Personality disorder lecture

Question 1

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Personality trait

Answer 1

• Characteristic with which an individual is born or develops early into life
• Influences the way they percive and relate to the enviroment
• Stable over time

Question 2

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Personality disorder

Answer 2

• Occurs When a personailty trait deviates from the expectations from a culture
• Become rigid and inflexible
• Contributes to maladapive patterns of behaviors or impairments in functioning
• Leads to distress
• Causes impairment in interpersonal relationships, dysfunction in cognition, affect and impulse control

All people have traits of personality disoders, it doesnt mean they have a personality disorder

Question 3

Early symptoms of personality disorders

Answer 3

• Usually occurs in late addolescence and early adult hood
• Temperment is an early symptoms

Question 4

Etiology of personality disorders

Answer 4

• Multifactorial: Hereditary, temperamental traits, environment and neurodevelopmental
• Genetics
• Psychological influences: Child abuse, trauma and neglect

Question 5

Antisocial personality disorder causes

Answer 5

• History of harsh erratic discipline
• Alc parent
• Abusive chaotic home life

Question 6

Borderline personality disorder causes

Answer 6

• Severe belittling
• Invalidation
• Sexual abuse
• Dysfunctional home life

Question 7

Cluster A disorders: Names

Answer 7

• Paranoid
• Schizoid
• Schizotypal

Question 8

Cluster B disorders: Names

Answer 8

• Borderline personality disorder
• Antisocial
• Histrionic
• Narcissistic

Question 9

Cluster C disorders: Names

Answer 9

• Avoidant
• Dependent
• OCD

Question 10

Cluster A disorder: Characteristics

Answer 10

• Odd eccentric behaviors
• Deficit in ability to relate to others

Question 11

Cluster B disorders: Characteristics

Answer 11

• Narcissistic
• Dramatic, Emotional, Erratic

Question 12

Cluster C disorders: Characteristics

Answer 12

• OCD personality
• Anxious
• Fearful

Question 13

Paranoid Personality disorder: Features

Answer 13

• Suspicious, Hypersensitive, Secretive
• Must have control or power in a relationship
• Suspicious of others, being guarded as a result
• Can be aggressive
• Rigid, not willing to accept other people’s ideas
• High feeling of importance (They’re after me)
• Outwardly cold, lacks humor
• Envious
• Does not accept responsibility of their actions
• Prepared for any real or imaginary threat
• Always watching out
• May misinterpret something normal and find a threat lying
• Overreacts with excessive anger
• Responds with counter attacking behavior
• Hard exteriors, immune or insensitive to feelings of others
• Can be prone to sue other people

Cluster A personality disorder

Question 14

Schizoid Personaility disorders: Features

Answer 14

• **Seclusive, Indifferent, Passive **
• Super flat affect, doesn’t like people, special interest
• Periphery of society (Avoids relationships, emotionally detached)
• Viewed by others as odd and lonely
• No interest in human relationships; feels uncomfortable around people
• Appears cold and aloof indifferent to others
• Prefers to work alone
• No spontaneity
• Energy toward non human interest (Math, astronomy, animals, work)
• Emotionally cold, indifferent to praise, flat affect
• Inappropriately serious about everything; difficulty with light hearted banter

Cluster A personailty disorder

Question 15

Schizotypal Personality disorder: Characteristics

Answer 15

• **Odd in thinking, Bizarre fantasy, Peculiar language **
• Symptoms more like schizophrenia
• Cognitive or perceptual distortions, behaves eccentric (Odd by other)
• Socially withdrawn and anxious
• Unhappy about lack of relationships
• Ideas of reference, bodily illusions, depersonalization, unusual telepathic and clairvoyant experiences, sixth sense (Thinks they have super powers
• Magical thinking
• Social anxiety and unhappiness increasing over time
• Under stress they experience worse psych symptoms, like delusions and hallucination brief
• Aloof, Bland, Apathetic
• Talks to self
• Speech pattern can be bizarre

