Personality disorders: Clinical

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Personality disorders: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 40-year-old woman comes to the psychiatric outpatient clinic because of decreased mood since the breakup with her boyfriend 6 months ago. She reports that she has been dating him for about 5 years but he left because she was "too clingy" and got tired of her frequent calls. She states that she has lived at home since dropping out of college because she does not like to be alone. She says that she has been calling her mother at work frequently since the breakup because she feels helpless, depressed and lonely. Which of the following is the most likely diagnosis?


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If you were to describe a friend’s personality, you might say they are creative, or easy-going but nervous in groups. Basically, you’re summarizing 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.

Now to diagnose a personality disorder, there are general criteria as well as features specific to the individual personality disorders.

The first general criteria for personality disorder is the presence of a constant pattern of inner experience and behavior that deviates substantially from the cultural norm, manifested in two or more of the following four areas: cognition - like, for example, deviations in the ways individuals perceive themselves, other people or events; affectivity such as changes in the range, intensity, and appropriateness of emotional responses; interpersonal functioning; and impulse control.

Second, this pattern is inflexible and present in most personal and social situations, including relationships, work and school.

And lastly, the pattern is stable, of long duration, and its onset is in adolescence or early adulthood.

The patterns should not be attributable to a substance like alcohol or another medical condition.

The DSM-5 lists ten personality disorders that are split into clusters A, B, and C.

Alright so cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

In paranoid personality disorder, there’s distrust and suspiciousness of others, which make individuals think that everything people do in relation to them is malevolent. This is shown by at least four of the following seven patterns.

First, individuals suspect that others are exploiting, harming, or deceiving them without having any reason or proof to think so.

Second, they are preoccupied with unjustified doubts about the loyalty or trustworthiness of those around them.


Personality disorders are a group of mental health conditions that affect a person's thoughts, emotions, and behaviors. They are grouped into clusters A, B, and C. Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Paranoid personality disorder is characterized by feelings of distrust and suspiciousness which make individuals think that everything people do is malevolent. In schizoid personality disorder, there’s detachment from social relationships and a limited expression of emotions, whereas schizotypal personality disorder presents with social and interpersonal deficits that cause discomfort and eccentric behavior.

In cluster B we have antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. In antisocial personality disorder, individuals show disregard for and violation of the rights of others. In Borderline personality disorder there’s instability in relationships, self-image, and affect, as well as impulsivity. Histrionic personality disorder is characterized by emotionality and attention-seeking; and in narcissistic personality disorder, people present with grandiosity, a need for admiration, and a lack of empathy.

Cluster C personality disorders consist of avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Avoidant personality disorder is characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. In Dependent personality disorder, there’s an excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation. Lastly, obsessive-compulsive personality disorder is characterized by excessive preoccupation with orderliness, perfectionism, and control, at the expense of efficiency.


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