Personality Disorders Flashcards
What are the OCEAN Five Factor Model Personality Traits?
Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism
The four traits commonly found in all personality disorders?
Denial, Ego syntonic, alloplastic, and unaffected
Define Ego Syntonic
Generally, behaviors are acceptable to the ego
Define Alloplastic
Adapt by trying to alter external environment
Personality Disorder is diagnosed when the symptoms are
rigid and maladaptive, produce functional impairment or subjective distress
What are cluster A personality disorder subytypes?
Schizo-typal, Schizoid, Paranoid
What are Cluster B personality disorder subytypes?
Narcissistic, Borderline, Anti-social, Histrionic
What are Cluster C personality disorder subtypes?
Obsessive Compulsive, Dependent, Avoidant
What are the general features of cluster A personality disorders?
odd aloof features
What are the general features of a cluster B personality disorder?
dramatic impulsive, erratic behaviors
What are the general features of a cluster C personality disorder?
anxious and fearful features
What are the four lodestars of the Inner life (Defense Mechanisms)?
Instinct, reality, important persons, conscience
Maladaptive coping of Fantasy
eccentric, lonely, or frightened seek solace and satisfaction within themselves by creating imaginary lives and especially imaginary friends – dependence on fantasy and appear to be aloof. Unsociableness is from fear of intimacy and therapists should maintain a quiet, reassuring, and considerate interest without insisting on reciprocal responses. Recognition of fear of closeness and respect for their eccentric ways are therapeutic and useful.
Maladaptive coping of Dissociation
Replacement of unpleasant affects with pleasant ones. If done consciously, it is termed denial. Often seen as dramatizing and emotionally shallow and may be labeled as histrionic. Behave like anxious adolescents and expose themselves to danger to erase anxiety. Confronting their vulnerabilities and defects make them defensive. They seek appreciation of their courage and attractiveness, so therapists be honest and upfront. These patients are often inadvertent liars and may benefit from ventilating their anxieties and remember what they “forgot”. Displacement is often used by therapists – talking with a patient about an issue of denial in a non-threatening circumstance – emphasizing the denial without confronting with facts.
Maladaptive coping of Isolation
Characteristic of controlled orderly persons often labeled OCD personality disorders. They remember the truth but without affect. In a crisis they may show intense self-restraint, overly formal social behavior and obstinance. Respond well to precise systematic and rational explanations and value efficiency, cleanliness, and punctuality. Clinicians should allow such patients to control their own care when possible.
Maladaptive coping of Projection
Patients attribute their own unacknowledged feelings to others. Excessive fault-finding and sensitivity to criticism may appear as prejudiced, hypervigilant injustice collecting but should not be met by defensiveness and argument. Strict honest, concern for patients’ rights and maintaining a formal concerned distance are helpful. Confrontation ensures a lasting enemy and early termination of the interview. Agree to disagree but do not agree with injustice collecting.
The technique of counterprojection is helpful – acknowledge and give paranoid patients full credit for their feelings and perceptions, neither dispute nor reinforce them but agree that what they are describing is conceivable. Then talk about real motives and feelings, misattributed to someone else and begin to cement an alliance.
Maladaptive coping of Splitting
Persons toward whom patients’ feelings are or have been ambivalent are divided into good and bad, and thus pitted against each other. Splitting is a way for the patient to manipulate and thus control who is in their lives and who is not before someone leaves of their own volition. Can be highly disruptive, especially in an inpatient setting. Gentle confrontation with the patient is important in dealing with the patient and boundary setting.
Maladaptive coping of Passive Aggressive
Turn their anger against themselves to manipulate the situation. A masochistic behavior that includes failure, procrastination, silky or provocative behavior, self-demeaning, clowning, and self-destructive acts but hostility in these behaviors is never entirely concealed. Helping the patient to vent their anger is the best way to deal with passive aggressive behavior.
Maladaptive coping of Acting Out
Patients express unconscious wishes or conflicts through action to avoid being conscious of either the accompanying idea or the affect. Tantrums, motiveless assaults, child abuse, and pleasureless sexual promiscuity are examples. The behavior occurs outside the patient’s awareness and appears to observers as unaccompanied by guilt. Realize when faced with acting out that the patient has lost control and anything the interviewer says will not be heard by the patient. It is important to get the patient’s attention.
