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Mental health > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

Percentage of psychiatric pt who have personality disorder

A

50%

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2
Q

Personality disorders are often comormid Dx (7)

A

Substance abuse, suicide, affective disorders, eating disorders, impulse-control disorders, anxiety disorders

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3
Q

Personality disorders are often (2)

A

ego-syntonic and allopastic

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4
Q

ego syntonic

A

acceptable to ego

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5
Q

alloplastic

A

trying to alter environment rather than themselves

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6
Q

Cluster A features and examples

A

odd, aloof features

e.g. schizotypal, schizoid, paranoid

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7
Q

Cluster A comorbidity

A

schizophrenia

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8
Q

Cluster B features and examples

A

Dramatic, impulsive, erratic features

e.g. boderline, antisocial, narcissistic, histrionic

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9
Q

Borderline PD comorbidity

A

depression

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10
Q

Antisocial PD comorbidity

A

alcohol abuse

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11
Q

Histrionic PD comorbidity

A

somatosensory disorder

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12
Q

Cluster C features and examples

A

anxious and fearful features

e.g. avoidant, dependent, obsessive-compulsive

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13
Q

T/F can pt meet criteria for more than one PD

A

True

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14
Q

Definition for defense mechanism

A

The unconscious mental processes that the ego uses to resolve conflicts among the four guiding principles (Instinct, reality, important persons and conscience)

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15
Q

Four guiding principles (defense mechanism)

A

Instinct, reality, important persons and conscience

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16
Q

defense mechanism:
Seeks solace and satisfaction within themselves by creating imaginary lives and imaginary friends.
- fearful of intimacy and closeness so they create imaginary lives
- OTs should not criticize, recognize their fear of closeness, remain reassuring and considerate.

A

Fantasy

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17
Q

Fantasy often found in pt with this PD

A

Schizoid PD

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18
Q

(defense mechanism)
The replacements of unpleasant affects with pleasant ones.
- To “erase” anxiety, they expose themselves to exciting dangers (exuberant and seductive behaviors)
- OTs consider using displacement ( talk to the pt about the issue of denial in an unthreatening way, empathize with the denied affect without directly confronting pt with facts.

A

Dissociation

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19
Q

Dissociation often found in pt with this PD

A

Histrionic PD

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20
Q

(defense mechanism)
a characteristic of controlled, orderly persons (Obsessive compulsive)
- pt may show formal social behavior, intensified self-restraint, and obstinacy.
- OTs, pt will respond well to precise, systematic, and rational explanations and value efficiency, cleanliness and punctuality
- whenever possible, OTs should allow pts control their own care and should not engage in a battle of the wills.

A

Isolation

21
Q

Isolation often found in which PD

A

Obsessive compulsive

22
Q

(Defense mechanism)
pts attribute their own unacknowledged feelings to others, fault finding and sensitivity to criticism
- OTs, confrontation is discouraged. OTs should not agree with the patients injustice beliefs but instead ask whether both can agree to disagree.
- OTs counterprojection is helpful (therapist gives the pts full credit for their feelings and perceptions, they never dispute nor reinforce them.

A

Projection

23
Q

Splitting (Defense mechanism)

A

people whom pts are feeling ambivalent are divided into good and bad.

24
Q

Passive agression(DM)

A

Turning their anger against themselves; also called masochism and includes failure, procrastination, silly or provocative behavior, self-demeaning clowning, and self-destructive acts (cutting)

25
Q

Acting out (DM)

A

tantrums, apparently motiveless assaults, child abuse and pleasureless promiscuity are common examples.

26
Q

Projective identification(DM)

A

long standing suspicion and mistrust of people in general

27
Q

Projective identification is often found in which PD

A

Borderline PD

28
Q
  • Long-standing suspicion and mistrust of persons in general
  • They refuse responsibility for their own feelings and assign responsibility to others & they are often hostile, irritable, and angry
  • Muscular tension, inability to relax, constantly scanning the environment, & their manner is often humorless and serious
A

Paranoid PD

29
Q

Diagnosis of paranoid PD (4 or more of the following)

A

Suspects that others are exploiting, harming or deceiving them
Preoccupied by unjustified doubts that others are unloyal
Reluctant to confide in others
Persistently holds grudges
Reads hidden demeaning or threatening meanings into benign remarks
Perceives attacks on his/her character that are not apparent to others
Questions fidelity of spouse or partner for no reason

30
Q

Hallmark features of paranoid PD

A

excessive suspiciousness and distrust of others

31
Q

Differential dx of paranoid PD

A

Those with paranoid PD do not have hallucinations or delusions (differentiates from paranoid schizophrenia)

32
Q

Treatment of paranoid PD

A
  • Therapists should be straightforward & direct; do not be overly warm
  • These patients usually do not do well in group therapy, however can be used for social skills & diminishing suspicions through role playing (later on in treatment course)
  • Pharmacotherapy
33
Q

This PD:

  • Discomfort with human interaction; lifelong pattern of social withdrawal
  • Introversion
  • Bland & constricted affect are noteworthy
  • Clinical features: May seem cold and aloof; may appear quiet, distant, seclusive, and unsociable; little need for emotional ties
  • Non-competitive, lonely jobs, they may have non-human interests (e.g. astronomy, mathematics, strongly attachment to animals
  • Appear lost in daydreams & self-absorbed, but they have normal capacity to recognize reality
A

Schizoid PD

34
Q

Treatment of Schizoid PD

A

Psychotherpay( similar to paranoid PD tx)

