Personality Disorders Flashcards
What is the Id
instinctive builogic drives and desires
“I want it now!”
What is the Ego?
logical and language based problem solving
“I think” or “We can compromise”
What is the Superego?
moral conscience based on ideals and values
“I should” or “It’s not right to do that”
What are defense mechanisms?
Ego defense mechanisms are how the ego solves problems by
- solving conflicts between the Id and the Superego
- keeps the person connected to reality
If tension cannot be resolved, what takes over?
defense mechanisms
What are primitive defenses?
childhood, dreams, psychotic adults use these
allow the user to eliminate the need to cope with reality
What is projection?
- primitive
- grossly frank delusions about external reality
- projects paranoid ideas out onto the world and onto other people
Example: man who cheated on wife, thinks she is cheating on him without evidence
What is denial?
- primitive
- refusal to accept external reality because it is too threatening
- Denies existence of trauma
Example: Pt sprained ankle but continues to go for a run
What is splitting?
- Primitive
- seeing some people as all good and others as all bad
Example: Pt idolizes you but demonizes previous provider
What is Displacement?
- Neurotic
- shifts sexual or aggressive impulses to a more acceptable or less threatening target
- redirects emotions or separates emotion
Example: mother yells at child when angry at spouse; Doc yells at front staff when frustrated with patient
What is Regression?
- Neurotic
- Temporary reversion of behavior to an earlier/less mature behavior
Example: adult “baby talking” when stressed
What is somatization/hypochondriasis?
- Neurotic
- transforming negative feelings towards others into negatiev feelings toward self, pain, illness, or anxiety
Example: student is embarrassed by resident on rotation, next day has upset stomach upon arrival to hospital
What is Introjection/Identification?
- Neurotic
- Opposite of projection, involves taking others behaviors or emotions and internalizing this. Can be conscious (imitation) or unconscious (defense).
Example: Student acts like mentor; Abused child becomes an abusive parent
What is Isolation of Affect?
- Neurotic
- Separating feelings from ideas and events
- Very calm when talking about sad/shocking/stressful events
- Cognitive info is recalled, but emotions are avoided
Example: person describes murder in detail but no emotional response is evident
What is Intellectualization?
- Neurotic
- Focusing on and exaggerating the intellectual aspect of a situation so as to distance oneself form anxiety
Example: Doc focuses on test results rather than pt’s emotions
What is Blocking?
- Neurotic
- Temporarily inhibits thinking
- Can include effect and behaviour
- Person just “stops” momentarily
What is Acting Out?
- Neurotic
- Covering up true feelings by discharging a different feeling (usually anger)
Example: Physical fight or bullying because person can’t handle internal emotions; Adolescent drinking ETOH because can’t cope with parents divorce
What is Reaction Formation?
- Neurotic
- Converting unconscious wishes or impulses considered threatening into the opposite action
Example: co-workers fight but they secretly are attracted to eachother
What is Undoing?
- Neurotic
- Do an action to “fix” or reverse a previously unacceptable behaviour
- seen in OCD, Body Dysmorohic Disorder, Partner Violence, etc
What is Rationalization?
- Neurotic
- Person convinces themselves that no wrong has happened and that the unacceptable is acceptable
Example: If the room wasn’t so noisy, I would have done better on the test.
What is Passive Aggressive?
- Neurotic
- aggression towards others expressed indirectly
Example: You need to return a borrowed dish to a neighbor but their dog ate your garden, so now you wait to give it back to them
AKA: A real Karen
What is Dissociation?
- Neurotic
- Drastic change in identity or character to avoid stress
- “out of body” experience
Example: memory may be “boxed” into another part of the conscious and not easy to recall, or moved into unconscious and thus unable to recall
What is Humor (as a defense mechanism)?
- Mature
- Using humor to express ideas and feelings
Example: student makes a joke out of being sleep deprived
What is Supression?
- Mature
- Conscious and intentional (thus not Repression)
- Delay paying attention to an emotional need an deal with it later
Example: Pt dies, but doctor puts grieving on hold in order to care for other patients
What is Altruism?
