Personality disorders

Question 1

Percentage of psychiatric pt who have personality disorder

Answer 1

50%

Question 2

Personality disorders are often comormid Dx (7)

Answer 2

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

Question 3

Personality disorders are often (2)

Answer 3

ego-syntonic and allopastic

Question 4

ego syntonic

Answer 4

acceptable to ego

Question 5

alloplastic

Answer 5

trying to alter environment rather than themselves

Question 6

Cluster A features and examples

Answer 6

odd, aloof features

e.g. schizotypal, schizoid, paranoid

Question 7

Cluster A comorbidity

Answer 7

schizophrenia

Question 8

Cluster B features and examples

Answer 8

Dramatic, impulsive, erratic features

e.g. boderline, antisocial, narcissistic, histrionic

Question 9

Borderline PD comorbidity

Answer 9

depression

Question 10

Antisocial PD comorbidity

Answer 10

alcohol abuse

Question 11

Histrionic PD comorbidity

Answer 11

somatosensory disorder

Question 12

Cluster C features and examples

Answer 12

anxious and fearful features

e.g. avoidant, dependent, obsessive-compulsive

Question 13

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

Answer 13

True

Question 14

Definition for defense mechanism

Answer 14

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

Question 15

Four guiding principles (defense mechanism)

Answer 15

Instinct, reality, important persons and conscience

Question 16

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.

Answer 16

Fantasy

Question 17

Fantasy often found in pt with this PD

Answer 17

Schizoid PD

Question 18

(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.

Answer 18

Dissociation

Question 19

Dissociation often found in pt with this PD

Answer 19

Histrionic PD

Question 20

(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.

Answer 20

Isolation

Question 21

Isolation often found in which PD

Answer 21

Obsessive compulsive

Question 22

(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.

Answer 22

Projection

Question 23

Splitting (Defense mechanism)

Answer 23

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

Question 24

Passive agression(DM)

Answer 24

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

Question 25

Acting out (DM)

Answer 25

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

Question 26

Projective identification(DM)

Answer 26

long standing suspicion and mistrust of people in general

Question 27

Projective identification is often found in which PD

Answer 27

Borderline PD

Question 28

- 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

Answer 28

Paranoid PD

Question 29

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

Answer 29

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

Question 30

Hallmark features of paranoid PD

Answer 30

excessive suspiciousness and distrust of others

Question 31

Differential dx of paranoid PD

Answer 31

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

Question 32

Treatment of paranoid PD

Answer 32

- 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

Question 33

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

Answer 33

Schizoid PD

Question 34

Treatment of Schizoid PD

Answer 34

Psychotherpay( similar to paranoid PD tx) Psychotherapy; OT groups

Question 35

How schizoid PD DIFFERS from schizotypal

Answer 35

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

Question 36

How schizoid DIFFERS from avoidant PD

Answer 36

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

Question 37

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

Answer 37

Schizotypal PD

Question 38

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

Answer 38

Antisocial PD

Question 39

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

Answer 39

Bordeline PD

Question 40

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

Answer 40

Histrionic PD

Question 41

How histrionic PD DIFFERS from borderline PD

Answer 41

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

Question 42

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

Answer 42

Narcissistic PD

Question 43

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”

Answer 43

Avoidant PD

Question 44

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

Answer 44

Dependent PD

Question 45

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

Answer 45

Obsessive - compulsive PD

Question 46

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

Answer 46

Passive-agressive Pesonality

Question 47

This Personality: | Pessimistic, anhedonic, duty bound, self-doubting, and chronically unhappy

Answer 47

Depressive personality

Question 48

This personality: | - desires to cause pain, achievement of sexual gratification by inflicting pain on themselves

Answer 48

Sadomasochistic personality