Psychotherapy; OT groups

35
Q

How schizoid PD DIFFERS from schizotypal

A

schizotypal is more similar to a person with schizophrenia regarding their perception, thought, behavior, and communication

36
Q

How schizoid DIFFERS from avoidant PD

A

individuals with avoidant PD are isolated but strongly wish to participate in activities

37
Q

This PD:
- Strikingly odd or strange, even to laypersons
- Magical thinking, peculiar notions, ideas of reference, illusions, and derealization
- May have brief psychotic episodes when under stress, but they never persist (differentiates from schizophrenia)
- Clinical features: disturbed thinking and communicating; their speech may be distinctive and peculiar, may have meaning only to them, and often needs interpretation
May have few friends (if any at all)
- Treatment: psychotherapy & pharmacology

A

Schizotypal PD

38
Q

This PD:

  • Inability to conform to the social norms that ordinarily govern many aspects of a person’s adolescent and adult behavior
  • These patients can act composed and credible, however, within them lurks tension, hostility, irritability, and rage
  • Failure to conform to social norms with respect to lawful behavior, indicated by repeatedly performing acts that are grounds for arrest, lack of remorse, consistent irresponsibility, reckless regard for safety of self of others
  • May appear normal and even charming
  • lying , truancy, running away from home, thefts, fights, substance abuse, and illegal activities are typical behaviors
  • These individuals may be your so-called “con men”
  • They exhibit no anxiety or depression
A

Antisocial PD

39
Q

This PD:
On the border between neurosis and psychosis
Extraordinarily unstable affect, mood, behavior, object relations, and self-image
Almost always appear to be in a state of crisis, mood swings are common
Patients can be argumentative one moment, depressed the next, then complaining they have no feelings the next
May have short lived psychotic episodes
Highly unpredictable behavior
Repetitive self-destructive acts (to elicit help from others, to express anger, or to numb themselves to overwhelming affect)– example: slitting wrists
They feel both dependent and hostile– they are dependent on those whom they are close with & when frustrated, can express enormous anger towards them
Cannot tolerate being alone, frantic search for companionship, no matter how unsatisfactory to their own company
Defense mechanisms associated: splitting, projective

A

Bordeline PD

40
Q

This PD:

  • Are excitable and emotional and behave colorful, dramatic, extroverted fashion
  • However, unable to maintain deep, long-lasting attachments
  • High degree of attention-seeking behavior
  • They tend to exaggerate their thoughts and feelings to make everything sound more important than it really is
  • They display temper tantrums, tears, and accusations when they are not the center of attention or receiving praise or approval
  • Seductive behaviors, may act on their sexual impulses to reassure themselves that they are attractive to the other sex, flirtatious, superficial relationships, vain, self-absorbed, fickle, overly trusting and gullible
  • Defense mechanisms: repression and dissociation
A

Histrionic PD

41
Q

How histrionic PD DIFFERS from borderline PD

A

borderline PD = suicide attempts, identify diffusion, brief psychotic episodes common

42
Q

This PD:
- Characterized by a heightened sense of self-importance, lack of empathy, grandiose feelings of uniqueness
- Underlyingly, their self-esteem is fragile & vulnerable to even minor criticism
- They consider themselves special and expect special treatment; they feel entitled
- Handle criticism poorly
Ambitious to achieve fame or fortune

A

Narcissistic PD

43
Q

This PD:

  • Show extreme sensitivity to rejection and may lead to socially withdrawn lives
  • Although shy, they are not asocial and show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance
  • In clinical interviews, the most striking aspect is anxiety about talking with an interviewer; their nervousness waxes and wanes due to them being unsure of whether the interviewer likes them
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Preoccupied with being criticized or rejected in social situations
  • Views self as socially inept, personally unappealing, or inferior to others
  • Hypersensitivity to rejection & timid
  • They are afraid to speak up in public or make requests of others
  • They are apt to misinterpret other persons’ comments as derogatory or ridiculing
  • Rarely attain much personal advancement or exercise much authority; often take jobs “on the sidelines”
A

Avoidant PD

44
Q

This PD:

  • Subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience severe discomfort when alone for more than a brief period
  • 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 & present in a variety of contexts
  • Difficulty making everyday decisions– needs an excessive amount of advice and reassurance from others
  • They prefer to be submissive
  • Pessimism, self-doubt, passivity, and fears of expressing sexual and aggressive feelings are typical behaviors
  • Needs others to assume responsibility for most major areas of their lives
  • Difficulty with initiation
A

Dependent PD

45
Q

This PD:
- Characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness
- Essential feature: a pervasive pattern of perfectionism and inflexibility
Stiff, informal, and rigid demeanor with flat or blunted affect, lack spontaneity & usually a serious mood
- Their answers to questions are unusually detailed
- Preoccupied with details, rules, lists, order, organization, and schedules to the extent that the major point of the activity is lost
- Perfectionism that interferes with task completion
Insist that rules be followed rigidly and cannot tolerate what they consider infractions

A

Obsessive - compulsive PD

46
Q

This Personality:

  • Characterized by covert obstructionism, procrastination, stubbornness, and inefficiency
  • Procrastinate, resist demands for adequate performance, find excuses for delays, and finds fault with those on whom they depend, they refuse to extricate themselves from the dependent relationships
  • Lack assertiveness and are not direct about their own needs and wishes
A

Passive-agressive Pesonality

47
Q

This Personality:

Pessimistic, anhedonic, duty bound, self-doubting, and chronically unhappy

A

Depressive personality

48
Q

This personality:

- desires to cause pain, achievement of sexual gratification by inflicting pain on themselves

A

Sadomasochistic personality

Mental health (4 decks)

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