34: Personality Disorders - Streyffeler Flashcards Preview

CS3: Exam 3 > 34: Personality Disorders - Streyffeler > Flashcards

Flashcards in 34: Personality Disorders - Streyffeler Deck (17):

healthy = response in a given situation is primarily driven by _______ conditions

- responds more to _______ reality than _______ beliefts


rather than past

external reality; internal beliefs


DSM5 definition of PD

enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasic and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.


______ of gen pop meet criteria for PD


20-30% of pts in primary care; up to 50% psych outpatients


symptoms of PD feel _____ to pt

normal (ego- syntonic)


among individuals meeting full criteria for 1 PD, ___ will meet full criteria for at least one additional PD


it is often helpful to think about their personality style


clusters for DP

A= odd, eccentric.
- includes paranoid, schizoid, schizotypal

B = dramatic, emotional, erratic
- includes antisocial, borderline, histrionic, narcissistic

C = anxious, fearful
- includes avoidant, dependent, OC PD


- pattern of excessive distrust and suspicion of others
- others have malevolent intent
- preoccupied with trustworthiness
- reluctant to confide in others; excessive need for self-sufficiency

paranoid PD

be open about what you are doing and why you are doing it. Avoid becoming defensive or dismissive
acknowlege pt's feelinga nd concerns.


- neither desires or enjoy close relationships
- preference for solitary activities
- little interest in sexual activities with another person
- appears cold, detached, or unemotional
- insensitive to praise or criticism

Schizoid PD

maintain a professional style and itnerest in their well-being
respect pt privacy
ask questions because they may not volunteer information


- discomfort with close relationships, lack of close friends or confidants AND
odd beliefs or magical thinking
- odd perceptual experiences
- peculiar behavior or appearance
- social anxiety that trends toward paranoid fears

Schizotypal PD

if possible, avoid confronting the odd beliefs or behaviors and simply accept their reality
if beliefs are causing medical prob, confront gently
screen for more florid forms of psychosis


- persistent disregard for the rights of others
- repeatedly engaging in illegal actions
- impulsivity and irresponsibility
- lack of REMORSE

antisocial PD

they are unlikely to follow rules of clinician-pt relationship
set and enforce clear boundaries
be mindful of possibility of drug-seeking or malingering


- desperation to avoid abandonment
- intense, unstable, all-good or all-bad relationships
- frequent suicidality or self-injury
- reactive, unstable mood
- poorly controlled anger

borderline PD

relationship with hcp is also likely to be intense and either idealizing or devaluing

avoid rescuing or abandoning - be predictable and stable. establish realistic expectations and clear boundaries.

completed suicide rate 8-10%


-desire to be center of attention at all times
- often seductive or sexually provocative
- rapidly shifting emotions
- theatrical, exaggerated
- suggestible

Histrionic PD

- take the dramatic nature of their communication into account with symptoms but dont dismiss
- maintain clear boundaries; set appropriate limits if pt is sexually provocative


- sees self as superior and expects others to do the same, but self esteem is very fragile
- only wants to associate with high-status ppl
- strong sense of entitlement
- willing to use others to achieve own ends
- lacks empathy
- arrogant and haughty

narcissistic PD

- avoid confronting the entitlement directly
- frame suggestions with a statement about the pt deserving the best care possible


- strong fears of criticism and rejection that lead to avoidance of activities involving interpersonal contact
- ongoing fear of shame or ridicule w/i intimate relationships
- need to be sure will be liked before entering into a relationship
- sees self as inadequate, inept and ifnerior

avoidant PD

pt will be very fearful of you disliking him/her
be calm, transparent and reassuring
- reassure that care-seeking was appropriate


- requires excessive advice and reassurance to make decisions
- needs others to assume responsibility for significant life tasks and functions
- fearful of being left alone to care for self

dependent PD

avoid making decisions for pt
offer options and support pt in making a decisions
schedule regular visit and reward independence


- preoccupied with details and order more than the main pt of task
- perfectionistic to a level that impairs functioning
- overconscientious and rigid around moral and ethical questions
- unable to discard worthless objects
- sees money as something to hoard

obsessive compulsive PD

* NOT same as OCD

- often have lengthy lists at appts or need to share minute detail
- expect perfect outcomes and service
- assume a consultant role to give pt max control
- set routine, outline options for pt
- give extra time


increased likelihood of depression particular with cluster _

C (anxious fearful)

adequate tx of depression can lessen severity of PD

elevated risk of suicide particular in cluster B