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NMSP Exam 3 > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What is Id?

A
  • Instinctive biological drives and desires

- “I want”

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2
Q

What can Id lead to?

A
  • Overindulgence and disregard for rights of others
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3
Q

What is Ego?

A
  • Logical and language based problem solving
  • “I think”
  • Balances needs of the id with external reality
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4
Q

What is Superego?

A
  • Moral conscience based on ideal and values of society
  • “I should”
  • Can be the self-critical aspect of personality
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5
Q

What are ego defenses?

A
  • How the ego solves problems
    1. Resolves conflicts between the desires of the id and the restrictions of the superego
    2. Keeps the person connected to reality (exhibited in daily behaviors)
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6
Q

What are some qualities of the ego defenses?

A
  • Unconscious
  • Change with circumstances
  • Can be useful (coping) or harmful (pathological)
  • Vary by intensity or extent
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7
Q

Why do we have defence mechanisms?

A
  • Major psychological drive for most people is to reduce tension
  • A major cause of tension is anxiety
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8
Q

How is the tension caused by anxiety resolved?

A
  • Increase in problem-solving thoughts (seek rational solution or seek how to escape solution)
  • If cannot (re)solved, defense mechanism takes over
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9
Q

What are defense mechanisms?

A
  • How we cope with stress in the world; created by our natural limitations and view of our self
  • Appear unconsciously to change, transform, or otherwise re-invent reality in either large or small ways
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10
Q

When can defense mechanisms become problematic?

A
  • When one or two patterns are used exclusively

- Lead to maladaptive functioning

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11
Q

What is the continuum of progressing in maturity?

A
  • Primitive (narcissistic) –> Basic (neurotic) –> Mature
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12
Q

When do primitive defenses naturally occur?

A
  • Throughout childhood, in dreams, and in psychotic adults
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13
Q

What happens if the three primitive defenses are used in conjunction?

A
  • Permits one to effectively rearrange external experiences to eliminate the need to cope with reality
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14
Q

What is projection (primitive)?

A
  • Grossly frank delusions about external reality, usually of a persecutory nature
  • The self projects paranoid ideas out into the world and onto other people
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15
Q

What is an example of projection?

A
  • A man who cheated on his wife believes his wife is having an affair even though there is no evidence of it
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16
Q

What is denial (primitive)?

A
  • Refusal to accept external reality because it is too threatening
  • Arguing against an anxiety-provoking stimulus by stating it doesn’t exist
  • A common initial response to shock or grief
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17
Q

What is an example of denial?

A
  • A patient with a sprained ankle goes for a long run
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18
Q

What is splitting (primitive)?

A
  • Seeing some people as all good and others as all bad
  • Often seen in borderline personality disorder
  • Sometimes the splitting can occur within one other person
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19
Q

What is an example of splitting?

A
  • Patient idolizes you but demonizes previous provider or your office staff
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20
Q

What are the three primitive defense mechanisms?

A
  1. Projection
  2. Denial
  3. Splitting
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21
Q

What is displacement (neurotic)?

A
  • Shifts sexual or aggressive impulses to a more acceptable or less threatening target
  • Redirecting emotion to a safer outlet
  • Separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening
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22
Q

What are some examples of displacement?

A
  • Mother yells at child when actually angry with spouse

- Physician yells at front office staff when frustrated with a patient

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23
Q

What is regression (neurotic)?

A
  • Temporary reversion of behavior to an earlier, less mature, more child-like behavior, rather than handling unacceptable impulses in a more adult way
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24
Q

What is an example of regression?

A
  • An adult begins talking in “baby talk” when stressed

- When stressed, an adult starts sucking on their thumb since it calmed them when they were younger

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25
Q

What is somatization/hypochondriasis (neurotic)?

A
  • Transforming negative feelings towards others into negative feelings toward self, pain, illness, anxiety
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26
Q

What is an example of somatization/hypochondriasis?

A
  • Student feels embarrassed by resident on rotation, then next day has upset stomach arriving at the rotation
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27
Q

What is introjection/identification (neurotic)?

A
  • This is the opposite of projection because it involves taking others’ behavior or emotions and internalizing them
  • When a person is aware of this, it is an imitation
  • When a person is not aware of this, it is a defense
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28
Q

What are some examples of introjection/identification?

