Personality Disorders Lecture Notes PDF

Personality Disorders HOLLY WARREN, MPAS, PA-C FALL 2024 1 Lecture Objectives  Students will learn the epidemiology, etiology, risk factors, and pathophysiology for Personality Disorders  Students will assess clinical presentation, physical exam findings, a...

Personality Disorders HOLLY WARREN, MPAS, PA-C FALL 2024 1 Lecture Objectives  Students will learn the epidemiology, etiology, risk factors, and pathophysiology for Personality Disorders  Students will assess clinical presentation, physical exam findings, and diagnostic data for Personality Disorders  Student will demonstrate a knowledge of differential diagnosis, treatment strategies, preventative strategies, and management for patients with Personality Disorders 2 NCCPA Blueprint Content  Antisocial PD  Narcissistic PD  Avoidant PD  Obsessive Compulsive PD  Borderline PD  Paranoid PD  Dependent PD  Schizoid PD  Histrionic PD  Schizotypal PD 3 Table of Contents 1. Personality Disorder Background 2. Personality Disorders 1. Cluster A- Paranoid, Schizoid, Schizotypal 2. Cluster B- Antisocial, Borderline, Histrionic, Narcissistic 3. Cluster C- Avoidant, Dependent, Obsessive Compulsive 3. Personality Disorders Diagnosis & Management 4 What is a Personality Disorder?  Deeply ingrained pattern of behavior since adolescence that deviates from social norms  Extremes of personality  Common elements:  Poor relationships with others  They do not recognize the problems themselves 5 Background  Epidemiology:  10-20% of the general population qualifies for a PD  50% of Psychiatric patients do as well  Some are more frequent in men (Ex: Antisocial PD) and some are more frequent in women (Ex: Borderline PD)  Risk Factors  Childhood neglect and abuse  Genetic factors- found genetic links for Antisocial and Borderline PD 6 Pathophysiology  Combination of biological, temperamental, and social etiologies  Classic psychoanalytic theory suggests that PD occur when a person fails to adapt and develop appropriately  Ex: Feeding, toilet training, early trust vs. mistrust cues, attachment with mother, aberrant parenting patterns, early relationship building 7  Classification  10 PD’s grouped into 3 clusters  Cluster A- generally odd or eccentric  Schizoid, Schizotypal, Paranoid  Cluster B- dramatic acting out behaviors  Antisocial, Borderline, Histrionic, Narcissistic  Cluster C- prominent anxiety or avoidance of novelty  Avoidant, Dependent, Obsessive-Compulsive - A= Weird, B= Wild, and C= Worried - It is helpful to have clusters and names for disorders when talking with colleagues, but some Psychiatrists find this to be an inappropriate artificial construct 8  Cluster A- Paranoid PD  Presence of general distrust or suspiciousness  Individuals feel they have been treated unfairly  Like to be autonomous  React in a hostile manner to others who they feel like seek to control them  Holds grudges  Blame their problems on others consistently  Unsuccessful in intimate relationships  When interviewed, patient is formal and skeptical I imagine someone who always thinks the government is infringing on their daily life. Cartoons on right side of slides from unknown source, but they are great! 9 Cluster A- Schizoid PD  Profound defect in the ability to develop personal relationships and to respond to others in a meaningful way  Preference of solitary pursuits  Social detachment  Restricted emotional expressivity  Differentials:  Avoidant PD- wishes had relationships with others, but restrained due to fear  Schizotypal PD- does not have a flat affect 10 Cluster A- Schizotypal PD  Peculiar behavior  Odd thoughts and speech  Unusual perceptive experiences  Magical beliefs  Differentials:  Schizoid PD- have a flat affect 11 Practice question  Which celebrity most likely has a Cluster A Personality Disorder?  A. Steve Jobs  B. Kanye West  C. Lady Gaga  D. Beyonce 12 Cluster B- Antisocial PD  Recurrent antisocial, delinquent, and criminal behavior that begins in early childhood (Conduct Disorder in ages < 18 yo)  Disregard for the rights and feelings of others  Negative job performance  Marital Instability  Use of illegal substances are common  Easily bored  Impulsive  Seek novelty in their lives 13 Cluster B- Borderline PD  Unstable, but intense interpersonal relationships  High emotional lability  Inappropriate or intense anger  Recurrent suicidal threats and gestures  10% completed suicide rate  Persistent identity disturbance  Heavily dependent on external validation  Chronic feelings of emptiness  Exaggerated attempt to avoid abandonment 14 Cluster B- Histrionic PD  Deliberate use of emotions or sexuality to draw attention  Feel best when they are the center of attention  Labile emotions to provoke a reaction from others  Highly concerned with interpersonal relationships, but they are repeatedly unsuccessful 15 Cluster B- Narcissistic PD  Grandiosity  Lack of empathy  Hypersensitive to evaluation by others  Manipulate those around them  Exaggerated sense of entitlement  Self centered  Think most problems relate to people not appreciating them  Vulnerable to self withdrawal and depression following injury to their self image  Dislike growing old, so become more depressed with later age 16 Practice question  Which celebrity most likely has a Cluster B Personality Disorder?  