Personality Disorders 3 Flashcards
- Provide reassurance, validate patient’s concerns
- Encourage reporting of symptoms and concerns
Provider strategies for provider tx pt w/ Avoidant PD
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
Narcissistic PD
- demanding, entitled attitude
- Excessive praise toward caregiver may turn to devaluation, in effort to maintain sense of superiority
- Denial of illness or minimization of symptoms
Problematic behavior of pt w/ Narcissistic PD
- Dramatic and urgent demands for medical attention
- Angry outbursts at provider if not responded to
- Patient may contribute to prolong illness or encourage medical procedures in order to get attention
- May abuse substances and medications
Problematic behavior of pt w/ Dependent PD
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
- Is unwilling to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
Avoidant PD
Supportive psychotherapy
- Establish and maintain a treatment alliance
- Provide patient with understand of their diagnosis and problems → avoid labeling patient as _____.
- Help patient develop more complete awareness of maladaptive behaviors
- Work with patient to identify realistic, attainable goals
- Therapist provides encouragement, reassurance, advice, and coaching, while modeling adaptive behavior
Tx for Narcissistic PD
- Views self as socially inept, personally unappealing, or inferior to others.
- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
Avoidant PD
Mnemonic for Narcissistic PD
S – special (believes they are special and unique)
P – preoccupied with fantasies (unlimited success, power, brilliance…)
E – envious
E – entitlement
E – excess admiration required
C – conceited (grandiose sense of self importance)
I – interpersonal exploitation
A – arrogant (haughty)
L – lacks empathy
- Provide reassurance and schedule frequent periodic check-ups
- Be consistently available but provide firm realistic limits to availability
- Enlist other members of the health care team in providing support for patient
- Help patient obtain outside support systems
- Avoid hostile rejection of patient
Provider strategies for pt w/ Dependent PD
- Flirtatious and seductive
- Creative and imaginative
- Play hunches rather than thinking things out
- Spontaneous without thought to consequences
- Lack analytical ability
Histrionic PD
- Urgently seeks another relationship as a source of care and support when a close relationship ends.
- Is unrealistically preoccupied with fears of being left to take care of himself or herself.
Dependent PD
- Personality style → dramatic
- Predominant theme → excessive emotionality and attention seeking
Histrionic PD
Mnemonic for Dependent PD
D – difficulty making everyday decisions
E – excessive lengths to obtain nurturance and support from others
P – preoccupied with fears of being left to take care
E – exaggerated fears of being unable to care for himself or herself
N – needs others to assume responsibility for his or her life
D – difficulty expressing disagreement with others
E – end of a close relationship is the beginning of another relationship
N – noticeable difficulties in initiating projects or doing things on his or her own
T – “take care of me” is his or her motto
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
Histrionic PD
•Substance abuse disorders
Comorbid disorder for Histrionic PD
- Outright rejection of patient’s demands, resulting in patient distancing self from caregiver
- Excessive submission to patient’s grandiose stance
Problematic behavior of provider tx pt w/ Narcissistic PD
- 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 (or institutions).
- Requires excessive admiration.
Narcissistic PD
- Depression is common due to fragile self-esteem
- Lying to oneself by distorting the facts so they feel more important
Narcissistic PD
Early development
- Hypersensitive due to parental criticism
- Difficulty temperament produces early rejection
Avoidant PD
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
Avoidant PD
- May not be forthcoming about symptom severity, may easily agree with provider out of fear of not being liked
- Tend to withhold information
- Avoids questioning / disagreeing with providers
Problematic behavior of pt w/ Avoidant PD
•Risk major depression if they lose the person they depend on
Dependent PD
Cognitive behavioral therapy
- Focus on breaking the negative cycle of avoidance
- Identify and correct dysfunctional attitudes and thoughts
- Reduce negative thought patterns and build social skills
- Graduated exposure to social situations
- Learn skills to improve intimacy
Tx for Avoidant PD
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Narcissistic PD
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Narcissistic PD
Mnemonic for Histrionic PD
P – provocative (or seductive) behavior
R – relationships, considered more intimate than they are
A – attention, must be at center of
I – influenced easily
S – speech (style) - wants to impress, lacks detail
E – emotional lability, shallowness
M – make-up - physical appearance used to draw attention to self
E – exaggerated emotions – theatrical
•Development linked to early disruptions in learning independence
Dependent PD
- Has a style of speech that is excessively impressionistic and lacking in detail.
- Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible (i.e., easily influenced by others or circumstances).
- Considers relationships to be more intimate than they actually are.