A
  • Student takes on characteristics of mentor

- Abused child becomes an abusive parent

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29
Q

What is isolation of affect (neurotic)?

A
  • Separating feelings from ideas and events
  • La belle indifference (seen in conversion disorder and Alzheimer’s) – very calm when talking about something that seems sad/stressful/shocking
  • Cognitive information is recalled, but emotions are avoided
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30
Q

What is an example of isolation of affect?

A
  • Person is describing a murder with graphic detail but no emotional response is evident
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31
Q

What is intellectualization (neurotic)?

A
  • Focusing on and exaggerating the intellectual aspect of a situation so as to distance oneself from anxiety
  • Emotion replaced by thoughts
  • Separating emotion from ideas
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32
Q

What are some examples of intellectulization?

A
  • Physician focuses on test results rather than patient’s emotions
  • “Notice how the bone is protruding from my leg. It is interesting to complete the physiology of this event”
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33
Q

What is blocking (neurotic)?

A
  • Temporarily inhibits thinking
  • Can include affect and behavior
  • The individual “stops” momentarily
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34
Q

What is acting out (neurotic)?

A
  • Covering up true feelings by discharging a different feeling (usually anger)
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35
Q

What are some examples of acting out?

A
  • Physical fight or bullying because individual can’t handle their internal emotions
  • Adolescent begins to drink alcohol every day to cope with parent’s divorce
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36
Q

What is reaction formation (neurotic)?

A
  • Converting unconscious wishes or impulses considered threatening into their opposite (an over-reaction)
  • Taking the opposite belief because the true belief causes anxiety
  • This defense works will in the short term only
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37
Q

What are some examples of reaction formation?

A
  • Two co-workers fight, but secretly attracted to each other

- Student who does not like kids becomes a pediatrician

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38
Q

What is undoing (neurotic)?

A
  • Do an action hoping to fix or reverse a previously unacceptable behavior
  • Seen in bulimia, intimate partner violence, compulsive behavior
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39
Q

What are some examples of undoing?

A
  • Individual buys flowers for partner after a fight
  • Superstitious behavior
  • Checking behavior (seen in OCD and body dysmorphic disorder)
40
Q

What is rationalization (neurotic)?

A
  • Individual convinces themselves that no wrong happened and that the unacceptable is acceptable
  • Usually an excuse or reason to justify their behavior
  • Often gives several reasons, as if trying to convince self
41
Q

What are some examples of rationalization?

A
  • If the room weren’t so noisy, I would have done better on the exam
  • Yes we killed civilians, but we were at war and were ordered to do so
42
Q

What is passive aggressive (neurotic)?

A
  • Aggression toward others expressed indirectly or passively
  • Not physical or verbal aggression
  • Creates serious problems
  • Does this instead of directly confronting problems
43
Q

What are some examples of passive aggressive?

A
  • You need to return a borrowed dish to a neighbor, but delay/stall after their dog destroys your flower garden
  • Patient does not keep appointments or habitually arrives late (because frustrated or angry)
44
Q

What is dissociation (neurotic)?

A
  • Drastic change in identity or character to avoid distress. Temporary
  • Seems like the experience is happening to someone else
  • Common and sometimes extreme in PTSD, substance abuse, and dissociative disorders
45
Q

What are some examples of dissociation?

A
  • Individual who was assaulted describes “watching” it happen to themselves, as if watching from outside their body
  • Traumatic memory “boxed” into another part of the conscious, so not easy to recall or maybe moved into unconscious so unable to recall
46
Q

What is humor (mature)?

A
  • Overtly expressing ideas and feelings, especially those too terrible to talk about
47
Q

What are some examples of humor?

A
  • Person laughs while being fired

- Student makes a joke out of being so sleep deprived

48
Q

What is suppression (mature)?

A
  • Conscious and intentional (the two ways it differs from repression)
  • A conscious decision to delay paying attention to an emotional need
  • Readily access and accept emotions later on
49
Q

What are some examples of supression?

A
  • After a patient dies, physician delays feelings in order to focus on the next patient and will “deal with it” later
  • Student decides to have a fun evening and “forget” about a pending exam
50
Q

What is altruism (mature)?

A
  • Constructive service to others. Brings pleasure and satisfaction
  • Service is above one’s own needs. Avoids discomfort
51
Q

What is an example of altruism?

