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Flashcards in psych wk 2-personality disorders Deck (90):

t or f personality disorders are unstable and flexible

f they are stable and inflexible and pervasive


t or f the pts personality disorder can be asymptomatic and then flare up when under stress



common fts and diagnostic criteria of Personaty disorder

Maladaptive cognitive schema
Affectivity and emotional instability
Impaired self-identity and interpersonal functioning
Impulsivity and destructive behaviour


what are maladaptive cognitive schema

their perception/interpretation of the world is skewed. They misinterpret the world incorrectly eg make assumptions that are incongruent witht he reality
• They often have dysfunctional responses to things. Misinterpret innocent gesture and have extreme reaction


t or f women are more likley to have personality disorders

f. it is seen to be equal in both genders


what kind of impulsive behav might a pt with personality disorder display and why do they often end up being seen by drs

often suicide attempts

often seen by drs due to destr behaviour


what are speculated et of personality disorders



what is temperament and how will they look at this

pt can have anxious, attached, relaxed, mellow temperament). Temperament has to do with adaptability. They will look all the way back to the infant and often temperamnt will show at this time


what kind of childhood might result in personality disorder

maltreatemet and childhood neglect. It significantly inc the risk of personality disorder


which meds indicate that there is a biologic influence in PDisorders

SSRIs--pts on these tend to have dec incidence of PDs
people w schizotypal PD can espond to atypical antipsychotics


what is one of the more common PDs we see in hospital

borderline PD


Cluster a b or c
Which has anxious, fearful thinking or behavior

Cluster c


Cluster a b or c
Odd or eccentric and often socially awkward or withdrawn

Cluster a-
a is for awkward and alone


Cluster a b or c
Orderly and anxious when in isolation
May display passive aggression

Cluster c


Cluster a b or c
Dramatic emotional and erratic

Cluster b


Cluster a b or c
Which is characterized by distorted thinking and what does this entail

Delusional or paranoid thoughts


What are general feat of cluster b

Dissociation or denial
Abusive behav both physical and emotional
Splitting or dichotomous thinking--no grey area just black and white
Emotional dysregulation-react before thinking and don't modulate emtitions well


How might aggression manifest differently in cluster b and c

Cluster b
Abusive behav that is verbal and physical

Cluster c
Passive aggression-indirect displays of hostility


Beyond being orderly, anxious, fearful and passive aggressive what characteristics might you see in cluster c

Self chosen failure-they'll take on things they know they can't complete
Dysthymic-mild depression symptoms but can still fx in daily life


Cluster a disorders are

Paranoid PD
Schizotypal PD

Cluster A-pss


cluster B disorders

cluster B

borderline PD..


cluster c disorders

avoidant PD
dependent PD
obsessive compulsive PD


OCPD vs OCD which would be more perfectionistic and orderly



char of OCPD

-inhibited stubborn, rigid and -perfectionist\preoccpied w orderliness or perfection
-excess devotion to work-excluding recreation and friendships
-reluctant to delegate to tohers
-might have difficulty discarding worthless object


when something doesnt go their way does OCPD get anxious or angry

likely more angry than anxious


which PD might adapt their personality to please others and often needs excessive advice or reassurance

dependent personality disorder


dependent personality disorder how do they present

they have diff making own decisions and seek out help of others for all trivial decisions
-have a need to be taken care of
\-submissive behav
-urgently ned to replace on relationship when another one ends
-will adapt their personality to please others


why are dependent PD pts submissive and what does this put them at risk of

they are submissive because they fear loss of support ordisapproval and abandonment

this puts them at risk of abuse


which PD is desperate for relationships but does not engage in social contact d/t shyness and sense of inadequacy

avoidant PD


which cluster is avoidant PD



char of avoidant PD

socially inhibited, shy and lonely
-sense of inadequacy w low self esteem
-desperate for relationships but avoid social contact
-reluctant to take risks or try new activities as they might be embarassed


