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Flashcards in Patient with personality disorder Deck (23):
1

Etiology

1. Genetic
Family history->substance misuse, schizophrenia
Temperament
2. Psychoanalytical
Getting "stuck" at stage of development
Anxieties of ego failed defenses
3. Trauma->childhood trauma alters neurotransmitter, hyperarousal, HPA
4. Defenses, attachment

2

Features of personality disorders

Enduring
Pervasive
Stable
Deviate from cultural norm
Maladaptive

Impacts:
1. Cognition->percieving self and others
2. Affect
3. Interpersonal function
4. Impulse control

3

Affect, behaviour and cognition encompass

Neurodevelopment (temperament)
and psychodevelopment
(secure base (age 1-7)+self esteem
(7-12)+self image 12-18)-->
integration and self identity

4

Cluster A

Odd, aloof, bizarre-->
neurodevelopement=
Paranoid
Schizoid
Schizotypal

5

Cluster B

Dramatic
Impulsive
Erratic-->
abandonment
issues
Borderline,
Antisocial
Narcisist,
Histrionic

6

Cluster C

Fearful and anxious-->
inferiority, low self esteem
OCPD, Dependent, AVoidant,
Passive aggressive

7

Attachment theory and personality

Secure vs insecure vs disorganised

Insecure=
1. Anxious-preoccupied
2. Dissmisive/avoidant
3. Fearful-avoidant

Insecure attachment
endures through life-->
unstable, destructive,
inappropriate relationships
cannot reflect on mind and
mind of others
Leads to disturbed sense of
self

8

History

Sources of distress
Comorbidities
Impairment of function
Complete psychiatric assessment
Substance use, suicide risk, relationships, work, legal, family, social

9

Features of schizoid, schizotypal, paranoid

1. Schizotypal:
Interpersonal/social deficits
Reduced capacity for close relationships
Eccenteric
Cognitive/perceptual disturbances
Odd thinking, ideas of reference
Social anxiety

2. Schizoid:
Detachment
Restricted emotional expression/interpersonal relationships
Solitary, indifferent
Affectively detached

3. Paranoid:
Distrustful
Suspscious
Holds grudges
Perceives threats in neutral events

10

Features of narcissistic, antisocial, histrionic

1. Histrionic:
++Emotional
Attention seeking
Discomfort if not COA
Shallow expression of emotion
Draws attention to self physically seductive

2. Narcissitic:
grandiosity
Needs admiration
Lacks empathy
Views self as special
Unwilling to recognise feelings of others
Exploitative
Arrogant

3. Antisocial:
Disregard rights of others
Beginning

11

Features of avoidant, dependant, OCPS

1. Avoidant
Social inhibition
Inadequacy
Hypersensitive to criticism
Reluctant to take risks for fear of rejection

2. Dependant:
Excess need to be taken care of
Submissive
Poor decision making, needs advices
Fears solitude
Clinging behaviour

3. Obsessive/compulsive
Preoccupied with ordiliness
Perfectionism
Lack flexibility, openness, efficiency
Overconscientious
Stubborn
Excessively rigid, devoted to work

12

Management of Cluster A

1. Patient communication and relationship management strategies
2. Antipsychotics
3. Antidepressant
4. Substance abuse treatment programme

13

Cluster B management

1. Patient communication and relationship management strategies
2. Psychotherapy->borderline and anti-social
3. Mood stabilisers->borderline
4. Substance abuse treatment programme

14

Cluster 3 management

1. Patient communication and relationship management strategies
2. Psychotherapy
3. Substance abuse treatment
4. Paroxetine, sertraline, fluoxetine->avoidant

15

Defenses in paranoid, psychiatric risks

1. Projection
2. Identification with the aggressor->taking on aspect of character that causes anxiety
3. Repression
4. Denial
5. Splitting

Fear of dependence and vulnerability to hostility
History of a harsh, punitive parent

1. Delusional disorder
2. Depression
3. Anxiety disorder
4. OCD

16

Schizoid defenses, psychiatric risks

1. Splitting
2. Projection
3. Denial
4. Rationalisation

Apparent self sufficiency, masks both the wish for and fear of closeness
Cold, neglectful parents

1. Delusional disorder
2. Schizophrenia
3. Anxiety disorder

17

Schizotypal defenses, psychiatric risks

1. Denial
2. Projection
3. Acting out
4. Fantasy

1. Depression
2. Anxiety
3. Schizophrenia
4. Delusional disorder

18

Antisocial defenses, psychiatric risk

1. Repression
2. Splitting
3. Denial

Repressing powerlessness and low self worth
Rage denied and split off
Empathetic failure, need for control
Inconsistent parenting, ineffectual or harsh discipline, parental criminality/substance use

1. Substance use
2. Depression
3. Criminality

19

Narcissistic defenses, psychiatric risk

1. Denial
2. SPlitting
3. Projection
4. Rationalisation
5. Intellectualisation

Fear of not being the best
Inability to deal with perceived threats to self and self worth
Emotional neglect, empathetic failure, inability to form meaningful relationships

1. Depression
2. Dysthymic
3. Substance abuse

20

Histrionic defenses, psychiatric risk

1. Projection
2. Splitting
3. Fantasy

Fear of impermanence of relationships, gender identity concerns
History of perceived rejection by same sex parent and identification with opposite sex parent

21

Avoidant personality defenses, psychiatric risk

1. Projection
2. Denial

Conscious desire for closeness with fear of closeness and rejection
Relative stable sense of self although feel worthless
History of parental rejection or severe life threatening/disfiguring illness in childhood

1. Depression
2. Anxiety

22

Dependent defenses, psychiatric risk

1. Denial
2. Repression

Fear of abandonment
Preserved cohesive sense of self
History of separation and losses

1. Anxiety disorders
2. Depression

23

OCPD defenses, psychiatric risk

1. Denial
2. Reaction formation
3. Intellectualisation
4. Isolation of affect

Fear of anarchy of biological drives
Fear of own destructiveness
Authoritarian and moralising parenting inducing shame and guilt

1. Anxiety disorders
2. Depression