Personality Disorder

Question 1

personality

Answer 1

evolving char and bx which person can be born with or dev in life incl major traits, intent, drivers, values, self-concept, abilities, emo patterns

Question 2

What determines bx?

Answer 2

Personality

Question 3

Personality dx

Answer 3

Enduring pattern of deviant inner experience and bx
- differs from cultural expectations and adapt to maladaptive bx
- pervasive, inflexible, stable
- lead to distress and impair
- dysfxn in cog, relx, affect, impulse control

Question 4

rf for personality dx

Answer 4

• genetic and NT
• psychosocial and enviro - parent, what kids see, trauma
• diathesis stress model

Question 5

comps of personality dx

Answer 5

• interpersonal relx impair
• dysfxn in cog
• affect dysfxn
• impulse control

Question 6

Overall tx

Answer 6

• psychopharm
• ind therapy
• DBT
• fam edu and therapy
• social skill
• group therapy
• tx but depends on degree of impairment and motivation

Question 7

Overall dx of personality dx

Answer 7

• specific and notable pattern of feel, think, bx
• enduring over time
• pervasive across many sites
• involve inner exp and ext bx
• differ signif from cultural expectations
• involve 2+ of think, feel, impulse control, interpersonal fxn
• lead to signif distress/impair in social, legal, occup, money, safety
• not better accounted for by other MH condx, med condx, subs

Question 8

Cluster A PD

Answer 8

eccentric and odd
- PaSS on the party
- paranoid, schizoid, schizotypal

Question 9

Sx of Cluster A PD

Answer 9

• neg sx like with schiz
• ind don’t lose contact with reality and less severe than w/ schiz
• remove self from others
• can be made aware of their thinking

Question 10

Paranoid PD

Answer 10

• longstanding intense distrust and sus
• anx and reluctant to confide with others, fear of harm
• jealous, controlling adults
• vindicate and unwilling to forgive
• hypervigilant, quick to anger, provoke others, counterattack
• insecure and fear being harmed

Question 11

Therapy for paranoid PD

Answer 11

role play (but group therapy can be scary)

Question 12

NC for paranoid PD

Answer 12

• counteract mistrust
• adhere to schedule and boundaries (esp when threatened)
• avoid overly friendly but acknowledge feels
• simple, direct lang
• neutral, kind affect

Question 13

Schizoid pd

Answer 13

• lowers, poor academic solitary
• inc prev of dx fam life
• avoid close relx - rarely marry
• depersonalize, detach, flat
• cold, detach, distant

Question 14

schizoid pd NC

Answer 14

• avoid too nice
• don’t inc socialize
• assess sx pt does not want to discuss
• protect against ridicule from other pt, hc worker
• protect personal space while encouraging participation gently
• psycho/group, anti dep dec 2nd gen antipsychotics

Question 15

schizoptypal pd

Answer 15

• severe social and interpersonal deficits
• rambling convo
• paranoia, sus, anx, distrust, odd, eccentric
• brief eps of halluc or delus
• can be made aware of odd beliefs and magical thinking, clairvoygant
• sus to cults and religious events, ideas of reference; events occur for you
• constricted, inappropriate affect

Question 16

NC for schizotypal PD

Answer 16

• respect social iso
• intervene in sus as needed esp SI
• reinforce appropriate bx and dress
• perform careful dx assess for dangerous sx (SI)
• may use lower dose antipsychotics

Question 17

Cluster B personalities

Answer 17

• dramatic, emo, antagonistic, erotic
• BAHNed from the party
• BPD, antisocial PD, histrionic, narcissistic

Question 18

Borderline PD

Answer 18

• suicidal bx, gestures, threat; self-mutilate
• affective instability, mood swing
• ID disturbance - empty feel, dysphoria, boredom
• intense anger, prob controlling rage
• paranoid ideation or severe dissociation under stress
• intense sensitivity to criticism
• perform bx as others wish
• efforts to avoid real or imagined abandonment
• unstable interpersonal relx
• impulsive in 2 areas that are self-damaging (money, sex, self-harm, sub use)
• see selves as victims

