Personality d/ ch 18

Question 1

Ten personality do

Answer 1

antisocial pd
avoidantpd
bpd
dependent pd
historionc pd
narcisstistic pd
ocpd
paranoid pd
schizoid pd
schizotypal pd

Temperatment - inborn tendencies to react in certain ways to new experiences or challenges. It becomes stable by age 2 and stability of personality traits evident by age 3.

Character not present at birth.Self directness, cooperativeness, self transcendence.

Personality sturcture - extraversion, agreeableness, neurotcisim, conscientiousness, opennes.

1. Person do have strong genetic influence and components within each personality do,
2. Personality do have been found to improve,

Personoality diosrders impair functioning by lack of educational attainment, problems with marital relationships, interpersonal relationships, employments, and social functioning.

PD inlduenced by conflict between personality traints and demands of culture.

Genetics 30-80% heritability.
childhood abuse, trauma, .

Question 2

Clusters

Answer 2

A - odd- eccentric - schizotypal, schizoid, paranoid
B - dramatic - emotional - BPD, antisocial, narcissistic, histrionic
C - anxious- fearful - avoidant, dependent, ocpd

Most amenable to tx - C
Least amenable - bpd, ppd, asps, npd,
Untreatable - npd and aspd severe cases.

Question 3

TX

Answer 3

• DBT bpd
• psychodynamic bpd
• behavioral therapy avpd
• cbt aspd.

Pharmacotherapy targets four symptoms clusters

1. cognitive-perceptual (antispychotic_
2. impulsivity and agression,(SSRI, antipsychotics)
3. mood instability (SSRI, AA, lithium)
4. anxiety-behavioral inhibition (SSRi, Maoi)

75% of bpd pts will attempt suicide.
Tx of Axis I do usually measure in terms o syndromal variation (whether pt meets criteria).
Tx of PD measured in terms of symptoms

Question 4

Cluster A ODD- eccentric

Answer 4

1. Paranoid PD - Heritability 28%, males, child hood abuse, insecure attachments patterns.
   May seek tx for anxiety, depression or SA do, suspicious without cause, read hidden meanings, unforgiving, lack sense of humor, unable to read social cues.

Tx - do not do well with group therapy. Antipsychotic, Lithium.

Have problems living and working with others.

2. Schizoid PD - splitting or cleaving, shut in or reclusive. , aloofness, lack desire to be in close relationships, not even part of family, solitary activist, indifference to approval or criticism of others. social isolation does not bother them.
   TX - indicifual psychotherapy, Cbt, reduce fear of engulment. Riperidone, benzos. .
   Begins n early childhood and stabilizes over time.
3. Schizotypal - schizophrenic like , deficits in interpersonal relationships and distortions in cognition and perceptions similar to schizophrenia but to a lesser degree. Imparied functioning in many domains.
   Males, structural bain abnormalities FL, temproal deficites.
   Hyperarousla to exernal stimuli, impairment of smooth puriseye movmemtn.
   Hx of birth complications, childhood abuse.

Presetnation: exposure to severe stresor may increase symptoms or cause psychos. See self as defective, disturbances of thinking, superstitious or paranoid, odd behaviors, eccentric, peculiar dress or unkempt, do not nave many friends, social network limit to family.

Tx supportive therapy, cognitive psychotherapy. Low dose antipsychotic. Olanzapien. CY.

Question 5

Dimensions

Answer 5

cognitive-perceptual organization
Impulse control
Affect regulation
Anxiety modulation

Question 6

Cluster B -

Answer 6

1. ASPD - exploitative and irresponsible behaviors, density or violate the rights of others, hx of CD before age 15. Lifelong tendency to commit crimes. Lack remorse.

Males, omeless, addiction, incarcerated. genetic predisposition, abn of brain development, childhood abuse, negative social influcednces. Heritability 68%. Poverty, parental incarceration. , lack of parental supervision.

Bio - réductions in brain volume.
Presetnation - bedweeting, hitting others, lying, aggressive, fire setting, cutely to animals, running away.
They do not show irritability, depression, or irrational thinking. avid responsibility for actions and abuse substance.

