psych- FOCUS: personality disorders

Question 1

personality comes from the greek & latin words?

Answer 1

PERSONA meaning mask

Question 2

i hate you dont leave me- what is this?

Answer 2

good for family and someone with BPD–> clinicians and students. help to understand, understand etiology, how to understand folks with BPd, connection between BPD & ADHD & substance abuse, sexual abuse and eating disorders.

Question 3

What is a personality disorder?

Answer 3

an enduring pattern of inner experiences and behaviour.

• deviates markedly from the expectations of a persons culture.
• pervasive, inflexible & stable
• leads to distress, impairment and interference with interpersonal relationships

Question 4

when do personality disorders usually emerge?

Answer 4

-adolescents or early adulthood

Question 5

is there a sharp line between abnormal and normal personality functioning?

Answer 5

NO! it is a continuum
-many of the same processes used in the development of personality are used in the development of personality disorder as well

Question 6

what is crucial in early childhood development?

Answer 6

-HEALTHY family & social life are crucial!!

Question 7

what do personality disorders usually coexist with?

Answer 7

other primary psych diagnosis like schizophrenia or bipolar or eating disorders

Question 8

what are common features & diagnostic criteria to personality disorders?

Answer 8

-maladaptive cognitive schema
-affectivity and emotional instability
-impaired self-identity
and interpersonal functioning
-impulsivity and destructive behaviour

Question 9

cognitive schema?? what is that & what does it mean to have maladaptive cognitive schema with personality disorders

Answer 9

persons cognitive schema= pattern of their thinking that determine how that specific person interprets events. they screen code and evaluate all incoming stimuli that leads them to feel a certain way and think a certain way, then behave in certain ways.
WITH PERSONALITY DISORDERS–> there is an interference in this cognitive schema, may misinterpret other peoples actions and events that result in dysfunctional ways of responding

Question 10

affectivity and emotional instability w/ personality disorders??

Answer 10

• emotions are a PSYCHO-physiologic reaction that define a persons mood and can be categorized as positive and neutral
• emotions can affect ones ability to learn and function. it is connected to ones memory and how one accesses and stores information
• WITH PERSONALITY DISORDER–> personal may have altered interpretation and experience of emotions. they may have emotional arousal or hyperarousal especially negative emotions–> can decrease their ability to remember new information and accurately perceive the environment

Question 11

impaired self identity and interpersonal functioning with personality disorders?

Answer 11

SELF-IDENTITY= major characteristic of personality disorders!!

• self-identity is central to normal development of a person’s personality; an intergration of social & occupational roles in affiliations self-attributed personality traits
• WITHOUT adequately formed identity–> individuals goal directed behaviour is IMPAIRED, interpersonal relationships disrupted

Question 12

every individuals limitations and goals are shaped by their ????

Answer 12

IDENTITY!! so in personality disorders ones identity is often impaired or incomplete

Question 13

impulsivity and destructive behaviour & personality disorders?

Answer 13

KEY FEATURE of personality disorders= impulsivity and destructive behaviours. impulsive behaviour often results in NEGATIVE consequences to others or themselves. some seem unable to consider the consequences of their actions before acting on impulse.
UNPREDICTABLE behavour too.. calm suddenly turning to rage turning into a physical alteration!!

Question 14

personality disorders frequently co-occur with?

Answer 14

disorder of mood, eating, anxiety, and substance use!!

Question 15

how can we distinguish personality disorder from bipolar disorder

Answer 15

bipolar= depressive and manic phases often over course of weeks or MONTHS, not during the day!!
-if someone has a highly reactive mood in their mood is changing throughout each day every day it is more likely to be a personality disorder

Question 16

personality disorders often amplify emotional _______??

Answer 16

DYSREGULATION

-term that describes poorly modulated mood characterized by mood swings

Question 17

what can be a risk factor for personality disorders?

Answer 17

LIFE CRISES OF ANY KIND!! grief, loss, trauma, childhood trauma
-vast majority of us will exhibit personality disorder traits or characteristics at some point in our lives!! usually more pronounced when we’re under a lot of stress or if we have had some kind of major life change or crisis!!

Question 18

how many canadians have a personality disorder?

Answer 18

estimated that 6-15% !!

Question 19

prevelance of PD and gender?

Answer 19

does not appear to affect it!!

Question 20

etiology of PD’s?

Answer 20

speculative and undetermined!!

• temperament
• genetics (parents!!)
• environment
• emotional/behavioural
• comorbidity

Question 21

treatment of PD’s?

Answer 21

…is challenging and complex, as people with these disorders may have difficulty recognizing or owning the fact that their difficulties are problems of their personality.
- No insight that it’s the way they see & interpret the world as part of the problem  difficult to accept &seek treatment for

We usually see people for this when they decide they need to make some changes within themselves  may have burnt bridges  no relationships  socially isolated  lost job or significant impact form personality disorder.

Question 22

CLUSTER A personality disorders?

