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Applied Behavioral Medicine > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Describe main characteristics of Antisocial Personality disorder

A
  1. Aggressive
  2. No remorse/regret, lack of empathy**
  3. Repeated violations of other people and doesn’t care or blames them
  4. Can’t read other people’s emotions
  5. Does not conform to social norms
  6. Controlling
  7. Reckless
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2
Q

Describe main characteristics of Avoidant Personality disorder

A
  1. Fearful, awkward, loner
  2. Want to have relationships with other people but afraid of being rejected (vs schizoid – don’t want relationships, lack of interest)
  3. Fear of being judged/scrutinized
  4. Spiral of being awkward and then people avoiding relationship with person and more fearful
  5. Hard to involve person in patient-provider relationship
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3
Q

Describe main characteristics of Borderline Personality disorder

A
  1. Inconsistency – love/hate, don’t leave me/I need you
  2. Emotions, relationships unstable
  3. Can be needy, attention seeking, push boundaries
  4. Want to feel special/have special relationship
  5. Want special privileges in patient-provider relationship – will put on pedestal but if one small slight will disown you
  6. Like walking on eggshells for family members
  7. Hard to differentiate from histrionic sometimes – very sexual for histrionic (Karen)
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4
Q

Describe main characteristics of Dependent Personality disorder

A
  1. People-pleaser
  2. Indecisive with even mundane things, helpless
  3. Wife relies on husband to make all decisions, do everything, go with her places, what to wear
  4. Can also see with children and parents, child can’t separate from parents even into adolescence
  5. Can also glom on to provider
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5
Q

Describe main characteristics of Histrionic Personality disorder

A

More sexual/provocative (Karen)

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6
Q

Describe main characteristics of Narcissistic Personality disorder

A
  1. Self-centered, inflated, grandiose
  2. Our president is perfect example according to Rachel
  3. Ego needs constant attention, will never admit to being wrong, extreme reaction to being criticized
  4. Never their fault, even if they behave poorly
  5. Always turn conversation around to talk about themselves, everything relates back to them
  6. Very entitled, demanding, wants special treatment because better than everyone else and they deserve it
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7
Q

Describe main characteristics of Obsessive Compulsive Personality disorder

A
  1. Rigidity around rules, neatness, cleanliness, order
  2. Houses are incredibly organized or neat
    * OCD can have messy house because not what they’re obsessing about
  3. Anxiety if things are out of place but in their mind everyone should be like them
  4. OCD: realize what they’re doing is irrational
  5. Not extreme anxiety with OCD
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8
Q

Describe main characteristics of Paranoid Personality disorder

A
  1. Suspicious, mistrust
  2. Don’t confide in anyone – feel info will be turned against you
  3. Healthcare: don’t trust provider
    - Office overcharging them
    - Ordering unnecessary tests to get more money
    - Other people getting better care than they are
  4. Everyone out to get them, to swindle them (interpret normal behavior this way)
  5. Not well liked by anyone
  6. Accusatory and unfriendly
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9
Q

Describe main characteristics of Schizoid Personality disorder

A
  1. Indifferent
  2. Don’t seek out relationships (not afraid, just don’t want them)
  3. Seek out jobs where don’t interact with people
  4. Viewed as cold, mean, hostile – but just don’t want to interact
  5. If parent, not interested in kid
  6. Few would work in healthcare setting – would not want to be in this setting except maybe radiologist or path
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10
Q

Describe main characteristics of Schizotypal Personality disorder

A
  1. Can look like schizophrenia and higher correlation with developing schizophrenia
    - But no negative sx or disordered sx
    - Not as extreme
  2. Odd way of viewing the world, magical thinking
  3. Phoebe on friends – quirky views on why things happen
  4. Can see symptoms that look like psychosis
  5. Hard time with relationships because so odd
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11
Q

Explain the difference between “normal” personality versus a PD

A

Normal: A collection of personality traits that added together define an individual
-A person’s personality is adaptable to different situations, people etc.– even if feels uncomfortable

PD: personality traits become rigid and NON-adaptive to situations
-interfere w/ daily fxning, success, can cause sign. distress or interpersonal relatioship problems

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12
Q

Personality is a person’s enduring and habitual patterns of:

A
  1. Behaving
  2. thinking
  3. emotional regulation
  4. ways of relating to others
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13
Q