are avoidant PD avoidant d/t performance anxiety

no. they are avoidant and their default is just not to deal with things as a maladaptive way to avoid the world


what is parasuicide

the deliberate self-injury w the intent to harm oneself
-compulsive self injurious behav
-episodic self-injurious behav
-repetitive self-mutilation


is parasuicide a way of showing their needs tothe world

no its an intimate private way of self soothing.
its a maladaptive form of coping that causes a numbing effct from endorphins and natural opiates


what is a common reason that people might use parasuicide as a coping method

people who have been sexually abused or abused in toher ways dont want to live in their bodies and dont feel anything. then they self harm and can feel something


what kind of compulsive self injurious behaviour is there and what is it often relieving

trichotillomania (hair pulling out), skin picking
these are often anxiety related


when someone has a parasuicide event what must you assess

the intent behind the action. do a suicide risk assessment


which personality disordr is often highly litigious and holds grudges

what cluster is it

paranoid PD

cluster a


paranoid PD char

pervasive distrust and suspiciousness of other people
-assume oters are out to get them, harm them or humiliate them
-hold grudges, are litigious, may display pathological jealousy


why are paranoid PD often brought in to mental health facility

because they call the police on someone else


why is Tx a challenge with paranoid PD

they mistrust everyone
in rder for Tx to be success they must have insight


what kind of med can work for some paranoid PD and why do they not work for others

often dont work because the delusions are so entrenched that they cant get out


what personality disorder might be mistaken for schizophrenia, they get taken into hospital and put on antipsychotics but they dont improve

schizotypal PD


what characterizes schizotypal PD

whcih cluster is it

perceptual distortion and eccentricity
-ideas of reference
-odd beliefs or magical thinking
-flat or incongreunt emotional responses

cluster A


what do ideas of reference mean (schizotypal PD)

they might think that eg a news anchor is sending them some coded messages that only they can understand. they will take tiny bits of that info and make lg connections from it.


d/t their flat or incongruent emotional responses how might a schizotypal pt present

they might seem to be on autism spectrum. they can be avoidant and live in their own world


are schizotypal pts often overtly distressed

not gen
they mght get paranoid in a bout of distress and be hsopitalized


which PD is indifferent to praise or criticism and often lacks a desire for intimacy



schizoid PD what characteristics does it have

pervasive social detachment-dont really have opinion of relationships
-tend to be socially isolated and often chose solitary activities
-indifferent to praise or critisism. they just dont care
-lacking a desire for intimacy


which PD often has difficulty appreciating pleasure and what is this called

schizoid PD


do schizoid pts often present in hospital



which PD can be describe relationships as more intimate than they are and thinks any attention is good even if the attention is for negative reasons



char of histrionic

-inappropriate sexually seductive or provocative
-seek excitement and attn
-outwardly they may seem charming and lively but inwardly they have threatened self esteem and sense of attractiveness
-describe relationships as more intimate than they are


what could be a consequence of histrionic PD needing attn and reactions from others (in terms of what the pt might do)

they might self harm if not getting the validation theyneed
they might fall in love right awayand be too intensely focused on the relationship which pushes the othr person away


histrionic-what are they vulnerable to

coercion and higher risk behav


which PD is characteriazed by grandiosity

What does this mean

narcissistic PD

They expect recognition and think they should be seen as superior to others without cause or reason
Think they are special or unique and can only be understood by high status people or institutions


Why might a narcissistic PD not want to talk to the nurse

They think they an only be understood by high status people or institutions


What kind of people might narcissistic of pts surround themselves with

Pts with low self esteem who will validate their need for constant admiration


What char does narcissistic pd have

Think they're special and only understood by high status people or institutions
Sense of entitlement
Need constant admiration
Lack empathy and take advantage of others to achieve their own needs


What happens when narcissistic PD needs aren't being met

They can react abusively


What approach to use w narcissistic PD

Be direct
Set limits around behaviour
Iron clad care plan!


