Personality Disorders and Obsessive-Compulsive Disorders (finished editing)

What is personality?

Unique traits that influence how a person perceives the world, behaves, relates, and copes.

What is the key distinction between a healthy personality and a personality disorder?

Flexibility; healthy personalities adapt while disordered personalities are inflexible with rigid patterns of thinking, feeling, and behaving.

What is a personality disorder?

An inability to modify behaviors to fit situations, leading to maladaptive coping and distress; and interferes with occupational engagement and interpersonal relationships

t/f people with personality disorders often do not realize or accept that there is something wrong with them

true

What is the DSM 5 definition of a personality disorder?

- An enduring pattern of inner experience and behavior that deviates markedly from cultural expectations.

- pervasive and inflexible

- distress and impairment in functioning

- occurs in cycles

What is the onset of most personality disorders according to the DSM-5?

adolescence or early adulthood

t/f people with personality disorders are stable over time

true

What are the four common areas in all personality disorders according to DSM 5?

- Thinking

- Feeling

- Interpersonal relationships

- Impulse control

Significant and persistent difficulties need to occur in how many categories in the DSM-5 to be diagnosed with a personality disorder?

At least 2

How many specific personality disorders are classified in DSM 5?

10 specific personality disorders classified into 3 clusters.

Why won't most people with a personality disorder seek help?

They do not realize or accept the disorder or their behaviors

Cluster A personality disorders are known as:

Odd and eccentric

What key characteristics are associated with Cluster A Personality Disorder?

- social awkwardness

- discomfort in interpersonal relationships

- distrust in others

Cluster A personality disorders include:

- paranoid

- schizoid

- schiotypal

What is a key trait of Paranoid Personality Disorder?

- Pervasive distrust and suspiciousness of others

- Belief that others are out to get them

- Self-sufficient (survivalist)

- tendency for isolation

How is Paranoid PD different from schizophrenia?

no disconnect from reality due to rigid thought patterns and cognitive beliefs

What defines Schizoid Personality Disorder?

- social detachment

- restricted emotional expression

- extreme introversion

- socially isolated

- limited ability to perceive social cues (especially emotions)

What are the characteristics of Schizotypal Personality Disorder?

- Social detachment

- interpersonal deficits

- eccentric behaviors

- social anxiety

- ideas of reference and paranoia ideations

During an OT life-skills group, a client refuses to store their belongings in the shared cubby area, insisting that others might “tamper with my stuff” even though no such incident has occurred. The client scans the room frequently, keeps physical distance from peers, and insists on completing all activities alone because “depending on people is dangerous.”

Which personality disorder best matches this presentation?

Paranoid Personality Disorder

3 multiple choice options

A client in a community-based OT program consistently chooses solitary tasks and shows little emotional expression during sessions. They do not appear distressed by isolation and report that they simply “don’t see the point” of forming relationships. They miss subtle emotional cues during conversations and seem indifferent to praise, criticism, or social interaction. They are quiet and cooperative but remain detached throughout therapy.

Which personality disorder best fits the client’s behavior?

Schizoid Personality Disorder

3 multiple choice options

A client in OT expresses discomfort being around others because they sense “hidden meanings” in everyday conversations. They occasionally comment that certain patterns in the room “must be sending a message.” Their thinking is organized but marked by unconventional or eccentric interpretations of events. They show social anxiety rooted not in fear of rejection, but in unusual perceptual experiences that make interactions feel unpredictable. They display odd mannerisms, dress eccentrically, and struggle to form close relationships.

Which personality disorder is most consistent with this presentation?

Schizotypal Personality Disorder

3 multiple choice options

What traits are associated with Cluster B personality disorders?

Dramatic, emotional, erratic traits with impulse control problems.

Cluster B personality disorders include:

- antisocial

- borderline

- histrionic

- narcissistic

What is Antisocial Personality Disorder characterized by?

- Disregard for the rights of others

- manipulative behavior

- lack of empathy

- can read social cues and exploit others

What is antisocial pd considered in the pediatric population?

