Personality Disorders Flashcards
Defense Mechanisms
1. Projection: the unconscious rejection of emotionally unacceptable personal features and attributing them to other people or situations i.e. projecting blame on another for self-failure.
2.Acting out behaviors: an individual deals with emotional conflicts or stressors by actions rather than reflections or feelings i.e. person gets into a physical fight rather than trying to solve it rationally. Self-mutilation is another example.
3. Splitting: inability to integrate the positive and negative qualities of oneself or others into a cohesive whole. Dichotomous thinking, tend to alternate between opposite poles, either good or bad. For example, the individual idealizes a friend at the start of a new relationship, hoping that this person will meet all of his or her needs. But at the first disappointment or frustration, the individual quickly shifts to devaluation, despising this friend.
3 Clusters
Cluster A: odd or eccentric behaviors
Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder
Show characteristics of detachment
_Cluster B: dramatic, emotional, or erratic behaviors _
Antisocial Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder
- Drama queen, very emotional, very erratic and unpredictable behavior
- Hyposensitive to criticism, issues with relationship dependency
Cluster C: anxious or fearful behaviors
Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder, Avoidant Personality Disorder
Etiology and Epidimology
- More common in people who are homeless or incarcerated
- Linked to childhood trauma
- Biological - interaction of genetics, neurobiology, and neurochemistry
- Psychological - i.e. a child develops maladaptive responses based on modeling or
Cluster B Antisocial Disorder DSM Criteria
- Failure to conform to social norms - unlawful behavior, repeatedly performing acts that are grounds for arrest
- Deceitfulness - repeatedly lying, use of aliases, or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- ** Irritability and aggressiveness** - repeated physical fights or assaults
- Reckless disregard for the safety of self or others
- Consistent irresponsibility - repeated failure to sustain consistent work behavior or honor financial obligations
- Lack of remorse - being indifferent to, or rationalizing, having hurt, mistreated, or
Antisocial Personality Disorder - Suggested Therapies
- Individuals diagnosed with APD are usually mandated to therapy by a court order or a significant other since they rarely seek treatment on their own.
- Effective psychotherapy treatment for this disorder is limited.
- Pharmacotherapy for anxiety, impulsive anger/rage, and depression i.e. benzodiazepines, mood stabilizers, antidepressants
- Careful use of addictive agents (e.g. benzos)
- Note: substance abuse is best handled through a well-organized treatment program before counseling and other forms of therapy are started.
Borderline Personality Disorder - DSM Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning in early adulthood and present in a variety of contexts, as indicated by five (5) or more of the following:
- ** **Frantic efforts to avoid real or imagined abandonment - intense fear of being abandoned
- Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Identity disturbance - unstable self-image or sense of self
- Impulsive self-destructive behaviors i.e. spending, sex, substance abuse, reckless driving, binge eating
- ** Recurrent suicidal behavior,** gestures, or threats, or self-mutilating behavior
- ** Affective instability** (frequent changes in mood, intense sadness, irritability, or anxiety usually lasting a few hours)
- Chronic feelings of emptiness
- Inappropriate intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms
Borderline Personality Disorder - Suggested Therapies
- Individual and group psychotherapy using dialectical behavior therapy - a form of cognitive-behavioral therapy based on dialectics, the practice of logical discussion.
- Antipsychotics may control anger and brief psychosis.
- Antidepressants such as SSRIs (i.e. Celexa, Prozac, Zoloft, Paxil) and MAOIs (i.e. Nardil, Parnate)
- Benzodiazepines (i.e. Ativan, Rivotril, Valium) may help anxiety.
Borderline Personality Disorder - Dialectical Behavior Therapy
Goals of DBT are to increase the patient’s ability to manage stress, regulate emotions and improve relationships with others.
- Treatment focuses on behaviour targets, beginning with identification and interventions for suicidal behaviours and then progressing to a focus on interrupting destructive behaviours. Finally, DBT addresses quality of life behaviours across a hierarchy of care i.e. skill acquisition.
Skills training focuses on 4 behavioral skills:
- Mindfulness - concentrated awareness of one’s thoughts, actions or motivations
- ** Interpersonal effectiveness** - problem solving in social and interpersonal situations
- Emotion regulation - techniques to control emotions
- Distress tolerance - strategies to tolerate and accept distress i.e. relaxation, prayer, imagery
Narcissistic Personality Disorder - DSM Criteria
A pervasive pattern of grandiosity (in fantasy and behavior), need for admiration, and lack of empathy beginning in early adulthood and present in a variety of contexts, as indicated by five (5) or more of the following:
- Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
- ** Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love**
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people
- Requires excessive admiration
- Has sense of entitlement (i.e. unreasonable expectations of especially favourable treatment)
- ** Exploitative** (i.e. takes advantage of others to achieve personal ends)
- ** Lacks empathy** - unwilling to recognize or identify with the feelings and needs of others
- ** Often envious of others** or believes that others are envious of self
- Shows arrogant, haughty behaviours or attitudes
Narcissistic Personality Disorder - Suggested Therapies
- Psychotherapy only works if patient acknowledges narcissism.
- Group therapy may help empathy.
- May seek help for depression, feeling that loved ones do not show enough appreciation of their special qualities.
- Antidepressants; Lithium may help those with mood swings
Obsessive-Compulsive Personality Disorder - DSM Criteria
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (4) or more of the following:
- Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
- Shows perfectionism that interferes with task completion
- Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
- Over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
- Unable to discard worn-out or worthless objects even when they have no sentimental value
- Reluctant to delegate tasks or to work with others unless they submit exactly to own way of doing things
- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
- Shows rigidity and stubbornness
Obsessive-Compulsive Personality Disorder - Suggested Therapies
- Supportive or insightful psychotherapy/cognitive behavioral therapy
- Clomipramine (Anafranil), a tricyclic antidepressant (TCA) and SSRIs (i.e. Celexa, Prozac, Zoloft, Paxil) for obsessional thinking and depression