A
  • Physician thinks, “I want to go to my child’s play at school, but the hospital needs me”
52
Q

What is sublimation (mature)?

A
  • Transform unpleasant emotion or instinct into positive action, behavior, or emotion
53
Q

What is an example of sublimation?

A
  • You are angry with a friend but rather than yell at them you: exercise, chop wood, paint, sing karaoke, clean
54
Q

What is the reason for defense mechanisms?

A
  • Protect us from being consciously aware of a thought or feeling which we cannot (or do not want to) tolerate
  • Defense only allows the unconscious thought or feeling to be expressed indirectly in a disguised form
55
Q

What are the characteristics of personality disorders?

A
  • Enduring pattern of inner experiences and behaviors
  • Deviate from the culture
  • Pervasive, inflexible
  • Onset in adolescence or early adulthood
  • Leads to distress, impairment
  • Over and above other conditions (substance abuse, other psych diagnoses)
56
Q

Where is functional impairment seen in personality disorders?

A
  • Relationships
  • Work
  • Academics
  • Unemployment
  • Domestic violence
  • Substance misuse
  • Increased health care use
  • Traumatic accidents
  • Early death from suicide or accidents
57
Q

Why is it hard to diagnose a personality disorder?

A
  • Many people have some features; few have full disorder

- The line between personal “quirkiness” and diagnosable can be hard to distinguish. Look for functional impairment

58
Q

What is the DSM-5 definition of personality disorders?

A

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two or more of the following:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
B. Enduring, inflexible, and pervasive pattern across a broad range of personal and social situations
C. Clinically significant distress or impairment
D. Pattern is stable and of long duration
E. Not better explained by other mental disorder
F. Not attributable to substance or other medical disorder

59
Q

What are disorders that seem odd and eccentric?

A
  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder
60
Q

What are some qualities of paranoid personality disorder?

A
  • Suspicious, especially of infidelity
  • Keeps grudges
  • Easily offended
  • Angry
  • Preoccupied with loyalty and trustworthiness
  • Suspects they have been victimized by exploitation or deception
61
Q

What is the management for paranoid personality disorder?

A
  • Be supportive
  • Listen to accusations and complaints (respect but do not collude)
  • Be open, honest, and respectful
  • Do not use interpretation
  • Clearly explain procedures, medications, and results of testing
  • Acknowledge rather than dismiss or cover up mistakes
  • After rapport is established, provide alternative explanations of others’ behaviors
  • These patients do not do well in group therapy
62
Q

What are some qualities of Schizoid personality disorder?

A
  • Reserved, remote, disconnected from others and social events
  • They deliberately isolate themselves from others because they dislike social contact, not because they have social anxiety disorder
  • Solitary interests/activities
  • Little interest in sexual contact with others
  • Limited friends; tend to only relate to 1st degree relatives
  • Indifferent to praise/criticism
  • Shows flat affect, emotional detachment/coldness
63
Q

What is the management of schizoid personality disorder?

A
  • Respect their space, acknowledge boundaries
  • Be supportive, don’t judge their disconnection
  • Understand their need for isolation
  • Do not impose social expectations. Don’t insist on reciprocal responses during conversations
  • Understand it might take some time to establish rapport
  • Referrals: tend to do better in individual therapy. Some can benefit from group, but only when they are ready
64
Q

What is an example of paranoid personality disorder?

A
  • Moody from Harry Potter
65
Q

What are some examples of Schizoid personality disorder?

A
  • Snape from Harry Potter
  • Sherlock Holmes (maybe)
  • Batman
66
Q

What are some qualities of Schizotypal personality disorder?

A
  • They tend to have closer interpersonal relationships than paranoid or schizoid patients, although they still display difficulty with intimacy
  • Odd thinking and speech
  • Magical thinking (bizarre fantasies, “sixth sense”)
  • Ideas of reference
  • Unusual perceptual experiences/bodily illusions
  • Paranoid ideation/suspiciousness
  • Constricted or inappropriate affect
  • Appearance is eccentric/odd
  • Lack of close friends
  • Excessive social anxiety (tends to be associated with paranoid fears)
67
Q

What is the management for schizotypal personality disorder?

A
  • Similar to schizoid personality disorder
  • Do not ridicule or judge
  • Respect their need for privacy
  • These patients may have misconceptions of their physical symptoms and proposed treatments
68
Q

What are some examples of schizotypal personality disorder?