Conduct disorder

t/f People with antisocial pd are often seen in the justice system

true

What defines Borderline Personality Disorder?

- Instability in interpersonal relationships

- unstable self-image

- impulsivity

- binary pov & thinking

- tendency for self-harm or suicidal attempts (maladaptive coping)

- emotional regulation difficulties

- difficulty accepting flexible thought patterns

What are the traits of Histrionic Personality Disorder?

- Excessive emotionality and attention-seeking behavior

- emotional manipulation and easily influenced by others

What characterizes Narcissistic Personality Disorder?

- Grandiosity

- need for admiration and think they deserve it

- lack of empathy

- vain

- exaggerated sense of self-worth with underlying fragile self-esteem

t/f people with histrionic or narcissistic pd can not be functional at all

false

A client in a vocational OT group frequently takes advantage of peers by convincing them to complete his tasks, later denying he ever asked for help. He shows no remorse when confronted, stating, “If they fell for it, that’s their problem.” He reads social cues easily and uses them to persuade or intimidate others for personal gain. When another client becomes upset by his actions, he laughs and comments that people are “too sensitive.”

Which personality disorder best matches this presentation?

Antisocial Personality Disorder

3 multiple choice options

During an OT self-management session, a client alternates between praising the therapist as “the only person who actually cares” and later accusing them of “abandoning me” when a scheduling conflict occurs. They struggle with emotional swings, engage in impulsive decisions such as quitting tasks suddenly, and report a history of self-harm when overwhelmed. They see situations as “all good” or “all bad” and become distressed when asked to consider more flexible interpretations.

Which personality disorder is most indicated by this pattern of behavior?

Borderline Personality Disorder

3 multiple choice options

A client in a group social skills session frequently interrupts others with dramatic stories and gestures. Their emotions shift rapidly depending on who is giving them attention. When another client shares something personal, they respond by theatrically crying and redirecting the spotlight onto themselves. They are easily influenced by peers and rely heavily on emotional manipulation to maintain attention from the group.

Which personality disorder best fits this presentation?

Histrionic Personality Disorder

3 multiple choice options

A client in an OT leadership-training group speaks over others and insists they should be the team leader because they are “clearly the most capable person here.” They become irritated when not praised and claim that group members “don’t appreciate my talent.” They show little empathy when peers express challenges and often dismiss others’ accomplishments. Despite their confident demeanor, they react defensively to mild criticism, appearing unexpectedly fragile.

Which personality disorder is most consistent with this presentation?

Narcissistic Personality Disorder

3 multiple choice options

What traits are common in Cluster C personality disorders?

Anxious and fearful traits, often involving avoidance and a need for care.

Cluster C personality disorders are also known as:

anxious and fearful

Cluster C personality disorders include:

- avoidant

- dependent

- obsessive-compulsive

What is Avoidant Personality Disorder characterized by?

- Social inhibition

- feelings of inadequacy

- hypersensitivity to criticism

- fear of rejection

- vigilance

- low self-esteem and personal causation

- dependent on a minimal support group

What defines Dependent Personality Disorder?

- Excessive need to be taken care of

- submissive and clinging behaviors

- unable to deal with being alone

- can be easily manipulated or taken advantage of by others

What characterizes Obsessive-Compulsive Personality Disorder (OCPD)?

- Preoccupation with order, perfectionism, and control at the expense of flexibility

- rigid thinking

- limited decision-making

- self-critical that leads to distress

- interferes with personal relations, academic success, and occupational engagement

How is OCPD and OCD different?

OCD has insight and thoughts that are unwanted and distressing

During an OT social participation group, a client avoids contributing ideas, repeatedly saying they “don’t want to sound stupid.” They sit near the exit, monitor others’ reactions closely, and become visibly anxious when addressed directly. When another peer offers mild feedback, the client withdraws completely and later reports feeling “embarrassed and judged.” They rely on a very small circle of safe people and refuse to attempt new tasks for fear of failing or being criticized.

