Personality Disorders

Question 1

personality traits

Answer 1

behaviors and patterns of perceiving or relating to others; and of thinking about self and others in environment

Question 2

personality traits may be

Answer 2

adaptive or maladaptive

Question 3

maladaptive traits are

Answer 3

inflexible; significant functional impairment and subjective distress

Question 4

persistent maladaptive traits =

Answer 4

personality disorder

Question 5

personality disorders are

Answer 5

long standing, believed to rise from very beginnings of personality developent

Question 6

what to look for in personality disorders

Answer 6

connections to Erickson’s developmental task completion, trust issues, autonomy issues are very common themes

Question 7

enduring personality disorders

Answer 7

a “cure” is unlikely

Question 8

personality disorders are

Answer 8

not responsive to short-term psychotherapy or drug therapy

Question 9

which axis are personality disorders identified

Answer 9

axis 2

Question 10

increased stress in patients with personality disorders

Answer 10

causes exacerbation of symptoms

Question 11

Cluster A

Answer 11

(secretive, suspicious) Cognitive = unable to trust, indecisive, poverty of thought Affective = Quick anger, social anxiety, blunted affect Behavioral = eccentric, craves solitude, argumentative, odd speech Sociocultural = impaired or nonexistent relationships, occupational difficulties

Question 12

Cluster B

Answer 12

(flamboyant, dramatic, attention-seeking) Cognitive = considers self special, unique, egocentric, no long range plans, often identity disturbances affective = intense, labile, no sense of guilt, anxious, depressed behavioral= dramatic, craves excitement, wants immediate gratification, self mutilation sociocultural = manipulates and exploits others, stormy relationships, no amount of attention is enough

Question 13

Custer C

Answer 13

(fearful, indecisive) Cognitive = moralistic, low self esteem, low self confidence Affective = anxious, fearful, depressed Behavioral = Tense, rigid routines, submissive, inflexible, passive-aggressive Sociocultural = Dependent on others, avoids overt conflict, seeks constant unconditional love

Question 14

Cluster A disorders

Answer 14

( Eccentric, isolative with major lack of trust) Paranoid personality disorder schizoid personality disorder schizotypal personality disorder

Question 15

paranoid personality disorder

Answer 15

increased risk in males substance abuse common increased risk if family history suspicious difficulty adjusting to change sensitive, argumentative feels irreversible injury by others - often without evidence unwilling to forgive even minor events anxiety, difficulty relaxing short temper difficulty problem solving lack of tender feelings toward others jealous of significant other - often without evidence

Question 16

schizoid personality disorder

Answer 16

lack of desire to socialize ; likes solitude lacks strong emotions detached, self absorbed lacks trust may have brief psychotic episodes when stressed difficulty expressing anger passive reaction to crisis

Question 17

schizotypal personality disorder

Answer 17

often seek help for anxiety or depression 30-50% also have major depression incorrectly interprets external events - believes all events refer to self superstitious, preoccupied with paranormal phenomena believes in magical control of others constricted or inappropriate affect anxious in social situations generally seeks therapy for depression, anxiety, dissociative D/O

Question 18

Communication strategies for Cluster A

Answer 18

reinforce reality limit discussion to concrete familiar topics clear, simple messages to avoid misinterpretation of words/phrases resist using logic to counteract clients inappropriate statements- client may engage in power struggle to defend self don’t use humor acknowledge pain, fear offer gentle reassurance when perceptions are frightening don’t touch the client - may be misinterpreted

Question 19

Cluster A pharmacological therapy

Answer 19

usually treated for axis 1 problem antidepressants, anxiolytics, low dose antipsychotics

Question 20

Cluster B Disorders

Answer 20

(dramatic, self centered) antisocial personality disorder borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

Question 21

antisocial personality disorder

Answer 21

Usually diagnosed by age 18 H/O conduct D/O High % in prison or h/o legal trouble High % with substance abuse increased incidence in males Irresponsible – Fail to honor financial obligations including child care Lack guilt Difficulty learning from mistakes Initial charm becomes coldness, manipulation, blaming others Lacks empathy Irritable affect

Question 22

borderline personality disorder

Answer 22

75% female H/O physical, sexual abuse, neglect, hostile conflicts Often early parental loss/separation Intense, stormy relationships Dichotomous thinking – all good or all bad Impulsive – often engages in reckless behavior - e.g. binging, spending money, reckless driving, unsafe sexual activity Self-mutilates Difficulty identifying self Negative/angry affect Feels empty, bored Difficulty being alone, feelings of abandonment

Question 23

dichotomous thinking

Answer 23

all good or all bad

Question 24

characteristics of borderline personality disorder

Answer 24

Usually above average intelligence Often initially very charming, ingratiating Tend to be very demanding - demand others meet their needs No sense of boundaries - others’ assertion of boundaries feels like rejection or punishment Not all traits may be present Don’t focus on analysis of condition but on behavior and your response to it BPD overlaps with many other disorders especially PTSD People with BPD suffer a lot of emotional pain and they don’t know what to do to feel better Most of behaviors come from unconscious motivations - little insight into “why” they feel and act as they do The best thing we can do for ourselves and people with BPD is set boundaries

