Approach to Personality Disorders Flashcards by Christian Wakim

What is the Id

Instinctive biological drives and desires

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What is the Ego

Logical and language based problem solving

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What is the SuperEgo

Moral conscience based on ideal and values of society, “I should”

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What is the purpose of defense mechanisms

Reduce tension

Rationally seek solution
if cant resolve -> defense mechanism

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in whom do primitive defences occur

Childhood
Dreams
Psychotic Adults

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What is projection

grossly frank delusions about external reality. Self projects paranoid ideas out into the world.

Wife cheating because I am cheating

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What is denial

Refusal to accept terms of external reality because it is too threatening

a 200 board score applies to Vascular Surgery residency at Johns hopkins

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What is splitting

Seeing some people as all good and other as all bad. Often seen with Borderline Personality Disorder

pt idolizes doc but hates nurses

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What is displacement

Shifts sexual or aggressive impulses to a more acceptable or less threatening target

Doc yells at nurses after a frustrating patient

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What is regression

Temporary reversion to an earlier less mature, behavior

adult begins baby talk when stressed

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What is somatization

Transforms negative feelings towards others into negative feelings towards self, pain, illness, anxiety

Student embarrassed by resident, stomach ache before rounds

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What is introjection/identification

Opposite of projection. involves taking in other behaviors or emotions and internalizing them.

Abused child becomes abusive parent -or-

Christian and Tanner watch too much letterkenny and I suggest you let that one marinate!

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What is isolation of affect

Separate feelings from ideas and events
-la belle indifference seen in conversion DO and Alzheimer’s

Person describes murder in graphic detail with no emotion

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What is intellectualization

focusing on and exaggerating the intellectual aspect of a situation so as to distance oneself from anxiety

physician focuses on lab results rather than patient emotion.

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What is blocking

temporarily inhibits thinking. Can include affect and behavior. Individual stops momentarily

like a pause button

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What is acting out

Covering up true feelings by discharging different feelings

bullies

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What is Reaction Formation

Converting unconscious wishes or impulses considered threatening into their opposite (over reaction)

Student who does not like kids becomes pediatrician

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What is undoing

Do an action hoping to fix or reverse a previously unacceptable behavior

-seen in bulimia, domestic violence

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what is Rationalization

Individual convinces themselves that no wrong happened and that the unacceptable is acceptable

Yes we killed civilians but we were at war, and were ordered to

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What is passive aggression

Aggression towards others expressed indirectly or passively

you need to return a bowl to neighbor but delay because dog destroys garden

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What is dissociation

Drastic change in identity or character to avoid stress. Common in PTSD, Substance abuse

Individual describes assault as if they were out of their body watching it

what is humor (mature defense mechanism)

Overtly expressing ideas and feelings especially those too terrible to talk about

I guess I’ll go fuck myself

What is suppression

Conscious and intentional decision to delay paying attention to an emotional need

after pt dies, physician continues working and will deal with it later

What is altruism

Constructive service to others

I want to go to allison’s birthday but the stupid floor piss baby needs me - Abbey and Bill Probably

What is sublimation

Transform unpleasant emotion into positive action angry with PCM but instead you exercise Paint Clean

What separates someone from being a little quirky compared to having a full blown personality disorder?

The extent of their functional impairment. The difference between, "ugh my pencils aren't aligned on my desk" and I will spend 1-2 hrs making sure everything is perfect or I cant start work.

To have a personality disorder, a person must display an enduring pattern that deviates from expected culture. The pattern must manifest in 2/4 of the following. What are the 4 areas

1. Cognition 2. Affectivity 3. Interpersonal Functioning 4. Impulse control.

What are the group A personality disorders

Schizotypal Paranoid Schizoid

What are the group B personality disorders

Borderline Histrionic Anti-social Narcissist

What are the group C personality disorderss

Dependent Avoidant OCPD

What is Paranoid personality disorder

suspicious, grudge holding, angry person who suspects they are being victimized by exploitation or deception

How do you manage paranoid personality disorder

Be supportive Respect pts thoughts but dont collude! Be open Honest and respectful Explain everything and dont cover up mistakes once rapport is established, provide alternative explanations

What is Schizoid personality disorder

removed and remote due to self isolation from lack of interest in socialization Solitary people, little interest in sexual contact with others flat affect

How do you manage schizoid personality disorder

Respect their space Don't judge disconnection Do not impose social expectations

What is Schizotypal personality disorder

Closer relationships than Paranoid or Schizoid - but still difficulty with intimacy Odd, magical thinking Delusions of reference and unusual perceptual experiences Excessive social anxiety

How do you manage schizotypal personality disorder

Do not judge or ridicule

Describe Borderline Personality Disorder

Appear in a state of crisis, highly unpredictable, cannot tolerate being alone, splitting, high comorbidities

How do you manage Borderline Personality disorder

Form clear and consistent boundaries be calm in your responses Never provide special exceptions (phone call on holidays) Refer to Dialectical Behavior Therapy

Describe histrionic personality disorder

Needs to be center of attention and may use seductive behavior to accomplish that. Increased risk for somatic symptom disorder, conversion disorder, and depressive disorders

How do you manage histrionic personality disorder

Maintain boundaries Provide reassurance Address seductive behaviors in straightforward manner while maintaining professional boundaries

Describe Antisocial Personality disorder

Pervasive disregard for violation of rights of others - steal - con - aggressive Individual must be 18 for diagnosis but patterns appear at 15 Incorrectly referred to as psychopath/sociopath

How do you manage Antisocial personality disorder

Firm limits Clear and consistent boundaries Caution when prescribing controlled substances

Describe NArcissistic personality disorder

requires excessive admiration entitled Envies others or believed they are envied Often feel contempt for others

How do you manage Narcissistic personality disorder

Acknowledge patient as special Avoid power struggles reinforce that they are respected and special monitor for depression/suicidality

What is avoidant personality disorder

pervasive pattern of social inhibition with feelings of inadequacy - doesn't want to hang out unless they know they are liked - unusually reluctant to take personal risks for new activities

How do you manage Avoidant personality disorder

Avoid critical comments reinforce appropriate help seeking behaviors Be patient with your patient

What is dependent personality disorder

need to be taken care of leading to submissive/clinging behavior Subordinate their own needs to the needs of others and may accept demeaning tasks to gain acceptance.

How do you manage dependent personality disorder

Tolerate repeated requests for reassurance Schedule pre-established times be careful when encouraging changing an abusive relationship

Describe obsessive compulsive personality disorder

Preoccupied with details, rules, lists, order, organization, or schedules Perfectionism that interferes with task completion Limited interpersonal skills, unwilling to compromise

How do you manage OCPD

Avoid power struggles Allow patient to have control when they can (XR med QD or IR med BID) Encourage limited information-seeking (or else they come back saying LOOK the DSM told me....)