personality disorders Flashcards
personality
enduring characteristics and behevior that compromise a person’s unique adjustment to life, like major life traits, interests, drives, values, self concept, abilities, emotional patterns; helps determine behavior
outside of awareness
born with or develop early in life
personality disorder
1 of most challenging to treat, dont realize problem
enduring pattern of deviant inner experiences and behavior, differ from cultural expectations, pervasive, inflexible, stable
leads to distress or impairment, dysF in cognition, impulse control, relationships, affect
influence ways in which one perceives and relates to env
contribute to maladaptive behavior or impair functioning, lead to distress
epidemiology and etiology
amplified emotional dysregulation
rf: genetic (traits), neurobio (NT), psychosocial (kids learn maladaptive, parenting, trauma), env, diathesis stress model
most common s/s
impair interpersonal relationships, dysF in cognition, affect, impulse control
overall treatment
need long term therapy
psychopharm (short term -> safe, anx, psychotic s/s), individual therapy, DBT, fam ed and therapy, social skills, group
prognosis
treatable, people grow and change throughout life
prognosis depends on degree of impairment and motivation
features and dx criteria
specific and notable patterns of thinking, feelings, behaving: enduring and persistent
pervasive -> across range of situations
involves internal and external behavior
differ significantly from culture
involved 2+ areas of functioning (feeling, thinking, interpersonal functioning - style and nature of relationships; impulse control)
l/t sig distress/impairment in social, legal, occupational, financial, safety, etc
not better accounted for by another mental health condition, med condition, substance
cluster A:
eccentric: paranoid, schizoid, schizotypal
wellness end of spectrum, negative s/s, dont lose contact with reality, s/s less severe than schizophrenia
odd or eccentric -> pass on the party: paranoid, schizoid, schizotypal
segregate and remove from other people, can be made aware of their thinking
cluster A: paranoid - s/s
intense distrust and sus (others exploit, harm, deceive, sus), reluctant to confide in others, anx; jealous, controlling as adults, unwilling to forgive (grudge) vindictive, hypervigilant, quick to anger, provoke others
reject tm, difficult to interview, preoccupied with doubts about loyalty and trustworthiness, read hidden meaning, harmless benign remarks or events, perceive attacks on character integrity, v anx and worried about being harmed
cluster A: paranoid - nc
group therapy -> threatening but role playing and social skills better, less sus
not often in hospital
counteracting mistrust (adhere to promise), adhered to schedules and boundaries, avoid being overly friendly but acknowledge feelings, use simple direct lang, project a neutral but kind affect
cluster A: schizoid - s/s
loners, poor academic performance, increased prevalence of disordered fam life, avoid close relationships, depersonalization, detachment, flat, cold, detached, distant
cluster A: schizoid - nc
avoid being too nice or friendly, dont try to increase socialization, assess for s/s the pt is reluctant to discuss, protect against groups ridicule, respect personal space while encourage participation
cluster A: schizotypal - s/s
severe social and interpersonal deficits, rambling, paranoia, sus, anx, distrust odd v eccentric, brief episodes of hallucination or delusion, can be made aware of odd beliefs and magical thinking (telepathic, paranormal, inappropriate affect), social anx and dont blend in
cults
cluster A: schizotypal - nc
respect need for social isolation, be aware of and intervene appropriately with pts sus, reinforce socially appropriate behavior and dress, perform careful dx assessment for s/s that may need intervention
low dose antipsych
cluster B
dramatic, emotional, antagonistic, erratic
BAHNed from the party: borderline, antisocial, histrionic, narcissistic
erratic: borderline, narcissistic, histrionic, antisocial
cluster B: BPD - s/s
suicidal behavior, gestures, threats, self mutilating
affective instability, mood swing (hrs/min), always in crisis, erratic emotional responses, intense response to perceived slights
identity disturbance: empty, dysphoria, boredom, do what others wish
intense anger or difficulty controlling
paranoid ideation or severe dissociation
unstable interpersonal relationships -> fear of abandonment, idealize others, violate boundaries, intense shame and hatred (self harm)
moody, irresponsible, intense dissociate w/ stress
efforts to avoid real or imagined abandonment
unstable interpersonal relationships
identity disturbance
impulsive in at least 2 areas that are self damaging (spending, sex, substance)
