Personality Disorders and OCD

What are personality disorders?

- maladaptive traits or behaviors that deviate from the norm

- begin early in life but are NOT diagnosed before 18 y/o

What are the different categories of personality disorders?

- pervasive (multiple contexts)

- persistent (years --> lifetime)

Who do personality disorders affect?

- cause substantial functional impairment & disruption to others

- +/- personal distress

- egosyntonic

What does egosyntonic mean for personality disorders?

- traits themselves usually do NOT cause distress for the patient

- many patients have no insight (do not perceive anything to be wrong)

- makes treatment VERY difficult

What is the etiology of personality disorders?

NO IDEA

What are the DSM-5 diagnostic criteria for a personality disorder?

- A: 1+ pathological personality trait

-B: persistent & pervasive across situations

-C: pattern leads to distress and impairment

-D: not normative for developmental stage or socio-cultural environment

-E: not due to substances/medication

-F: leads to significantfunctional impairment

What is considered a mild personality disorder?

- notable problems, but some relationships and/or occupational roles are able to be maintained

- typically NOT associated with substantial harm to self or others

What is considered a moderate personality disorder?

- marked problems that are extensive enough to cause some degree of compromise to most relationships and/or occupational roles

- often have a past history and future expectation of harm to self or others but not to a degree that causes long-term damage or has endangered life

What is considered a severe personality disorder?

- severe problems affecting ALL areas of life & the ability and/or willingness to perform expected occupational/social roles is severely compromised or absent

- associated with both a past history & future expectation of severe harm to self or others that has caused long-term damage or has endangered life

How are personality disorders classified?

- MAD: cluster A

- BAD: cluster B

- SAD: cluster C

What are the "mad" disorders?

1. paranoid personality disorder

2. schizoid personality disorder

3. schizotypal personality disorder

What are "mad" disorders typically associated with?

psychotic disorders

What is paranoid disorder?

- pervasive distrust and suspicion of others indicated by at least 4 criteria

- suspect without evidence that others are exploiting, harming, or deceiving them

- preoccupied with unjustified doubts regarding loyalty or trustworthiness of friends/associates

- will not confide in others

- interpret benign remarks/events as threatening or demeaning

- perceives attacks on character & quick to counterattack

- hold grudges

What is schizoid disorder?

- a disinterest in social interactions and limited emotional expression indicated by at least 4 criteria

- emotionally cold/detached/reclusive, flattened affect

- neither wants nor likes close relationships

- very little interest in engaging in any sexual experiences

- no close friends other than immediate relatives

- seldom derives pleasure from any activities

- almost constantly picks introverted activities

- indifferent to both praise & criticism from others

What is schizotypal disorder?

- mental distortions and discomfort w/ close relationships indicated by at least 5 criteria

- ideas of reference (thinking everything is related to them)

- magical thinking (strange beliefs different from norms and influences behavior)

What episodes can someone with schizotypal disorder experience?

true psychotic episodes

What disorders can schizotypal be associated with?

- major depressive disorder

- likely to progress to full schizophrenia

What are cluster B disorders associated with?

mood, substance abuse, & somatization disorders

What are the "bad" disorders?

1. antisocial personality disorder

2. borderline personality disorder

3. histrionic personality disorder

4. narcissistic personality disorder

what is antisocial disorder?

- disregard for and violation of the rights of others

- lack of empathy or remorse for actions

- common in prisons

What are the criteria for antisocial disorder?

- must be over 18 y/o

- often begins in childhood as ODD or CD (must have met criteria for CD before age 15 & patterns continue after 15)

What is borderline disorder?

- unstable/labile interpersonal relationships, self-image, & affect/mood + marked impulsivity with 5 criteria

- markedly & persistently unstable self-image

- unstable or markedly reactive affect/mood

- chronic feelings of emptiness

- inappropriate, intense anger that is difficult to control

- unstable & intense interpersonal relationships

- frantic efforts to avoid real or imagined abandonment

What is borderline disorder associated with?

- recurrent self-harm

- suicide rates that peak in adulthood

- co-morbid MDD or BD

What is histrionic disorder?

- consistent attention-seeking behaviors and emotional dysregulation with 5 criteria

- Must be the center of attention

- Seductive/provocative behavior

- Uses appearance to draw attention (Flamboyant)

- Shifting & shallow emotions

- Dramatic or exaggerated expressions/reactions

- Impressive but vague & superficial speech (lacks detail)

- Easily influenced by others ("suggestible")

- Considers relationships more intimate than they are

What conditions are often associated with histrionic disorder?

somatization & substance abuse

What is narcissistic disorder?

- pretentious and constant need for admiration with 5 criteria

- Grandiose sense of self-importance

- Self-esteem is actually quite fragile

- Fantasies about unlimited success, power, brilliance, beauty, or ideal love

- Envy others or believe that others are envious of them

- Exploit others for their own gain

- Lack empathy & remorse

What are the "sad" disorders (aka anxiety)?

1. avoidant personality disorder

2. dependent personality disorder

3. obsessive-compulsive personality disorder

What is avoidant disorder?

- intense social anxiety/phobia

- great desire for companionship, but extremely shy

- require strong guarantee of unconditional acceptance

How does schizoid disorder compare to avoidant?

there is NO desire for companionship

What is dependent disorder?

- excessive need to be taken care of resulting in submissiveness and clinging behavior with 5 criteria

- rely on others for important aspects of life

- difficulty disagreeing with others (fear loss of support)

- fear they are unable to care for themselves

What is obsessive-compulsive personality disorder?

- preoccupation with order, perfectionism, and control of self and others with 4 criteria (NOT the same as OCD)

- Orderliness

- perfectionism

- Excessively devoted to work & productivity, resulting in neglect of leisure activities & friends

- Rigid, stubborn, emotionally constricted

- inflexible

- miserly or hoarding tendencies

How does OCD differ from obsessive-compulsive personality disorder?

- obsessive-compulsive is egosyntonic

- OCD is egodystonic

What is an egosyntonic disorder?

symptoms are not distressing to the pt BUT they still have a lot of insight and awareness of their disorder

Are most personality disorders egosyntonic or egodystonic?

egosyntonic

1 multiple choice option

How are personality disorders treated?

- no pharmacotherapy (can treat symptomatically)

- psychotherapy if the patient is willing

What is OCD?

obsessions (thoughts) and compulsions (behaviors/rituals) that are time-consuming and cause functional impairment

What checklist is used for OCD?

Yale Brown assessment checklist

What SSRI is often used for OCD?

clomipramine

What is a good supplement considered to add to the treatment of OCD?

N-acetylcysteine

What meds suggest beneficial treatment effects for trichotillomania?

N-acetylcysteine, clomipramine, & olanzapine