Behavioral Med Personality Disorders

personality

an individual's set of stable, predictable emotional and behavioral traits

personality traits

how an individual thinks, feels, acts, and perceives surroundings

personality disorder

condition in which personality traits are inflexible, rigidly pervasive, and maladaptive that can interfere with daily functioning

ego-syntonic

personality disorders first appear in

adolescence or early adulthood

personality disorder comorbidities

may have more than one personality disorder

predispose for other psychiatric conditions

personality disorder prognosis

high rates of disability

worsens prognosis and relapse rate of other mental disorders

Millon Clinical Multiaxial Inventory (MCM)

assesses personality traits

self-administered

22 overlapping scales

personality style, significant patterns, associated disorders

Minnesota Multiphasic Personality Inventory (MMPI)

developed to aid in diagnosis of mental disorders

administered by a professional

9 scales

9 scales of MMPI

hyperchondriasis, depression, hysteria, psychopathic deviance, masculinity/femininity, paranoia, anxiety, schizophrenia, and mania

There is potential ___ with MMPI and other tests

bias

personality disorder DSM-5 criteria

-an enduring pattern of behavior that deviates significantly from the individuals cultural standard

-rigidly pervasive

-onset adolescence/early adulthood

-stable through time

-leads to unhappiness and impairment

-representative of long-term functioning

-manifests in at least 2 of: cognition, affectivity, interpersonal function, impulse control

stress tends to

exacerbate symptoms of personality disorder

can revert back to baseline after stressor abates

personality disorder treatment

difficult to treat

psychotherapy (mainstay)- group or individual

pharmacotherapy used to treat other psychiatric comorbidities

personality disorder cluster A

"mad and weird"

odd thinking and eccentric behavior

examples of personality disorder cluster A

paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder

personality disorder cluster B

"bad and wild"

dramatic and erratic behavior

examples of personality disorder cluster B

antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder

personality disorder cluster C

"sad and worried"

severe anxiety and fear

examples of personality disorder cluster C

avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder

Cluster A causes

may be genetic, environmental

linked to schizophrenia, esp schizotypal

Cluster A treatment

psychotherapy

focused on supporting individual-challenging beliefs can elicit negative responses

paranoid PD is common among

psych inpatients

women > men

paranoid PD risk factors

Fhx of schizophrenia and delusional disorders

parents exhibited irrational anger outbursts in childhood

paranoid PD features

generalized distrust or suspiciousness

feel mistreated and bears grudges

can be hostile if autonomy is threatened

poor or fixated eye contact

externalization of emotions and blame

paranoid PD diagnosis

clinical diagnosis based on features

paranoid PD differentials

other cluster A, narcissistic and borderline PDs, delusional disorder, schizophrenia

paranoid PD treatment

antipsychotics for decompensation

cognitive techniques to correct overgeneralizations, and splitting can be useful

paranoid PD group therapy

difficult due to suspicious nature

do not see family members w/o patient present

paranoid PD pride themselves on being

rational and objective

paranoid PD differentiated from schizophrenia and delusional disorder by

absence of positive symptoms

schizoid PD features

prefers to be alone

no/few intimate relationships

little interest in people

idiosyncratic interpretation of social transactions

restricted affect

intact reality testing

chooses hobbies/activities/jobs what are solitary

schizoid PD is rare in treatment settings due to

social withdrawal

schizoid PD is MC in

men

also more severe in men

schizoid PD risk factors

lack of emotional nurturing

famine

Fhx of schizophrenia

possibly related to autism

schizoid PD diagnosis

profound inability to develop personal relationships and to respond to others in a meaningful way

schizoid PD differentials

avoidant and schizotypal PDs, ASD

schizoid PD treatment

psychopharmacotherapy only for comorbid conditions

family therapy for clarifying expectations and correcting behaviors

group therapy for acquisition of social skills and directed feedback

individual therapy is difficult- cognitive approach can help explore distorted relationship views

schizotypal PD features

peculiar behavior, odd thoughts, odd speech, unusual perception, magical beliefs

social dysfunction, social anxiety, lack of motivation

occupational underachievement

high rates of depression/anxiety

schizotypal PD is MC in

men

schizotypal PD risk factors

fhx of schizophrenia

schizotypal PD is on the ___ spectrum

schizophrenia

schizoptypal PD diagnosis

clinical diagnosis - features of odd behavior and perception

social dysfunction

schizotypal PD differentials

other Cluster A, schizophrenia

schizotypal comorbidities

mood disorder, anxiety, SUD

schizotypal PD treatment

antipsychotics

group therapy for social skills training

individual therapy focused on directed, supportive approach. cognitive focus for distorted thinking

cluster B causes

linked to depressive and substance use disorders

may be genetic, environmental

cluster B treatments

antidepressants

psychotherapy

4 B's of cluster B PDs

"bad, borderline, flamBoyant, best"

