Personality Disorders Flashcards
(37 cards)
What are Freud’s structures of the mind?
Id
Ego
Superego
Define Id
instinctive biological drives and desires (impulsive)
“I want”
leads to overindulgence and disregard for rights of others
think of as inner child
Define Ego
logical and language based problem solving
“I think”
balances id with external reality
Define Superego
moral conscience based on ideal and values of society
“I should”
self-critical aspect of personality
Define defense mechanisms
how ego solves problems
- resolves conflicts between desires of Id and restrictions of Superego
- keeps person connected to reality
defenses are:
~unconscious
~change with circumstances
~can be useful (coping) or harmful (pathological)
~vary by intensity or extent
Why do we use defense mechanisms?
reduce tension and anxiety
start with problem-solving and seeking rational solution–> if can’t resolve, defense mechanisms take over
When do defense mechanisms become problematic?
when 1-2 patterns are used exclusively
lead to maladaptive functioning
tendency to deteriorate into less mature defenses under distress or frustration
What are primitive defenses?
occurs naturally throughout childhood, in dreams and psychotic adults
pathological if frequently used in non-psychotic adults
rearrange external experiences to eliminate the need to cope with reality
Examples of primitive defenses
Projection
-frank delusions about external reality, projects paranoid ideas out onto the world and other people
“man who cheats on wife believes wife is too without evidence”
“mom hates herself, tells daughter she hates her”
“teacher yells at you, you think they hate you”
Denial
-refusal to accept reality because too threatening
Splitting
- seeing some people as all good and others as all bad
“patient idolizes you but demonizes previous provider or your office staff”
Examples of basic or neurotic defenses?
Displacement
-shifts sexual or aggressive impulses to more acceptable/less threatening target
“mother yells at child when actually angry with spouse”
Regression
-temporary reversion of behavior to less mature rather than handling unacceptable impulses in adult way
“adults uses baby-talk when stressed”
Somatization/Hypochondriasis
-transforming negative feeling towards others to self, pain, illness, anxiety
“student embarrassed by resident, next day has upset stomach when arriving at hospital”
Introjection/Identification
-internalizing other’s behaviors or emotions; when aware, imitation; when unaware, defense
“abused child becomes abusive parent”
Isolation of affect
-separating feelings from ideas and events, calm when talking about something emotional
“person describing murder with graphic detail but no emotional response”
Intellectualization
-focusing on and exaggerating intellectual aspect of situation to distance from anxiety
“physician focuses on test results rather than pt emotions”
Blocking
-temporarily inhibits thinking, stops momentarily
Acting Out
-covering up true feelings by discharging a different feeling, usually anger
“kid drinks alcohol to cope with divorce, fights because can’t handle intense emotions)
Reaction Formation
- converting unconscious wishes or impulses considered threatening to opposite (over-reaction); only works well short-term
“student who doesn’t like kids becomes pediatrician”
Undoing
-doing an action hoping to fix or reverse previous unacceptable ehavior
“buy flowers after fight, superstitious behavior”
Rationalization
-convinces themselves that no wrong happened and that the unacceptable is acceptable; excuse to justify behavior
“if room weren’t so noisy, better exam performance”
Passive aggressive
-aggression expressed indirectly
“delay returning borrowed dish to neighbor after dog destroys your garden”
Dissociation
-drastic change in identity or character to avoid distress, temporary
“watching trauma happen to them”
What are mature defense mechanisms?
common in emotionally healthy adults
helps integrate conflicting emotions and thoughts
Examples of mature defense mechanisms
Humor
-jokes out of being sleep deprived, laugh when fired
Suppression
- intentional and conscious decision to delay paying attention to emotional need
“physician process death after workday”
Altruism
-constructive service to others, above one’s needs so avoids discomfort
Sublimation
-transform unpleasant emotion or instinct into positive action, behavior or emotion
“angry with friend, instead of yell you chop wood or exercise”
What is the purpose of defense mechanisms?
protect us from being consciously aware of a thought or feeling we don/t want or can’t tolerate
basically allows unconscious feeling to be expressed indirectly via disguised form
What is the characteristic of personality disorders?
functional impairment of ADLs
–> unemployment, academic, family, etc
serious impairment of all aspects of life of long duration
many people have aspects but not full impairment
Describe Cluster A personality disorders
seem odd, eccentric
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Describe Paranoid Personality Disorder
overall suspicious, especially with infidelity
keeps grudges and easily offended
angry
preoccupied with loyalty and trustworthiness
suspects they have been victimized by exploitation or deception
How to manage person with paranoid personality disorder
respect accusations/complaints but DO NOT COLLUDE
be open and honest, supportive
clearly explain things, especially with mistakes
after rapport established: provide alternative explanations of other’s behavior
don’t do well in group therapy
Describe Schizoid Personality Disorder
reersed, remote, disconnected from others and social events
–> HERMET, remove themselves by choice
solitary events
little interest in sexual contact
flat affect, emotion detachment/coldness
few friends, like being alone
indifferent to praise or criticism
How to manage others with schizoid personality disorder
respect their space
do not impose social expectations
takes time to establish rapport
individual therapy, group when ready
Describe Schizotypal Personality Disorder
closer interpersonal relationships c/t paranoid or schizoid, but still display difficulty with intimacy
odd thinking and speech, magical thinking or sixth sense
unusual perceptual experiences or bodily illusions
constricted (less) or inappropriate affect
appearance is odd or eccentric
excessive social anxiety with paranoid fears
How to manage schizotypal personality disorder?
do not ridicule
respect need for privacy
similar to schizoid approach
Describe Cluster B personality types
seem dramatic, emotional, erratic
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Antisocial Personality Disorder
- Narcissistic Personality Disorder
Define borderline personality disorder
appear to be in state of crisis
short-lived psychotic episodes during times of stress d/t not able to handle emotions
–> self harm, substance abuse, high risk sexual activity
highly unpredictable
can’t be alone
identify with more inanimate objects or animals
SPLITTING
-extremely disruptive (black and white)
high comorbidity
How to manage borderline personality disorder?
dialectic behavior therapy
clear and consistent boundaries (don’t give out phone # or do anything out of the normal for your patients)
–> if they feel abandoned, will try suicide or other behavior to keep you close
adequate preparation if going to be gone to not spark their abandonment–> coordinate care
