Personality Disorders 2 Flashcards
Borderline PD: clinical features (5)
- Unstable personal relationships (Hot→Cold→Hot); constant making & breaking of friendships
- Fear abandonment
- Impulsive
- Self-mutilating
- Suicidal gestures (in relationship to abandonment)
(Borderline shifts rapidly; do NOT confuse w/manic bipolar)
Borderline PD: etiology
- Demanding search for nurturance
- Parent-child interaction: early abandonment
- Hx abuse (physical & sexual)
- Insecure attachment
Borderline PD: Defense mechanisms (2)
- Splitting (love you one day; hate you the next)
- Black and white thinking
(makes it hard to create physician/patient relationship)
Borderline PD: Ddx (3)
- Narcissistic PD
- Antisocial PD
- Bipolar
Borderline PD: Trmt (5)
- Dialectical behavioral therapy (specific to borderline PD)
- Mindfulness
- Stress tolerance
- Emotional regulation
- Mood stabilizers
(watch out for couter-transferrance; they req. experienced therapist)
(DBT = CBT + Group therapy)
Histrionic PD: clinical features (5)
- Want to be the center of attention: loud, wild stories, hand gestures
- Inappropriate sexual behavior
- Very concerned with physical appearance
- Emotionally expressive (labile & shallow)
- Impressionistic
Histrionic PD: Ddx
- Dependent PD
- Borderline PD
- Narcissistic PD
Histrionic PD: etiology
Psychoanalytic theory:
- oedipal phase of development: unduly encouraged (making the relationship between daughter more important than his relationship w/his wife)
- child fears the loss of or retaliation by the same sex parent
- most likely biogenetically determined by temperment
Histrionic PD: tx
- Individual psychodynamic therapy
- Increase awareness
- Stay in present
- Need to allow for support and ventilation of needs
(avoid reconstructing childhood)
Narcissistic PD: clinical features (4)
- Lacks empathy
- Grandiose self-esteem & important (constant bragging)
- Overreacts to criticism: rage
- Relationships: like to appear self-sufficient & exploit others
(In love w/themselves)
Narcissistic PD: Ddx (4)
- Manic Depressive
- Histrionic PD
- Antisocial PD
- Adjustment Disorder
Narcissistic PD: etiology
Psychoanalytical Theory:
Parents who are over-involved with their career; unable to react to their child’s needs
Create veneer of invulnerability and self-sufficiency to cover up their emptiness
Narcissistic PD: tx
- Psychodynamic psychotherapy
- Convey empathy for pt’s sensitivity & disappointment → Positive idealized transference
(self-entitlement feelings get in the way; not self-reflective)
Kernberg theory of narcissistic PD (2)
- Vulnerability needs to be addressed early
- Allow patient to address grandiosity and it’s consequences
What are the 3 personality disorders in the “wacky”/Category C?
- Avoidant PD
- Dependent PD
- Obsessive-Compulsive PD
Avoidant personality: clinical features (5)
- Avoid social interaction: feel people do not like them but wish they could socialize
- Afraid of embarrassment
- Low self-esteem & hypersensitivity to negative evaluation of others
- Socially inept & self-conscious (shy)
- Constrict lives and avoid new activities
Avoidant personality: DDX
- Schizoid personality
- Social phobia
Avoidant personality: etiology
- Parental rejection and censure
- Psychodynamic Theory: exaggerated desire for acceptance or an intolerance of criticism
- Biological (inborn temperament)
Avoidant personality: Tx (3)
- Psychotherapy w/supportive techniques and sensitivity to protective defenses
- Therapy: Group or CBT
- Meds: SSRIs or Anxiolytics
(less addictive personality type)
Dependent PD: Clinical features (4)
- Clingy with low self confidence
- Rely on the help of others
- Refuse to make decisions
- Don’t like to express their opinions → abusive relationships
(can be exploited by antisocial PD)
Dependent PD: etiology
- Underindulgence during oral phase (birth - 2 y.o.)
- Parental prohibition of independent behavior
- Cultural: women are taught to be dependent (more so in some)
Dependent PD: Ddx (2)
- Borderline PD
- Avoidant PD
Dependent PD: Tx (2)
- Psychotherapy
- Group or CBT
(Focus on fears of independence, increase self-esteem, assertiveness and independent fxning)
Dependent PD: psychotherapy focuses on _____ (2).
- Explorer fears of independence
- Encourage self-esteem, assertiveness, independent functioning
Obsessive-compulsive PD: clinical features (5)
- Preoccupied with order and control (to-do lists, plans, emotions)
- Inflexible at work and in relationships (extreme perfectionism)
- Overwork
- Difficulty disgarding worthless objects
- Severe superego
Obsessive-compulsive PD: Ddx
Obsessive-compulsive disorder (OCD)
(different but co-exist)
Obsessive-compulsive PD: difficulties of treatment (2)
- Intellectualization: they can draw the therapist into a long and drawn-out conversation without progress on issues
- Bad emotional expression
Obsessive-compulsive PD: etiology
- Excessive parental control, criticism & shaming
- Constitutional factors: excessive rage→ power struggles with others
(Old theory: Freud: anal phase)
Obsessive-compulsive PD: tx:
Psychoanalytic Therapies: Focus on control and feelings that are being avoided (cognitive tech.: diminish need to control & perfectionism; dynamic: focus on feelings)
(avoid getting sucked into affectless discussion, use power struggles to address the need to control)
