Personality Disorders
What is the relationship between a history of conduct disorder before age 15 and the diagnosis of antisocial personality after age 18? a. A history of some conduct disorder symptoms before age 15 is one of the required criteria for a diagnosis of antisocial personality disorder in adulthood. b. All children with conduct disorder will go on to receive a diagnosis of anti-social personality disorder in adulthood. c. Antisocial personality disorder diagnosis is independent of conduct disorder. d. Conduct disorder is the same as antisocial personality disorder, except that financial irresponsibility is also a required feature of antisocial personality disorder. E. Conduct disorder is the same as antisocial personality disorder except that remorse is present in conduct disorder.
A history of some conduct disorder symptoms before age 15 is one of the required criteria for a diagnosis of antisocial personality disorder in adulthood. Explanation: Criterion C for the diagnosis of antisocial personality disorder states, "there is evidence of conduct disorder with onset before age 15 years." Like antisocial personality disorder, conduct disorder involves a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. The specific behaviors characteristic of conduct disorder fall into one of four categories: aggression to people and animals, destruction of property, deceitfulness or theft, or serious violation of rules. The likelihood of developing antisocial personality disorder in adult life is increased if the individual experienced childhood onset of conduct disorder (before age 10 years) and accompanying attention-deficit/hyperactivity disorder.
Which of the following presentations is characteristic of schizotypal personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. c. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. d. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. Explanation: The essential feature of schizotypal personality disorder is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. This pattern begins by early adulthood and is present in a variety of contexts.
Which of the following presentations is characteristic of schizoid personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. c. A pattern of detachment from social relationships and a restricted range of emotional expression. d. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of detachment from social relationships and a restricted range of emotional expression. Explanation: The essential feature of schizoid personality disorder is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with schizoid personality disorder appear to lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not seem to derive much satisfaction from being part of a family or other social group.
Which of the following presentations is characteristic of antisocial personality disorder? a. A pattern of preoccupation with orderliness, perfectionism, and control. Apatternofdetachmentfromsocialrelationshipsandarestrictedrangeof emotional expression. Apatternofdistrustandsuspiciousnesssuchthatothers'motivesareinter- preted as malevolent. A pattern of disregard for, and violation of, the rights of others. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
A pattern of disregard for, and violation of, the rights of others. Explanation: The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder. Because deceit and manipulation are central features of antisocial personality disorder, it may be especially helpful to integrate information acquired from systematic clinical assessment with information collected from collateral sources. For this diagnosis to be given, the individual must be at least age 18 years (Criterion B) and must have had a history of some symptoms of conduct disorder before age 15 years.
Which of the following presentations is characteristic of paranoid personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent. c. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. d. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent. Explanation: The essential feature of paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation.
Which of the following presentations is characteristic of histrionic personality disorder? a. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. b. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. c. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. d. A pattern of grandiosity, need for admiration, and lack of empathy. e. A pattern of excessive emotionality and attention seeking.
A pattern of excessive emotionality and attention seeking. Explanation: The essential feature of histrionic personality disorder is pervasive and excessive emotionality and attention-seeking behavior. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with histrionic personality disorder are uncomfortable or feel unappreciated when they are not the center of attention (Criterion 1). Often lively and dramatic, they tend to draw attention to themselves and may initially charm new acquaintances by their enthusiasm, apparent openness, or flirtatiousness.
Which of the following presentations is characteristic of narcissistic personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. c. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. d. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of grandiosity, need for admiration, and lack of empathy. Explanation: The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts. Individuals with this disorder have a grandiose sense of self-importance.
Which of the following presentations is characteristic of borderline personality disorder? a. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. b. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. c. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. d. A pattern of grandiosity, need for admiration, and lack of empathy. e. A pattern of excessive emotionality and attention seeking.
A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Explanation: The diagnostic criteria for borderline personality disorder require the presence of a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts. Individuals with borderline personality disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior.
