2/16: Personality and Impulse Control

Question 1

Definition of personality disorders

Answer 1

enduring pervasive/inflexible behavior different from cultural expectations @ adolescence/early adult –> impairment
(stable over time)

Question 2

are traits a disorder?

Answer 2

NO

Question 3

prevalence of personality disorders

Answer 3

10-20% of general population

Question 4

when do personality disorders typically begins?

Answer 4

start in late adolescence, often with signs in childhood

established patterns in adulthood

Question 5

late-onset personality changes

Answer 5

suggestive of undiagnosed “other” problems (dementia, substance abuse, medical illness, neuro problems)

Question 6

what do personality trait feature predict?

Answer 6

1) health and mortality, 2) academic success, 3) job performance, 4) capacity for lasting relationships, 5) drug abuse and criminality

Question 7

Early experiences: Sigmund Freud

Answer 7

“fixation at an early stage prevents healthy personality development

Question 8

Early experiences: Erickson

Answer 8

1) certain tasks need to be mastered at certain stages of development
2) must have “basic trust” (w/mistrust, the stress of chronic chaos negatively regulates neuro-bio development)

Question 9

effects of extended early emotional trauma and abuse

Answer 9

adversely affect coping skills + brain dev

Question 10

_ are over-represented in the medical population.

Answer 10

Traumatized pts

Question 11

what are defense mechanisms

Answer 11

cognitive strategies to help deal with stressful information

Question 12

examples of defense mechanisms

Answer 12

early trauma is often “repressed” (i.e. not accessible to conscious memory)

more on p77 (table 9.1)

Question 13

three personality clusters

Answer 13

weird, wild, worried

p390 (table 49.2)

Question 14

Cluster A

Answer 14

WEIRD:

odd and eccentric ppl

Question 15

personality disorders of Cluster A

Answer 15

paranoid, schizoid, schizotypal, bio relatives of ppl w/schizophrenia

Question 16

paranoid personality

Answer 16

• always looks for wrong-doing and hidden malicious meaning
• rigid, defensive, self-righteous
• suspicious of partner fidelity
• preoccupied with doubts of others’ motives
• very unforgiving of mistakes
• use defense mechanism of projection (blaming)

Question 17

schizoid personality

Answer 17

• solitary loner: do NOT want close relationships
• take pleasure in few, if any, activities
• emotionally cold, detached
• choose solitary jobs and night shifts
• may be the premorbid phase of schizophrenia

Question 18

how does social phobia (social anxiety) differ from schizoid personality?

Answer 18

social phobia: DESIRE friends (unlike schizoid)

• afraid of embarrassment
• avoids social contacts bc of anxiety

Question 19

Schizotypal personality

Answer 19

cognitive/perceptual distortions –> odd enough to think psychotic, but truly NOT (pt is still in touch w/reality)

Question 20

Features of schizotypal

Answer 20

• distortions when not on drugs
• odd appearance and speech (vague, metaphorical, over-elaborate)
• no close friends or associates
• suspicious, magical thinking but still in touch with reality
• can be the premorbid phase to schizophrenia

Question 21

Cluster B

Answer 21

DRAMATIC: emotional, erratic

Question 22

characteristics of Cluster B

Answer 22

• impulsive erratic mood swings
• life long pattern of instability
• short attention span and seek excitement
• intense, stormy relationships: multiple marriages + divorces
• somatization (inc somatic complaints that are out of prop during stressful times)

Question 23

defense mechanisms of Cluster B

Answer 23

denial, projection, somatization

Question 24

Cluster B and bipolar illness

Answer 24

• chaotic lifestyle, often mistaken for “bipolar”

- if Cluster B, will NOT improve with Rx (except if +psychotherapy)

Question 25

Antisocial personality disorder

Answer 25

SOCIAL, but defies social rules (≠antisocial)

-must be 18 or older for dx, shown evidence of conduct disorder with onset before age 15

Question 26

key feature of antisocial personality

Answer 26

No conscience ("moral imbecile")
-life long pattern, never at fault/no guilt or remise, social class differences, attracted to other Cluster B partners, chaotic family life, multiple marriages-superficial charmers

Question 27

histrionic personality disorder

Answer 27

• multiple somatic complaints
• highly suggestible, naive
• sexually seductive, often unaware
• emotionally labile
• imprecise and global in verbal descriptions
• FHx of antisocial and EtOH
• choatic family

Question 28

narcissistic personality

Answer 28

• grandiose sense of self-importance and entitlement
• overlaps with antisocial
• preoccupied with self
• may be arrogant, devalues others
• demanding of special tx
• may become suicidal when rejected
• chaotic family life