Which personality disorder best matches this presentation?

Avoidant Personality Disorder

3 multiple choice options

A client in an OT self-management program repeatedly asks the therapist to make decisions for them, such as what goals to set or which activities to practice at home. They express fear about attending sessions alone and insist on bringing a friend to every appointment. When the friend is unavailable one day, the client becomes distressed and states they “cannot function without someone there.” They agree too quickly with others’ opinions to avoid disapproval and frequently allow peers to take advantage of them.

Which personality disorder best fits this behavior pattern?

Dependent Personality Disorder

3 multiple choice options

A client in an OT time-management workshop spends most of the session perfecting the formatting of their planner instead of completing the assigned scheduling task. They insist there is only one “correct” way to perform each activity and become distressed when peers take simpler or more flexible approaches. They struggle to make decisions without excessive planning, often criticizing themselves harshly for minor errors. Their rigid need for order and control interferes with group participation and delays progress toward their personal goals.

Which personality disorder is most consistent with this presentation?

Obsessive-Compulsive Personality Disorder (OCPD)

3 multiple choice options

What is the etiology of personality disorders?

Genetic disposition, biological factors, and environmental influences.

How do personality disorders impact occupational performance?

They lead to cognitive distortions, emotional regulation issues, managing impulse control, and significant interpersonal problems.

Which clusters of personality disorders may have difficulty with conflicts in the workplace?

clusters a and b because of difficulty following the rules

3 multiple choice options

What are dysfunctional thinking patterns in personality disorders?

- black and white thinking (all or nothing thinking)

- idealizing and then devaluing others or self

- distrustful, suspicious thoughts

- unusual or odd beliefs

- perceptual distortion

black-and-white thinking (all-or-nothing thinking)

rigid and polarized thinking that do not offer room for shades of gray; no room for compromises, alternatives, or interpretations

During a coping-skills OT session, a client becomes upset after making a small mistake while assembling a craft project. They immediately tear the project apart and say:

“I messed up one piece—it’s ruined. I can’t do anything right. If it’s not perfect, it’s a total failure.”

Later in the same session, the therapist reschedules an appointment due to a meeting. The client reacts by saying:

“You’re either here for me all the time, or you don’t care about me at all.”

What type of dysfunctional thinking pattern is demonstrated?

black or white thinking

3 multiple choice options

idealizing and then devaluing others and self

seeing others or self as all good or all bad

A client starts OT with a new therapist and immediately becomes enthusiastic, saying:

“You’re the best therapist I’ve ever had. You understand me better than anyone. You’re perfect—finally someone who won’t let me down.”

During the next session, the therapist gently reminds the client to practice a coping strategy they agreed on but did not complete. The client’s demeanor shifts dramatically. They cross their arms and respond:

“You’re just like everyone else. You don’t actually care. Why should I listen to you? You don’t know what you’re doing.”

Later, when reflecting on the interaction, the client says:

“I’m such an idiot for trusting you. I ruin everything. I’m either amazing or I’m worthless—there’s nothing in between.”

What type of dysfunctional thinking pattern is demonstrated?

idealizing and then devaluing others and self

3 multiple choice options

distrustful, suspicious thoughts

The motivations of others are questioned, and others are seen as dishonest or harmful

During an OT session, the therapist offers the client positive feedback on their progress with daily routines. Instead of feeling encouraged, the client stiffens and looks away. They quietly mutter:

“She’s not complimenting me because I’m doing well… she’s only saying nice things so I’ll take her job. She’s trying to make me look competent so they’ll replace her.”

When the therapist later explains a new activity, the client frowns and adds:

“I know what she’s doing. She’s trying to set me up. Nobody is that friendly unless they want something.”

What type of dysfunctional thinking pattern is demonstrated?

distrustful and suspicious thoughts

3 multiple choice options

unusual or odd beliefs

often in the form of superstitions or worldviews that are extreme

During an OT social-skills group, the therapist asks participants to share a fun fact about themselves. One client sits up confidently and says:

“I have a special ability—I can predict where all my friends will go on their next summer vacation. I don’t need to ask them or anything. I can just sense it. The universe gives me signs.”

