Patient with personality disorder Flashcards
Etiology
1. Genetic Family history->substance misuse, schizophrenia Temperament 2. Psychoanalytical Getting "stuck" at stage of development Anxieties of ego failed defenses 3. Trauma->childhood trauma alters neurotransmitter, hyperarousal, HPA 4. Defenses, attachment
Features of personality disorders
Enduring Pervasive Stable Deviate from cultural norm Maladaptive
Impacts:
- Cognition->percieving self and others
- Affect
- Interpersonal function
- Impulse control
Affect, behaviour and cognition encompass
Neurodevelopment (temperament) and psychodevelopment (secure base (age 1-7)+self esteem (7-12)+self image 12-18)--> integration and self identity
Cluster A
Odd, aloof, bizarre--> neurodevelopement= Paranoid Schizoid Schizotypal
Cluster B
Dramatic Impulsive Erratic--> abandonment issues Borderline, Antisocial Narcisist, Histrionic
Cluster C
Fearful and anxious–>
inferiority, low self esteem
OCPD, Dependent, AVoidant,
Passive aggressive
Attachment theory and personality
Secure vs insecure vs disorganised
Insecure=
- Anxious-preoccupied
- Dissmisive/avoidant
- Fearful-avoidant
Insecure attachment endures through life--> unstable, destructive, inappropriate relationships cannot reflect on mind and mind of others Leads to disturbed sense of self
History
Sources of distress Comorbidities Impairment of function Complete psychiatric assessment Substance use, suicide risk, relationships, work, legal, family, social
Features of schizoid, schizotypal, paranoid
1. Schizotypal: Interpersonal/social deficits Reduced capacity for close relationships Eccenteric Cognitive/perceptual disturbances Odd thinking, ideas of reference Social anxiety
2. Schizoid: Detachment Restricted emotional expression/interpersonal relationships Solitary, indifferent Affectively detached
3. Paranoid: Distrustful Suspscious Holds grudges Perceives threats in neutral events
Features of narcissistic, antisocial, histrionic
1. Histrionic: \++Emotional Attention seeking Discomfort if not COA Shallow expression of emotion Draws attention to self physically seductive
2. Narcissitic: grandiosity Needs admiration Lacks empathy Views self as special Unwilling to recognise feelings of others Exploitative Arrogant
- Antisocial:
Disregard rights of others
Beginning
Features of avoidant, dependant, OCPS
1. Avoidant Social inhibition Inadequacy Hypersensitive to criticism Reluctant to take risks for fear of rejection
2. Dependant: Excess need to be taken care of Submissive Poor decision making, needs advices Fears solitude Clinging behaviour
3. Obsessive/compulsive Preoccupied with ordiliness Perfectionism Lack flexibility, openness, efficiency Overconscientious Stubborn Excessively rigid, devoted to work
Management of Cluster A
- Patient communication and relationship management strategies
- Antipsychotics
- Antidepressant
- Substance abuse treatment programme
Cluster B management
- Patient communication and relationship management strategies
- Psychotherapy->borderline and anti-social
- Mood stabilisers->borderline
- Substance abuse treatment programme
Cluster 3 management
- Patient communication and relationship management strategies
- Psychotherapy
- Substance abuse treatment
- Paroxetine, sertraline, fluoxetine->avoidant
Defenses in paranoid, psychiatric risks
- Projection
- Identification with the aggressor->taking on aspect of character that causes anxiety
- Repression
- Denial
- Splitting
Fear of dependence and vulnerability to hostility
History of a harsh, punitive parent
- Delusional disorder
- Depression
- Anxiety disorder
- OCD
Schizoid defenses, psychiatric risks
- Splitting
- Projection
- Denial
- Rationalisation
Apparent self sufficiency, masks both the wish for and fear of closeness
Cold, neglectful parents
- Delusional disorder
- Schizophrenia
- Anxiety disorder
Schizotypal defenses, psychiatric risks
- Denial
- Projection
- Acting out
- Fantasy
- Depression
- Anxiety
- Schizophrenia
- Delusional disorder
Antisocial defenses, psychiatric risk
- Repression
- Splitting
- Denial
Repressing powerlessness and low self worth
Rage denied and split off
Empathetic failure, need for control
Inconsistent parenting, ineffectual or harsh discipline, parental criminality/substance use
- Substance use
- Depression
- Criminality
Narcissistic defenses, psychiatric risk
- Denial
- SPlitting
- Projection
- Rationalisation
- Intellectualisation
Fear of not being the best
Inability to deal with perceived threats to self and self worth
Emotional neglect, empathetic failure, inability to form meaningful relationships
- Depression
- Dysthymic
- Substance abuse
Histrionic defenses, psychiatric risk
- Projection
- Splitting
- Fantasy
Fear of impermanence of relationships, gender identity concerns
History of perceived rejection by same sex parent and identification with opposite sex parent
Avoidant personality defenses, psychiatric risk
- Projection
- Denial
Conscious desire for closeness with fear of closeness and rejection
Relative stable sense of self although feel worthless
History of parental rejection or severe life threatening/disfiguring illness in childhood
- Depression
- Anxiety
Dependent defenses, psychiatric risk
- Denial
- Repression
Fear of abandonment
Preserved cohesive sense of self
History of separation and losses
- Anxiety disorders
- Depression
OCPD defenses, psychiatric risk
- Denial
- Reaction formation
- Intellectualisation
- Isolation of affect
Fear of anarchy of biological drives
Fear of own destructiveness
Authoritarian and moralising parenting inducing shame and guilt
- Anxiety disorders
- Depression