Cluster A personailty disorder

Question 16

Histionic Personality disorder: Charecteristics

Answer 16

• ** Attention seeking, Flamboyant, Proactive **
• Attention seeking, Excitable, emotional behaviors
• Seeking approval
• More often women
• Behavioral expression may be influenced by sex role stereotypes
• May vary across cultures and age groups

Cluster B personality disorder

Question 17

Narcissitic Personality disorder: Charecteristics

Answer 17

• Excessive self admiration, Egocentric, Sense of grandiose
• Pervasive pattern of grandiosity and over concern with issues of self esteem

Cluster B personailty disorder

Question 18

Borderline Personality disorder: Charecteristics

Answer 18

• **Impulsive, Self mutilation, MANIPULATION **
• Disruptive pattern of instability of self identity, interpersonal relationships marked with impulsivity and destructive behaviors
• From families that were subjected to constant belittling devaluation and invalidation

Cluster B personality disorder

Question 19

Antisocial Personality disorder: Charecteristics

Answer 19

• **Rule breaking, aggressive, abusive **
• May have history of violence partner abuse, anger, vindictive behavior, recklessness
• Diagnosis made at 18+, typically evidence of conduct disorder in adolescent
• Substance abuse is common comorbid disorder
• No moral compass
• Commonly referred to as sociopaths

Cluster B personality disorder

Question 20

Antisocial personailty disorder: Features

Answer 20

• Deceitful, manipulative
• Lack of guilt, anxiety
• Lack of empathy
• Socially unresponsive
• Exploitative
• Guiltless behavior with complete disregard for rights of others
• No concern for law
• Low tolerance for frustration
• Easily provoked
• Appear cold and callous, often intimidate others
• Unable to delay gratification

Question 21

Borderline personality disorder: Features

Answer 21

• Chronic depression
• Inability to be alone
• Chronic fear of abandonment
• Clinging
• Manipulative
• Emotional dysregulation can lead to self mutilation and suicide, in response to Rejection
• Predictable maladaptive behaviors related to separation
• Severe impaired capacity for attachment
• Characterized by instability and dysfunction in affective behavioral and interpersonal domains
• Emotional instability
• **Always in a state of crisis
• Frequent mood swings
• Intense affect with frequent changeability
• thriving on chaos **

Question 22

Histrionic personality disorder features

Answer 22

• Over concern with attention and appearance
• Colorful dramatic and extroverted behavior in excitable and emotional people
• Excessive time seeking attention or making themselves attractive
• Inappropriate seduction or provocative dress and flirting
• Flamboyant or self drama behavior
• Underlying insecurity
• Act out when not getting attention
• Difficulty maintaining long lasting relationships
• Needs constant affirmation
• Needs approval, if they don’t get approval results in feeling of dejection and anxiety

Question 23

Narcissistic personality disorder

Answer 23

• Grandiose sense of self importance
• Exaggerated self worth
• Sense of specialness or entitlement
• Handles criticism with defeat, shame, dejection, rage or depression
• Fragile self esteem
• Exploitive, lacking empathy
• Expressive concern about appearance rather than substance, requires admiration
• Lacks empathy
• Exploits others to meet their needs
• Blames others
• Relationships superficial and based on belief what their partner can do for them
• Lacks humility, self centered

Question 24

Avoidant Personality disorder: Charecteristics

Answer 24

• Fears criticism, overly serious, withdrawn
• Sensitive to rejection, feels inferior
• Tends to be very sensitive, touchy evasive and mistrustful
• Desires affection but fear rejection or ridicule; social isolation as a result
• Avoids situations that require socialization (Shy,awkward in these situations)
• Desires close relationships but fear of being shamed/ridiculed
• Lack empathy due to preoccupation with own self deprecation
• Prevalence is same in men and women
• Does not respond with rage with rejection, hypersensitive to criticism
• Speech is usually slow and constrained with frequent hesitations, fragmentary thought sequence and occasional confused digressions
• Distressed by isolation
• All have social phobias
• View others as critical, betraying and humiliating
• May be perceived as timid withdrawn or cold
• **Low self worth **

