Cluster B Personality Disorders Flashcards

Question

how many features are listed in criterion A for narcissistic PD? how many are required?

Answer 1

pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by 5+ of: 1. has a grandiose SENSE OF SELF IMPORTANCE (i.e exagerrates achievements and talents, expects to be recognized as superior without commensurate achievements) 2. is preoccupied with fantasies of UNLIMITED SUCCESS, power, brilliance, beauty, or ideal love 3. believes that he or she is "SPECIAL" and unique and can only be understood by, or should associate with, other special or high status people (or institutions) 4. requires EXCESSIVE ADMIRATION 5. has a sense of ENTITLEMENT (i.e unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations) 6. is INTERPERSONALLY EXPLOITATIVE (i.e takes advantage of others to achieve his or her own ends) 7. LACKS EMPATHY: is unwilling to recognize or identify with the feelings and needs of others 8. is often ENVIOUS of others or believes that others are envious of him or her 9. shows ARROGANT, HAUGHTY behaviours or attitudes

Answer 2

overt/oblivious covert/hypervigilant

Answer 3

relatively well functioning outpatients who could afford psychoanalysis professionals who described vague feelings of emptiness/depression, felt slighted by others

Answer 4

inpatients/outpatients who were more primitive, more arrogant, more aggressive

Answer 5

viewed the narcissist's grandiosity and exploitation as evidence of ORAL RAGE which results from the EMOTIONAL DEPRIVATION caused by an indifferent and spiteful parent when this occurs, the childs sense of being special provides an emotional ESCAPE from perceived threat/indifference by the parent grandiosity, entitlement that develops protects a split off of the "real self" here, the "real self" contains strong, unconscious feelings of ENVY, DEPRIVATION, FEAR and RAGE--> thus the defensive structure in narcissistic personality disorder is remarkably similar to one wiht borderline PD

Answer 6

Kohut believed narcissism is DEVELOPMENTALLY ARRESTED as an early stage, when an individual needs a FEEDBACK ENVIRONMENT to maintain their cohesive selves he formulated that self-object transferences recreate the situation with parents that was not fully successful during childhood (mirroring, idealizing) when a narcissist does not get the response they need (i.e an empathic deficit) they are prone to FRAGMENTATION OF SELF (experience a narcissistic injury) common concepts introduced by Kohut are: 1. Mirror transference--> im great, look at me! 2. idealizing transference--> you are great, i'm great because i'm with you 3. twinship transference--> you are great and i am just like you

Answer 7

highly SENSITIVE INHIBITED, shy DIRECTS ATTENTION towards OTHERS listens carefully for evidence of SLIGHTS/CRITICISMS easily HURT FEELINGS--> prone to feeling ASHAMED or humiliated

Answer 8

NO AWARENESS of impact on others arrogant and AGGRESSIVE self ABSORBED need to be CENTER OF ATTENTION have "sender but no receiver" closely matches DSM IV criteria generally much harder to treat

Answer 9

no, self esteem is FRAGILE Vulnerability in self-esteem ○ Very sensitive to injury (from criticism or defeat) ○ May not show outwardly → feel humiliated, degraded, hollow, empty ○ React with disdain, rage, defiant counterattack ○ May lead to social withdrawal ○ Appearance of humility to mask/protect grandiosity

