Personality Disorders 3 Flashcards
(62 cards)
1
Q
- Provide reassurance, validate patient’s concerns
- Encourage reporting of symptoms and concerns
A
Provider strategies for provider tx pt w/ Avoidant PD
2
Q
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
A
Narcissistic PD
3
Q
- demanding, entitled attitude
- Excessive praise toward caregiver may turn to devaluation, in effort to maintain sense of superiority
- Denial of illness or minimization of symptoms
A
Problematic behavior of pt w/ Narcissistic PD
4
Q
- Dramatic and urgent demands for medical attention
- Angry outbursts at provider if not responded to
- Patient may contribute to prolong illness or encourage medical procedures in order to get attention
- May abuse substances and medications
A
Problematic behavior of pt w/ Dependent PD
5
Q
- 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.
A
Avoidant PD
6
Q
Supportive psychotherapy
- Establish and maintain a treatment alliance
- Provide patient with understand of their diagnosis and problems → avoid labeling patient as _____.
- Help patient develop more complete awareness of maladaptive behaviors
- Work with patient to identify realistic, attainable goals
- Therapist provides encouragement, reassurance, advice, and coaching, while modeling adaptive behavior
A
Tx for Narcissistic PD
7
Q
- 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.
A
Avoidant PD
8
Q
Mnemonic for Narcissistic PD
A
S – special (believes they are special and unique)
P – preoccupied with fantasies (unlimited success, power, brilliance…)
E – envious
E – entitlement
E – excess admiration required
C – conceited (grandiose sense of self importance)
I – interpersonal exploitation
A – arrogant (haughty)
L – lacks empathy
9
Q
- Provide reassurance and schedule frequent periodic check-ups
- Be consistently available but provide firm realistic limits to availability
- Enlist other members of the health care team in providing support for patient
- Help patient obtain outside support systems
- Avoid hostile rejection of patient
A
Provider strategies for pt w/ Dependent PD
10
Q
- Flirtatious and seductive
- Creative and imaginative
- Play hunches rather than thinking things out
- Spontaneous without thought to consequences
- Lack analytical ability
A
Histrionic PD
11
Q
- 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.
A
Dependent PD
12
Q
- Personality style → dramatic
- Predominant theme → excessive emotionality and attention seeking
A
Histrionic PD
13
Q
Mnemonic for Dependent PD
A
D – difficulty making everyday decisions
E – excessive lengths to obtain nurturance and support from others
P – preoccupied with fears of being left to take care
E – exaggerated fears of being unable to care for himself or herself
N – needs others to assume responsibility for his or her life
D – difficulty expressing disagreement with others
E – end of a close relationship is the beginning of another relationship
N – noticeable difficulties in initiating projects or doing things on his or her own
T – “take care of me” is his or her motto
14
Q
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
A
Histrionic PD
15
Q
•Substance abuse disorders
A
Comorbid disorder for Histrionic PD
16
Q
- Outright rejection of patient’s demands, resulting in patient distancing self from caregiver
- Excessive submission to patient’s grandiose stance
A
Problematic behavior of provider tx pt w/ Narcissistic PD
17
Q
- 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.
A
Narcissistic PD
18
Q
- Depression is common due to fragile self-esteem
- Lying to oneself by distorting the facts so they feel more important
A
Narcissistic PD
19
Q
Early development
- Hypersensitive due to parental criticism
- Difficulty temperament produces early rejection
A
Avoidant PD
20
Q
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
A
Avoidant PD
21
Q
- May not be forthcoming about symptom severity, may easily agree with provider out of fear of not being liked
- Tend to withhold information
- Avoids questioning / disagreeing with providers
A
Problematic behavior of pt w/ Avoidant PD
22
Q
•Risk major depression if they lose the person they depend on
A
Dependent PD
23
Q
Cognitive behavioral therapy
- Focus on breaking the negative cycle of avoidance
- Identify and correct dysfunctional attitudes and thoughts
- Reduce negative thought patterns and build social skills
- Graduated exposure to social situations
- Learn skills to improve intimacy
A
Tx for Avoidant PD
24
Q
- 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.
A
Narcissistic PD
25
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Narcissistic PD
26
Mnemonic for Histrionic PD
P – provocative (or seductive) behavior
R – relationships, considered more intimate than they are
A – attention, must be at center of
I – influenced easily
S – speech (style) - wants to impress, lacks detail
E – emotional lability, shallowness
M – make-up - physical appearance used to draw attention to self
E – exaggerated emotions – theatrical
27
•Development linked to early disruptions in learning independence
Dependent PD
28
* Has a style of speech that is excessively impressionistic and lacking in detail.
* Shows self-dramatization, theatricality, and exaggerated expression of emotion.
* Is suggestible (i.e., easily influenced by others or circumstances).