A
  • Professor trelawney from Harry Potter
  • Kramer (seinfeld)
  • Phoebe (friends)
  • Willy Wonka
69
Q

What personality disorders seem to be dramatic, emotional, and erratic?

A
  • Borderline personality disorder
  • Histrionic personality disorder
  • Antisocial personality disorder
  • Narcissistic personality disorder
70
Q

What are some qualities of borderline personality disorder?

A
  • Pattern on undermining self just before a goal can be accomplished
  • Appear to be in a state of crisis
  • Short-lived psychotic episodes during times of stress
  • Highly unpredictable
  • Cannot tolerate being alone
  • Can identify more with inanimate objects/animals
  • Splitting
  • High comorbidity
71
Q

How is splitting seen in borderline personality disorder?

A
  • Ambiguity and shades of gray in interpersonal relationships are eliminated so that the patient sees themselves and others in clearly demarcated categories of black and white
  • These views may change rapidly and frequently, with an idealized person suddenly becoming a despised person
72
Q

What is the management for borderline personality disorder?

A
  • Simple communication with clear and consistent boundaries
  • Calm demeanor in response to inevitable crises
  • Preparation of patient for any changes in case arrangements (such as coverage during a holiday) to avoid sense of abandonment for patient
  • Coordination of care with other treatment providers in order to avoid patient use of splitting
  • Have open and continuous communication with staff
  • In addition, consider having a practice protocol with regard to after-hour coverage and use of email communication
  • Refer to dialectical behavioral therapy
73
Q

What is an example of borderline personality disorder?

A
  • Meredith from Grey’s Anatomy
74
Q

What are some qualities of histrionic personality disorder?

A
  • Needs to be center of attention
  • Interactions characterized by inappropiate sexual seductiveness/provocative behavior
  • Shallow expression of emotions that can rapidly shift
  • Uses physical appearance to draw attention
  • Speech is excessively impressionistic and lacking in detail
  • Self-dramatization, theatrically, exaggerated show of emotion
  • Suggestible
  • Makes everything sound more important than it is
  • Considers relationships to be more intimate than they are
  • Increased risk for suicidal gestures/threats
  • Increased risk for somatic symptom disorder, conversion disorder and depressive disorder
75
Q

What is the management for histrionic personality disorder?

A
  • Maintain professional boundaries
  • Provide reassurance
  • Address seductive behaviors in straightforward manner while maintaining your professional boundaries
76
Q

What are some examples of histrionic personality disorder?

A
  • Blanche Dubois– A streetcar named desire

- Scarlett O’Hara– Gone with the wind

77
Q

What are some qualities of antisocial personality disorder?

A
  • Pervasive disregard for violation of rights of other as indicated by:
    1. Failure to conform to social norms/laws
    2. Deceitfulness (lying/conning for profit/pleasure)
    3. Impulsivity/lack of planning
    4. Irritability/Aggressiveness that leads to fights/assaults
    5. Consistent irresponsibility- inconsistent work history and fiances
    6. Lack of remorse- indifferent/rationalize behaviors
78
Q

What is important about age in antisocial personality disorder?

A
  • Must be 18

- Have evidence of behavior patterns before age 15

79
Q

What are people with antisocial personality disorder referred to as?

A
  • Psychopaths or sociopaths
80
Q

How may an antisocial person look?

A
  • May be extraverted, very charming, and seductive
  • Have little regard for social convention and socially accepted morals
  • Most are great at conning people
  • Have a deep desire to manipulate and cheat
81
Q

What is the management for antisocial personality disorder?

A
  • Firm limits
  • Simple, straightforward communication
  • Clear and consistent behaviors
  • Address self-destructive behaviors
  • Exercise caution when prescribing controlled substances due to potential for illegal use
  • In addition, be aware of tendencies of these patients to be less than truthful and to disregard rules
82
Q

What are some examples of antisocial personality disorder?

A
  • Ted Bundy
  • Bernie Madoff
  • The Joker
83
Q

What are some qualities of narcissistic personality disorder?