Common shared traits amongst personality disorders

A
  1. Skewed/distorted sense of self (lack insight into self)
  2. Low frustration intolerance because so inflexible
  3. Difficulty dealing with stress
  4. Often blames others, has “victim” mentality, lack of responsibility for own behaviors
  5. Often has poor/no insight into personality issues
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14
Q

Describe the reasons providers should be aware of/knowledgeable about PD’s

A
  1. Board exams may ask to identify a personality disorder
  2. If treating a patient with meds and not responding -> an underlying personality disorder may be the reason
  3. If annoyed by/uncomfortable with/befuddled by a patient -> an underlying personality disorder may be the reason
  4. Awareness is important! Helps provider not be as bothered or frustrated w/pt
    * *Naming the personality disorder is not always necessary, important or even beneficial to the patient. Awareness is the key!
  5. Patients with personality disorders can be frustrating, annoying, even scary BUT remind yourselves that they are suffering
    - they to live with themselves all the time

**The ultimate goal as a provider is to provide as good care while maintaining our safety and boundaries

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15
Q

Example: Hannibal Lector, Miss Trunchbull (Matilda), Kevin (We Need to Talk about Kevin), The Joker, Mr. Harvey (Lovely Bones)

A

Antisocial

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16
Q

These terms go with what personality disorder:

  1. antisocial
  2. Avoidant
  3. boderline
  4. Dependent
  5. Histrionic
  6. Narcissistic
  7. Obsessive compulsive
  8. Paranoid
  9. Schizoid
  10. Schizotypal
A
  1. Cruel, lack of empathy:
  2. Fearful, awkward, loner:
  3. Unstable frenemy
  4. indecisive, ppl pleaser, obsequious (obedient)
  5. Praise me
  6. self-centered, entitled, lacking empathy for others
  7. Just right, perfectionism
  8. suspicious mistrust
  9. Indifferent
  10. eccentric, discomfort w/ close relationships
17
Q

i. Example: Elsa from Frozen, Charlie Brown, Michael Jackson

A

Avoidant

18
Q

Health care challenges of Avoidant PD

A
  1. Avoids seeking medical care: Afraid of one-on-one social interaction
  2. Fear of judgment or scrutiny for their medical conditions (weight/cholesterol/HTN, etc.)
  3. Lack of faith in themselves that they could make changes to improve health
  4. Lack of social support
  5. Difficulty opening up to to provider/giving a complete history
19
Q

Management as a provider

  1. These patients tend to “get on your nerves” and are prone to form intense relationships
  2. Establish good boundaries and emotional boundaries
  3. Make sure to have a chaperone present during sensitive exams
  4. Avoid using medical jargon to avoid distorted communication
A

Borderline

20
Q

Presentation

  1. Difficulty expressing disagreement/dealing with conflict 

  2. Fear of Abandonment - do not like being alone 

  3. Difficulty making simple decisions - what outfit to wear, yogurt to eat 
etc.
  4. Pretty common (runs in families, seen in female > males)
  5. Red flags: adolescents who rely on parents for age-appropriate decisions
A

Dependent

21
Q

Managment of dependent

A

pscyhotherpay

meds to tx underlying anxiety/depression

22
Q

Dependent health care issues

A
  1. Unable to participate in shared decision making 

  2. Places needs of caregiver above their own 

  3. Higher rates of anxiety, depression, phobias, substance abuse
23
Q

i. Examples: Scarlet O’Hara, stepsisters from Cinderella, Miss Piggy, Regina from Mean Girls

A

Histrionic

24
Q

Presentation

  1. Provocative or seductive behavior 

  2. Relationships are considered more intimate
than reality
  3. Attention seeking 

  4. Dramatic, over-react to minor issues (hangnail is a medical emergency)
A

Histronic

25
Q

Histrionic health care issues

A
  1. Difficult patients!
  2. Hard to take history
  3. Makes medical staff uncomfortable
  4. Exaggerates symptoms and difficulties
  5. Emotionally needy and time consuming
26
Q

i. Example: Gaston from Beauty and the Beast

A

Narcissitic

27
Q

Presentation

  1. Expect constant attention, affirmation 

  2. Sense of entitlement
  3. Grandiose sense of self-importance
  4. Expects to be recognized as special by others
  5. Lack of empathy
  6. Preoccupied by fantasies of perfect love
  7. Arrogant behaviors or attitudes
  8. Extreme negative reaction to rejections
A