Which of the following presentations is characteristic of obsessive-compulsive personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. c. A pattern of preoccupation with orderliness, perfectionism, and control. d. A pattern of detachment from social relationships and a restricted range of emotional expression. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of preoccupation with orderliness, perfectionism, and control. Explanation: The essential feature of obsessive-compulsive personality disorder is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with obsessive-compulsive personality disorder attempt to maintain a sense of control through painstaking attention to rules, trivial details, procedures, lists, schedules, or form to the extent that the major point of the activity is lost.
Which of the following presentations is characteristic of avoidant personality disorder? a. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. b. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. c. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. d. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. e. A pattern of grandiosity, need for admiration, and lack of empathy.
A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Explanation: The essential feature of avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts. Individuals with avoidant personality disorder avoid work activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
Which of the following presentations is characteristic of dependent personality disorder? a. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. b. A pattern of submissive and clinging behavior related to an excessive need to be taken care of. c. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. d. A pattern of grandiosity, need for admiration, and lack of empathy. e. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
A pattern of submission and clinging behavior related to an excessive need to be taken care of. Explanation: The diagnostic criteria for dependent personality disorder require a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and presenting in a variety of contexts.
Which of the following behaviors or states would be highly unusual in an individual with schizoid personality disorder? A. An angry outburst at a colleague who criticizes his work. B. Turning down an invitation to a party. C. Lacking desire for sexual experiences. D. Drifting with regard to life goals. E. Difficulty working in a collaborative work environment.
An angry outburst at a colleague who criticizes his work. Explanation: One of the hallmarks of schizoid personality disorder is the reduced expression of emotion in interpersonal settings, often making them appear indifferent to criticism from others. It is also typical of individuals with schizoid personality disorder to choose solitary experiences and avoid social events. They may have difficulty in collaborative work environments because of their lack of social skills, but can thrive in jobs with considerable social isolation, like a nighttime warehouse security guard.
Which of the following is one of the general criteria for a personality disorder in DSM-5? a. An enduring pattern of inner experience that deviates markedly from the expectations of the individual's culture. b. The pattern is flexible and confined to a single personal or social situation. c. The pattern is fluctuating and of short duration. d. The pattern leads to occasional mild distress. e. The pattern's onset can be traced to a specific traumatic event in the individual's recent history.
An enduring pattern of inner experience that deviates markedly from the expectations of the individual's culture. Explanation: A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.
A 25-year-old man has a childhood history of repeated instances of torturing animals, setting fires, stealing, running away from home, and school truancy, beginning at the age of 9 years. As an adult he has a history of repeatedly lying to others; engaging in petty thefts, con games, and frequent fights (including episodes in which he used objects at hand—pipe wrenches, chairs, steak knives—to injure others); and using aliases to avoid paying child support. There is no history of manic, depressive, or psychotic symptoms. He is dressed in expensive clothing and displays an expensive wristwatch for which he demands admiration; he expresses feelings of specialness and entitlement; the belief that he deserves exemption from ordinary rules; feelings of anger that his special talents have not been adequately recognized by others; devaluation, contempt, and lack of empathy for others; and lack of remorse for his behavior. There is no sign of psychosis. What is the appropriate diagnosis? A. Antisocial personality disorder. B. Malignant narcissism. C. Narcissistic personality disorder. D. Antisocial personality disorder and narcissistic personality disorder. E. Other specified personality disorder (mixed personality features).