* Considers relationships to be more intimate than they actually are.
Histrionic PD
29
* Show extreme pleasure as the center of attention and who behave in whatever way necessary to ensure that this happens
* Exaggerated emotional reactions, approaching theatricality, in everyday behavior
* Need for immediate gratification → demand reassurance, praise or approval
Histrionic PD
30
* Overly dramatic, attention seeking behavior, with tendency to draw caregiver into excessively familiar relationship
* Inadequate focus on symptoms and their management, with over emphasis on feeling states
* May provide answers they believe provider wants to hear
* Tendency to somatize
Problematic behavior of pt w/ Histrionic PD
31
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Avoidant PD
32
* Inability to set limits to availability, thus leading to burnout
* Hostile rejection of patient
Problematic behavior of provider tx pt w/ Dependent PD
33
* Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
* Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
Narcissistic PD
34
Individual psychotherapy
•Solution-focused therapy → short-term alleviation of difficulties within the patients life
Tx for Histrionic PD
35
* Is preoccupied with being criticized or rejected in social situations.
* Is inhibited in new interpersonal situations because of feelings of inadequacy
Avoidant PD
36
* 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).
Dependent PD
37
* Generous validation of patient’s concerns, with attentive but factual response to questions
* Allow patients to maintain sense of competence by rechanneling their “skills” to deal with illness, obviating need for devaluation of caregivers
* Present treatment recommendations in the context of their right to the best care
Provider strategies for tx pt w/ Narcissistic PD
38
•Mood disorders, social phobia, obsessive-compulsive disorder, eating disorders
Comorbid disorders of Dependent PD
39
* Is uncomfortable in situations in which he or she is not the center of attention.
* Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
Histrionic PD
40
* Feeling overly concerned for the patient, taking on a paternalistic role that may increase patient’s sense of inadequacy
* May feel angry and betrayed by patient if the patient’s symptoms turn out to be more extensive than initially reported
Problematic behavior of pt w/ Avoidant PD
41
* Personality style → devoted
* Predominant theme → feelings of inadequacy, inability to make own decisions, submissiveness, avoidance of confrontation for fear of losing source of support
Dependent PD
42
* Mood disorders, social phobia, obsessive-compulsive disorder, eating disorders
* Schizoid PD, obsessive-compulsive PD
Comorbid disorders of pt w/ Avoidant PD
43
Individuals often appear anxious or fearful
* Avoidant
* Dependent
* Obsessive-compulsive
Cluster C
44
* Bipolar I disorder, depression, substance abuse disorders, anxiety disorders
* Paranoid PD
Comorbid disorders of Narcissistic PD
45
A _pervasive and excessive_ need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts
Dependent PD
46
* Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs
* Manipulative, self-centered, take advantage of others
Narcissistic PD
47
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Dependent PD
48
A _pervasive_ pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts
Histrionic PD
49
* Difficulty making everyday decisions → will cling to other people
* Difficulty disagreeing with other people for fear that they will lose their temper
* Extremely passive
Dependent PD
50
Mnemonic for Avoidant PD
A – avoids occupational activities
V – views self as socially inept
O – occupied with being criticized or rejected
I – inhibited in new interpersonal situations
D – declines to get involved with people
E – embarrassed by engaging in new activities
R – restrains from intimate relationships
51
* Performing excessive workup (when patient is dramatic) or inadequate workup (when patient is vague)
* Allowing too much emotional closeness, thereby losing objectivity
* Frustration with patient’s dramatic or vague presentation
Problematic behavior of pt w/ Histrionic PD
52
* Difficult to treat for a multitude of reasons
* Present for treatment only when a situational factor (stress) has made their ability to function and cope effectively impossible
* Much quicker to seek treatment and exaggerate their symptoms and difficulties in functioning
* Emotionally needy → often reluctant to terminate therapy
Tx for pt w/ Histrionic PD
53
* Many can function in a protected environment
* Some marry, have children and live lives surrounded only by family members
* If support system fails they are subject to depression, anxiety and anger
Avoidant PD
54
* Personality style → sensitive
* Predominant theme → social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Avoidant PD
55
* 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.
Dependent PD
56
* 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.
Dependent PD
57
Cognitive behavioral therapy
* Focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking
* Inability to make important life decisions
* Inability to initiate relationships
* Target skills that foster independence → avoid fostering independence from healthcare system
Tx for Dependent PD
58
* Personality style → self-confident
* Predominant theme → grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
Narcissistic PD
59
* Feel like they don’t measure up to others
* Fearful of, any involvement with other people and is terrified at the prospect of being publicly embarrassed
Avoidant PD
60
61
* Show respectful and professional concern for feelings, with emphasis on objective issues
* Avoid excessive familiarity
Provider strategy for tx pt w/ Histrionic PD
62
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts
Narcissistic PD