When another group member gently asks how they know, the client explains:

“It’s the patterns in the room. The way the lights flicker or how people move tells me everything. Most people don’t notice these messages, but I do.”

What type of dysfunctional thinking pattern is demonstrated?

unusual or odd beliefs

3 multiple choice options

perceptual distortion

fleeting distortions that the person can eventually recognize were not factual

perceptual distortion example

"i thought i heard my name but i guess i was wrong"

affectivity

problematic emotional response patterns to an extreme degree and with persistence

What are the characteristics of problematic emotional responses in personality disorders?

Extreme and persistent emotional responses, leading to chronic anger, irritability, or lack of empathy.

What are the two extremes of impulse control problems?

- Uninhibited (risky behaviors)

- Inhibited (risk avoidance, limited self-expression, problem-solving)

What are the options are medical management of personality disorders?

- psychotherapy

- medications

What is the goal of psychotherapy in treating personality disorders?

To improve functioning by addressing present-day struggles and developing a meaningful life.

What role do medications play in the treatment of personality disorders?

They are used as an adjunct to therapy to treat symptoms associated with personality disorders.

What kind of OT interventions can be done for people with personality disorders?

- CBT

- DBT

- Life skills training

- Medication management

In the CBT approach, what kind of skill would an OT intervention focus on for a client with a personality disorder?

Coping strategies

In the DBT approach, what kind of skills would an OT intervention focus on for a client with a personality disorder?

skills training involving mindfulness, social skills, and emotional regulation

What kind of personality disorder would benefit the most from life skills training interventions?

antisocial personality to reduce recidivism and promote community integration

What are the different kinds of Obsessive Disorders?

- OCD

- body dysmorphic disorder

- hoarding disorders

What are the defining features with obsessive disorders?

obsessions and compulsions

obsessions

persistent thoughts, urges, and/or images that are unwanted and intrusive

compulsions

repetitive behaviors or mental acts as a response of obsessive thoughts

What is the difference between obsessive-compulsive disorder (OCD) and OCPD?

OCD involves unwanted thoughts and compulsions, while OCPD involves rigid perfectionism and control.

How often do the obsessions and compulsions occur for a person with OCD?

more than 1 hr/day

What kind of obsessions and compulsions happen for people with OCD?

content that is specific to the individual and have common themes

What are the defining features of Body Dysmorphic Disorder (BDD)?

- Excessive concerns about perceived flaws in physical appearance

- behaviors are repetitive and can consume 3-8 hrs of the individual's day

- leading to social isolation

What characterizes Hoarding Disorder?

Persistent difficulty discarding items, leading to safety risks and diminished quality of life.

A client in an OT group reports spending 2–3 hours each day repeatedly checking locks and appliances even though they know they are already secured. They describe distressing, intrusive thoughts about something terrible happening if they don’t perform these rituals. The behaviors interfere with daily activities and social participation. The content of their thoughts and rituals is specific to their personal fears rather than general routines.

Which disorder is most consistent with this client’s presentation?

Obsessive-Compulsive Disorder

3 multiple choice options

A client spends 5–6 hours per day examining perceived flaws in their facial features, frequently checking mirrors and comparing themselves to images online. They report significant distress and have begun avoiding social interactions and group therapy because they feel “too ugly to be around others.” Their preoccupation with appearance dominates their daily routine and limits participation in meaningful activities.

Which disorder best matches this presentation?

Body Dysmorphic Disorder

3 multiple choice options

A client’s home is filled with stacks of newspapers, clothes, and household items, making movement through the space difficult and creating fire hazards. They report difficulty discarding items, even those that are broken or no longer useful, insisting they “might need them someday.” This accumulation negatively impacts safety, hygiene, and overall quality of life, and the client becomes distressed when others suggest getting rid of possessions.

Which disorder is most consistent with this presentation?

Hoarding Disorder

3 multiple choice options