Antisocial personality disorder and narcissistic personality disorder. Explanation: This individual's history indicates 1) a pervasive pattern of disre- gard for and violation of the rights of others, 2) age over 18 years, 3) features of conduct disorder beginning before age 15 years, and 4) no evidence of bipolar disorder or schizophrenia. Therefore, he meets the criteria for a diagnosis of antisocial personality disorder. In addition, he can be described as demonstrating grandiosity, feelings of specialness, need for admiration, and lack or empathy for the needs and feelings of others, suggesting that he also meets the criteria for a diagnosis of narcissistic personality disorder. Other personality disorders may be confused with antisocial personality disorder because they have certain features in common. It is therefore important to distinguish among these disorders based on differences in their characteristic features. If an individual has personality features that meet criteria for one or more personality disorders in addition to antisocial personality disorder, all can be diagnosed. Individuals with antisocial personality disorder and narcissistic personality disorder share a tendency to be tough-minded, glib, superficial, exploitative, and lack empathy; however, narcissistic personality disorder does not include characteristics of impulsivity, aggression, and deceit. In addition, individuals with antisocial personality disorder may not be as needy of the admiration and envy of others, and persons with narcissistic personality disorder usually lack the history of conduct disorder in childhood or criminal behavior in adulthood. Malignant narcissism is not a DSM-5 diagnostic term. The diagnosis of "other specified personality disorder" applies to presentations in which symptoms characteristic of a personality disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the personality disorders diagnostic class.
A 36-year-old woman is approached by her new boss, who has noticed that despite working for her employer for many years, she has not advanced beyond an entry level position. The boss hears that she is a good employee who works long hours. The woman explains that she has not asked for a promotion because she knows she's not as good as other employees and doesn't think she deserves it. She explains her long hours by saying that she is not very smart and has to check over all her work, because she's afraid that people will laugh at her if she makes any mistakes. On reviewing her past evaluations, her boss notes that there are only minor critiques and her overall evaluations have been very positive. Which of the following personality disorders would best explain this woman's lack of job advancement? A. Narcissistic personality disorder. B. Avoidant personality disorder. C. Obsessive-compulsive personality disorder. D. Schizoid personality disorder. E. Borderline personality disorder.
Avoidant personality disorder. Explanation: Avoidant personality disorder is characterized by feelings of inadequacy, hypersensitivity to criticism, and a need for reassurance. As a result, a person with avoidant personality disorder tends to be reluctant to take risks or engage in challenging activities, which results in interpersonal and occupational impairment. People with narcissistic personality disorder or borderline personality disorder may also be highly sensitive to criticism, but a key feature of narcissistic disorder is grandiosity, and that of borderline personality disorder is an unstable self-image, rather than persistently low self-esteem. Long work hours and rechecking work can be seen with obsessive-compulsive personality disorder, but in that disorder the cause is a perfectionistic or rigid style of approach, not fear of criticism or humiliation. People with schizoid personality disorder are generally relatively indifferent to criticism from others.
Individuals with obsessive-compulsive personality disorder are primarily motivated by a need for which of the following? A. Efficiency. B. Admiration. C. Control. D. Intimacy. E. Autonomy.
Control. Explanation: Individuals with obsessive-compulsive personality disorder attempt to maintain a sense of control through a rigid preoccupation with order and detail. Unlike individuals with narcissistic personality disorder, their desire for perfection comes from this need for control rather than a need for admiration. The individual's rigidity and perfectionism can cause a debilitating degree of inefficiency. Individuals with this disorder may have difficulty expressing affection or tolerating expressions of affection from others and tend to avoid intimacy, but they do have the capacity for intimacy. They are sensitive to hierarchies and can be rigidly deferential to the authority figures they respect.
Which of the following findings would rule out the diagnosis of obsessive-compulsive personality disorder (OCPD)? a. A concurrent diagnosis of obsessive-compulsive disorder. b. A concurrent diagnosis of antisocial personality disorder. c. Evidence of psychotic symptoms. d. Evidence that the behavioral patterns reflect culturally sanctioned interpersonal styles. e. A concurrent diagnosis of cocaine use disorder.