Narcissitic

28
Q

Narcissistic health care issues

A
  1. May think they are the most important patient
  2. Demanding (may demand to see the doctor instead of the PA)
  3. Co-morbidities: anxiety, depression, substance abuse
29
Q

i. Example: Monica from Friends

A

Obsessive compulsive

30
Q

Presentation:

  1. Preoccupation with lists, rules, details, and schedules to an excessive extent
  2. Unable to complete a project b/c their overly strict standards are not met
  3. Friendships and leisure activities come second to work
  4. Rigid following of morals, ethics, or values
  5. Hoarding-type tendencies
  6. Lack of faith in others to complete tasks that meet their standards
  7. Stubborn in their ways
A

Obsessive compulsive

31
Q
  1. May never make the appointments due to compulsions acting as a barrier and consuming an excessive amount of time
  2. Would make their appointment months in advance, show up very early to the appointment, and be upset if the doctor or PA was disorganized or late
A

Obsessive compulsive

32
Q

Compare OCD and OCPD

A

OCPD (OCD)

  1. Insight: mindset is WNL (OCD- no their thoughts/compulsions are not reasonable)
  2. Distress: find comfort in their actions (O and C cause distress)
  3. Guilt: not guilty for actions, feel others should be as attentive (feel guilting asking to conform to their compulsions/routines)
  4. Anxiety: actions are not anxiety driven, motivated by perfectionism (engage in C to reduce anxiety around their O)
  5. Time: worked into their schedule, no viewed as extra time commitment (very time consuming, involuntary taking time away from daily schedules)
33
Q

i. Example: suspecting classmates of sabotaging grades, bearing grudges, reluctant to confide in other because fear will use information against them, interprets benign remarks as demeaning

A

Paranoid

34
Q

Presentation

  1. Pervasive distrust and suspiciousness of others (motives are interpreted as malevolent)
  2. Beginning by early adulthood
  3. Present in a variety of context, as indicated by > four of the following:
    - Suspects others are exploiting, harming, or deceiving
    - Has unjustified doubts about the loyalty or trustworthiness of friends or associates
    - Is reluctant to confide in others because of unwanted fear that information will be used maliciously against them
    - Reads hidden demeaning or threatening meanings into benign remarks or events
    - Persistently bears grudges (i.e. unforgiving of insults, injuries, or slights)
    - Perceives attacks on his or her character or reputation; quick to react angrily or to counterattack
    - Has recurrent suspicions, regarding fidelity of spouse/partner
A

Paranoid

35
Q

Paranoid health care issues

A
  1. Difficulty obtaining a complete history from the patient (may not want to confide in the provider)
  2. Patient may be suspicious of the health care system or motives of provider
  3. Patient may have difficulty trusting management, plan and recommendations made by the provider (may suspect provider of having ulterior motives, or that provider is trying to deceive, harm, or exploit him or her)
  4. May be easily offended or read into remarks made by a provider
  5. Any issues that do arise while treating patient (side-effects to medications, complications etc.) may lead to the patient bearing a grudge against the provider
36
Q

Presentation

  1. No close friends or confidants 

  2. Littler or no interest in sexual experiences with other people 

  3. Indifferent to praise or criticism 

  4. Appears cold, detaches or flattened 
in affect
  5. Can develop into schizophrenia, but some people will just continue to have persistent schizoid personality disorder
  6. Difficulty finding joy in anything, lack of emotion 

  7. Struggle with intimate relationships because people get frustrated that they are not feeling any 
emotions 

  8. Views the world as “dull and boring” 

A

Schizoid

37
Q

Presentation

  1. Odd beliefs, suspicions (i.e. believe in paranormal activity)
  2. Paranoid ideation 

  3. Eccentric: purple hair, piercings
  4. Discomfort with close relationships; worry about how they will be judged, that they won’t be accepted 

  5. Extensive social anxiety that does not diminish with time 

A

Schizotypal

38
Q

distinguish schizotypal between schizophrenia


A
  1. No gradual decline with these people


2. No hallucinations - auditory or visual (instead have magical ideas)

39
Q

schizotypal health care issues

A
  1. May have unusual descriptions for why things have happened (a unicorn bit me)
  2. Go off on tangents

  3. Paranoid ideas
  4. Difficulty trusting provider 


Applied Behavioral Medicine (6 decks)

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