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Flashcards in Personality Disorders Deck (42)
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1
Q
Personality Disorder
A
-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
Q
Egosyntonic
A
-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
Q
Egodystonic
A
-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
Q
Typically present to psychiatrists because behaviors is causing significant problems for ______
A
others

-use defense mechanisms (immature>mature)
5
Q
Immature defense mechanisms
A
-Denial
-Splitting
-Acting Out
-Projection
-Projection Identification
6
Q
Mature defense mechanisms
A
-Altruism
-Anticipation
-Humour
-Identification
-Sublimation
-Suppression
7
Q
Neurotic defense mechanisms
A
-Displacement
-Intellectualization
-Isolation
-Rationalization
-Reaction Formation
-Repression
-Undoing
8
Q
Cluster A
A
-"weird"
-"odd/eccentric"
-Paranoid Personality Disorder
-Schizoid Personality Disorder
-Schizotypal Personality Disorder
9
Q
Cluster B
A
-"wild or "dramatic/emotional/eccentric"
-Antisocial Personality Disorder
-Borderline Personality Disorder
-Histrionic Personality Disorder
-Narcissistic Personality Disorder
10
Q
Cluster C
A
-"worried"
-“Anxious, Fearful”
-Avoidant Personality Disorder
-Dependent Personality Disorder
-Obsessive-Compulsive Personality Disorder
11
Q
Paranoid Personality disorder
A
-Cluster A
-Intense suspicion & distrust towards others

-project the responsibility onto others

-hostile, irritable, hypersensitive, angry
-rarely seek treatment
-men>women
12
Q
Paranoid Personality Disorder criteria
A
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
Q
Qualities of Paranoid Personality Disorder
A
-Formal in manner
muscular tension, hypervigilant, perpetual scanning when under stress
-Speech : goal directed and logical
-*projection*, prejudice, occasional ideas of reference
14
Q
Difference between Paranoid Personality Disorder and Paranoid Schizophrenia is that Paranoid Schizophrenia has
A
hallucinations and deterioration in functioning
15
Q
Schizoid Personality Disorder
A
-"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
Q
Schizoid Personality Disorder criteria
A
-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
Q
Schizoid Personality Disorder qualities during exam
A
-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
Q
Schizotypal Personality Disorder
A
-Strikingly odd, strange
-Magical thinking, peculiar notions, ideas of reference, illusions, and derealization
-Unstable, confused with bipolar
19
Q
Epidemiology of Schizotypal Personality Disorder
A
-females with fragile X syndrome

-higher with FH (family hx) schizophrenia

-monozygotic twins > dizygotic twins
20
Q
Schizotypal Personality Disorder
A
-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
Q
Difference between Schizotypal personality disorder and paranoid personality disorder
A
paranoid personality disorder lacks the odd behavior of patients (not as eccentric)
22
Q
Antisocial Personality Disorder
A
-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
Q
Epidemiology of Antisocial Personality Disorders
A
-poor urban areas
-The highest prevalence is men with alcohol use disorder
-prison populations,
-men> women.
-larger families
-onset
24
Q
Chemical imbalance with Antisocial Personality Disorder
A
**Low levels of serotonin (5HT, metabolite 5-HIAA)**