Answer 10

devalue them

Answer 11

when recognized at all, they are viewed disparagingly as a weakness

Answer 12

1. Grandiose sense of self-importance ○ Overesmate abilies, inflate accomplishments, boasul, pretenous ○ Assume others aribute same value, surprised if not praised 2. Fantasies of unlimited success, power, brilliance, beauty ○ May ruminate about “long overdue” admiraon, privilege ○ Compare themselves favorably to famous/privileged people 1. Believe they are superior, special, unique ○ Expect others to recognise them as such ○ Can only be understood or assoc with other special/high-status people ■ May aribute “unique”, “perfect”, “gied” qualies to those associated ■ Self-esteem enhanced by idealized value they assign to those associated ■ Believe their needs are special, beyond ordinary people ○ Insist on having only the “top” person, or being affiliated with the “best” ○ Devalue those who disappoint them 2. Require excessive admiraon ○ Self-esteem very fragile ○ May be preoccupied with how they’re doing, how favourably regarded à need constant admiraon ○ Expect arrival to be greeted with great fanfare, astonished if others do not covet their possessions ○ May fish for complements, with great charm 1. Sense of entlement ○ Unreasonable expectaon of especially favorable treatment ○ Expect to be catered to → frustrated if not 2. Interpersonal exploitaon (conscious or unwing) ○ Due to sense of entlement + lack of empathy ○ Expect to be given whatever they want, no maer effect on others ○ Only form relaonships if other person seems likely to help them ■ Advance their purposes, enhance their self-esteem ○ Oen usurp special privileges, extra resources 3. Lack of empathy ○ Difficulty recognizing desires, subjecve experiences, feelings of others ○ Assume others totally concerned about their welfare ○ Discuss own concerns in inappropriate + lengthy detail ○ Oen contemptuous + impaent when others talk about themselves ○ May be oblivious to hurul remarks they may inflict (“My new gf is epic!” to ex) ○ When recognized needs of others, they are viewed disparagingly as weakness ○ Emoonal coldness, lack of reciprocal interest 1. Oen envious of others, believe others envious of them ○ Begrudge others’ success à feel they deserve instead ○ Harshly devalue contribuons of others 1. Arrogant/haughty behaviors, patronizing atudes ○ Complain about others’ “rudeness” or “stupidity” ○ Condescending evaluaon of physicians

Answer 13

entitlement, need for admiration, lack of empathy

Answer 14

● Vulnerability in self-esteem ○ Very sensive to injury (from cricism or defeat) ○ May not show outwardly → feel humiliated, degraded, hollow, empty ○ React with disdain, rage, defiant counteraack ○ May lead to social withdrawal ○ Appearance of humility to mask/protect grandiosity ● Impaired interpersonal relaons ○ Problems from entlement, need for admiraon, lack of empathy ● May have impaired vocaonal funconing ○ Unwillingness to take risk (where defeat possible) ○ Achievement may be disrupted due to intolerance of cricism/defeat ● Psychiatric illness ○ Sustained feelings of shame/humiliaon → depressed mood ○ Sustained grandiosity → hypomania ○ Anorexia nervosa, SUDs ○ Histrionic, borderline, ansocial, paranoid

Answer 15

mentalization-based therapy transference-focused psychotherapy schema-focused psychotherapy DBT for significant self destructive behaviours **individual psychotherapy is viewed by many as the basic treatment of choice--> can be very challenging for therapists, and confrontation and mirroring techniques are suggested

Answer 16

impairment can be severe--> may include marital problems and interpersonal relationship conflicts may face occupational difficulties and show an unwillingness to take risks in competitive or other situations in which defeat is possible may have more difficulties in the aging process--> i.e midlife crisis

Answer 17

I3 -- A3 -- ESP Identity Interpersonal relationships Impulse control (in 2+ areas of life) Affect (irritable/labile) Anger Abandonment Empty Suicidal Paranoia (micro psychosis)

Answer 18

pervasive pattern of INSTABILITY in interpersonal relationships, self image, affects and marked IMPULSIVITY beginning in early adulthood, present in a variety of contexts --needs 5+ of: 1. frantic efforts to avoid real/perceived ABANDONMENT 2. pattern of UNSTABLE and INTENSE interpersonal relationships 3. marked and persistently UNSTABLE SELF IMAGE or sense of self 4. impulsivity in 2+ areas that are potentially self damaging (i.e spending, sex, substance use, reckless driving, binge eating) 5. recurrent SUICIDAL BEHAVIOUR, gestures or threats, or self mutilating behaviour 6. affective INSTABILITY due to MARKED REACTIVITY of mood (episodic intense dysphoria, irritability, anxiety usually lasting hours-days) 7. chronic feelings of EMPTINESS 8. inappropriate INTENSE ANGER or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights) 9. transient stress related PARANOID IDEATION or severe DISSOCIATIVE symptoms