Histrionic PD
- Show extreme pleasure as the center of attention and who behave in whatever way necessary to ensure that this happens
- Exaggerated emotional reactions, approaching theatricality, in everyday behavior
- Need for immediate gratification → demand reassurance, praise or approval
Histrionic PD
- Overly dramatic, attention seeking behavior, with tendency to draw caregiver into excessively familiar relationship
- Inadequate focus on symptoms and their management, with over emphasis on feeling states
- May provide answers they believe provider wants to hear
- Tendency to somatize
Problematic behavior of pt w/ Histrionic PD
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Avoidant PD
- Inability to set limits to availability, thus leading to burnout
- Hostile rejection of patient
Problematic behavior of provider tx pt w/ Dependent PD
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
Narcissistic PD
Individual psychotherapy
•Solution-focused therapy → short-term alleviation of difficulties within the patients life
Tx for Histrionic PD
- Is preoccupied with being criticized or rejected in social situations.
- Is inhibited in new interpersonal situations because of feelings of inadequacy
Avoidant PD
- Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
- Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
Dependent PD
- Generous validation of patient’s concerns, with attentive but factual response to questions
- Allow patients to maintain sense of competence by rechanneling their “skills” to deal with illness, obviating need for devaluation of caregivers
- Present treatment recommendations in the context of their right to the best care
Provider strategies for tx pt w/ Narcissistic PD
•Mood disorders, social phobia, obsessive-compulsive disorder, eating disorders
Comorbid disorders of Dependent PD
- Is uncomfortable in situations in which he or she is not the center of attention.
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
Histrionic PD
- Feeling overly concerned for the patient, taking on a paternalistic role that may increase patient’s sense of inadequacy
- May feel angry and betrayed by patient if the patient’s symptoms turn out to be more extensive than initially reported
Problematic behavior of pt w/ Avoidant PD
- Personality style → devoted
- Predominant theme → feelings of inadequacy, inability to make own decisions, submissiveness, avoidance of confrontation for fear of losing source of support
Dependent PD
- Mood disorders, social phobia, obsessive-compulsive disorder, eating disorders
- Schizoid PD, obsessive-compulsive PD
Comorbid disorders of pt w/ Avoidant PD
Individuals often appear anxious or fearful
- Avoidant
- Dependent
- Obsessive-compulsive
Cluster C
- Bipolar I disorder, depression, substance abuse disorders, anxiety disorders
- Paranoid PD
Comorbid disorders of Narcissistic PD
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts
Dependent PD
- Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs
- Manipulative, self-centered, take advantage of others
Narcissistic PD
•No strong clinical trials of medication efficacy nor are there any medications approved for use by the FDA
Dependent PD
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts
Histrionic PD
- Difficulty making everyday decisions → will cling to other people
- Difficulty disagreeing with other people for fear that they will lose their temper
- Extremely passive
Dependent PD
Mnemonic for Avoidant PD
A – avoids occupational activities
V – views self as socially inept
O – occupied with being criticized or rejected
I – inhibited in new interpersonal situations
D – declines to get involved with people
E – embarrassed by engaging in new activities
R – restrains from intimate relationships
- Performing excessive workup (when patient is dramatic) or inadequate workup (when patient is vague)
- Allowing too much emotional closeness, thereby losing objectivity
- Frustration with patient’s dramatic or vague presentation
Problematic behavior of pt w/ Histrionic PD
- Difficult to treat for a multitude of reasons
- Present for treatment only when a situational factor (stress) has made their ability to function and cope effectively impossible
- Much quicker to seek treatment and exaggerate their symptoms and difficulties in functioning
- Emotionally needy → often reluctant to terminate therapy
Tx for pt w/ Histrionic PD
- Many can function in a protected environment
- Some marry, have children and live lives surrounded only by family members
- If support system fails they are subject to depression, anxiety and anger
Avoidant PD
- Personality style → sensitive
- Predominant theme → social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Avoidant PD
- Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
- Needs others to assume responsibility for most major areas of his or her life.
Dependent PD
- Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
- Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
Dependent PD
Cognitive behavioral therapy
- Focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking
- Inability to make important life decisions
- Inability to initiate relationships
- Target skills that foster independence → avoid fostering independence from healthcare system
Tx for Dependent PD
- Personality style → self-confident
- Predominant theme → grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
Narcissistic PD
- Feel like they don’t measure up to others
- Fearful of, any involvement with other people and is terrified at the prospect of being publicly embarrassed
Avoidant PD
- Show respectful and professional concern for feelings, with emphasis on objective issues
- Avoid excessive familiarity
Provider strategy for tx pt w/ Histrionic PD
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts
Narcissistic PD
