Personality Disorders Flashcards
What are Freud’s structures of the mind?
Id
Ego
Superego
Define Id
instinctive biological drives and desires (impulsive)
“I want”
leads to overindulgence and disregard for rights of others
think of as inner child
Define Ego
logical and language based problem solving
“I think”
balances id with external reality
Define Superego
moral conscience based on ideal and values of society
“I should”
self-critical aspect of personality
Define defense mechanisms
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
Why do we use defense mechanisms?
reduce tension and anxiety
start with problem-solving and seeking rational solution–> if can’t resolve, defense mechanisms take over
When do defense mechanisms become problematic?
when 1-2 patterns are used exclusively
lead to maladaptive functioning
tendency to deteriorate into less mature defenses under distress or frustration
What are primitive defenses?
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
Examples of primitive defenses
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”
Examples of basic or neurotic defenses?
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”
What are mature defense mechanisms?
common in emotionally healthy adults
helps integrate conflicting emotions and thoughts
Examples of mature defense mechanisms
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”
What is the purpose of defense mechanisms?
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
What is the characteristic of personality disorders?
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
Describe Cluster A personality disorders
seem odd, eccentric
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Describe Paranoid Personality Disorder
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
How to manage person with paranoid personality disorder
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
Describe Schizoid Personality Disorder
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
How to manage others with schizoid personality disorder
respect their space
do not impose social expectations
takes time to establish rapport
individual therapy, group when ready
Describe Schizotypal Personality Disorder
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
How to manage schizotypal personality disorder?
do not ridicule
respect need for privacy
similar to schizoid approach
Describe Cluster B personality types
seem dramatic, emotional, erratic
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Antisocial Personality Disorder
- Narcissistic Personality Disorder
Define borderline personality disorder
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
How to manage borderline personality disorder?
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
Describe Histrionic Personality Disorder
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
Hot to manage histrionic personality disorder?
maintain professional boundaries
provide reassurance
address seductive behaviors in straightforward manner while maintaining professional boundaries
be neutral, no emotion
Describe Antisocial Personality Disorder
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
Hot to manage antisocial personality disorder?
firm limits, don’t break rules
simple, straightforward communication
caution when prescribing controlled substances
address self-destructive behaviors
Describe Narcissist Personality Disorder
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
Hot to manage narcissist personality disorder?
acknowledge them as special
self-confident in interactions
avoid being defensive
huge blows with medical issues–> watch for depression, suicide
Describe Cluster C personality disorders
seem fearful and anxious
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive Compulsive Personality Disorder
Describe Dependent Personality Disorder
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
Hot to manage dependent personality disorder?
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
Describe Avoidant Personality Disorder
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
Hot to manage avoidant personality disorder?
avoid critical comments
have patience and understanding
minimize number of new people they come in contact with
Describe Obsessive Compulsive Personality Disorder (OCPD)
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
How to manage OCPD?
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