- Constructive service to others, brings pleasure and satisfaction
Example: Doctor thinks: I want to see my child’s play, but my patients need me.
What is Sublimation?
- Mature
- Transform unpleasant emotoin into positive action, behavior, or emotion
Example: angry with friend so you exercise, chop wood, pain, sing, clean, etc.
How can you tell if someone is “Quirky” or diagnosable?
look for Functional Impairment!
A personality disorder defined is an enduring pattern of inner experience and behavior that deviates from expectations in ___ areas
two or more areas
- Cognition
- Affectivity
- Interpersonal functioning
- Impulse Control
What patterns of behavior must be identified to diagnose a personality disorder?
- Enduring, inflexible and pervasive pattern of behavior across personal and social situations
- Clinically significant distress or impairment
- Stable pattern of long duration
What Conditions fall under “Cluster A”
Schizotypical
Paranoid
Schizoid
Describe Paranoid Personality Disorder
Suspicious
Grudges
Offendable
Angry
Pre-occupied with loyalty
Suspects they are a victim/exploited
How to manage Paranoid Personality Disorder?
Respect but do not collude
Be open, honest and respectful
After rapport is established, provide alternative explanations for other’s behavior.
No group therapy
Describe Schizoid Personality Disorder?
Dislike social contact, but not because of anxiety
Solitary interests
Little interest in sex
Flat affect
What is the best management for Schizoid Personality Disorder?
Respect their space
Do not impose social expectations
Describe Schizotypical Personality Disorder
Difficulty with intimacy
Odd thinking and speech
Magical thinking
Unusual Perceptual experiences
Constricted or Inappropriate affect
Appearance is eccentric/odd
Excessive social anxiety/paranoid fears
What is best management for Schizotypical Personality Disorder?
Do no ridicule or judge
May have misperceptions of symptoms/treatments
What are Cluster B Disorders?
Borderline Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder
Narcissistic Personality Disorder
Describe Borderline Personality Disorder
appear to be in a state of crisis
highly unpredictable
splitting
identify more with inanimate objects/animals
What is the best management for Borderline Personality Disorder?
Be clear and consistent with boundaries
Coordinate care with other providers to avoid splitting
What is Histrionic Personality Disorder?
Need Center of Attention
Show sexual seductive/provocative behavior
Shallow emotions that can rapidly shift
What is the best management for Histrionic Personality Disorder?
Address Seductive behaviors in professional manner
maintain boundaries
Describe Antisocial Personality Disorder
Must be 18 y/o or older
Evidence of behavior patterns before age 15
Old term for: “psychopath” or “sociopath”
Not asocial-may be very extraverted, charming, seductive
Great at conning people
Manipulate and cheat people
What is the best management for Antisocial Personality Disorder
Firm limits
Caution when prescribing controlled substances
Describe Narcissistic Personality Disorder
Reqiure excessive admiration
Often feel contempt for others
have “special” needs or requirements
What is the best management for Narcissistic Personality Disorder?
Acknowledge pt as special
Avoid power struggles
Monitor for depression/SI
Use “I” statements
What are Cluster C disorders?
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive Compulsive Personality Disorder
Describe Avoidant Personality Disorder
social inhibition with feelings of inadequacy
Unusually reluctant to take personal risks or new activities
What is the best mangament for Avoidant Personality Disorder?
Avoid critical comments
Have patience and understanding
Describe Dependent Personality Disorder
Subordinate their own needs for the needs of others and may accept demeaning tasks in order to gain acceptance
Feels uncomfy when alone
What is the best management for Dependent Personality Disorder
Tolerate requests for reassurance
When encouraging change in dynamics of an abusive relationship, assess the pt’s stage of change (motivational interviewing)
Describe Obessive Compulsive Personality Disorder
Preoccupied with details, rules, lists, order, organization, schedules, etc. to the extend that the point of the activity is lost
Perfectionism that interferes with the task
Unwilling to compromise and insist that others submit to their needs
Rigidity and stubbornness
What is the best management for OCPD?
Avoid power struggles and use motivational interviewing
Allow the pt to have control when you can
try to understand their need for control
