Personality Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What are Freud’s structures of the mind?

A

Id

Ego

Superego

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2
Q

Define Id

A

instinctive biological drives and desires (impulsive)

“I want”

leads to overindulgence and disregard for rights of others

think of as inner child

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3
Q

Define Ego

A

logical and language based problem solving

“I think”

balances id with external reality

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4
Q

Define Superego

A

moral conscience based on ideal and values of society

“I should”

self-critical aspect of personality

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5
Q

Define defense mechanisms

A

how ego solves problems

  • resolves conflicts between desires of Id and restrictions of Superego
  • keeps person connected to reality

defenses are:
~unconscious

~change with circumstances

~can be useful (coping) or harmful (pathological)

~vary by intensity or extent

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6
Q

Why do we use defense mechanisms?

A

reduce tension and anxiety

start with problem-solving and seeking rational solution–> if can’t resolve, defense mechanisms take over

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7
Q

When do defense mechanisms become problematic?

A

when 1-2 patterns are used exclusively

lead to maladaptive functioning

tendency to deteriorate into less mature defenses under distress or frustration

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8
Q

What are primitive defenses?

A

occurs naturally throughout childhood, in dreams and psychotic adults

pathological if frequently used in non-psychotic adults

rearrange external experiences to eliminate the need to cope with reality

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9
Q

Examples of primitive defenses

A

Projection
-frank delusions about external reality, projects paranoid ideas out onto the world and other people

“man who cheats on wife believes wife is too without evidence”

“mom hates herself, tells daughter she hates her”

“teacher yells at you, you think they hate you”

Denial
-refusal to accept reality because too threatening

Splitting
- seeing some people as all good and others as all bad

“patient idolizes you but demonizes previous provider or your office staff”

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10
Q

Examples of basic or neurotic defenses?

A

Displacement
-shifts sexual or aggressive impulses to more acceptable/less threatening target

“mother yells at child when actually angry with spouse”

Regression
-temporary reversion of behavior to less mature rather than handling unacceptable impulses in adult way

“adults uses baby-talk when stressed”

Somatization/Hypochondriasis
-transforming negative feeling towards others to self, pain, illness, anxiety

“student embarrassed by resident, next day has upset stomach when arriving at hospital”

Introjection/Identification
-internalizing other’s behaviors or emotions; when aware, imitation; when unaware, defense

“abused child becomes abusive parent”

Isolation of affect
-separating feelings from ideas and events, calm when talking about something emotional

“person describing murder with graphic detail but no emotional response”

Intellectualization
-focusing on and exaggerating intellectual aspect of situation to distance from anxiety

“physician focuses on test results rather than pt emotions”

Blocking
-temporarily inhibits thinking, stops momentarily

Acting Out
-covering up true feelings by discharging a different feeling, usually anger

“kid drinks alcohol to cope with divorce, fights because can’t handle intense emotions)

Reaction Formation
- converting unconscious wishes or impulses considered threatening to opposite (over-reaction); only works well short-term

“student who doesn’t like kids becomes pediatrician”

Undoing
-doing an action hoping to fix or reverse previous unacceptable ehavior

“buy flowers after fight, superstitious behavior”

Rationalization
-convinces themselves that no wrong happened and that the unacceptable is acceptable; excuse to justify behavior

“if room weren’t so noisy, better exam performance”

Passive aggressive
-aggression expressed indirectly

“delay returning borrowed dish to neighbor after dog destroys your garden”

Dissociation
-drastic change in identity or character to avoid distress, temporary

“watching trauma happen to them”

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11
Q

What are mature defense mechanisms?

A

common in emotionally healthy adults

helps integrate conflicting emotions and thoughts

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12
Q

Examples of mature defense mechanisms

A

Humor
-jokes out of being sleep deprived, laugh when fired

Suppression
- intentional and conscious decision to delay paying attention to emotional need

“physician process death after workday”

Altruism
-constructive service to others, above one’s needs so avoids discomfort

Sublimation
-transform unpleasant emotion or instinct into positive action, behavior or emotion

“angry with friend, instead of yell you chop wood or exercise”

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13
Q

What is the purpose of defense mechanisms?

A

protect us from being consciously aware of a thought or feeling we don/t want or can’t tolerate

basically allows unconscious feeling to be expressed indirectly via disguised form

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14
Q

What is the characteristic of personality disorders?

A

functional impairment of ADLs
–> unemployment, academic, family, etc

serious impairment of all aspects of life of long duration

many people have aspects but not full impairment

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15
Q

Describe Cluster A personality disorders

A

seem odd, eccentric

  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
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16
Q

Describe Paranoid Personality Disorder

A

overall suspicious, especially with infidelity

keeps grudges and easily offended

angry

preoccupied with loyalty and trustworthiness

suspects they have been victimized by exploitation or deception

17
Q

How to manage person with paranoid personality disorder

A

respect accusations/complaints but DO NOT COLLUDE

be open and honest, supportive

clearly explain things, especially with mistakes

after rapport established: provide alternative explanations of other’s behavior

don’t do well in group therapy

18
Q

Describe Schizoid Personality Disorder

A

reersed, remote, disconnected from others and social events
–> HERMET, remove themselves by choice

solitary events

little interest in sexual contact

flat affect, emotion detachment/coldness

few friends, like being alone

indifferent to praise or criticism

19
Q

How to manage others with schizoid personality disorder

A

respect their space

do not impose social expectations

takes time to establish rapport

individual therapy, group when ready

20
Q

Describe Schizotypal Personality Disorder

A

closer interpersonal relationships c/t paranoid or schizoid, but still display difficulty with intimacy

odd thinking and speech, magical thinking or sixth sense

unusual perceptual experiences or bodily illusions

constricted (less) or inappropriate affect

appearance is odd or eccentric

excessive social anxiety with paranoid fears

21
Q

How to manage schizotypal personality disorder?

