Master the board step 3

Master the Boards: USMLE Step 3
Personality Disorders (PD)
When the case describes
self-aggression or selfmutilation,
the diagnosis
is often passive-aggressive
personality disorder
(example of acting out).
Personality disorders are pervasive, inflexible, and maladaptive thoughts or
behaviors. More males have antisocial and narcissistic PDs; more females have
borderline and histrionic PDs.
Treatment
··
Psychotherapy
··
Use of mood stabilizers and antidepressants is sometimes useful for Cluster
B PDs.
FEATURES
EXAMPLES
Cluster A: Peculiar thought processes, inappropriate affect
Paranoid PD:
• Distrust and suspiciousness
- Individuals are mistrustful and suspicious of the motivations and
actions of others and are often secretive and isolated.
- They are emotionally cold and odd.
- They often take legal action against other people.
• Often confused with paranoid schizophrenia.
• Main defense mechanism is projection.
Schizoid PD:
• Detachment and restricted emotionality
- Individuals are emotionally distant and fear intimacy
with others.
- They are absorbed in their own thoughts and feelings
and disinterested.
• Main defense mechanism is projection
Schizotypal PD:
• Discomfort with social relationships, thought distortion,
eccentricity
- Like schizoid PD except they also have magical thinking,
clairvoyance, ideas of reference, or paranoid ideation.
• Symptoms aren’t severe enough for classification of
schizophrenia
A 62-year-old man lives in an apartment and
constantly accuses his neighbors of stealing
his mail and prying into his apartment.
He believes that all his neighbors are
conspiring to have him removed from the
building.
A 68-year-old man lives in the country-side
manning a lighthouse near a remote village.
He is seen in town 2–3 times a year to
purchase supplies. He has no known friends
or family.
A 28-year-old man lives in a small coastal
town attempting to start his own internet
herbal business. He believes that the herbs
have magical powers and he sells their
magical properties of healing for a living.
He believes that spirits are guiding him to
wealth.
Cluster B: Mood lability, dissociative symptoms, preoccupation with rejection
• Histrionic PD:
- Colorful, exaggerated behavior and excitable, shallow
expression of emotions
- Use of physical appearance to draw attention to self
- Sexually seductive
- Discomfort in situations where not the center of attention.
A 30-year-old woman presents to the doctor’s
office dressed in a sexually seductive
manner and insists that the doctor
comment on her appearance. When the
doctor refuses to do so, she becomes upset.
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