Personality Disorders Flashcards
Characteristic of all personality disorders
- Consistent over time
- Behavior/traits difficult to modify
- Character deficits are ego-syntonic (bad insight)
- Use defense mechanisms (often primative)
- Anxiety and depression common presenting symptoms
Behavior in PDs deviates in at least 2/4 areas:
- Cognition (perception, interpretation)
- Affectivity (range, intensity, lability, appropriateness of emotional response)
- Interpersonal fxning
- Impulse control
Paranoid Personality Disorder Description
Pervasive distrust/suspiciousness of others –> motives interpreted as malevolent; often uses projection as defense mechanism
Paranoid PD Criteria
4+:
- Suspects w/o basis to be exploited, deceived, or harmed
- Questions w/o justification loyalty/trustworthiness
- Reluctant to confide in others (fears info will be used against them)
- Reads hidden meaning (demeaning/threatening)
- Bears grudges, is unforgiving
- Perceives attacks on character/reputation and quick to act angrily
- Recurrent suspicions w/o justification re: fidelity of spouse/partner
Management of Paranoid PD
- Develop trusting relationship
- Be honest/straightforward but not overly intimate
- Inform at each step of diagnosis/tx plan
- Anticipate anger, suspiciousness and noncompliance
Schizoid PD Description
Pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal setting
Schizoid PD Criteria
4+:
- Neither desires/enjoys close relationships
- Chooses solitary activities almost always
- Little if any interest in sexual experiences w/ another person
- Takes pleasure in few if any activities
- Lacks close friends/confidants
- Appears indifferent to praise/critcism
- Shows emotional coldness, detachment, flattened affect
Schizoid PD management
- Appreciate need for privacy
- Focus on technical aspects of tx
- Avoid very personal, close relationship
Schizotypal PD Description
Pattern of social/interpersonal deficits marked by acute discomfort w/ and reduced capacity for close relationship as well as by cognitive/perceptual distortions and eccentricities of behavior
Shizotypal PD Criteria
5+:
- Ideas of reference
- Odd beliefs, magical thinking
- Unusual perceptual experiences
- Odd thinking and speech (vague, circumstantial)
- Suspiciousness or paranoid ideation
- Inappropriate or constricted affect
- Behavior/appearance that is odd, eccentric, peculiar
- Lack of close friends/confidants
- Excessive social anxiety
Management of schizotypal PD
Avoid judgmental attitude about patient’s beliefs
Antisocial PD Description
Pattern of disregard for/violation of rights of others since age 15yrs (over 18 yrs, m>f)
Antisocial PD Criteria
3+:
- Fails to conform to social normal w/ respect to lawful behavior
- Deceitfulness
- Impulsivity/failure to plan ahead
- Reckless disregard for safety of self/others
- Consistent irresponsibility
- Lack of remorse
Evidence of conduct disorder w/ onset before 15 yrs
Antisocial PD management
Be aware that you might be manipulated, pt may feign physical symptoms, use firm no-nonsense approach (not punitive but w/ limits)
Borderline PD Description
Pattern of instability of interpersonal relationships, self-image, and affects and marked impulsivity; often use splitting as defense mechanism, F>M
Borderline PD criteria
5+:
- Frantic efforts to avoid real/imagined abandoment
- Pattern of unstable and intense interpersonal relationships
- Identity disturbance (unstable sense of self)
- Impulsivity in at least 2 ares that are potentially self damaging
- Recurrent suicidal behavior, threats, gestures, self-mutilation
- Affective instability
- Chronic feelings of emptiness
- Inappropriate, intense anger or lack of control of anger
- Transient, stress-related paranoid ideation or dissociative symptoms
Boderline PD Management
- Tailor meds to pt symptoms (antipsychotics often used)
- Patient may split staff, act in unstable/angry manner
- Consistent tx approach to manage pt’s fears of abandonment
- Monitor countertransference, discuss w/ supervisor
Histrionic PD Description
Pattern of excessive emotionality and attention seeking beginning by early adulthood and present in variety of contexts
Histrionic PD Criteria
5+:
- Uncomfortable in situation where not center of attention
- Inappropriate seductive/provocative behavior
- Consistently uses physical appearance to draw attention to self
- Rapidly shifting and shallow expression of emotion
- Self-dramatization, theatricality, exaggerated expressions of emotions
- Easily influenced by others/circumstances
- Considered relationships more intimate than they are
Management of Histrionic PD
- Prepare for overly dramatic expression of complaints – dont overreact
- Set clear boundaraies
- Avoid close relationship – may be misinterpreted as sexual
Narcissistic PD Description
Pattern of gradiosity, need for admiration, lack of empathy
Narcissistic PD Criteria
5+:
- Grandioise sense of self importance
- Preoccupied w/ fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believes they are special/unique and can be understood only by special high-status people
- Req excessive admiration
- Sense of entitlement
- Interpersonally expoitative
- Lacks empathy
- Envious of others
- Shows arrogant, haughty behavior/attitude
Narcissistic PD Management
Acknowledge pts sense of self-importance and include pt in decision making as appropriate
Tactfully acknowledge the physicians knowledge
Anticipate pt may degrade more junior members of team
Avoidant PD Description
Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Avoidant PD Critera
4+:
- Avoids social/occupational activies that involve interpersonal contact due to fears of criticism and rejexn
- Unwilling to get involved w/ people unless certain of being liked
- Shows restraint w/in intimate relationships
- Preoccupied w/ being criticized or rejected in social situations
- Inhibited in new social situations because feels inadequate
- Views self as socially inept, inferior, personally unappealing
- Unusually reluctant to take personal risks or engage in new activities because may prove embarrassing
Management of Avoidant PD
Pt likely timid to disclose personal details/symptoms
Physician may need to take initiative in discussing medical care
Approach should build trust and emphasize availability/respect
Dependent PD Description
Excessive need to be taken care of that leads to submissive/clinging behavior and fears of separation
Dependent PD Criteria
5+:
- Difficulty making everyday decisions w/o excessive advice/reassurance from others
- Needs others to assume responsibility for most major areas
- Difficulty expressing disagreement w/ others
- Difficulty initiating projects or doing things on their own
- Great lengths to get others to like/support them, even volunteering to do unpleasant things
- Uncomfortable/helpless when alone
- Urgently seeks another relationship when one ends
- Unrealistically preoccupied w/ fears of being left to care for themselves
Dependent PD Management
- Recognize that illness provides secondary gain in form of caretaking/attention
- Schedule regular, brief appts
- Pt may be overly compliant w/ acceptance of tx
- Set firm, realistic limits on doctor-pt relationship
- Watch for burnout/negative countertransferance
OCPD Description
Pattern of preoccupation w/ orderliness, perfectionism, mental, and interpersonal control at expense of flexibility, openness, efficiency
OCPD Criteria
4+:
- Preoccupied w/ details, rules, lists, order organization, or schedules to extent that major point of activity lost
- Perfectionism that interferes w/ task completion
- Excessively devoted to work and productivity to exclusion of leisure/friendships
- Over conscientious, scrupulous, and inflexible about morality, ethics, values
- Unable to throw out worthless objects
- Reluctant to delegate tasks/work in a group unless other submit exactly to their way of doing things
- Miserly spending style
- Rigid and stubborn
Management of OCPD
- Recognize pt is particularly troubled by loss of control related to illness
- Be “scientific” physician who can provide detailed explanations and includes pt in decision making
- Pt should be given as much control over tx as possible