A

do not ridicule

respect need for privacy

similar to schizoid approach

22
Q

Describe Cluster B personality types

A

seem dramatic, emotional, erratic

  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Antisocial Personality Disorder
  • Narcissistic Personality Disorder
23
Q

Define borderline personality disorder

A

appear to be in state of crisis

short-lived psychotic episodes during times of stress d/t not able to handle emotions
–> self harm, substance abuse, high risk sexual activity

highly unpredictable

can’t be alone

identify with more inanimate objects or animals

SPLITTING
-extremely disruptive (black and white)

high comorbidity

24
Q

How to manage borderline personality disorder?

A

dialectic behavior therapy

clear and consistent boundaries (don’t give out phone # or do anything out of the normal for your patients)
–> if they feel abandoned, will try suicide or other behavior to keep you close

adequate preparation if going to be gone to not spark their abandonment–> coordinate care

25
Q

Describe Histrionic Personality Disorder

A

needs to be the center of attention

inappropriate seductiveness or provocative behavior–> uses physical appearance to draw attention

shallow expression of emotions that can rapidly shift

theatricality, exaggerated show of emotion

considers relationships to be more intimate than they are

increased risk for suicidal gestures or threats

increased risk for somatic sx disorder, conversion disorder and depressive disorders

26
Q

Hot to manage histrionic personality disorder?

A

maintain professional boundaries

provide reassurance

address seductive behaviors in straightforward manner while maintaining professional boundaries

be neutral, no emotion

27
Q

Describe Antisocial Personality Disorder

A

think criminal

pervasive disregard for violation of rights of others

  • -> failure to conform to social norms/laws
  • -> deceitfulness
  • -> impulsivity/lack of planning
  • -> irritable, aggressive
  • -> consistent irresponsibility
  • -> lack of remorse, rationalize behavior
  • -> AKA psychopath or sociopath
  • -> usually extroverted, charming, seductive
  • -> deep desire to manipulate and cheat

don’t diagnose until after 18, but pattern before 15

con artists, hackers

28
Q

Hot to manage antisocial personality disorder?

A

firm limits, don’t break rules

simple, straightforward communication

caution when prescribing controlled substances

address self-destructive behaviors

29
Q

Describe Narcissist Personality Disorder

A

requires excessive admiration

sense of entitlement

exploitive in relationships

often feel contempt for others

will seek out best physician to treat their “special” needs
–> like splitting in borderline but not as much emotion

lack empathy, but has sense of right/wrong

believes other envy them or they envy others

think they are better than everyone

30
Q

Hot to manage narcissist personality disorder?

A

acknowledge them as special

self-confident in interactions

avoid being defensive

huge blows with medical issues–> watch for depression, suicide

31
Q

Describe Cluster C personality disorders

A

seem fearful and anxious

  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive Compulsive Personality Disorder
32
Q

Describe Dependent Personality Disorder

A

difficulty making decisions without lots of reassurance

put others needs above theirs, may take demeaning tasks in order to gain acceptance

need others to assume responsibility

difficulty expressing disagreement out of fear of losing approval or support

feels uncomfortable or helpless when alone–> think they can’t take care of themselves

33
Q

Hot to manage dependent personality disorder?

A

tolerate repeated requests for reassurance

schedule visits are regular, pre-established times
-controls need to see you, will make up new symptom to do so

when ill, they are frustrated they aren’t being helped

active in treatment planning

assess patient’s stage of change in abusive relationship

34
Q

Describe Avoidant Personality Disorder

A

pervasive pattern of social inhibition with feelings of inadequacy/negative evaluation

avoids significant interpersonal contact

unwilling to try things unless certain they will be liked

unusually reluctant to take personal risks or new activities

restraint within relationships because of fears of shame or ridicule

views self as inferior or unappealing

35
Q

Hot to manage avoidant personality disorder?

A

avoid critical comments

have patience and understanding

minimize number of new people they come in contact with

36
Q

Describe Obsessive Compulsive Personality Disorder (OCPD)

A

preoccupied with details, rules, lists, order, etc
–> can’t see forest through trees to the point that they can’t get anything done

perfectionism interferes with task completion

excessively devoted to work and productivity over leisure and friends

hung up on rules, ethics, etc

unwilling to compromise and insist others submit to their needs

rigid, stubborn

37
Q

How to manage OCPD?

A

avoid power struggles–> use motivational interviewing

allow patient to have control when possible

acknowledge work but point out avoiding treatment is harmful

encourage limited information-seeking on the internet