view selves as victims -> not responsible for problems
cluster B: BPD - splitting
defense mechanism, dont integrate and accept pos and negative feelings
people and life situations are either all good or all bad -> no grey
cluster B: BPD - nc
usually more self harm, boundary pushing, decomp when in pt
risk assess and triggers
trust, consistent, empathetic, validation (active listening), be predictable and avail, therapeutic (manage s/s, enhance emotional reg, promote inter personal skills)
teach coping for emotional reg -> mindful, ground, journal, cbt, distract, breathe
set boundaries (healthy, help them recognize) and conflict resolution -> handle disagreement without self destruct, outburst, manipulative
safety: overwhelmed, emotional crisis, who to contact, #s, methods
cluster B: antisocial - cm
psychopath, sociopath
antagonistic: deceitful, manipulative, hostile, con, false names, for pleasure or profit
disinhibited: increase risk taking, disregard responsibilities, impulsive, substance abuse, criminal misconduct
lack of empathy, remorse, guilt; violate others (indifferent to hurting others), evidence of conduct disorder with onset <15, need to prove superiority, center of universe, irritability and aggressiveness -> phys fight, assault; superficially charming but deceitful, lack genuine warmth
antisocial v borderline
antisocial: legal, outwardly destructive, M
borderline: less legal, self destructive, F
cluster B: antisocial - nc
identify blocks to therapeutic relationship
identify dysF thinking patterns, dev new problem solving
self responsibility facilitation -> accept responsibility, positive feedback, consequences
anger control assistance -> mediation, meds
help build new support system
self awareness enhancement -> recognize thoughts and feelings
cluster B: histrionic - cm
behaviors motivated by intense desire to gain nurturance and support, intentional
excitable, dramatic, high funcitoniong
bold, attention seeking, provocative, sexually seductive -> hard to diff from mania
self centered, low frustration
excessive emotions, smothering
no insight, limited relationships -> dont realize behaviors interfere
considers relationships more intimate than they are
cluster B: histrionic - nc
ignore sexual flirtations, dont overreact, model concrete lang and assertiveness
clarify inner feelings, sometimes SI (assess), set boundaries (staff and peers)
with anx, SAD, other personality disorders
cluster B: narcissistic - cm
feeling entitles, self importance, arrogant, superiority, exaggerate success
lack of empathy, exploit others
low self esteem and hypersensitivity (to criticism), fear abandonment
constant need for admiration
only want to hangout with other special people
cluster B: narcissistic - nc
neutral and calm, dont take things they say to heart
promote stronger pt identity -> v fragile inside
set boundaries, avoid power struggles, dont become defensive
model empathy
cluster C:
anx: avoidant, dependent, obsessive compulsive
worried, anx, fearful
party is DOA: dependent, obsessive compulsive avoidant
cluster C: dependent - cm
high need to be taken care of, clinging -> enter new relationships quickly
fear separation and abandonment
manipulate others to take responsibility, submissive, they dont think they can handle it
stay in relationship even if unhealthy
difficulty initiating projects, doing things on own, making decisions, dont trust own judgement, others have better ideas, no self confidence
cluster C: dependent - nc
address current stressors
set limites
be aware of strong countertransference
use therapeutic relationship for assertiveness training
encourage indep and self efficacy
cluster C: obsessive compulsive - cm
rigid, inflexible standards, preoccupation with perfection
excessive goal seeking that is self defeating or relationship defeating
strict standards interfere with project completion -> perfection, dont delegate
unhealthy focus on perfection
workaholics, stubborn
exclude leisure and friends
does not interfere greatly with daily functioning as obsessive compulsive disorder does -> no loop
cluster C: obsessive compulsive - nc
seek help when cant keep up with care
guard against power struggles
remember pt has difficulty with unexpected change
provide structure but with time to complete habitual behaviors
promote calm supportive env
encourage group, maybe meds
cluster C: avoidant - cm
low self esteem
shyness increases with age
inferiority
reluctant to engage with others -> dont want to be rejected
subject to dep, anx, anger
preoccupied with rejection and perceived shortcomings, humiliation, failure
cluster C: avoidant - nc
friendly, accepting, reassure
accept pt fears and empathy
enhance new social skills
exercises to prevent failures -> succeed at
assertiveness training