Answer 19

impulsivity

Answer 20

women 3:1 men

Answer 21

4-10x more common

Answer 22

35-67% based on twin studies

Answer 23

**less effective modulation of amygdala (increased activity in amygdala)** --> when instructed to use a cognitive strategy to reduce emotional intensity, unable to fully activate regions involved in cognitive control--> DORSOLATERAL ACC, INFERIOR FRONTAL GYRUS--> leads to less effective modulation of amygdala DEFICITS in fronto-limbic connections, frontal lobe functioning

Answer 24

physical/sexual abuse neglect hostile conflict early parental loss

Answer 25

threats of separation/rejection or increased responsibility

Answer 26

1. Franc efforts to avoid real or imagined abandonment ○ Percepon of impending separaon/rejecon, loss of external structure ○ May lead to profound changes in self-image, affect, cognion, behavior ○ Very sensive to environmental circumstances ○ Intense abandonment fears + inappropriate anger ■ Even if me-limited separaon or unavoidable changes (e.g. end of apt, few min late ■ “Abandonment” implies they are “bad” ○ Intolerance of being alone, needing to have other people with them ○ Franc efforts to avoid abandonment → may be impulsive, suicidality, self-harm 2. Unstable + intense relaonships ○ May inially idealize caregivers/lover, demand me ++, share inmate details too early ○ May quickly switch to devaluing, other person doesn’t care/give enough, not “there” enough ○ CAN empathize and nurture others, but only with expectaon other person will be there (to meet own needs on demand) ○ Sudden + dramac shis in view of others (seen as beneficent supports vs cruelly punive) ■ May reflect disillusionment with caregiver whose nurturing qualies were idealized or whose rejecon/abandonment is expected 3. Unstable self-image or sense of self ○ Sudden + dramac shis in self-image → shiing goals, values, vocaonal aspiraons ■ Career, sexual identy, values, types of friends ○ Image usually based on being bad or evil ○ May feel they do not exist at all ■ Usually happens when lacking meaningful relaonship, nurturing, support ○ Worse performance in unstructured work, school situaons 4. Impulsivity, in 2+ areas, potenal self-damaging ○ Gamble, spend irresponsibly, binge eat, abuse substances, unsafe sex, driving 5. Recurrent suicidal behavior, gestures, threats, self-mulaon ○ Completed suicides in 8-10% of such individuals ○ Oen reason presenng for help ○ Precipitated by threats of separaon/rejecon or ↑ responsibility ○ Self-harm may occur during dissociave experiences ■ Reaffirms ability to feel or ridding sense of being evil 6. Affecve instability due to marked mood reacvity ○ Intense episodic dysphoria, irritability, anxiety (hours-days) ○ Baseline dysphoria → disrupted by anger, panic, despair (rarely relieved) ○ May reflect extreme reacvity to interpersonal stresses 7. Chronic feelings of empness ○ Easily bored, may constantly seek something to do 8. Inappropriate + intense anger, difficulty controlling anger ○ Extreme sarcasm, bierness, verbal outbursts ○ Oen when caregiver is neglecul, withholding, uncaring, abandoning ○ Oen followed by shame + guilt → contribute to feeling of being evil 1. Transient, stress-related paranoid ideaon + dissociaon ○ Generally insufficient for addional diagnosis ○ Abandonment (real or perceived) frequently precipitates à return (real or perceived) of caregiver’s nurturance may result in remission of Sx

Answer 27

Paern of undermining themselves ○ When goal about to be realized (dropping out, regressing, breaking up) ● Stress-related psychoc symptoms ○ Hallucinaons, body-image distorons, ideas of reference, hypnagogic ○ May hear name being called, see shadowy figures/illusions ● May feel more secure with transional objects (vs interpersonal relaonship) ○ e.g. pets, inanimate possessions ● Premature death from suicide ○ (up to) 80% have suicidal behaviors ○ 8-10% complete ○ Especially if co-occurring depressive disorder or SUDs ○ Recurrent job loss, interrupted educaon, separaon, divorce = common