psychopathy

not a formal diagnosis

do not experience any emotions or remorse for actions

blends in with society

desire to see others suffer

antisocial PD features

disregard for rights/feelings of others

poor job performance

unstable relationships

substance abuse

impulsivity, easily bored, seek novelty

exploitation of others

unable to avoid behaviors that lead to punishment

antisocial PD risk factors

fhx

family dysfunction

family w adult criminality

lack of affection/emotional support during childhood

alcoholic father

there is a correlation between ___ and later development of antisocial PD

conduct disorder

antisocial PD diagnosis

must be 18yo or older

recurrent criminal and delinquent behavior

pervades all aspects of life

disregard for others

often hx of similar childhood behaviors w onset before 15yo

antisocial PD differentials

other personality disorders, sexual dysfunction, mood or anxiety disorders

aggressive symptoms of antisocial PD improve w

age

antisocial PD prognosis

peak mid-30s-40s

high rates of alcoholism, depression

antisocial PD treatment

psychopharmacologic agents for symptoms

family psychotherapy for relationships

group therapy with other antisocial PDs for sense of beloning

individual therapy not as effective, CBT can increase effects

borderline PD features

inappropriate anger, mood lability

repeated suicidal gestures or self-injury

chronic boredom/emptiness

fear of abandonment

use of splitting defense mechanisms

unstable, intense relationships

poor reality testing

poor self-image that requires frequent validation

expectation of mistreatment

borderline PD risk factors

childhood abuse

fhx

borderline PD diagnosis

mood instability

unstable relationships

impulsivity

persistent feelings of emptiness

lack of identity/self-image

borderline PD treatment

mood stabilizers, SSRIs, antipsychotics

group/family therapy for interpersonal issues

dialectical behavioral therapy to recognize patterns of self-destruction

mentalization-based therapy to create alliance w the patient

histrionic PD cardinal feature

deliberate use of excessive, superficial emotionality and sexuality to draw attention, evade unpleasant responsibilities, and control others

histrionic PD is common in psych settings bc

patients actively seek treatment

histrionic PD risk factors

low self-esteem

fhx

histrionic PD diagnosis

increased sexuality and emotionality for gains

labile emotions

preoccupation w physical appearance

superficial relationships

histrionic PD prognosis

prognosis is good

symptoms improve over time regardless of tx

histrionic PD treatment

psychopharmacologic agents usually not effective

group therapy w similar patients to mirror behavior

narcissistic PD features

grandiosity

lack of empathy

lack of consideration of others

egotistical

exaggerated sense of entitlement

manipulative

hypersensitivity to evaluation

envy of others

injury to self-image

narcissistic PD MC in

men

narcissistic PD risk factors

lack of clear, appropriate parental appreciation of child's accomplishments- either over or under-reaction

narcissistic PD diagnosis

pervasive pattern of grandiosity

need for admiration

lack of empathy

narcissistic PD differentials

hypomania, antisocial PD, BPD

narcissistic PD treatment

psychopharmacotherapy for cormorbid conditions

group therapy w other narcissistic PD can help improve insight

couples therapy w role-reversal

individual therapy can be challenging

Cluster C causes

may be genetic, environmental

linked to anxiety disorders

cluster C treatment

antidepressants, psychotherapy

avoidant PD features

avoidance due to anxiety

introverted/limited social interactions

excessive concern with evaluation by others

avoidance of unfamiliar social situations

fear of rejection

passive, submissive

low self-esteem

avoidant PD is MC in

women

begins in early adulthood

avoidant PD risk factors

do not outgrow social akwardness

stagnated emotional growth

avoidant PD diagnosis

4 or more:

inhibition

feelings of inadequacy

avoid careers that require a lot of interpersonal communication

fear of being shamed/ridiculed in intimate relationships

preoccupation w social criticism/rejection

sees self as socially inept, unappealing or inferior

avoids personal risk or engaging in new activities

avoidant PD treatment

beta blockers (propanolol)

anxiolytics and antidepressants

assertiveness training

dependent PD features

reliance on others, clingy, submissive

fear of abandonment

attempt to appease others

poor self-esteem

inhibited expression of anger or displeasure

panic disorder and agoraphobia common

dependent PD risk factors

childhood dependent behaviors were rewarded

independent activities discouraged

older age

dependent PD diagnosis

submissiveness in relation to others

low self-esteem

feeling inadequate

dependent PD treatment

SSRIs or TCAs for fatigue/anxiety

group therapy to develop relationships and autonomy

family and individual therapy to achieve state of independence

obsessive-compulsive PD features

rigidity, inflexibility

affective constriction

obstinance

perfectionistic

difficulty submitting in relationships

refusal to work with others

describes own life in intellectual way

obsessive-compulsive PD risk factors

fhx of OCD

obsessive-compulsive PD diagnosis

4 or more:

preoccupation w orderliness

perfectionism

control

preoccupied w organization/rules

devoted to work/productivity

over conscientious, inflexible

unable to discard worthless objects

reluctant to delegate tasks

miserly spending

rigidity/stubborness

obsessive-compulsive PD treatment

SSRIs may help reduce perfectionism and treat anxiety/depression

psychotherapy- focus on inaccuracy of key assumptions

often do not see traits as maladaptive so difficult to treat