A. Steve Jobs  B. Kanye West  C. Lady Gaga  D. Beyonce 17 Cluster C- Avoidant PD  Anxiety-> avoidance of social interactions  Low self esteem  Hypersensitive to rejection  Anxiety and discomfort when discussing their problems  Avoidance of new social situations  Submissive role in relationships  Wishes had relationships, but restrains self out of fear  Differential diagnosis:  Schizoid PD- indifferent to others  Social Anxiety Disorder- essentially the same condition, but Avoidant PD is consistent throughout life rather than a possibly transient condition 18 Cluster C- Dependent PD  Lifelong interpersonal submissiveness  Poor self-esteem  Feelings of inadequacy  Greatly fear abandonment  Careful to not displease anyone 19 Cluster C- Obsessive Compulsive PD  Restriction of emotions  Strict on things being tidy or done right  Perfectionism  Do not like to compromise, so have poor relationships  Not interested in heavily emotional relationships  Solemn, intellectual type 20 Practice question  Which celebrity most likely has a Cluster C Personality Disorder?  A. Steve Jobs  B. Kanye West  C. Lady Gaga  D. Beyonce 21 Diagnosis  Diagnosis  Clinical per DSM-5 Criteria  Each Personality Disorder with individual criteria  Highlights of the DSM-5 Criteria include:  Consistently abnormal behavior (per the context of the culture)  Consistently inflexible in changing behavior  Behavior leads to clinical distress  Behavior can be traced back to adolescence  Not due to another mental disorder, drugs, or medical condition 22 Diagnosis  Diagnostic Tools:  Million Clinical Multiaxial Inventory (MCMI)  Self-administered  344 true/false questions  Minnesota Multiphasic Personality Inventory (MMPI)  Specifically developed as a diagnostic aid  More research behind it, so used more often  576 true/false questions 23 “ As a group, the personality disorders are one of the most difficult and complicated emotional disorders to diagnose and to treat. Diagnosis is difficult in part because the disorders are often difficult to differentiate from each other, ” due to overlapping symptoms, and because the boundary between normality and psychopathology for each diagnosis is not distinct. Treatment of personality disorders is also difficult. Almost by definition, they are well-established behaviors and/or ways of thinking that are not perceived by the afflicted individual as abnormal or aberrant. Current Diagnosis and Treatment: Psychiatry, 3rd Edition 24 Differential Diagnosis  All of the other PD’s, because co-occurrence is common  Mood Disorder  Anxiety Disorder  Substance Abuse 25  Management  Counseling, counseling, counseling!!!  Cognitive Behavioral Therapy (CBT):  Modify thought patterns in order to change mood and behavior  Dialectical Behavioral Therapy (DBT):  Like CBT, but with extra emphasis on 4 key areas  Mindfulness  Distress Tolerance  Emotion regulation  Interpersonal effectiveness  Family counseling- counseling with the entire family and/or group present DBT was originally designed to treat Borderline PD, but is helpful for other PD’s as well. 26 Management Cont.  Medications can be used for:  The acutely psychotic patient with a Cluster A PD- Antipsychotics  A depressed patient with a Cluster B PD- SSRI  A highly emotionally labile patient with Borderline PD- Lithium  An anxious patient with a Cluster C PD- SSRI 27 Activity time!  Purpose: Improve memorization of traits unique to different PDs  Steps:  I have assigned different groups different clusters of PDs  Work in your table group to come up with a fictional character for each personality disorder in your assigned cluster (Ex: Mickey Mouse)  Time limit: 7-8 minutes to come up with characters for ALL personality disorders, then 2-3 minutes to share what you came up with 28 Works Cited  American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5 (5th ed., Vol. 1).  Ebert, M., Leckman, J., & Petrakis, I. (2019). Current: Diagnosis & Treatment, Psychiatry (3rd ed., Vol. 1). McGraw Hill.  Williams, D. A. (2019). Pance Prep Pearls (3rd ed.). Kindle Direct Publishing Platform. 29 The end! 30