Personality Disorders NF
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Created by:
Sbdrmle Plus on May 4, 2012
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Dr. Fernandez-Sweeny 5.4.12
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16 terms
Terms | Definitions |
|---|---|
 When Studying Psychological Disorders: Focus on... | 1) Clinical description 2) Causation (etiology) 3) Treatment & Outcome 4) Dr. Sweeney will test by pt presentation and ask us what the disorder is (if there is one) |
| General Nature of Personality Disorders | 1) Enduring & Pervasive!!! 2) Enduring pattern and behavior & relatively stable predispositions that deviate from the individual's culture 3) Inflexible & maladaptive, causing distress and/or impairment, however, may be egosyntonic 4) Patterns in: cognition, affectivity, interpersonal rxning, & inpulse control 5) Inflexible & maladaptive, causing distress and/or impairment, however, may be egosyntonic (do not distress the individual that has the symptoms=still diagnosable) 6) Coded on Axis II of DSM-IV |
| Categorical vs Dimensional | 1) Categorical: current classification, specific # of characteristics to meet criteria 2) Dimensional view: Utilizing grouping of symptoms or core traits or temperaments, measured on a continuum (ie NEO-PI: 5 factor personality model=neuroticism, extraversion, opennes to experience, agreeable, conscientious) |
| Personality Disorders Prevalence & Etiology | 1) Affects about 0.5-2.5% of general population (10-30% of all individuals served in inpt settings, 2-10% in outpt settings) 2) Origins are thought to begin in childhood (high rate of neglect and childhood sexual, physical, or emotion abuse in those diagnosed with personality disorders) 3) Tend to run a chronic course if untreated 4) High comorbidity & overlap of personality disorders (axis I often complicates tx of personality disorder) 5) Genetics may a role in schizotypal, antisocial, & bipolar personality disorders 7) Possible gender bias in Dx: try to avoid stereotypes... antisocial (typically Dx in males) vs histrionic (typically Dx in females), & bipolar |
| Cluster Classification | 1) Cluster A: odd or eccentric 2) Cluster B: dramatic, emotional, erratic 3) Cluster C: fearful or anxious |
| Cluster A: Paranoid Personality Disorder | 1) Pervasive & unjustified distrust & suspicion of everyone (may include family), secretive & isolates, emotionally cold & odd, do not have psychotic symptoms (may become psychotic under stress), possible cause is early learning that ppl are dangerous & the world is a dangerous place 2) Treatment options: few will seek professional help on their own, may feel forced to attend counseling by others, tx focusing on dvpmt of trust, cognitive therapy to counter negativistic thinking, lack of good outcome studies, low-dose antipsychotics may decrease paranoia & anxiety |
| Cluster A: Schizoid Personality Disorder | 1) Pervasive pattern of detachment from social relationships (classic loner, disinterested in others), restricted emotion (particularly w/ expressing anger), indifferent to praise or criticism, little interest in sex, date infrequently, & often don't marry, may be associated with dysphoria 2) Tx options: few seek professional help, focus on value of interpersonal relationships, building empathy & social skills, no effective drugs 3) Comorbidity of Schizoid: schizotypal, paramoid, & avoidant personality disorders 4) Cultural impact: pts moving from rural to metropolitan environments, immigrants from other countries, there are some cultures where it is 'not okay' to be anxious or depressed so putting a title to it may upset pt |
| Cluster A: Schizotypal Personality Disorder | 1) Discomfort with social relationships, cognitive/perceptual distortions & eccentricities, behavior & dress is odd & unusual, socially isolated & highly suspicious, comorbidity with MDD (30-50%), may have short-lived psychotic episode due to stress (if stressor is removed, pt returns to baseline) 2) Unlike in Schizoid personality disorder these pts have peculiar patterns of thinking (magical thinking, ideas of references, & illusions) 3) Causes include a phenotype of a schizophrenia genotype (more than any other personality disorder), more generalized brain deficits 4) Treatment options: main focus is on developing social skills (specifically social anxiety & awkwardness), cognitive therpay to address cognitive distortions, address comorbid depression, medical treatment is similar to schizophrenia (low dose antipsychotic), prognosis is generally poor |
| Cluster B: Antisocial Personality Disorder | 1) Pts are dramatic emotional erratic 2) Failure to comply w/ social norms, violation of the rights of others, irresponsible, impulsive, & deceitful, lack of conscience, empathy, & remorse 3) This diagnosis is not given to individuals under the age of 18yrs old (very important cut-off, under 18=conduct disorder) pt must have a long history of symptoms (DSM criteria says pt must meet 3 or more criteria for the past 12 months, and at least 1 consistently for 6 months) 4) Relation w/ conduct disorder & early behavior problems: genetics (increased incidence in family members, antisocial father or alcoholic father), primary environmental factors (lack of consistent person to give emotional & loving support as a young child), families typically have histories of criminal & violent behavior 5) Co-morbidities include: substance abuse, other personality disorders, sexual dysfunction, paraphilias, mood disorders, anxiety disorders 6) Treatment options: few seek tx on their own (usually court mandated), antisocial behavior is predictive of poor prognosis, emphasis is placed on prevention & rehabilitation (impulse control & substance abuse counseling), often incarceration is the only viable alternative, symptoms peak around 25 and may remit by 40yrs old |