Evidence that the behavioral patterns reflect culturally sanctioned interpersonal styles. Explanation: OCPD must be distinguished from behavior that remains within a normal range; for example, if an individual's OCPD-like behaviors are culturally sanctioned (e.g., they occur within the context of a culture that places substantial emphasis on work and productivity), then a personality disorder diagnosis would not be appropriate. OCPD can coexist with a number of other disorders. For example, OCPD can be comorbid with obsessive-compulsive disorder (OCD), and an OCD diagnosis carries an elevated risk for OCPD, even though the majority of those with OCD do not have OCPD. Substance use disorders can be comorbid with OCPD, and there may be an association between OCPD and depressive disorders, bipolar and related disorders, and eating disorders. Psychotic disorders may also coexist with OCPD.
Which of the following statements about the development, course, and prognosis of borderline personality disorder (BPD) is true? a. The risk of suicide in individuals with BPD increases with age. b. A childhood history of neglect, rather than abuse, is unusual in individuals with BPD. c. Follow-up studies of individuals with BPD identified in outpatient clinics have shown that 10 years later, as many as half of these individuals no longer meet full criteria for the disorder. d. Individuals with BPD have relatively low rates of improvement in social or occupational functioning. e. There is little variability in the course of BPD.
Follow-up studies of individuals with BPD identified in outpatient clinics have shown that 10 years later, as many as half of these individuals no longer meet full criteria for the disorder. Explanation: The prognosis for symptomatic improvement in BPD is better than many clinicians realize, and there is considerable variability in the disorder's course. Individuals with BPD are at increased risk of suicide, but the risk is greatest during early adulthood and decreases with age. Also, a majority of individuals with BPD attain greater stability in their relationships and voca- tional functioning in their 30s and 40s. Individuals with BPD do have an increased incidence of childhood neglect as well as an increased incidence of childhood physical and sexual abuse.
While collaborating on a presentation to their customers, the members of a sales team become increasingly frustrated with their team leader. The leader insists that the members of the team adhere to his strict rules for developing the project. This involves approaching the task in sequential manner such that no new task can be begun until the prior one is perfected. When other members suggest alternative approaches, the leader becomes frustrated and insists that the team stick to his approach. Although the results are inarguably of high quality, the team is convinced that they will not finish in time for the scheduled presentation. When voicing these concerns to the leader, he suggests that the real problem is that the other members of the team simply don't share his high standards. Which of the following disorders would best explain the behavior of this team leader? A. Narcissistic personality disorder. B. Obsessive-compulsivedisorder(OCD). C. Avoidant personality disorder. D. Obsessive-compulsive personality disorder (OCPD). E. Unspecified personality disorder.
Obsessive-compulsive personality disorder (OCPD). Explanation: OCPD describes a series of enduring, maladaptive traits and behaviors characterized by excessive perfectionism, preoccupation with orderliness and detail, and need for control over one's emotions and environment. Although this borders on what might be considered a commendable work ethic, the frustration this leader causes among his team and the possibility that the project may not be completed in time raise the likelihood of a disorder. The differential diagnosis involves a number of other personality disorders, including narcissistic personality disorder and avoidant personality disorder. Whereas individuals with narcissistic personality disorder may profess a de- sire to strive for perfection, this is in the service of self-aggrandizement. Individuals with avoidant personality disorder may also wish for perfection, but they are highly self-critical. Neither of these disorders is characterized by the rigidity typical of OCPD. Despite the similarity in names, OCD is usually easily distinguished from OCPD by the presence of true obsessions and compulsions in OCD. When criteria for both OCPD and OCD are met, both diagnoses should be recorded.
Which of the following is not a characteristic of narcissistic personality disorder (NPD)? a. Excessive reference to others for self-definition and self-esteem regulation. b. Impaired ability to recognize or identify with the feelings and needs of others. c. Excessive attempts to attract and be the focus of the attention of others. d. Persistence at tasks long after the behavior has ceased to be functional or effective. e. Preoccupation with fantasies of unlimited success or power.
