others often insist on treatment rather than the patient recognizing a problem independently.

What two broad treatment modalities may be used for personality disorders?

Psychotherapy and pharmacotherapy.

Which is generally more important for personality disorders: psychotherapy or pharmacotherapy?

Psychotherapy.

Why can psychotherapy be particularly difficult in personality disorders?

Low insight and disorder-specific interpersonal/behavioral difficulties.

What are the three DSM personality disorder clusters?

Cluster A, Cluster B, and Cluster C.

How is Cluster A described?

Aloof, odd, eccentric.

Which disorders are in Cluster A?

Paranoid, schizoid, and schizotypal personality disorders.

How is Cluster B described?

Dramatic, impulsive, exploitative, erratic.

Which disorders are in Cluster B?

Borderline, antisocial, narcissistic, and histrionic personality disorders.

How is Cluster C described?

Anxious and fearful.

Which disorders are in Cluster C?

Avoidant, dependent, and obsessive-compulsive personality disorders.

A patient is persistently suspicious, distrustful, and interprets others' actions as malicious. Most likely personality disorder?

Paranoid personality disorder.

What is the core feature of paranoid personality disorder (PPD)?

Pervasive suspiciousness and mistrust.

How does a patient with PPD commonly interpret the actions of others?

As deliberately demeaning, malicious, threatening, or exploitative.

How may a patient with PPD react to perceived threats or slights?

Become angry, hostile, defensive, counterattack, or hold grudges.

When does PPD typically begin?

Early adulthood.

Does PPD occur only in isolated situations?

No; it appears in a variety of contexts.

What relationship behaviors may suggest PPD?

Unjustified doubts about loyalty of friends/coworkers and pathologic jealousy toward a partner.

What defense mechanism is classically associated with PPD?

Projection.

A patient feels hostile toward a coworker but believes the coworker is hostile toward them. What defense mechanism?

Projection.

Is projection required for the DSM diagnosis of PPD?

No; it is a psychodynamic explanation, not a required DSM criterion.

Why may a patient with PPD be baffled about being referred for psychiatric treatment?

Poor insight.

What physical/behavioral findings may be seen in PPD - clinical features?

Muscular tension, inability to relax, scanning the environment for clues, and a humorless manner.

What is speech generally like in PPD?

Goal-directed and logical.

What are ideas of reference?

Interpreting events in the environment as specifically relating to oneself, often negatively.

often trelaly serious or intense ppople.

A patient sees coworkers whispering and smiling and assumes they are making fun of them. What phenomenon?

Ideas of reference.

How many DSM-5 features are required for PPD?

At least 4.

What DSM-5 features characterize PPD?

Suspicion/persecutory thoughts, doubts about loyalty, inability to confide, interpreting experiences as threatening/hostile, holding grudges, feeling attacked, and distrust of a partner's faithfulness.

PPD vs delusional disorder: what is the key distinction?

by the absence of fixed delusions.

Are hallucinations or formal thought disorder typical of PPD?

No.

A patient thinks, "My coworker probably excluded me from lunch because they dislike me, so I should be careful." PPD or paranoid delusion?

PPD-type suspiciousness.

A patient is absolutely convinced a coworker has secretly poisoned their food for months despite strong contradictory evidence. PPD or paranoid delusion?

Paranoid delusion.

What is the treatment of choice for PPD?

Psychotherapy.

What therapeutic style is recommended for PPD?

Professional and straightforward. Be very direct, you don't have to be warm because they might think you're manipulating them.

Is there strong evidence for medication to treat PPD itself?

No; evidence for pharmacotherapy of the personality disorder alone is limited.

How can medications be used in PPD?

Treat specific symptoms as appropriate with agents such as antipsychotics, antidepressants, or mood stabilizers.

A patient has lifelong social withdrawal, is cold/aloof, and has little desire for relationships. Most likely diagnosis?

Schizoid personality disorder.

What is the core feature of schizoid personality disorder?

Lifelong social withdrawal with detachment from relationships.

How are patients with schizoid PD commonly described?

Quiet, distant, seclusive, unsociable, cold, and aloof.

can dress uniquely like dressing like the 80s.

Do patients with schizoid PD generally desire emotional closeness?

No; they have very little need or desire for emotional connection. They're perfectly content by themselves, which is a big distinction from other personalities.

What is the typical relationship pattern in schizoid PD?

Few or no relationships; intimacy is delayed or avoided.

What type of work may people with schizoid PD prefer or excel at?

Noncompetitive, solitary jobs.

How do patients with schizoid PD typically respond to praise or criticism?

They are indifferent.

What emotion may patients with schizoid PD have difficulty expressing?

Anger.

Are positive psychotic symptoms typical of schizoid PD?

No.

How does schizoid PD differ from schizophrenia or delusional disorder regarding psychosis?

Schizoid PD typically lacks positive psychotic symptoms.

A schizoid patient may appear lost in daydreams, but what is generally intact?

Ability to recognize reality.

How many DSM-5 features are required for schizoid personality disorder?

At least 4.

What DSM-5 features characterize schizoid personality disorder?

Doesn't enjoy relationships, prefers being alone, little interest in sex, little enjoyment of activities, few friends, indifference to others' opinions, and emotional constriction.

What is the preferred treatment for schizoid personality disorder?

Psychotherapy.

What is the role of pharmacotherapy in schizoid personality disorder?

Limited evidence; medications may be used for specific symptoms as needed.

A patient has eccentric behavior, magical thinking, strange beliefs, and unusual perceptions but generally intact reality testing. Most likely diagnosis?

Schizotypal personality disorder.

What is the core feature of schizotypal personality disorder?

Odd/strange mannerisms, beliefs, cognition, and perceptual experiences with interpersonal deficits.

What unusual cognitive/perceptual features may occur in schizotypal PD?

Magical thinking, peculiar notions, illusions, derealization, and perceived supernatural abilities.

What may communication be like in schizotypal PD?

Eccentric; speech may have meaning mainly to the patient and require interpretation.

What types of beliefs may occur in schizotypal PD?

Superstitious or odd beliefs, including beliefs in supernatural abilities.

What is the fantasy pattern in schizotypal PD?

Rich fantasy life with excessive daydreaming or unusual fears.

Is reality testing generally intact in schizotypal personality disorder?

Yes; the patient can generally recognize reality when challenged.

What interpersonal pattern occurs in schizotypal PD?

Poor interpersonal relationships with few close connections.

How may severe schizotypal PD affect functioning and self-care?

Occupational impairment and, in severe cases, poor hygiene/self-care.

Is schizotypal personality disorder part of the schizophrenia spectrum?

Yes.

What future psychiatric risk is increased in schizotypal PD?

Later psychotic disorders, including schizophrenia.

Can schizotypal PD include ideas of reference and unusual perceptions?

Yes.

What major psychotic feature is absent in schizotypal PD?

Persistent psychosis.

Can psychotic symptoms ever occur in schizotypal PD?

Yes; brief psychotic symptoms may occur during severe stress.

Schizotypal PD vs schizophrenia: which generally has less cognitive and functional impairment?

Schizotypal PD.

Compare the course of schizotypal PD vs schizophrenia.

Schizotypal PD = chronic, stable personality pattern; schizophrenia = persistent psychotic disorder with greater functional deterioration.

How many DSM-5 features are required for schizotypal personality disorder?

At least 5.