34: Personality Disorders - Streyffeler

Question 1

healthy = response in a given situation is primarily driven by _______ conditions

• responds more to _______ reality than _______ beliefts

Answer 1

current

rather than past

external reality; internal beliefs

Question 2

DSM5 definition of PD

Answer 2

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

Question 3

______ of gen pop meet criteria for PD

Answer 3

10-15%

20-30% of pts in primary care; up to 50% psych outpatients

Question 4

symptoms of PD feel _____ to pt

Answer 4

normal (ego- syntonic)

Question 5

among individuals meeting full criteria for 1 PD, ___ will meet full criteria for at least one additional PD

Answer 5

60%

it is often helpful to think about their personality style

Question 6

clusters for DP

Answer 6

A= odd, eccentric.
- includes paranoid, schizoid, schizotypal

B = dramatic, emotional, erratic
- includes antisocial, borderline, histrionic, narcissistic

C = anxious, fearful
- includes avoidant, dependent, OC PD

Question 7

• pattern of excessive distrust and suspicion of others
• others have malevolent intent
• preoccupied with trustworthiness
• reluctant to confide in others; excessive need for self-sufficiency

Answer 7

paranoid PD

be open about what you are doing and why you are doing it. Avoid becoming defensive or dismissive
acknowlege pt’s feelinga nd concerns.

Question 8

• neither desires or enjoy close relationships
• preference for solitary activities
• little interest in sexual activities with another person
• appears cold, detached, or unemotional
• insensitive to praise or criticism

Answer 8

Schizoid PD

maintain a professional style and itnerest in their well-being
respect pt privacy
ask questions because they may not volunteer information

Question 9

• discomfort with close relationships, lack of close friends or confidants AND
  odd beliefs or magical thinking
• odd perceptual experiences
• peculiar behavior or appearance
• social anxiety that trends toward paranoid fears

Answer 9

Schizotypal PD

if possible, avoid confronting the odd beliefs or behaviors and simply accept their reality
if beliefs are causing medical prob, confront gently
screen for more florid forms of psychosis

Question 10

• persistent disregard for the rights of others
• repeatedly engaging in illegal actions
• impulsivity and irresponsibility
• lack of REMORSE

Answer 10

antisocial PD

they are unlikely to follow rules of clinician-pt relationship
set and enforce clear boundaries
be mindful of possibility of drug-seeking or malingering

Question 11

• desperation to avoid abandonment
• intense, unstable, all-good or all-bad relationships
• frequent suicidality or self-injury
• reactive, unstable mood
• poorly controlled anger

Answer 11

borderline PD

relationship with hcp is also likely to be intense and either idealizing or devaluing

avoid rescuing or abandoning - be predictable and stable. establish realistic expectations and clear boundaries.

completed suicide rate 8-10%

Question 12

• desire to be center of attention at all times
• often seductive or sexually provocative
• rapidly shifting emotions
• theatrical, exaggerated
• suggestible

Answer 12

Histrionic PD

• take the dramatic nature of their communication into account with symptoms but dont dismiss
• maintain clear boundaries; set appropriate limits if pt is sexually provocative

Question 13

• sees self as superior and expects others to do the same, but self esteem is very fragile
• only wants to associate with high-status ppl
• strong sense of entitlement
• willing to use others to achieve own ends
• lacks empathy
• arrogant and haughty

Answer 13

narcissistic PD

• avoid confronting the entitlement directly
• frame suggestions with a statement about the pt deserving the best care possible

Question 14

• strong fears of criticism and rejection that lead to avoidance of activities involving interpersonal contact
• ongoing fear of shame or ridicule w/i intimate relationships
• need to be sure will be liked before entering into a relationship
• sees self as inadequate, inept and ifnerior

Answer 14

avoidant PD

pt will be very fearful of you disliking him/her
be calm, transparent and reassuring
- reassure that care-seeking was appropriate

Question 15

• requires excessive advice and reassurance to make decisions
• needs others to assume responsibility for significant life tasks and functions
• fearful of being left alone to care for self

Answer 15

dependent PD

avoid making decisions for pt
offer options and support pt in making a decisions
schedule regular visit and reward independence

Question 16

• preoccupied with details and order more than the main pt of task
• perfectionistic to a level that impairs functioning
• overconscientious and rigid around moral and ethical questions
• unable to discard worthless objects
• sees money as something to hoard

Answer 16

obsessive compulsive PD

• NOT same as OCD
• often have lengthy lists at appts or need to share minute detail
• expect perfect outcomes and service
• assume a consultant role to give pt max control
• set routine, outline options for pt
• give extra time

Question 17

increased likelihood of depression particular with cluster _

Answer 17

C (anxious fearful)

adequate tx of depression can lessen severity of PD

elevated risk of suicide particular in cluster B