Persistence at tasks long after the behavior has ceased to be functional or effective. Explanation: Although individuals with NPD and those with obsessive-compulsive personality disorder (OCPD) may both profess a commitment to perfection, persistence at tasks long after the behavior has ceased to be functional is more characteristic of the perfectionism of individuals with OCPD rather than that of individuals with NPD. In contrast to the self-criticism of individuals with OCPD, individuals with NPD are more likely to believe that they have reached perfection. The other options are all characteristic traits of individuals with NPD.
Which of the following DSM-IV personality disorder diagnoses is no longer present in DSM-5? A. Antisocial personality disorder. B. Avoidant personality disorder. C. Borderline personality disorder. D. Personality disorder not otherwise specified (NOS). E. Schizotypal personality disorder.
Personality disorder not otherwise specified (NOS). Explanation: Although the DSM-5 task force considered the possible elimination of several DSM-IV personality disorder diagnoses (including paranoid, schizoid, and histrionic personality disorders) based on their low prevalence and weak evidence for validity, the decision was made to keep all 10 DSM-IV personality disorders for DSM-5, with the exact same criteria. The NOS category has been removed, and instead two diagnoses have been introduced: other specified personality disorder and unspecified personality disorder.
A 43-year-old warehouse security guard comes to your office complaining of vague feelings of depression for the last few months. He denies any particular sense of fear or anxiety. As he gets older, he wonders if he should try harder to form relationships with other people. He feels little desire for this but notes that his coworkers seem happier than he, and they have many relationships. He has never felt comfortable with other people, not even with his own family. He has lived alone since early adulthood and has been self-sufficient. He almost always works night shifts to avoid interactions with others. He tries to remain low-key and undistinguished to discourage others from striking up conversations with him, as he does not understand what they want when they talk to him. Which personality disorder would best fit with this presentation? A. Paranoid. B. Schizoid. C. Schizotypal. D. Avoidant. E. Dependent.
Schizoid. Explanation: His avoidance of others is not based on fears of being exploited, deceived, or harmed, as in paranoid personality disorder, nor is it based on a fear of being found inadequate, as might be seen in avoidant personality disorder. There is no mention of odd or eccentric behavior, and he even makes a deliberate effort not to appear unusual in any way. Individuals with dependent personality disorder often feel uncomfortable or helpless when alone, and constantly seek out nurturance and support from others.
A cardiologist requests a psychiatric consultation for her patient, a 46-year-old man, because even though he is adherent to treatment, she is concerned that he "seems crazy." On evaluation, the patient makes poor eye contact, tends to ramble, and makes unusual word choices. He is modestly disheveled and wears clothes with mismatched colors. He expresses odd beliefs about super- natural phenomena, but these beliefs do not seem to be of delusional intensity. Collateral information from his sister elicits the observation that "He's always been like this—weird. He keeps to himself, and likes it that way." Which of the following conditions best explains this man's odd behaviors and beliefs? A. Schizoid personality disorder. B. Schizotypal personality disorder. C. Paranoid personality disorder. D. Delusional disorder. E. Schizophrenia.
Schizotypal personality disorder. Explanation: Schizotypal personality disorder is characterized by pervasive social and interpersonal deficits, which include odd behaviors, odd beliefs and speech, and social withdrawal. The odd beliefs may include ideas of reference or even paranoid ideation, but true delusions and hallucinations are not present. Individuals with schizoid personality disorder or paranoid personality disorder may also be loners, and either of these disorders may coexist with schizotypal personality disorder. However, neither of those disorders is characterized by marked oddness or eccentricity.
Which of the following cognitive or perceptual disturbances are associated with borderline personality disorder? A. Odd thinking and speech. B. Ideas of reference. C. Odd beliefs. D. Transient, stress-related paranoid ideation. E. Superstitiousness.
Transient, stress-related paranoid ideation. Explanation: In borderline personality disorder, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur during periods of extreme stress, but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. Odd thinking and speech, ideas of reference, odd beliefs, and superstitiousness are characteristic of schizotypal personality disorder rather than borderline personality disorder.
