Physician Assistant Exam: Personality Disorders

The Physician Assistant Exam (PANCE) will expect you to be familiar with personality disorders. One of the marks of a personality disorder is behaviors or thought processes that are very different from societal norms. The person isn’t making it in life. In addition, the person doesn’t see the behaviors as inappropriate.

How to diagnose and treat personality disorders

When evaluating someone for a personality disorder, you’re looking for patterns of behavior. In many cases, the affected person has demonstrated a certain pattern of behavior over a long period of time, but it may have gone unrecognized. If someone has a personality disorder in childhood, the odds are pretty good that it will continue into his or her adult life.

Diagnosis of a personality disorder is subjective, and it consists of observing and discovering “patterns of disorder.” A personality disorder can be thought of as a type of psychosis, as the person can deviate from societal norm. Here are some areas to pay attention to in your evaluation:

  • An inability to fully function in society

  • Rigid and dysfunctional patterns of feeling and thinking

  • Rigid and inflexible patterns of behavior

  • Lack of emotional response or abnormal emotional response

The gold standard of treatment for personality disorders is behavioral and/or cognitive therapy. Counseling is vital. This can manifest as individualized counseling sessions or even group sessions involving a family member or significant other. Medications are utilized only when needed; the mainstay of treatment is intense counseling or psychotherapy.

Common personality disorders

Personality disorders come in several forms. The DSM lists 10 disorders in three groups in Axis II, and the list tends to evolve over time. Personality disorders are behaviors that differ prominently from social expectations. Mildness or severity is subjective, depending on the degree of impairment.

Borderline personality disorder

Borderline personality disorder is a common example of a personality disorder. The person may have significant issues with low self-esteem and can experience the extremes of moods. He or she can either really like or really hate someone. The affected person can also have a tendency toward self-mutilation. The patient has a tendency to exhibit impulsive, high-risk activities such as alcohol/drug abuse, unsafe sex practices, gambling, or other reckless behaviors.

Borderline personality disorder is commonly diagnosed in young people, females more often than males. Identification of this condition and intense psychotherapy are so important in the treatment of this personality disorder.

Antisocial personality disorder

Antisocial personality disorder refers to a pattern of behavior in which the affected person doesn’t care about others or about laws and/or societal norms. This person tends to engage in criminal acts, for example, and not feel remorse for his or her actions. This type of behavior usually occurs for years.

Many people with antisocial personality disorder have a history of conduct disorder that began when they were children or in their teenage years. Conduct disorder can include behaviors such as bullying, picking fights, and showing cruelty to animals. Again, the issue is recognizing a pattern of behavior.

Split personality

Dissociative identity disorder (DID) is a condition in which the person displays multiple distinct identities, or personalities. The condition isn’t prevalent in the general population but may be more prevalent in people diagnosed with another mental illness.

Dissociative identity disorder is not schizophrenia. Although a person with schizophrenia experiences confused thinking, delusions, and/or hallucinations, he or she has only one identity. What complicates things is that dissociative identity disorder is often comorbid with other disorders.

Causes of dissociative identity disorder include a history of abuse, particularly both severe sexual and physical abuse in childhood. The affected person tries to disconnect from his or her environment by forming other personalities. The goal of therapy is to try to merge the various personalities into a singular identity. This can be difficult and requires intense psychotherapy.

Which of the following statements is true concerning personality disorders?

(A) The behaviors associated with personality disorders often occur acutely over a period of weeks to months.
(B) Symptoms of personality disorders include delusions and hallucinations.
(C) Self-harm is a component of borderline personality disorder
(D) Giving someone a wedgie could be a sign of a social phobia.
(E) The treatment of personality disorders involves the use of multiple medications.

The correct answer is Choice (C). Self-harm is one important criterion used in the diagnosis of borderline personality disorder. Regarding Choice (A), personality disorders involve patterns of behavior that have likely been occurring over a period of years, not acutely over weeks to months. Delusions and hallucinations, Choice (B), are seen more often with psychotic disorders, such as schizophrenia, than with personality disorders.

Concerning Choice (D), don’t confuse social phobia with antisocial personality disorder. Social phobia is a fear of social events and social situations. An example of a social phobia is a fear of speaking in public. Although the person with social phobia may exhibit avoidance behavior (avoiding high-profile public events), he or she doesn’t engage in criminal or abusive behavior, which is the hallmark of antisocial personality disorder.

As for Choice (E), the main treatment of personality disorders is psychotherapy. Medications can be adjunctive, but they’re not the primary means of therapy.

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