Tx - psychotherapy CBT, anticonvulsants, AAa, queitapie, dilantin. BB.

2. BPD - characterized by a pattern of emotional deregulation, mood instability, intense interpersonal relationships, impulsivity, intense anger, recurrent suidcidal threats, self mutilating behaviors, problems wit sense of identity, feeling os emptiness, and frantic efforts to avoid abandonment.

In feamles, co occurring eating do , identity disturbance, PTSD. Onset 18 yr.

Etio - genetic influence heritability 69%.
abn brain development, poor fit child temper and parent ability to meet needs, adviser child experiences, unstable early environments, parental psychopathology, absence of protective factors.

BPD cx by high harm avoidance and high novelty seeking. soft neurological signs.

Presetnation - cognitive impariment all black or white thinking, unusual perceptions, odd reasoning,

Emotional dysregualtion - verbal outbursts of intense nger, empty, feeling breed,

Fragild self concept - high level of interperonsal dependency, unstable goals, values, friends, ideas. chaotic relationships, difficulty tolerating being alone, fear of abadhonement,

Behavioral dyrselation, impulsive behavior, SA abuse, promiscuity, SIB, maladpative defense mechanism.

Tx - DT, ACT, structure is essential, cbt, .

Cognitive-
AA, olanzaopine, risperidone, ariprippazole.

Afective dyregulation - SSRI

impulsive - lamictcal, divalproxes, tegretol.

3. Histrionic - excessive emitonality, attn seeking, concern for appearnce, flighty thinking, dramatic behaviors, .Temper tantrum, outbursts of anger to minor events.
   Age of onset is 25.
   Heritabilyt 67%
   child maltreatment

tx - CBT, suportive therapy, CBT. No pharmacological trial. Rapid, intense, shifting, emotions, act on emotions emotions without thinking about them logically.

4. Narcisstic - high sense of self importance and grandiose belief, special unique, entitled, inexhaustible need for admiration, lack empathy, egotistical, cannot accept the success of others.

Arrogant
condenscending
desire to be admired
hypersnsitivity to ciriticism and feeling injured easily
diffciutlmy amitian a sense of self esteem
having am nay fantasizes but few accomplishments
readily blaming others
cosnpiuous lackof empathy
highly self referential .

Coomon in men.

Question 7

Cluster C

Answer 7

1. Avoidant PD - shame, guilt, fear of being rejected, unworthy of love, hypersentsititvy, feeling of inadequacy. social ineptness, and defectiveness. Exteme
   Crave relationships
   TX - supprotive therapy, SSRI for anxiety., 2ndline neuron tin ,buproprion, and benzos, BB.
2. Dependent PD- inadequate, incompetent,, helpless, lack self-confidence, put needs afar others needs. didfulty making decisions. Separation anxiety, uses ingratiating, provides helot to others, frightens other by usin threats of self harm. toleratate expletive coworkers and perform demeaning jobs imply to be part of the group. Risk of domestic abuse.

Risk chronic illness in child hood, childhood depression, heritability 57%, childhood neglect. .

Core feature is need to obtain and maintain nurutuin and supportive relationships. Distressed is alone. Often wish they were more independedn and autonomous.

Tx - CBT, FT, Couples, therapy, group therapy. No psychotropics.

3. OCPD - preoccupation wit orderliness, perfectionism, control, detail, overconscietnious, rluctance, to delegate tasks, miserliness, and rigitidy. . Their degree of perfectionism interpfers with completing a task and reaching their goals and impair ucntioning in interpseonal relationships and vocational situations.

More common in men, oldest child, heritability is 78%,. May become critical and self devaluing if severe stressors., May seek to control the psych evaol. . Rigid and stubborn. Wll educated and martin employment, acirvites are rigidly structures as well as hobby and leisure actives, unable to compromise, have limited interpersonal skills and few friends, difficulty ng controlling anger. Indecisive and ruminate about making decisions. ,
Tx , pscyodynamic therapy, psychoanalysis, cbt, group . SSRi help with behaviors, citalopram, and paroxeine. .