Maladaptive coping of Projective Identification
Appears mostly in borderline PD and consists of 3 steps: (1) an aspect of the self is projected onto someone else; (20 the projector tries to coerce the other person into identifying what has been projected and (32) the recipient of the projection and the projector feel a sense of oneness.
Paranoid Personality Disorder is characterized by
Longstanding suspiciousness and mistrust. Refuse responsibility for their own feelings and assign responsibilities to others. Often hostile, irritable, and angry. Includes: Bigots, injustice collectors, pathologically jealous spouses and litigious cranks.
What may be seen in a diagnostic interview with someone who has Paranoid Personality Disorder?
Formal in manner, surprised about the need for psychiatric help, muscular tension, inability to relax, need to scan the environment for clues, serious and humorless, speech is often goal directed and logical. Thought content shows evidence of projection, prejudice, and occasional ideas of reference.
What does this describe? Begins in early adulthood, expect to be exploited or harmed by others, frequently dispute loyalty or trustworthiness without just cause, pathologically jealous without reason, externalize own emotions and use projection. Affectively restricted and appear unemotional, pride themselves in being rational and objective. Lack warmth and are impressed with power and rank. Express disdain for those who appear weak, sickly, or impaired. Socially may appear businesslike and efficient but generate fear or conflict in others.
Paranoid Personality Disorder
How do you differentiate Paranoid personality disorder from schizophrenia or psychosis?
Absence of fixed delusions, no hallucinations or thought disorders. Rarely capable of being over involved. No history of antisocial behavior.
What treatments are available for Paranoid Personality Disorder?
Psychotherapy is the treatment of choice. Therapist must be straightforward, trust and toleration of intimacy are troubled areas. Professional and not overly warm style. Overzealous use of interpretations increases mistrust. Does not do well in group therapy. May need to set rules or limits on their actions. Deal with delusional accusations realistically and gently.
What pharmacotherapy is useful for paranoid personality disorder?
Agitation and anxiety (diazepam), antipsychotic (haloperidol), some patients may have reduced paranoid ideation (pimozide)
What is schizoid personality disorder characterized?
Lifelong pattern of social withdrawal, often seen as eccentric, isolated, or lonely. Discomfort with human interaction, introverted, bland affect.
Diagnosis of Schizoid personality disorder may note what upon examination?
may appear ill at ease with poor eye contact, aloof, inappropriately serious but underneath is fear, difficult to be lighthearted and humor may seem adolescent. Speech is goal directed but give short answers to avoid conversation. May use unusual figures of speech and may be fascinated with inanimate objects or metaphysical constructs. Unwarranted sense of intimacy with persons they do not know well. Sensorium is intact, memory functions well, and proverb interpretations are abstract.
How to differentiate Schizoid Personality Disorder
lacks delusions/hallucinations seen in schizophrenia, delusional disorder, and affective disorder with psychotic features. Less social engagement, no aggressive verbal behavior, and less projection than is seen with paranoid personality disorder. Patients with avoidant personality disorders are isolated but wish to participate in activities.
Schizoid Personality Disorder treatment
Psychotherapy-tend toward introspection, may reveal fantasies, imaginary friends, and fears of dependence. Group therapy-silent for long periods but do become involved.
Pharmacotherapy for schizoid personality disorder
small doses of antipsychotics, antidepressants and psychostimulants may be beneficial. Serotonergic agents-may make less sensitive to rejection. Benzodiazepines-may help diminish interpersonal anxiety.
How are schizotypal personality disorders characterized?
Strikingly odd or strange-magical thinking, peculiar notions, ideas of reference, illusions and derealization
What may be present during a diagnostic exam for schizotypal personality disorder
Based on peculiarities of thinking, behavior, and appearance. History taking may be difficult due to unusual way of communicating. Exhibit disturbed thinking and communicating. speech may be distinctive or peculiar and may only have meaning to them. May not know their own feelings but aware of the feelings of others especially negative ones. May be superstitious and claim clairvoyance. Inner world-may have vivid imaginary relationships and childlike fears and fantasies. May admit to perceptual illusions or macropsia and confess other persons seem wooden and all the same. Usually isolated and have few friends. May show features of borderline PD. Under stress may decompensate and have brief psychotic symptoms. In severe cases may exhibit anhedonia and severe depression.
Schizotype is the premorbid personality of the patient with
schizophrenia
