Group: Personality Disorders Flashcards
- Describe current understanding of personality structure and the development of personality.
personality is thought to be a constellation of motivations, beliefs and interpersonal behaviors that each individuals possesses, helps to organize behavior, in particular in response to stress
Clingier neurobiological model posits that there are 3 dimensions of temperament related to corresponding alterations in DA, NE and 5-HT systems
Five- factor model states that extremes in any of the characteristics can lead to disorder
genetic component
- Define personality disorder.
Enduring pattern of maladaptive traits that are inflexible and pervasive across a broad range of situations and that cause significant distress or impairment
- Recognize the three clusters of personality disorders and the 10 specific personality disorders
Cluster A (odd/eccentric): paranoid, schizoid, and schizotypal personality disorders
Cluster B (dramatic, emotional): antisocial, borderline, histrionic and narcissistic personality disorders
Cluster C (anxious, fearful): avoidant, dependent and obsessive compulsive personality disorders
- Describe the epidemiology, pathophysiology, clinical presentation, course, and prognosis of borderline personality disorder.
2% of people 3:1 women;
may arise in patients with high emotional vulnerability exposed to an invalidating environment as a child
boarders between neurosis and psychosis, a severe disturbance of mood and behavior with high levels of co-morbid, suicide, unable relationships and distortions of self-image; often alternate between valuing and devalue
10% complete suicide, many have chronic, severe symptoms ½ no longer meet full criteria after 10yrs
- Describe the epidemiology, pathophysiology, clinical presentation, course, and prognosis of antisocial personality disorder.
3% of men, 1% of women
disregard for and violation of the rights of others and marked lack of empathy, meet criteria for conduct disorder as a child
often co-morbid substance use, ADHD and pathological gambling, higher rates of criminality and suicide; risky behavior and self harm can be dangerous for patients
Discuss the diagnostic criteria for Borderline Personality Disorders.
- Pattern instability of interpersonal relationships, self-image and affects and marked impulsivity
a. Frantic efforts to avoid real or imagined abandonment
b. Pattern of unstable and intense idealization and devaluation of relationships
c. Identity disturbance- unstable self-image or sense of self
d. Impulsivity in at least two areas that are self damaging: $, sex, binge eating etc.
e. Recurrent suicidal behavior, gestures or threats, self-mutilating behavior
f. Affective instability due to reactivity in mood
g. Chronic feelings of emptiness
h. Inappropriate, intense anger or difficulty controlling anger
i. Transient, stress-related paranoid ideation or severe dissociative symptoms
Discuss the diagnostic criteria for Antisocial Personality Disorder.
- Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3+ of following
a. Failure to conform to social norms/ respect lawful behavior
b. Deceitfulness: repeated lying, use of aliases or conning for pleasure/profit
c. Impulsivity or failure to plan ahead
d. Irritability and aggressiveness as indicated by physical fights/assaults
e. Reckless disregard for safety of self or others
f. Consistent irresponsibility as indicated by repeated failure to sustain consistent work or honor financial obligations
g. Lack of remorse as indicated by indifference or rationalizing having hurt, mistreated or stolen from another
i. At least 18 years old, antisocial behavior is not exclusively during schizophrenia or bipolar disorder
- List the treatments available for borderline personality disorder, including psychotropic medications and psychosocial interventions.
Dialectical behavioral therapy: validation, mindfulness, developing emotional regulation, distress tolerance, and interpersonal effectiveness skills
antidepressants, antipsychotics (dissociative symptoms) and anticonvulsants (mood stabilizers), avoid BZD and TCA (overdose)
List possible medical conditions that could present with symptoms similar to those in personality disorders.
neoplasia-frontal lobe tumor, TBI, infection (HIV, herpes, encephalitis, or neurosyphyilis), endocrine conditions, autoimmune disorders, epilepsy, cerebrovascular disease and neurodegenerative disorders (esp. frontal or temporal lobes)
- Recognize the role of personality factors in patients’ interactions with health care professionals.
paranoid: often do not seek medical tx because of distrust; use non-defensive approach, acknowledge patient’s concerns
schizoid: socially isolated by choice, often do not seek tx.
antisocial: exploitive with medical professionals, use limit setting and legal back up if necessary
borderline: alternate between value and devaluing relationships, respond with validating but also set appropriate limits
histrionic: theatrical, charming; respond with consistent, stabilizing responsiveness
narcissistic: entitled patients, respond with non-defensive collaboration
dependent: clinging patient: use limit setting and reassurance
obsessive-compulsive: insistence on high standards by patients, respond with logical suggestions, ask permission to modify expectations
What is transference and countertransferance.?
transferance is how the patient reacts to the doctor based on past experiences or relationship
counter transferance is how the provider reacts to the patient based on past experiences or relationships
bottom line: do the right thing, regardless about how you feel about the patient