Question 29

borderline personality

Answer 29

• unstable moods/mood swings
• stormy relationships, poor choices
• often confused with “bipolar”
• all or nothing thinking (known as splitting)
• chaotic family lives

Question 30

features of borderline

Answer 30

• substance abuse/mis-use
• hx of severe physical, emotional, or sexual abuse
• alcoholic or mentally ill parent
• self-injurous behavior (e.g. wrist slashing, self-stabbing, piercing, cutting to see blood)
• suicidal gestures and attempts
• chronic feeling of emptiness, relieved by pain and by seeking relationships

Question 31

defense mech of borderline

Answer 31

splitting

Question 32

examples of borderline behavior

Answer 32

• pt in acute emotional distress
• seems to require “special” tx
• causes a great deal of strife and confusion
• splitting
• rapid shifts in mood and manner
• boundary issues
• unstable relationships

Question 33

splitting

Answer 33

• seeing the world in black and white
• playing ppl against each other
• causes discord and stress in environment
• a defense mech
• feel despair and agitation

Question 34

Cluster B disorders

Answer 34

antisocial, histrionic, narcissistic, borderline

Question 35

Cluster C

Answer 35

WORRIED: anxious, fearful

Question 36

Cluster C disorders

Answer 36

OCD, dependent, avoidant

“compulsive, clingy, cowardly”

Question 37

obsessive-compulsive PERSONALITY disorder

Answer 37

• rigid, orderly, miserly, “anal”
• excessive devotion to work, humorless
• hoarders
• sticklers for rules, details
• schedule everything
• upset when things don’t go by plan

Question 38

dependent personality

Answer 38

• excessive need to be cared for
• urgently seek attachments
• cannot be alone or make independent decisions
• clinging, insecure

Question 39

avoidant personality

Answer 39

• closely linked to anxiety disorder
• can’t take risks
• avoid conflict, responsibility
• procrastinate
• passive-aggressive behavior
• go to great lengths to avoid being judged
• example: can’t finish college degree for fear of judgment and having responsibility

Question 40

approaching tx of personality disorders

Answer 40

1) listen
2) maintain calm and good, firm boundaries
3) find and support the pts strengths
- psychological issues (including dysfx defense mech) must be considered

Question 41

impulse control disorders

Answer 41

oppositional-defiant disorder
intermittent explosive disorder (losing self-control)
Kleptomania (habitual stealing)
pyromania (habitual fire-setting)
pathological gambling
trichotillomania
*all are closely linked to antisocial personality disorder

Question 42

gambling disorder

Answer 42

addictive disorder + impulse problem

Question 43

trichotillomania

Answer 43

impulsive hair pulling

-impulse problem + OCD

Question 44

excoriation

Answer 44

skin picking

-impulse problem + OCD

Question 45

tx options for personality disorders

Answer 45

• antisocial personality: legal
• other disorders: supportive and caring approach that includes firm limits and boundaries
• psychotherapy
• meds if the pt is also suffering from a mood or anxiety disorder

Question 46

contextual model for psychotherapy

Answer 46

therapist confidence
belief in tx
relationship b/w pt and therapist
rational for the tx
the pt's meaning to the therapy

Question 47

defense mechanism of paranoid personality

Answer 47

projection (“blaming”)

Question 48

how does OCD differ from OCPD?

Answer 48

OCPD: behavior consistent w/one’s own beliefs and attitudes
OCD: aware of the disorder and don’t like it

Question 49

intermittent explosive disorder

Answer 49

experience sudden bursts of anger, assault of others, or destruction of property; aggression disproportionate to the triggering event, and not seen b/w episodes; men + 1˚ relatives of affected persons at higher risk

Question 50

intermittent explosive disorder + predisposing factors

Answer 50

perinatal trauma, head trauma, encephalitis, hyperactivity, disrupted psychosocial environment

Question 51

intermittent explosive disorder + best tx

Answer 51

psychotherapy + Rx (SSRIs-fluoxetine, paroxetine, sertaline)

Question 52

kleptomania

Answer 52

impulse sto steal, relief of tension after the act reinforces the behavior, MC in women

Question 53

kleptomania + assoc w/?

Answer 53

brain disease, mental retardation, faulty monoamine metabolism, cortical atrophy, enlargement of lateral ventricles, focal neuro signs

Question 54

pyromania

Answer 54

repetitive, deliberate fire-setting; relieves tension or from attraction to fire/firefighting equipment; Men + ppl w/mentally retardation, alcoholism, or delinquent traits