Question 25

boundaries for borderline personality disorder

Answer 25

Communicate honestly, fairly and consistently Don’t argue or bargain Follow through - message must be consistent in words and actions Remain calm - refrain from responding emotionally to provocation or manipulation Avoid power struggles by enforcing rules and limits consistently and refusing to respond to manipulative behavior (remember manipulation could be quite charming or ingratiating) Give positive feedback when appropriate - help person identify strengths Stay focused on topic of discussion - don’t get side-tracked to other issues, what other people did, etc. Be compassionately objective - clear - consistent Respect your own boundaries and model that behavior - we teach others what our boundaries are by how we let others treat us

Question 26

Histrionic personality disorder

Answer 26

More common in women Rapid fluctuation in emotions Attention-seeking, self-centered Sexually seductive, flamboyant Very attentive to own appearance Dramatic style of speech Vague logic-lacks conviction in arguments, often switches sides Shallow emotional expression Craves immediate satisfaction Many c/o physical illness Suicide gestures

Question 27

narcissistic personality Disorder

Answer 27

50-70% are males Grandiose view of self Lack of empathy Needs to admired Preoccupied with fantasies of success, brilliance, beauty, ideal love

Question 28

communication strategies for Cluster B

Answer 28

Don’t argue, rationalize or bargain Stay calm! Communicate expectations clearly Avoid power struggles Help client focus on thoughts/feelings behind self-destructive actions Be consistent! Confront inappropriate behavior – try to assess if behavior stems from fear or attention-seeking Be compassionately objective Give positive feedback when appropriate Help client stay focused on topic of discussion Help client assume responsibility for feelings

Question 29

Cognitive therapies for Cluster B

Answer 29

DBT, CBT Work with client to see consequences of inappropriate behaviors Build trusting relationship Help client develop strategies for self-destructive behaviors Help client develop skills for social adaptation

Question 30

pharmacological therapy for cluster B

Answer 30

Aimed at Axis 1 diagnosis Anti-depressants, axiolytics

Question 31

Cluster C disorders

Answer 31

(Fearful, anxious) avoidant personality disorder dependent personality disorder obsessive compulsive personality disorder

Question 32

avoidant personality disorder

Answer 32

Fearful of criticism, disapproval, rejection Avoids social interactions Withholds thoughts, feelings Negative sense of self, low self-esteem

Question 33

dependent personality disorder

Answer 33

Submissive, clinging Unable to make decisions by themselves Cannot express negative emotions Difficulty following through on tasks

Question 34

obsessive-compulsive personality disorder

Answer 34

Preoccupied with perfection, organization, structure, control Procrastinates Abandons projects due to dissatisfaction Excessive devotion to work Difficulty relaxing Rule-conscious Self-criticism, unable to forgive own errors Reluctant to delegate Unable to discard anything Insist others conform to own methods, ideas

Question 35

Communication strategies for Cluster C

Answer 35

Help client explore misinterpretation of others’ actions/remarks as criticism Discuss and model assertive communication & behaviors Help client learn to express feelings Help client learn to have fun/develop leisure activities

Question 36

cognitive therapy for cluster C

Answer 36

Learn new ways to cope with anxiety,anger,other emotions Help client recognize/eliminate unrealistic expectations of self/others Formulate ways to increase client’s social interactions Plan activities to enhance client’s self-esteem, decision-making

Question 37

pharmacological therapy for cluster C

Answer 37

Aimed at Axis 1 dx Anti-depressants, axiolytics

Question 38

interventions for cluster C

Answer 38

Promote safety Assess for suicidal ideation Contract for safety Assess for escalation of anger -> rage; impulsive violent action Contract for no violent acts Teach alternate means to manage anger Group therapy to practice problem-solving/explore alternatives Assess for self-mutilation Contract to talk c staff if urge to self-mutilate Put pt. on close observation until pt identifies need for self-harm has passed Identify other means of emotional release – i.e. wrap in sheet movement therapy If wounds occur treat in non-judgmental way – with little discussion Encourage journaling Physical restraint if necessary

Question 39

what are interventions aimed at

Answer 39

aimed at modifying life-long disruptive/dysfunctional behaviors/thoughts

Question 40

major thing to remember about antisocial personality disorder

Answer 40

there is no sense of guilt. Nothing is their fault

Question 41

what to remember about borderline personality disorder

Answer 41

neglect, a lot of sexual abuse , emotional separation of a parent, or physical separation

Question 42

borderline personality disorder (important)

Answer 42

attempt suicide with no clear expectation of death , death is not the goal

Question 43

anti social is very

Answer 43

id oriented. They only think about themselves

Question 44

important for narcissitic disorder

Answer 44

help client assume responsibility for feelings