Question 19

Splitting

Answer 19

Ind can’t integrate and accept pos and neg feelings
- ppl incl self and life situations all good or bad
- love or hate you

Question 20

NC for BPD

Answer 20

• comprehensive access–rf and emo triggers
• tend to get worse when admitted
• build trust and therapeutic enviro with consis, empathy, validation
• teach coping for emo reg—deep breath
• safety plan (esp in crisis, who to call)
• set boundaries and conflict resolution, be predictable and available

Question 21

Antisocial PD

Answer 21

• antagonistic, disinhibited, lack empathy, remorse, guilt
• violate others rights, hurt others, con others, false names
• avoidance of conduct dx before 15y age
• need to prove superiority
• center of universe
• irritable and aggressive
• superficially cheerful but deceitful
• more males
• more outward probs

Question 22

NC for antisocial PD

Answer 22

• IC blocks to therapetic relx
• ID dysfxn think patterns, dev new prob solve bx
• self responsibility facilitation
• anger control asst
• help build new support system
• self-awareness enhancement

Question 23

histrionic PD

Answer 23

• excitable, dramatic, high fxn
• bold, attn seeking-provocative
• excess emo, smothering
• no insight, limit relx
• consider relx more intimate than they are
• intentional desire to gain emo support

Question 24

How to distinguish histrionic PD from bp dx

Answer 24

• doesn’t fluc like bipolar
• can be hard to separate from mania

Question 25

NC for histrionic PD

Answer 25

• ignore flirtation
• model concrete lang
• help clarify inner feels
• can be SI
• set firm boundary with staff and peers
• often with anx, sub use, other PD

Question 26

Narcissitic PD

Answer 26

• feel entitled, self-impatient
• lack empathy, exploit others
• fear abandonment
• low SE and hypersens
• constant need for admiration
• only want to interact with other special ppl

Question 27

NC for narcissistic PD

Answer 27

• promote strong pt/strong sense of self
• outward strong, inward fragile
• clear boundary
• avoid power struggle
• avoid defenesless
• remain neutral

Question 28

Cluster C personalities

Answer 28

• party is DOA (dead on arrival)
• anxious
• dependent, obsessive-compulsive, avoidant

Question 29

Dependent PD

Answer 29

• overwhelm need to be cared for; clinging
• fear separate/abandon
• manipulate others to take responsibilities; submissive
• intense anx when left along even briefly

Question 30

NC for dependent PD

Answer 30

• psychotherapy
• address current stressors and feel alone
• set limits
• be aware of strong countertransference
• therapeutic for assertiveness training
• encourage ind and self-efficacy

Question 31

Obsessive compulsive dx

Answer 31

• rigid, inflexible; workaholics
• excess goal seeking that is self-defeating or relx-defeating
• strict standards interfere with project completion
• unhealthy focus on perfection

Question 32

How does OCD differ from obsessive-compulsive PD

Answer 32

does not interfere greatly with daily functioning

Question 33

NC for obsessive-compulsive PD

Answer 33

• seek help when overwhelmed and can’t keep up with org
• guard against power struggle
• remember pt has prob dealing with unexpected changes
• provide struc but with time to complete habitual bc
• promote calm, supp enviro

Question 34

Meds for OCPD

Answer 34

fluoxetine or clomipramine

Question 35

Avoidant PD

Answer 35

• low self-esteem, lonely, overly sensitive
• shyness inc with age
• feel inferior
• reluctant to engage with new ppl
• subject to dep, anx, anger
• preocc with reject, fail, humiliation

Question 36

NC for avoidant PD

Answer 36

• friendly, accept, reassure
• enhance social skills
• accept pt fears
• designs exercises to prevent fail

Question 37

Tx for avoidant PD

Answer 37

• trust build
• group therapy
• assertiveness training
• antidep/antianx