Personality Disorders

Question 1

personality disorders =

Answer 1

enduring subjective experiences and behavior that deviate from normal standards, are rigidly pervasive, have an onset in adolescence/early adulthood, stable through time and lead to unhappiness and impairment

Question 2

Common defense mechanisms

Answer 2

• Mature
• Immature
• Functional
• Dysfunctional
• neurotic

Question 3

Mature defense mechanisms =

Answer 3

• Altruism: deriving personal satisfaction from helping others
• Anticipation: planning for future stress with preparation
• Humor: lessening negative situations with laughter
• Sublimination = transforming negative instinct into positive

Question 4

Neurotic defense mechanisms

Answer 4

• Displacement: shifting aggressive impulses onto less threatening target
• Intellectualization: focusing on the intellectual rather than anxiety producing emotional aspects of the situation
• Rationalization: convincing oneself they did nothing wrong
• Repression: unconsciously putting unacceptable thoughts or memories out of mind

Question 5

Immature defense mechs

Answer 5

• Passive aggression: aggression towards others is expressed passively or indirectly; turn their anger against themselves
• Denial: refusal to accept external reality because it is too threatening
• Splitting: seeing oneself or others as either all good or all bad
• Projection: denial of ones own deficiency and then perceiving that deficiency on others
• Projection identification: the object of the projection begins to act in a way to confirm the projectors feelings

Question 6

Other defense mechs from book:

Answer 6

• Fantasy: to find solace create imaginary lives, seem aloof

- Dissociation: replacing unpleasant affects with pleasant ones; seen as dramatically or emotionally shallow

Question 7

Cluster A PD’s

Answer 7

• aka weird: familial associations with psychotic disorders
  1) Paranoid
  2) Schizoid
  3) Schizotypal

Question 8

Cluster B PDs

Answer 8

• wild = familial associations with mood disorders
  1) Borderline PD
  2) Histrionic
  3) Narcissitic
  4) Antisocial

Question 9

Cluster C PDs

Answer 9

• worried - familial association with anxiety disorder
  1) Avoidant
  2) Obsessive Compulsive
  3) Dependent

Question 10

Paranoid PD

Answer 10

• a pervasive distrust and suspiciousness of others
• suspects others are exploiting or harming them
• preoccupied with unjustified doubts about loyalty
• reluctant to confide in others because of unwarranted fear that info will be used against them
• reads hidden threatening meanings into benign things
• persistently bears grudges
• perceives attacks on his/her character or reputation that are not apparent to others
• Recurrent suspicion regarding infidelity of partner

Question 11

Paranoid PD tx

Answer 11

• psychotherapy

- meds to tx agitation and anxiety: diazapam, antipsychs (haloperidol)

Question 12

Schizoid PD

Answer 12

• pervasive pattern of social withdrawal and restricted range of expression and emotions with at least 4 of following:
• neither desire nor enjoys close relationships
• almost always chooses solitary activities
• little interest in sexual experiences with another person
• takes pleasure in few, if any activities
• lacks close friends, other than first degree relatives
• appears indifferent to the praise or criticism of others
• emotional coldness, detachment or flattened affect

Question 13

Schizoid PD tx

Answer 13

• psychotherapy

- meds: antipsychs, antidepressants, psychostimulants

Question 14

Schizotypal PD

Answer 14

• pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close rltnshps, as well as by cognitive or perceptual distortions and eccentricities of behavior, indicated by at least 5 of the following:
• Ideas of reference
• odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norma
• unusual perceptual experiences including bodily illusions
• odd thinking or speech
• suspicious or paranoid ideation
• inappropriate or constricted affect
• behavior or appearance that is odd, eccentric, or peculiar
• lack of close friends other than relatives
• excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than neg judgments about self

Question 15

Schizotypal PD tx

Answer 15

-low dose anti psychs

Question 16

Borderline PD

Answer 16

pervasive pattern of instability of interpersonal rltnshps, self-image, and affects and marked impulsivity beginning early adulthood and present in variety of contexts; indicated by 5 of following

• frantic efforts to avoid abandonment
• unstable and intense rltnshps characterized by alternating between extremes of idealization and devaluation
• identity disturbance
• impulsivity in at least 2 areas that are potentially self damaging
• recurrent suicidal behaviors, gestures, threats or self mutilating behavior
• chronic feelings of emptiness
• inappropriate intense anger, or difficulty controlling anger
• transient, stress-related paranoia or severe dissociative sx;s