What might narcissistic PD try to do

Split the staff for their manipulative needs
Bend the rules


How much insight do narcissistic PD pts have. Consequence of this

Very little
The Tx outlook is not hopeful for them because they don't see anything wrong with themselves


Which PD has behaviour that is a self fulfilling cycle and causes exactly what thy fear- abandonment

Borderline pd


Which PD must have hx of conduct disorder before age 15

Antisocial pd


Antisocial PD how does it present

Disregard and violate the rights of others
-no remorse for wrongdoing and no empathy
-irritability and aggressiveness
-marked readiness to blame others or to offer plausible rationalization a for their behavior
History of a conduct disorder before age 15


Why can antisocial PD pass lie detector tests

They don't care
They won't get the Hr or BP inc


What might be a precursor to conduct disorder and when does it occur

Ages 6-11 they might have oppositional defiant disorder in which the kid struggles in school, gets in trouble and is aggressive


ODD can turn into conduct disorder

What is conduct disorder

Violent and criminal behaviour eg arson, property crimes, break and entering ABUSE AND TORTURE OF ANIMALS!


What is the difference between sociopathy and psychopathy

Psychopaths commit crimes against a particular person and sociopaths commit crimes against society in gen eg hurler


Does antisocial PD think anything is wrong with their health

No. Thy rarely seek help directly


What do interventions focus on for antisocial PD

Often treatment of addiction
Not curative treatment
The treatment is mandatory user parole (70% of inmates have this condition)


What are the key assessments to do for pt with antisocial PD

Quality of relationship that you're having with that person
Violence risk


What kind of impulsive behav might antisocial Pd pt have

Often other directed violence when pts needs aren't being met


What could trigger violence in antisocial Pd

When pt perceives disrespect which occurs when they think that their needs aren't being met


How is it best to manage antisocial PD

Structures consistent environment
Nurse must be self aware (pt might try to manipulate
Hold pt accountable to their behav
Sit down and write care plan with them..this is what the behaviour will be, this is what we hope the outcome will be. Disclose the rationale


Why is the hospital environ not great for borderline pd pt

They must continually make and end relationships


Borderline pd what characterizes this

Unstable relationships self image and affect
-mood lability
Fear of rejection
-unstable and intense interpersonal relationships
Recurrent suicidal behav, threats self mutilation, and gestures


Borderline pd what does their impulsivity often lead to

Default is to hurt themselves


What is a significant risk factor for borderline

Other risk factors

Maltreatment eg physics and sexual abuse!
Parental abandonment and alienation


Et of borderline

Might be genetic link as it is more common in first degree relatives
-fmri shows frontal limbus dysfunction
-psychological theories suggest that if kids exposed to abusethy develop maladaptive cog processes


What is the priority for borderline

70% of borderline pts have suicide attempt in their lifetime and 10% conplete.
Self harm risk is always very high


Char of borderline

Affective instability
Identity disturbances
Unstable personal relationships
cognitive dysfx
Dysfx or maladaptive behav


what do borderline pd fear most



how might borderine pt think of their nurse

they might idolize them *youre my favoroite nurse*


how does cognitive dysfx mandifest in borderline

black and white thinking
extreme interpretation of events
disorganzied thoughts
misconstrue env
pathologic jealousy
mild dissociative

highly sensitive to criticism
struggle to find happiness internally


what kind of dysfunctional or maladaptive behav might borderline pt have

impulsivity and self injury or parasuicide


Tx of borderline PD

primary tx is Dialectical behav therapy
low dose antidepressant or mood stabilizer could be used


what is dialectical bheav therapy

dev from buddhist principles this aims to reconnect w body
-there is a skills roup which is often run by someone with BPD in recovery and they teach skills such as describing emotions without judgement
-interpersonal effectiveness skills-conflict mgmt, empowerment, self worth, self esteem
-mindfulness skills
-distress tolerance-helping them feel distress is a normal part of life


if pt self harms what do you do

put steri strips on it and move on