A
  • Requires excessive admiration
  • Sense of entitlement
  • Exploitive in relationships
  • Lacks empathy, but has a sense of right/wrong
  • Envies others or believes others envy them
  • Believes that he/she is special and unique and wants to associate only with other special or high-status people
  • Become enraged when don’t get what they believe is due to them
  • Relationships are fragile
  • Often feel contempt for others
  • Will seek out the best physicians to treat their “special” needs
84
Q

What is the management of narcissistic personality disorder?

A
  • Acknowledge the patient as special
  • Convey self-confidence in interactions
  • Avoid power struggles or being defensive
  • Medical illnesses can be a blow to their self-esteem- may exaggerate symptoms- Reinforce that they are respected and appreciated
  • Use “I” statements when possible
  • Validate concerns while also establishing boundaries
  • Monitor for depression and suicidality
85
Q

What are some examples of narcissistic personality disorder?

A
  • Lucy from Charlie Brown
  • Gilderoy Lockhart
  • Gaston (Beauty and the Beast)
86
Q

What are some personality disorder that seem fearful and anxious?

A
  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive compulsive personality disorder (OCPD)
87
Q

What are some qualities of avoidant personality disorder?

A
  • Pervasive pattern of social inhibition with feelings of inadequacy/negative evaluation as evident by:
    1. Avoids occupational activities that involved significant interpersonal contact
    2. Unwillingness to get involved unless certain of being liked
    3. Restraint within relationships because of fears of shame or ridicule
    4. Inhibited in new interpersonal situations
    5. Views self as socially inept, personally unappealing, or inferior
    6. Unusually reluctant to take personal risks or new activities
88
Q

What is the management for avoidant personality disorder?

A
  • Avoid critical comments
  • Reinforce appropriate help-seeking behaviors
  • Medical illnesses may be embarrassing to them
  • Have patience and understanding
  • Respond with a calm and reassuring demeanor
  • Minimize new and unfamiliar staff contacts
89
Q

What are some examples of avoidant personality disorder?

A
  • Kim Basinger

- Donny Osmond

90
Q

What are some qualities of dependent personality disorder?

A
  • Pervasive and excessive need to be taken care leading to submissive/clinging behavior with fears of separation as evident by the following:
    1. Difficulty making decisions without excessive advice/reassurance
    2. Needs others to assume responsibility
    3. Difficulty expressing disagreement out of fear of losing approval/support
    4. Subordinate their own needs to the needs of others and may accept demeaning tasks in order to gain acceptance
    5. Cannot initiate projects on own
    6. Needs excessive nurturance and support
    7. Feels uncomfortable/helpless when alone– belief that they cannot take care of themselves
91
Q

What is the management of dependent personality disorder?

A
  • Tolerate repeated requests for reassurance
  • Schedule primary care visits at regular, pre-established times (such as monthly) rather than as unscheduled visits prompted by the emergence of new symptom complaints
  • When medically ill they may become frustrated that they are not being helped
  • Be active in treatment planning
  • Be careful when encouraging a patient to change the dynamics of an abusive relationship- Assess patient’s stage of change
92
Q

What are some examples of dependent personality disorder?

A
  • Bill Dauterive– King of the Hill

- Dobby

93
Q

What are some qualities of obsessive compulsive personality disorder?

A
  • Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of activity is lost
  • Perfectionism that interferes with task completion
  • Excessively devoted to work and productivity at the exclusion of leisure and friendships
  • Overly conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
  • Reluctant to delegate tasks or to work with others unless they submit to his/her way
  • Typically have limited interpersonal skills. Are typcially unwilling to compromise and insist that others submit to their needs
  • Rigidity and stubbornness
  • Be careful to distinguish from autism spectrum, OCD, and hoarding
94
Q

What is the management of obsessive compulsive personality disorder?

A
  • Provide information about conditions/treatments without extended discussion. Give precise and rational explanations
  • Avoid power struggles (use motivational interviews)
  • They value efficiency and punctuality
  • Acknowledge the importance of “work” but point out how avoiding treatment have harmful consequences
  • Medical illnesses will interfere with the person’s work, lifestyle, and sense of control
  • Allow the patient to have control when you can
  • Try to understand their need for control
  • Encourage limited information- seeking on the internet and through other resources while reinforcing other interests
95
Q

What are some examples of obsessive compulsive personality disorder?

A
  • Adrian Monk (character)

- Bree Van Der Kamp (Desperate housewives)

NMSP Exam 3 (18 decks)

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