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Flashcards in Personality Disorders Deck (42)
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1

Personality Disorder

-an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
-pervasive and inflexible
-onset in adolescence or early adulthood
-stable over time
-leads to distress and impairment

2

Egosyntonic

-behaviors do not directly distress
the person, but impact most on those with
whom the person relates
-Belief that there is nothing wrong with what they are doing (rarely seek tx)
-Personality Disorder
-Anorexia Nervosa

3

Egodystonic

-thoughts/behaviors that are in conflict with person’s ideal self-image
-They know that there is a problem with their behavior
-Obsessive Compulsive Disorder

4

Typically present to psychiatrists because behaviors is causing significant problems for ______

others

-use defense mechanisms (immature>mature)

5

Immature defense mechanisms

-Denial
-Splitting
-Acting Out
-Projection
-Projection Identification

6

Mature defense mechanisms

-Altruism
-Anticipation
-Humour
-Identification
-Sublimation
-Suppression

7

Neurotic defense mechanisms

-Displacement
-Intellectualization
-Isolation
-Rationalization
-Reaction Formation
-Repression
-Undoing

8

Cluster A

-"weird"
-"odd/eccentric"
-Paranoid Personality Disorder
-Schizoid Personality Disorder
-Schizotypal Personality Disorder

9

Cluster B

-"wild or "dramatic/emotional/eccentric"
-Antisocial Personality Disorder
-Borderline Personality Disorder
-Histrionic Personality Disorder
-Narcissistic Personality Disorder

10

Cluster C

-"worried"
-“Anxious, Fearful”
-Avoidant Personality Disorder
-Dependent Personality Disorder
-Obsessive-Compulsive Personality Disorder

11

Paranoid Personality disorder

-Cluster A
-Intense suspicion & distrust towards others

-project the responsibility onto others

-hostile, irritable, hypersensitive, angry
-rarely seek treatment
-men>women

12

Paranoid Personality Disorder criteria

4+ of the following:
1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
2. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
4. reads hidden demeaning or threatening meanings into benign remarks or events
persistently bears grudges (i.e. is unforgiving of insults, injuries, or slights)
5. perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counter-attack
6. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

13

Qualities of Paranoid Personality Disorder

-Formal in manner
muscular tension, hypervigilant, perpetual scanning when under stress
-Speech : goal directed and logical
-*projection*, prejudice, occasional ideas of reference

14

Difference between Paranoid Personality Disorder and Paranoid Schizophrenia is that Paranoid Schizophrenia has

hallucinations and deterioration in functioning

15

Schizoid Personality Disorder

-"Loners"
-no friends, no interests
-Socially withdrawn, introverted with little external affect
-often feel no need to form emotional ties with others
*they are able to recognize reality
*Like to be alone, don’t want to have friends
-Understand reality, not psychotic, probably wont be in clinics/drs offices

16

Schizoid Personality Disorder criteria

-pattern of detachment from relationships
-restricted range of expression of emotions
1. neither desires nor enjoys close relationships, including being part of a family 

2. almost always chooses solitary activities 
3. has little, if any, interest in having sexual experiences with another person 

4. takes pleasure in few, if any, activities 

5. lacks close friends or confidants other than first-degree relatives 

6. appears indifferent to the praise or criticism of others 

7. shows emotional coldness, detachment, or flattened affect

17

Schizoid Personality Disorder qualities during exam

-appear ill at ease 
-rarely tolerate eye contact
-Affect : constricted, aloof, or inappropriately serious
-Speech : goal directed, avoid spontaneous conversation 

-not in therapy by choice, wont usually seem much progress with therapy

18

Schizotypal Personality Disorder

-Strikingly odd, strange
-Magical thinking, peculiar notions, ideas of reference, illusions, and derealization
-Unstable, confused with bipolar

19

Epidemiology of Schizotypal Personality Disorder

-females with fragile X syndrome

-higher with FH (family hx) schizophrenia

-monozygotic twins > dizygotic twins

20

Schizotypal Personality Disorder

-perceptual distortions and eccentricities of behavior
*5+ of the following:
1.  ideas of reference 
2. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (ex: superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations) 
3. unusual perceptual experiences, including bodily illusions 
4. odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) 
5. suspiciousness or paranoid ideation 

6. inappropriate or constricted affect 
7. behavior or appearance that is odd, eccentric, or peculiar 

8. lack of close friends or confidants other than first-degree relatives 
9. excessive social anxiety that does not diminish with familiarity and tends to be associated with *paranoid fears* rather than negative judgments about self 

21

Difference between Schizotypal personality disorder and paranoid personality disorder

paranoid personality disorder lacks the odd behavior of patients (not as eccentric)

22

Antisocial Personality Disorder

-Violate the rights of others, breaks the law (theft, substance abuse)
-Can be quite seductive (particular with the opposite sex)
-Onset: childhood – early adolescence
-Antisocial PD diagnosis: must be at least 18
-Conduct D/O :

23

Epidemiology of Antisocial Personality Disorders

-poor urban areas
-The highest prevalence is men with alcohol use disorder
-prison populations,
-men> women.
-larger families
-onset

24

Chemical imbalance with Antisocial Personality Disorder

**Low levels of serotonin (5HT, metabolite 5-HIAA)**

*High levels of free testosterone*

-Lower levels of cortisol

25

Antisocial Personality Disorder qualifications

-pattern of disregard for and violation of the rights of others occurring since age 15 years
*3+ of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness and repeated lying
3. impulsivity
4. irritability & aggressiveness (fights/assault)
5. reckless disregard for safety
6. consistent irresponsibility
7. lack of remorse

*MUST BE AT LEAST 18 YRS OLD
*Conduct Disorder with onset before age 15 years
*occurrence is not during Schizophrenia or Manic Episode.

26

Borderline Personality Disorder

-Volatile emotional life, swing wildly between idealizing and devaluating

-border between neurosis and psychosis

-extraordinarily unstable affect, mood, behavior, object relations, and self-image

-Exhibits self-destructive behaviors (cutting, scratching)

-Some report paranoid ideations when stressed and severe dissociation (may become disconnected from reality)
-women>men

27

Case from Boards: Highly disruptive hospitalized patient on the medical floor. On interview, he says some nurses are incompetent and cruel but wildly praises others.
What is this defense mechanism?

(go from being very positive to very negative back and forth with extreme emotions) Splitting

28

Borderline Personality Disorder criteria

-pattern of instability of interpersonal relationships, self-image, and affects, and a marked impulsiveness beginning by early adulthood
*5+ of the following:

1. frantic efforts to avoid real or imagined abandonment
2. unstable and intense interpersonal relationships (love them then hate them)
3. identity disturbance: persistently unstable self-image or sense of self
4. impulsivity in a least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating, eating disorder, cutting)
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours; rarely days)
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent fights)
9. transient, stress related paranoid ideation or severe dissociative symptoms

29

Clinical features of Borderline Personality Disorder

-always appear to be in a state of crisis
-brief psychotic episodes
repetitive self-destructive acts
-tumultuous interpersonal relationship
-cannot tolerate being alone
-chronic feelings of emptiness
-projective identification
-splitting

EX: Patient says “You’re going to hate me and I’m going to fire you after 2 sessions”
-Defense mechanism is pt projecting anger
-You feelings may be influenced by THEIR behaviors

30

Treatment for Borderline Personality Disorder

*Dialectical behavior therapy (DBT)- greatest for borderline personality
-good for people who self harm, strong suicidal impulses
-Overactive amygdala (signals danger)
-Prefrontal cortex is underactive (supposed to regulate an overactive amygdala)