| Prevailing Neurobiological Theories on Antisocial Personality (Definitely not trauma) | 1) Underarousal hypothesis: cortical arousal is to low, thus pt is easily bored, & utilizes violent actions to increase cortical arousal 2) Cortical immaturity hypothesis: cerebral cortex is not fully dvlped 3) Fearless hypothesis: fail to respond to dangerous cues, higher threshold for perceiving fear 4) Gray's model of behavioral inhibition & activation, reward & punishment |
| Cluster B: Borderline Personality Disorder | 1) Mneumonic for symptoms is P.R.A.I.S.E. = P:paranoid ideas, R:relationship instability, A:angry outbursts, affective instability, & abandonment fears, I:impulsive behavior & identity disturbance, S:suicidal behavior, E:emptiness 2) Unstable affect, mood swings, unstable interpersonal relationships, marked impulsivity, fear of abandonment, very poor self-image w/ chronic feelings of emptiness or boredom, recurrent suicidal gestures (cutting behaviors as a means of relief of pain, completed suicide in up to 10% of pts<-IMPORTANT!!!!), comorbidity is high, if stressed may become psychotic 3) Primary defense mechanism is splitting 4) Causes include genetics (runs in families) & early trauma and abuse seems to play some etiology role, psychoanalytic view: disruption in early dvlpmt individuation=separation between care taker (typically mother) 5) Treatment options include: SSRIs may provide short term depression relief, mood stabilizers for diminishing anger, irritability, & self mutilation, 1st gen & atypical antipsychotics to decrease paranoid & other psychotic ideation, psychotherapy to dialectiacal behavioral therapy finish above from recording 6) Predictors of poor prognosis include antisocial behavior, chronic anger, & overuse of medical facilities 7) Good prognosis factors include high IQ, good social support structure, & increased self-discipline |
| Cluster B: Histrionic Personality Disorder | 1) Overly dramatic, sensational, & sexually provocative, often impulsive & need to be the center of attention, thinking & emotions are perceived as shallow, common diagnosis in females 2) Causes unknown but there is an association between histrionic & antisocial (some ppl think that is't 3) Tx options: focus on attention seeking & long-term negative consequences ( finish tx |
| Cluster B: Narcissistic Personality Disorder | 1) Exaggerated & unreasonable sense of self-importance/entitlement, believe they are special, pre-occupied w/ fantasies of success, require admiration from others, lack sensitivity & empathy for other ppl, may react with rage to criticism, envious, & arrogant, aging when physical changes occur, prone to mid-life crisis & depression 2) Causes may be failure to learn empathy as a child (lack of clear parental appreciation of the child's accomplishment, conversely may be from excessive attention), sociological view is a product of the 'me' generation, 3) Tx options: tend not to seek treatment, must address depression, focus on grandiosity, lack of empathy, |
| Cluster C: Avoidant Personality Disorder | 1) Extreme sensitivity to the opinions & possible criticism from others, highly avoidant of most interpersonal relationships as a self-protective measure, shy away from work or social relationships b/c of fears of rejection due to core sense of inadequacy, unusually reluctant to take personal risks due to possible embarrassment, tend ot have few relationships 2) Causes include: numerous factors have been proposed, difficult temperament & early rejection, in famil |
| Cluster C: Dependent Personality Disorder | 1) Subordinates own needs for those of others, reliance on others to make major & minor life decisions, unreasonable fear of abandonment, clingy & submissive in interpersonal relationship (abusive relationships), typically paired with narcissist, associated features include self-doubt, excessive humility, poor independent fxning, mood disorders, & anxiety 2) Causes are still largely unclear linked to early disruptions in learning independence 3) Tx options: often experience fatigue, malaise, & vague anxiety (tx with SSRIs, TCAs, & anxiolytics)therapy typically progresses gradually, tx targets include skills that foster independence |
| Cluster C: Obsessive-Compulsive Personality Disorder | 1) Excessive & rigid fixation on doing things the 'right way', strive for sense of control, highly perfectionistic which may contribute to procrastination, orderly, & emotionally shallow, may be irritated by others who do not value order, may be obsessed with work & productivity, obsessions & compulsions are absent or rare (distinguishment from OCD) 2) Causes unknown 3) Tx options: |
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