Answer 28

mood disorders PTSD ADHD eating disorders (BULIMIA) SUDs other PDs *comorbidity is the rule not the exception

Answer 29

no, generally not--> only to treat comorbidities or as adjunctive to therapy NICE guidelines--> drug treatment should not be used *specifically* for borderline PD or for individual sx or behaviour assoc with the disorder cochrane--> total borderline PD severity is not influenced by any drug

Answer 30

safer in OD

Answer 31

to treat comorbid disorders may reduce anger--moderate effect ?affective instability, interpersonal sensitivity? NO EFFECT ON MOOD (if borderline PD alone)

Answer 32

if comorbid bipolar LAMOTRIGINE may reduce anger/aggression, lability, impulsivity

Answer 33

if brief psychotic symptoms OLANZAPINE--> small to moderate effect on anger, psychotic sx, affective instability, anxiety quetiapine--> equivocal evidence, one study = may have benefit in aggression, but 2 other negative studies abilify, ziprasidone--> poor to no evidence

Answer 34

dont--more harm than benefit

Answer 35

omega 3 fatty acids 3 studies some benefit in suicidality, depression, irritability, aggression

Answer 36

if have both, there seems to be significantly less response + earlier relapse than if have MDD alone and receiving ECT

Answer 37

maybe--> one study found improvement in a task measuring impulsivity

Answer 38

highly active, responsive, validating clear roles and responsibilities of therapist and patient emphasis on ability of patient to control behaviour limit setting

Answer 39

DBT--best CBT mentalization based, schema, transference, psychodynamic

Answer 40

DEARMAN Describe Express Assert REinforce Mindful Appear confident Negotiate as needed

Answer 41

DBT → 'gold standard', distress tolerance, idenfying feelings and not react, develop coping skills ■ Mindfulness--> Wise Mind (Rational Mind + Emotional Mind) ■ Distress Tolerance ■ Emotional Regulation ■ Interpersonal Effectiveness--> DEARMAN: Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate as needed

Answer 42

integrative cognitive therapy--> behavioural, cognitive and experiental techniques focus on therapeutic relationship, daily life outside therapy, past traumatic experiences encourages ATTACHMENT between therapist and patient--> "LIMITED REPARENTING" goal is STRUCTURAL CHANGE to PERSONALITY addresses 4 dysfunctional schema modes

Answer 43

structural change to personality

Answer 44

twice weekly x 3 years

Answer 45

mode = negative pattern of thinking, feeling, behaving 1. detached protector 2. punitive parent 3. abandoned/abused child 4. angry/impulsive child

Answer 46

by substituting negative patterns of thinking, feeling behaving with healthier alternatives

Answer 47

psychodynamic orientation focus on increasing capacity for mentalization

Answer 48

process of imagining the thoughts and feelings in one's own and other's minds in order to understand interpersonal interactions differentiation of own mental states from those of others shapes our understanding of other and ourselves central to human communication and relationships enables us to understand misunderstandings

Answer 49

borderline PD sx arise when patient stops mentalizing, leading to pathological certainty about others motives, disconnection from the grounding influence of reality, and desperate need for proof of feelings through the actions of others attachment interactions become "hyperactivated" and feed into distress, difficulty coping rather than providing safety and security

Answer 50

stabilized borderline PD problems by strengthening the patient's capacity to mentalize under the stress of attachment activation therapist stance = curious, not knowing, intended to help patient assess interpersonal situations and their emotional responses, through a more grounded, flexible and benevolent lens

Answer 51

a MANUALIZED, psychoanalytically oriented therapy designed to address key features of personality disorder at the borderline level of organization --> identify DIFFUSION, primitive defense mechanisms, unstable reality testing, internall/externally expressed aggressions patients inherent INTERPERSONAL DYNAMIC EMERGES in the transference and are jointly examined to resolve the splits between the good and bad that drive instabilities in affect and relationships

Answer 52

more balanced, integrated ways of thinking about oneself and others

Answer 53

twice weekly x 3 years, typically under supervision

Answer 54

data suggests that some do regress in hospital but some do benefit from a short admission

