the collection of signs and symptoms that together constitute a particular disorder - depression, substance abuse, somatization, eating disorders, PTSD, anxiety disorders, etc

personality disorders Flashcards by Kara S

personality disorder: definition

enduring pattern of inner experience and behavior that deviates markedly from the individual’s culture

pervasive, inflexible
stable over time
leads to distress, impairment
rarely seek treatment, rarely hospitalized

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personality disorder: onset

adolescence or early childhood

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personality disorders: cluster a

“odd and/or eccentric”
- indifference, impassivity, formality

paranoid
schizoid
schizotypal

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personality disorders: cluster b

“dramatic, emotional, erratic”
- chaotic, impulsive

antisocial
borderline
histrionic
narcissistic

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personality disorders: cluster c

“anxious, fearful”
- over-control

avoidant
dependent
obsessive compulsive

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personality disorder: diagnostic criteria

in addition to defintion -
pattern manifests 2 or more areas:
- cognition
- affectivity
- interpersonal functioning
- impulse control

NOT all four areas at once, unless severe illness

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defense mechanism

used by ego to protect the self from being overwhelmed by anxiety

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paranoid personality disorder

pervasive, enduring distrust and suspicion

defensive, abrasive, sarcastic, hostile
avoidant, jealous
attempts to appear unemotional

common defense mechanism: projection

therapeutic communication: supportive, honest, concrete

treatment: (rarely seek it) supportive, occasional anti-psychotics

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paranoid personality disorder: common defense mechanism

projection

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schizoid personality disorder

detachment and restricted emotional expressions

constricted, indifferent, remote
lack desire for intimacy
react passively to adverse circumstances

common defense mechanism: intellectualization

communication: engage
treatment: (unlikely to seek) short-term, solution-focused, brief, short-term pharm

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schizoid personality disorder: common defense mechanism

intellectualization

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schizotypal personality disorder

interpersonal deficits and acute discomfort with close relationships (can be frightening)

perceptual disturbances, eccentricities
constricted, distrustful

common defense mechanism: undoing

treatment: supportive, structured therapy that encourage social interaction, skills training (slowly, because threatening!); acute psychosis following stress may require short-term medication

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schizotypal personality disorder: common defense mechanism

undoing

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antisocial personality disorder

disregard for, violation of, the rights of others
- deceitful, manipulative, callous
- irresponsible, impulsive, aggresive
- must be > 18 yo with hx of conduct disorder > 15yo
- 3% men, 1% women, first degree relatives high risk
common dm: acting out

treatment: (don’t seek) considered one of the most difficult to treat
therapeutic community: token system, limit setting
pharm: acute axis I or extreme aggression

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antisocial personality disorder: common defense mechanism

acting out

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DSM IV: Axis I

the collection of signs and symptoms that together constitute a particular disorder

depression, substance abuse, somatization, eating disorders, PTSD, anxiety disorders, etc

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DSM IV: Axis II

personality disorders

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borderline personality disorder

instability of interpersonal relationships, self-image, affect

marked impulsivity; manipulative, volatile
patterns of undermining self, self-inflicted abuse
premature death from suicide, recurrent job loss, broken relationships (intense for short time)
significant family history (abuse, neglect, conflict, loss, separation); risk 5x in first degree
75% female

common dm: regression

therapy: boundaries & limits, providers work as team
pharm: transient symptoms of axis I, mood-stabilizers effective for severe

borderline personality disorder: common defense mechanism

regression

borderline personality disorder: course

early adulthood: chronic instability, serious dyscontrol

young adult: greatest time of risk for impairment, suicide

30-40’s: stabilize

histrionic personality disorder

pattern of excessive emotionality and attention seeking

need to be center of attention, dramatic, manipulative, superficial
high degree of suggestibility

common dm: dissociation
treatment: (quicker to seek treatment, exaggerate sx, reluctant to stop tx) - no known effective therapy; use modeling, concrete/detailed interaction

histrionic personality disorder: common defense mechanism

dissocation

narcissistic personality disorder

grandiosity and need for admiration, lack of empathy
- acts self-assured, nonchalant, arrogant, exploits others, lies

common dm: rationalization
therapy: (often terminate therapeutic relationship prematurely) brief, supportive OR long-term intensive

avoidant personality disorder

social inhibition, feelings of inadequacy, hypersensitivity
- ambivalent, preoccupied, guarded, empty

common dm: fantasy

communication: empathetic understanding, reassurance, friendly
therapy: assertiveness training, social exposure with relaxation training, cognitive therapy
pharm: comorbid anxiety disorders

avoidant personality disorder: common defense mechanism

fantasy

dependent personality disorder

excessive need to be taken care of leading to submissive and clinging behavior; fear of separation - timid, kind, passive, gullible - prognosis: good! common dm: introjection communication: limits, feedback therapy: insight oriented, assertiveness/social skills, anxiety management, combo therapy

dependent personality disorder: common defense mechanism

introjection

obsessive compulsive personality disorder

preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility/efficiency - tense, disciplined, industrious common dm: reaction formation treatment: difficult s/t intellectualizing; combo therapy pharm: SSRI, TCA

therapeutic management (all personality disorders): 3 main foci

boundaries consistent persistence in therapy

manipulative client: characteristics

verbal? | non-verbal?

therapeutic strategy: manipulative client

limits: clear, realistic, enforceable, have consequences DO NOT NEGOTIATE avoid power struggles

therapeutic strategy: angry client

LISTEN! | - calm, don't touch, communicate expectations, problem-solve

therapeutic strategy: impulsive client

identify feelings/needs explore impact anger management assertive skills, roleplay

group therapy helpful for which clusters?

c and some b

projection

common defense mechanism of: paranoid personality disorder person unconsciously rejects emotionally unacceptable personal features and attributes them to other people, objects, or situations through

intellectualization

common defense mechanism of: schizoid personality disorder a form of isolation; concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions

undoing

common defense mechanism of: schizotypal personality disorder compensates for an act or communication - ex: giving a gift to undo an argument, compulsive hand washing as cleansing oneself of act/thought perceived as unacceptable

regression

common defense mechanism of: borderline personality disorder temporary reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way

dissociation

common defense mechanism of: histrionic personality disorder disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment

rationalization

common defense mechanism of: narcissistic personality disorder justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener

fantasy

common defense mechanism of: avoidant personality disorder tendency to retreat into fantasy in order to resolve inner and outer conflicts.

introjection

common defense mechanism of: dependent personality disorder a subject takes into itself the behaviors, attributes or other external objects, especially of other people (ex: husband having sx that dead wife experienced; child seeing self as inferior thanks to over critical parents)

reaction formation

common defense mechanism of: obsessive compulsive personality disorder aka "overcompensation" - unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion