AssessmentsCluster A personality disorders
Cluster A personality disorders
USMLE® Step 1 style questions USMLE
A 30-year-old man is brought to the emergency department by the local paramedics after a motor vehicle accident. The patient is conscious and has minor lacerations over the right forearm. On further questioning, the patient says, “I was passing by a big sale on car tires, and then later on, I was involved in an accident caused by tire failure. That store was selling new tires, and therefore, other tires had to fail.” The patient believes he has a “sixth sense” which enables him to predict bad events before they happen. He lives alone at home and says, “I prefer it this way.” Past medical history is unremarkable. Vitals are within normal limits. Physical examination reveals a middle-aged man with multiple lacerations on the right forearm. On mental status examination, it is noted that the patient is wearing undergarments on the outside and multiple layers of mismatched clothing underneath. The patient has a flat affect and avoids eye contact. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
If you were asked to describe a friend’s personality, you might describe them as generally being a creative type, or easy-going but nervous in groups.
Basically, you’re trying to summarize the personal traits that make them who they are—either how they think or how they act.
Sometimes these thought patterns or behaviors which make up a person’s personality can actually be harmful in the sense that they interfere with their day-to-day functioning in their personal life, at work, or in social settings.
If this were the case, we would say that the individual has a personality disorder.
These used to be under the category “Axis 2” but that way of organizing isn’t used anymore.
Paranoid personality disorder describes someone who is accusatory or generally distrustful and suspiciousness of other people without really having a reason to do so, and assumes that others will disappoint them, manipulate them, or talk about them behind their back.
Because of this, they think excessively about making sure that they have the loyalty of their friends and family.
These beliefs are so strong that they wind up affecting the way individuals act.
These people react severely if they feel that they have been lied to, or slighted in any way, which can result in their holding grudges for long periods of time.
In many ways, this behavior can totally affect the individual’s work, family life and the way they relate to those around them, creating a cycle that leads to even more paranoid behaviors, and ultimately, to social withdrawal or awkward behaviors.
Unsurprisingly, these people tend to have superficial relationships, because it’s hard to have ‘real’ bonds when you do things such as accusing your partner of cheating without having proof.
Schizoid personality disorder describes people that are aloof and avoid social interaction because they simply aren’t interested in getting to know others and not because it causes them anxiety or because they think they are possible threats.
These people even find physical contact in all forms to be less pleasurable, from sexual activity to holding hands, leading these people to be far less motivated to seek them out compared to the average individual.
In addition to generally preferring to be alone, they might also have a flat affect and emotional blunting, meaning that they tend not to show positive or negative emotions.
Finally there’s schizotypal personality disorder, which is where an individual comes across as being quirky.
These people seem overly superstitious or might engage in excessive magical thinking, which is where they might think that two completely random events are causally linked.