*High levels of free testosterone*

-Lower levels of cortisol
25
Q
Antisocial Personality Disorder qualifications
A
-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
Q
Borderline Personality Disorder
A
-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
Q
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?
A
(go from being very positive to very negative back and forth with extreme emotions) Splitting
28
Q
Borderline Personality Disorder criteria
A
-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
Q
Clinical features of Borderline Personality Disorder
A
-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
Q
Treatment for Borderline Personality Disorder
A
*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)
31
Q
Histrionic Personality Disorder
A
-excitable and emotional
-colorful, dramatic, extroverted fashion
-inability to maintain deep, long-lasting attachments
-women > men
-association with alcohol use disorder
-Drug use (cocaine), sleeping with multiple partners, fired from job, sleeping with people from work, etc
32
Q
Histrionic Personality Disorder criteria
A
-excessive emotionality and attention seeking, beginning in early adulthood
*5+ of the following:
1. is uncomfortable in situations in which he/she is not in the center of attention
2. interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. displays rapidly shifting and shallow expression of emotions
4. consistently uses physical appearance to draw attention to self
5. has a style of speech that is excessively impressionistic and lacking in detail
6. shows self dramatization, theatricality, and exaggerated expression of emotion
7. is suggestible, i.e. easily influenced by others or circumstances
8. considers relationships to be more intimate than they actually are
33
Q
Histrionic Personality Disorder may be confused with Borderline PD, but borderline will also have
A
+suicide attempts, brief psychotic episodes
34
Q
Narcissistic Personality Disorder
A
-heightened sense of self-importance
-lack of empathy
-grandiose feelings of uniqueness
-Underneath, self-esteem is fragile and vulnerable to even minor criticism
35
Q
Narcissistic Personality Disorder clinical examples you may see
A
-Aging is very difficult
-Become more narcissistic
-Problems that happened with parents (usually mom) where mom told them child wasn’t good enough, etc; had an event happen in childhood
-Ex: Someone who doesn’t get a result they want and they sue a doctor to try and exert their dominance and power
-Patient calling doctor at midnight for pain meds; thinks they are very self important
-Patient will call doctor at 8pm “just to talk”
-Patient will go against you/feel disappointed when you don’t give in to what they want
-Patients have boundary issues
36
Q
Narcissistic Personality Disorder criteria
A
-grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood
*5 or more of the following:
1. has a grandiose sense of self importance (exaggerates achievements, and talents, expects to be recognized as superior )
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love)
3. believes 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/her expectations
6. is interpersonally exploitive, ie, takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings of others
8. is often envious of others or believes that others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes.
37
Q
Avoidant Personality Disorder
A
-shy, extremely sensitive to rejection
-may lead socially withdrawn lives
-great desire for companionship
-inferiority complex
*Wont get involved in relationships because they are afraid of getting hurt*
-Usually socially inept
-WANT to have relationships but are afraid
38
Q
Avoidant Personality Disorder criteria
A
-pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
*4+ of the following:
1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
2. is unwilling to get involved with people unless certain of being liked
3. shows restraint within intimate relationships because of fear of being shamed or ridiculed
4. is preoccupied with being criticized or rejected in
5. is inhibited in new interpersonal situations because of feelings of inadequacy
6. views self as socially inept, personally unappealing, or inferior to others
7. is usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
39
Q
Dependent Personality Disorder
A
-Can do little on their own, nor can they be alone
-get others to assume responsibility for major areas of their lives,
-lack self-confidence
-may experience intense discomfort when alone for more than a brief period
40
Q
Dependent Personality Disorder criteria
A
-excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
*5+ of the following:

1. has difficulty in making everyday decisions without an excessive amount of advice and reassurance from others
2. needs others to assume responsibility for most major areas of his/her life
3. has difficulty expressing disagreement with others because of fear of loss of support or approval
4. has difficulty initiating projects or doing things on his/her own
5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for self
7. urgently seeks another relationship as a source of care and support when a close relationship ends
8. is unrealistically preoccupied with fears of being left to take care of himself
41
Q
Obsessive Compulsive Personality Disorder
A
-emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness
-perfectionism and inflexibility
-NOT the same as OCD
**Egosyntonic: may be very successful, orderly, rigid, perfectionist, not flexible, high functioning, succeed in work
(OCD is egodystonic)
-May not be as functional with relationships/personal life
-Patients often have backgrounds characterized by harsh discipline
-oldest siblings, m>f
-freud: treated harshly during potty training stage “anal stage
42
Q
Obsessive-Compulsive Personality Disorder criteria
A
-preoccupation with orderliness, perfectionism, & mental and interpersonal control, at the expense of flexibility, openness, & efficiency,
*4+ of the following:
1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2) shows perfectionism that interferes with task completion ( unable to complete a project because his or her own overly strict standards are not met)
3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
5) is unable to discard worn-out or worthless objects even when they have no sentimental value
6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophe
8) shows rigidity and stubbornness.