Personality disorders Flashcards
Name the DSM IV TR Clusters and their characteristics
Cluster a: aloof, odd, eccentric
Cluster B: emotional, dramatic, big screen
Cluster C: cowering, anxious, fearful
Name the four characteristics that are shared by all personality disorders
Inflexible and maladaptive stress response
Disability and work and love
Able to get under the skin of others
Ability to evoke personal conflict
Name the three subcategories of cluster a
Paranoid, schizoid, schizotypal
Name the characteristics of paranoid personality disorder and what causes it
Excessively Mistrustful Excessively suspicious Without justification People are evil so watch out Cause is unclear. Possible early life experiences, biological
Name the characteristics of schizoid personality disorder
Social deficiencies
Seem cold, indifferent, aloof
Extreme social detachment, loner
Limited range of emotions
Name the interventions used for cluster a personality disorders
Establish trust – this is difficult, go slowly, kiss
Be genuine – do not challenge
Do not rush or push – explain all treatments
Address mistaken assumptions, reality
Keep physical and emotional distance
Keep safe and reassure
Medications may include antipsychotics, anti-anxiety, SSRI
They are unlikely to initiate treatment – don’t do well in groups
Name the four personality disorders and cluster B
Antisocial, histrionic, narcissistic, borderline
Name the characteristics of antisocial personality disorder (APD)
Long histories of
Violating cultural norms, violating the rights of others, aggressiveness and impulsiveness, LACK OF REMORSE, see themselves as victims, not always criminal
Genetic and developmental influences
2% - 3% of general population, greater than 50% in jail, link to conduct disorder, APD, and criminality runs in families
Neurobiological influences
Under arousal hypothesis – low cortical arousal
Fearlessness hypothesis – fail to show normal fear, fail to avoid punishment
Name the treatments for APD
Focus on reinforcing appropriate behaviors, to see connection between behaviors and feelings
Straightforward, matter-of-fact approach, detached caring
Convey expectations and consequences
Avoid power struggles and arguments
Protect others
Many don’t seek treatment, poor outcomes
Expect manipulation
Name the red flags that indicate you are being manipulated
Instant intimacy
Entitlement
Flattery
Sexually provocative behavior
Name interventions for manipulative behavior
Consistency for all that care for the patient
Communication to all that care for the patient
Document
Teamwork – introduce next shift, etc.
Kiss: repeat and repeat
Don’t threaten or be defensive, use detached caring
Don’t avoid them
Teach them to be assertive and direct with needs, give them choices
BUT STAY CONSISTENT WITH CONSEQUENCES
Name the characteristics of borderline personality disorder
Unstable relationships - attempts to avoid abandonment
Poor self-image – mood swings, feeling of emptiness
Severe impulsivity – substance abuse, sex, suicidality, self-mutilation
Anger/rage – blames others
Splitting – Defense mechanism – good or bad – idealization greater than devaluation
Manipulative
Name the causes of borderline personality disorder
Runs in families, Biological connection 3:1 female to male, 2% of population, greater than 20% of psych patients Connection with mood disorders Contribution to early abuse Commonly "the problem patient"
MEDS MAY BE USEFUL TO TREAT SPECIFIC SYMPTOMS
(ANXIETY, MOOD LABILITY, EVEN MILD PSYCHOTIC THINKING), BUT BE CAREFUL…
Explain interventions for borderline personality disorder patients
Support, empathize, but be honest and real
Encourage to identify and talk about feelings rather than act them out
Need structure, limits, consistency by all staff
Try to establish trust and relationship, don’t avoid them, but reinforce only appropriate behavior
Don’t rescue, allow consequences
Recognize transference, countertransference, rescue fantasies
Establish boundaries, don’t take sides, don’t argue, don’t keep secrets
Explain histrionic personality disorder
Overly dramatic Center of attention Seductive and provocative Emotions are shallow Emphasis on appearance Likes to watch others watch them
Explain treatment for histrionic personality disorder
Teach stress reduction and coping skills
Reward more appropriate behavior
Watch for suicidal ideation
Discuss characteristics of narcissistic personality disorder
Grandiose – exaggerated self-importance, entitlement Rages if challenged Preoccupied with attention Requires admiration Seductive and provocative Little empathy
What are the causes for narcissistic personality disorder
Lack of early experiences with empathy/altruism
A function of the “me” generation?
Treatment for narcissistic personality disorder
Focus on feelings – needs of others
Remain nonjudgmental, avoid criticism, but don’t reinforce their entitlement
Respect, but set limits, remain neutral, and nondefensive
Name the three personality disorders in cluster c
Avoidant, dependent, obsessive-compulsive
Name the characteristics of avoidant personality disorder
Fear of rejection
Dependent/clingy
Poor self-concept
Anxiety
Discuss the characteristics of dependent personality disorder
Extreme dependency
Seeks reassurance
Submissive, vulnerable
Anxiety
What are the characteristics of obsessive-compulsive personality disorder
Perfectionism, orderliness, control Rules, details Repetition and rehearsal No insight Not full-blown obsessions or compulsions Anxiety
What is the difference between a personality disorder and an anxiety disorder
.
Cluster C diagnoses in general
Extremely sensitive to others opinions Nonassertive, low self-esteem, submissive, passive Avoids social relationships Takes few risks – fears failure Socially inhibited and anxious
Cluster C interventions/ treatment
Target anxiety and social skills
Give them responsibility and avoid making them dependent on you
Treatment is similar to social phobia
Systemic desensitization, behavior rehearsal, reassure and support as needed during stress
General interventions for personality disorders
What is HALT
Teaching coping skills skills to avoid __________ And therefore __________.
Identify ____________ And encourage patient to recognize own behavior.
Learn anger triggers, management and assertiveness.
Be empathetic and aware.
Develop a _________ system.
Don’t get into ____________ fantasies.
Hungry, angry, lonely, tired
Stress, regression
Manipulation
Support
Rescue
When can antidepressants help
Treating signs of depression
Low self-esteem, suicidal ideation, compulsive behavior
When can anticonvulsants (mood stabilizers) help
Balancing the intensity of feelings between borderline and histrionic personality disorders
Controlling impulsive and aggressive behavior
When can antipsychotics help
With paranoia, unstable mood, disorganized thoughts