Cluster C personailty disorder

Question 25

Dependent Personality disorder: Charecteristics

Answer 25

• Clingy, indecisive, submissive
• Exaggerated belief that they are incapable of survival alone
• Avoids positions of responsibility and becomes anxious when forced into them
• Relies on others for most areas of their life
• ** Lack of self confidence ** and extreme reliance on others
• Low self worth
• Believes that they cannot function on their own
• Passive, overly generous and thoughtful , underplay their own attractiveness and achivements
• Clinging, and submissive
• Can’t imagine being alone =Tolerance of poor treatment by partner, including abuse
• Suffering in silence
• Perceive self as unable to separate from other, cannot work independently
• Fear of abandonment

Cluster C personality disorder

Question 26

Obsessive compulsive Personality disorder: Charecteristics

Answer 26

• Perfectionist, Passive aggressive, rigid
• Preoccupied with orderliness control and achievement of perfection
• Obsessed with rules and details
• Tasks often cannot be completed
• Devotion to work excludes pleasurable activities
• Uncomfortable with aspects of relationships that individuals cannot control
• Difficulty expressing emotion
• Inflexible, rigid perfectionism, preservation, (Pursues task even if its impossible
• Intensive Fear of making mistakes
• Recurrent obsessions and compulsions are absent (This would be in OCD)
• Formal demeanor, lack of sense of humor, limited interpersonal skills
• High achievers in areas that require attention to detail

Cluster C personality disoder

Question 27

Personailty disorder assessment

Answer 27

• Assess for suicidal or homicidal thoughts
• Assess for other psych disorders or medical disorder (Substance abuse)
• View assessment from person’s ethnic, cultural and social background
• Did the pt experience a recent loss or trauma (Exasperation)

Question 28

Interventions for manipulation

Answer 28

• Set clear limits
• United front: All limits should be enforced by staff equally
• Refer to limits frequently as pt with try and push em
• Teaching approach, but firm
• Firm but supportive
• Consistency
• Behaviors should be documented objective (Time date, circumstance)
• Provide clear boundaries and consequences
• Avoid discussing yourself or others with patient or keeping secret for pt (Manipulation tactic)
• Don’t accept gifts or doing favors (Manipulation tactic)

Question 29

Interventions for impulsive behaviors

Answer 29

• Identify needs and feelings underlying behavior (Insecurity)
• Discuss with pt current and previous impulsive acts
• Explore effects on pt and others
• Help recognize cues to triggers of impulsive behaviors
• Teach and rehearse alt behaviors
  *** pt safety is number one **
• Provide physical activity
• 1:1 during exacerbations
• monitor behavior frequently
• Encourage pt to seek out staff when self mutilation is present
• Do not offer sympathy from wounds of self mutilation
• Positive reinforcement of desired behaviors, emotions
• Remove dangerous objects that can be used to harm self or others
• Ensure adequate amount of staff if show of force is needed
• Sedating meds if needed
• Mechanical restraints (Needs order)

Question 30

Psychotherapy: Cognitive behavioral therapy

Answer 30

• Helps pt become aware of their thought process so they can recognize negative behaviors and reframe thinking to improve functioning

Question 31

Psychotherapy: Dialectical Behavioral Therapy (DBT)

Answer 31

• Focuses on stabilizing patient and achieving behavioral control
• Emotional regulation
• Distress tolerance skills
• Constant crisis intervention

First line therapy for BPD

Question 32

Pharmacological therapy

Answer 32

• No meds to treat PD
• Used to treat underlying symptoms (Anxiety, depression and all that)
• Caution use of Benzo (Abuse potential)
• Atypical antipsychotic for psychosis induced by stress
• Antidepressants and mood stabilizers used to manage mood and treat aggression