Question 17

Borderline PD tx

Answer 17

• dialectal behavioral therapy, cognitive therapy

- SSRIs, MAOIs, Mood stabalizers, anti-anxiety, anti psychs

Question 18

Histrionic PD

Answer 18

pervasive pattern of excessive emotionality and attn seeking, beginning by early adulthood and present in variety of contexts; indicated by at least 5 of following

• uncomfortable when not center of attn
• inappropriate sexually seductive or provocative behavior
• displays rapidly shifting and shallow expression of emotions
• uses physical appearance to draw attn to self
• has a style of speech that is excessively impressionistic and lacking in detail
• self-dramatization, theatrically and exaggerated expression of emotion
• easily influenced by others or circumstances
• considers rltnshps to be more intimate then they are

Question 19

Histrionic PD tx

Answer 19

-psychoanaltyically oriented therapy

meds when sx;s are targeted

Question 20

Narcissistic PD

Answer 20

pervasive pattern of grandiosity, need for admiration and lack of empathy with 5 or more of following:

• has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior)
• is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• 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)
• requires excessive admiration
• has a sense of entitlement
• is interpersonally exploitative, i.e., takes advantage of others
• lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
• is often envious of others or believes that others are envious of him or her
• shows arrogant, haughty behaviors or attitudes

Question 21

Narcissistic PD: “SPECIAL”

Answer 21

S – Special
P – Preoccupied with fantasies of success, power, brilliance, love
E – Entitlement; envious
C – Conceited (grandiose self-importance)
I – Interpersonal exploitation
A – Arrogant; needs admiration
L – Lacks empathy

Question 22

Narcissistic Tx

Answer 22

psychotherapy (group)
Lithium if have mood swings
antidepressants because deal with rejection poorly

Question 23

Antisocial PD

Answer 23

Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years with at least 3 of following:
• failure to conform to social norms with respect to lawful behaviors
• deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit
• impulsivity or failure to plan ahead
• irritability and aggressiveness
• reckless disregard for safety of self or others
• consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
• lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Question 24

Antisocial PD tx

Answer 24

meds: Ritalin, antieleptic to control impulse behavior

Question 25

Avoidant PD

Answer 25

-extreme sensitivity to rejection and lead socially withdrawn life Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation • avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection • is unwilling to get involved with people unless certain of being liked • shows restraint within intimate relationships because of the fear of being shamed or ridiculed • is preoccupied with being criticized or rejected in social situations • is inhibited in new interpersonal situations because of feelings of inadequacy • views self as socially inept, personally unappealing, or inferior to others • is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Question 26

Avoidant PD tx

Answer 26

- psychotherapy | - meds if have anxiety/depression associated with it

Question 27

Main difference btwn Avoidant PD and Schizoid PD

Answer 27

- avoidant PDs have great desire for companionship but are too fearful of negative evaluation and embarrassment - schizoid have no desire for close rltnshps

Question 28

Obsessive Compulsive PD

Answer 28

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency • preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost • shows perfectionism that interferes with task completion • excessively devoted to work and productivity to the exclusion of leisure activities • is overconscientious, scrupulous, and inflexible about matters of morality • unable to discard worn-out or worthless objects even when they have no sentimental value • reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things • miserly spending style toward both self and others; money is to be hoarded • shows rigidity and stubbornness

Question 29

Main feature of OCPD

Answer 29

-perfectionism and inflexibility

Question 30

Dependent PD

Answer 30

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation• has difficulty making everyday decisions without an excessive amount of advice and reassurance from others • needs others to assume responsibility for most major areas of his or her life • has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution. • has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) • goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant • feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself • urgently seeks another relationship as a source of care and support when a close relationship ends • is unrealistically preoccupied with fears of being left to take care of himself or herself

Question 31

Dependent PD, think "OBEDIENT"

Answer 31

``` O=obsessive about approval B=bound by other's decisions E= enterprises are rarely initiated due to lack of self confidence D= difficult to make decisions I= invalid feelings while alone E= engrossed with fears of self-reliance N= needs to be in a rltnshp T= tentative about decisions ```

Question 32

Dependent PD tx

Answer 32

- insight-oriented therapy, behavioral, assertiveness training and family/group therapy - meds to tx anxiety/depression that may be associated with it