Approach to Personality Disorders Flashcards
What is the Id
Instinctive biological drives and desires
What is the Ego
Logical and language based problem solving
What is the SuperEgo
Moral conscience based on ideal and values of society, “I should”
What is the purpose of defense mechanisms
Reduce tension
- Rationally seek solution
- if cant resolve -> defense mechanism
in whom do primitive defences occur
- Childhood
- Dreams
- Psychotic Adults
What is projection
grossly frank delusions about external reality. Self projects paranoid ideas out into the world.
Wife cheating because I am cheating
What is denial
Refusal to accept terms of external reality because it is too threatening
a 200 board score applies to Vascular Surgery residency at Johns hopkins
What is splitting
Seeing some people as all good and other as all bad. Often seen with Borderline Personality Disorder
pt idolizes doc but hates nurses
What is displacement
Shifts sexual or aggressive impulses to a more acceptable or less threatening target
Doc yells at nurses after a frustrating patient
What is regression
Temporary reversion to an earlier less mature, behavior
adult begins baby talk when stressed
What is somatization
Transforms negative feelings towards others into negative feelings towards self, pain, illness, anxiety
Student embarrassed by resident, stomach ache before rounds
What is introjection/identification
Opposite of projection. involves taking in other behaviors or emotions and internalizing them.
Abused child becomes abusive parent -or-
Christian and Tanner watch too much letterkenny and I suggest you let that one marinate!
What is isolation of affect
Separate feelings from ideas and events
-la belle indifference seen in conversion DO and Alzheimer’s
Person describes murder in graphic detail with no emotion
What is intellectualization
focusing on and exaggerating the intellectual aspect of a situation so as to distance oneself from anxiety
physician focuses on lab results rather than patient emotion.
What is blocking
temporarily inhibits thinking. Can include affect and behavior. Individual stops momentarily
like a pause button
What is acting out
Covering up true feelings by discharging different feelings
bullies
What is Reaction Formation
Converting unconscious wishes or impulses considered threatening into their opposite (over reaction)
Student who does not like kids becomes pediatrician
What is undoing
Do an action hoping to fix or reverse a previously unacceptable behavior
-seen in bulimia, domestic violence
what is Rationalization
Individual convinces themselves that no wrong happened and that the unacceptable is acceptable
Yes we killed civilians but we were at war, and were ordered to
What is passive aggression
Aggression towards others expressed indirectly or passively
you need to return a bowl to neighbor but delay because dog destroys garden
What is dissociation
Drastic change in identity or character to avoid stress. Common in PTSD, Substance abuse
Individual describes assault as if they were out of their body watching it
what is humor (mature defense mechanism)
Overtly expressing ideas and feelings especially those too terrible to talk about
I guess I’ll go fuck myself
What is suppression
Conscious and intentional decision to delay paying attention to an emotional need
after pt dies, physician continues working and will deal with it later
What is altruism
Constructive service to others
I want to go to allison’s birthday but the stupid floor piss baby needs me - Abbey and Bill Probably
What is sublimation
Transform unpleasant emotion into positive action
angry with PCM but instead you
exercise
Paint
Clean
What separates someone from being a little quirky compared to having a full blown personality disorder?
The extent of their functional impairment.
The difference between, “ugh my pencils aren’t aligned on my desk” and I will spend 1-2 hrs making sure everything is perfect or I cant start work.
To have a personality disorder, a person must display an enduring pattern that deviates from expected culture. The pattern must manifest in 2/4 of the following. What are the 4 areas
- Cognition
- Affectivity
- Interpersonal Functioning
- Impulse control.
What are the group A personality disorders
Schizotypal
Paranoid
Schizoid
What are the group B personality disorders
Borderline
Histrionic
Anti-social
Narcissist
What are the group C personality disorderss
Dependent
Avoidant
OCPD
What is Paranoid personality disorder
suspicious, grudge holding, angry person who suspects they are being victimized by exploitation or deception
How do you manage paranoid personality disorder
Be supportive
Respect pts thoughts but dont collude!
Be open Honest and respectful
Explain everything and dont cover up mistakes
once rapport is established, provide alternative explanations
What is Schizoid personality disorder
removed and remote due to self isolation from lack of interest in socialization
Solitary people, little interest in sexual contact with others
flat affect
How do you manage schizoid personality disorder
Respect their space
Don’t judge disconnection
Do not impose social expectations
What is Schizotypal personality disorder
Closer relationships than Paranoid or Schizoid - but still difficulty with intimacy
Odd, magical thinking
Delusions of reference and unusual perceptual experiences
Excessive social anxiety
How do you manage schizotypal personality disorder
Do not judge or ridicule
Describe Borderline Personality Disorder
Appear in a state of crisis, highly unpredictable, cannot tolerate being alone, splitting, high comorbidities
How do you manage Borderline Personality disorder
Form clear and consistent boundaries
be calm in your responses
Never provide special exceptions (phone call on holidays)
Refer to Dialectical Behavior Therapy
Describe histrionic personality disorder
Needs to be center of attention and may use seductive behavior to accomplish that.
Increased risk for somatic symptom disorder, conversion disorder, and depressive disorders
How do you manage histrionic personality disorder
Maintain boundaries
Provide reassurance
Address seductive behaviors in straightforward manner while maintaining professional boundaries
Describe Antisocial Personality disorder
Pervasive disregard for violation of rights of others
- steal
- con
- aggressive
Individual must be 18 for diagnosis but patterns appear at 15
Incorrectly referred to as psychopath/sociopath
How do you manage Antisocial personality disorder
Firm limits
Clear and consistent boundaries
Caution when prescribing controlled substances
Describe NArcissistic personality disorder
requires excessive admiration
entitled
Envies others or believed they are envied
Often feel contempt for others
How do you manage Narcissistic personality disorder
Acknowledge patient as special
Avoid power struggles
reinforce that they are respected and special
monitor for depression/suicidality
What is avoidant personality disorder
pervasive pattern of social inhibition with feelings of inadequacy
- doesn’t want to hang out unless they know they are liked
- unusually reluctant to take personal risks for new activities
How do you manage Avoidant personality disorder
Avoid critical comments
reinforce appropriate help seeking behaviors
Be patient with your patient
What is dependent personality disorder
need to be taken care of leading to submissive/clinging behavior
Subordinate their own needs to the needs of others and may accept demeaning tasks to gain acceptance.
How do you manage dependent personality disorder
Tolerate repeated requests for reassurance
Schedule pre-established times
be careful when encouraging changing an abusive relationship
Describe obsessive compulsive personality disorder
Preoccupied with details, rules, lists, order, organization, or schedules
Perfectionism that interferes with task completion
Limited interpersonal skills, unwilling to compromise
How do you manage OCPD
Avoid power struggles
Allow patient to have control when they can (XR med QD or IR med BID)
Encourage limited information-seeking (or else they come back saying LOOK the DSM told me….)