Answer 55

young adult years, then wanes

Answer 56

considerable variability most common = chronic instability in early adulthood episodes of serious affective, impulsive dysregulation high levels of health and MH resource use sx often LIFELONG --can improve with therapeutic intervention, often in year 1 during age 30-40--> greater stability after 10 years---> 50% no longer meet full criteria

Answer 57

"acute sx"--> impulsivity, self harm/SI, help seeking suicidal efforts--> resolve early "chronic, trait based"--> chronic dysphoria, loneliness, emptiness, fear of abandonement--> improve but to a LESSER degree

Answer 58

Maclean Borderline Personality Screen

Answer 59

a pervasive pattern of EXCESSIVE EMOTIONALITY and ATTENTION SEEKING, beginning by early adulthood and present in a variety of contexts, as indicated by5+ of: 1. is uncomfortable in situations in which he or she is not the center of attention 2. interaction with others is often characterized by inappropriate sexually seductive or provicative behaviour 3. displays RAPIDLY SHIFTING and SHALLOW expression of emotions 4. consistently uses PHYSICAL APPEARANCE to draw attention to self 5. has style of speech that is excessively impressionistic and lacking in detail 6. shows SELF DRAMATIZATION, theatricality, and exagerrated expressions of emotion 7. is SUGGESTIBLE 8. considers relationships to be more intimate than they actually are

Answer 60

often lively, dramatic, tends to draw attention to self may initially CHARM, with enthusiasm, openness, FLIRTACIOUSNESS charm WEARS THIN--> continually demands attention

Answer 61

unknown--> clinical experience suggests increased risk of suicidal gestures threats to get attention, coerce better caregiving

Answer 62

somatic symptom disorder conversion disorder MDD

Answer 63

● Difficulty achieving emotional intimacy (romanc, sexual) ○ Oen act out a role (vicm, princess) à but unaware ■ May seek to control partner (emotional manipulation + seduction but also dependency) ○ Impaired relationship with same-sex friends (sexually provocative .: threat) ○ May alienate friends (demanding aenon) ○ Oen become depression, upset when not center of aenon ● Crave novelty, simulation, excitement ○ Tendency to become bored → want immediate satsfaction ○ Oen intolerant of situaons involving delayed graficaon ○ Intial enthusiasm with jobs/projects à interest may lag quickly ○ May neglect long-term relationships à excitement of new relationships ● Suicide risk = unknown ○ Clinical experience → ↑ risk of suicidal gestures ■ Threats to get aenon, coerce beer caregiving

Answer 64

psychotherapy particular focus on the therapeutic alliance behavioural techniques, assertiveness training

Answer 65

CALLOUS MAN Conduct disorder before at 15 + Current age is above 18 Antisocial acts +commits acts that are grounds for ARREST Lies frequently Lacunae +Lacks a superego Obligations not honored Unstable--cant plan ahead Safety of self and others ignored Money problems--spouse and children not supported Aggressive + Assaultive Not occurring exclusively during SCZ or mania

Answer 66

(or use I3 A3 ESP) I RAISED A PAIN Identity disturbance Relationships are unstable Abandonment is frantically avoided Impulsivity Suicidal gestures Emptiness Dissociative symptoms Affective instability Paranoid ideation (stress related and transient) Anger is poorly controlled Idealization followed by devaluation Negativistic (undermine themselves with self defeating behaviour)

Answer 67

I CRAVE SIN Inappropriate behaviour--seductive, provocative Center of attention Relationships perceived to be closer than they are Appearance most important Vulnerable to other's suggestions Emotions exagerrated Shifting emotions + Shallow Impressionistic manner of speaking (lack of detail) Novelty cravings

Answer 68

A FAME GAME Admiration required in excessive amounts Fantasizes about unlimited success, brilliance Arrogant Manipulative Envious of others Grandiose sense of importance Associates with special people Me first attitude Empathy lacking for others

Cluster B Personality Disorders Flashcards

(106 cards)