Answer 22

• schizotypal
• paranoid
• schizoid
• described as odd or eccentric personalities, thinking, and/or behaviour.
• common characteristics include social awkwardness and social withdrawal (social aversion)
• DISTORTED THINKING

Question 23

schizotypal personality disorder? tell me about it

Answer 23

-Perceptual distortion and eccentricity.
-Ideas of reference.
o Odd beliefs or magical thinking.  believe that thoughts have the power to cause or prevent things from happening. They think they have control over an entity
o Live in a fantasy type world
o Hallucinations may occur
o Bizarre fragmented delusions
o They have constructed a fantasy world  not a psychosis though
o Mirror but fall short of what would justify the diagnosis of schizophrenia
o Peculiar dress, thinking, speech or behaviour
o Metaphorical speech
o Beliefs about world are inconsistent with cultural normal  odd to others
o Acute discomfort in social settings  reduced capacity for close relationships
o Close relatives with schizophrenia… genetic commonality
o Key pieces of assessment  determine if the unconventional beliefs are psychosis or their personality? Is it prodromal schizophrenia or schizotypal personality?
Flat or incongruent emotional responses

Question 24

paranoid personality disorder? tell me about it

Answer 24

o Pervasive distrust and suspiciousness of other people.
o Assume that others are out to harm them, take advantage of them, or humiliate them in some way.
o Tend to hold grudges, are litigious and may display pathological jealousy.
o They put a lot of effort into protecting themselves and keeping their distance from others minor intrusions from others arouse major hostility or the person believes they have sinister meaning have a desire to avoid relationships where they’re not in complete control and will terminate ones where they are not in control
o there are mistrustful of others motives even of relatives and close friends the actions of others are often misinterpreted as deception deprecation and betrayal especially regarding Fidelity or trustworthiness of a spouse or friend suspicions are magnified in two major distortions of reality this is a cognitive distortion
o they tend to be rigid and controlled in hypervigilant to any environmental changes they thrive on predictability and stability they don’t usually seek help from mental health workers but rather frequently contacted police
o it is often described that they have a stable pattern of non-psychotic paranoid behavior and so this is significantly different than a person who is experiencing paranoia as a result of
psychostimulant use or as a result of paranoid subtype schizophrenia

Question 25

schizoid personality disorder? tell me about it

Answer 25

• Pervasive pattern of social detachment and restricted range of emotional expression.
• Tend to be socially isolated, don’t seek out or enjoy close relationships, and almost always choose solitary activities.
• Lacking a desire for intimacy.
• Emotionally  aloof, detached, cold or apathetic
• They are expressively impassive and interpersonally unengaged they tend to be unable to experience joyful and pleasurable aspects of life
• their introverted and reclusive they have difficulty making friends and are uninterested in social activities
• they gain little satisfaction in personal relationships and much prefer to be alone
  -they appear incapable of forming social relationships and their interests are directed at objects things or abstractions from within
• they engage in primarily solitary activities
  the best example I can give you a person with schizoid PD would be a hermit in the mountains or someone who doesn’t want to be a part of society and goes off and lives in the boondocks in northern BC alone.

Question 26

CLUSTER B personality disorders??

Answer 26

-described as dramatic, emotional, and erratic lcuster of personalities- General features include:
o dissociation or denial
o abusive behaviors (physical and emotional, sexual)
o splitting/dichotomous thinking
o emotional dysregulation
The most challenging to work with  high level of intensity when forming & maintaining relationships

Question 27

histrionic personality disorder?? tell me about it

Answer 27

o Inappropriate, sexually seductive or provocative behavior.
o Seek excitement and attention (attention seeking behaviors).  subconsciously to cope with stressors such as negative feelings  sense of fulfilment
o Outwardly appear charming and lively but have a threatened self-esteem and sense of attractiveness.
o Exhibitionist & uncomfortable when they aren’t the center of attention
o Loud & inappropriate appearances
o Describes relationships as more intimate than they are.
o May say they know someone famous when they don’t actually.
Manipulative  change perception or behaviour of others through underhanded, deceptive or abusive tactics  for personal gain or to protect their image.

Question 28

narcissistic personality disorder?? tell me about it

Answer 28

o Grandiosity (self-love and self-importance). INFLATED EGO
o Believes that they are special, unique, and can only be understood by high status people or institutions.  expect to be recognized as superior even without these accomplishments.
o Sense of entitlement.
o Needs constant admiration and attention.  esp. those of high value or high social status
o Lack empathy and takes advantage of others to achieve their own needs.
o Experiences personal insecurities, despite inflated self-love.
o Etiology unknown.
o Pre-occupied with fantasy of unlimited success, power, beauty, social status & wealth
o May actually be excessively preoccupied with personal adequacy and power and etc. and mentally unable to see the destructive damage they are causing to themselves or others
o they may figuratively step on and crush others as a way to get ahead in life and make it to the top
o the person may constantly be asking others outright or in their own head what has this person done for me lately what have you done for me lately and their expectations are often unrealistic
o they believe that the whole world centres around them people are seen as a means to an end
o there is thought to be a serious sense of insecurity deep within the person who has narcissistic PD even despite their outward projection of superiority and ego narcissistic
o rage can occur if the person’s grandiosity or their ego’s challenge and particularly if the person who is challenging them is perceived as having lower value or status than the person with NPD
o narcissistic rage is typically an unleash of total fury a can be physical and verbal and emotional abuse may also be followed by the person with narcissistic personality disorder avoiding that person in the future
o they may even go out of their way to sabotage the other person through direct or indirect means to regain their value or their own personal self-worth
people with narcissistic PD lack empathy and take advantage of others to achieve their own needs

Question 29

antisocial personality disorder? WHAT IS IT!!

Answer 29

o Disregards and violates others’ rights. (disregard for safety of self & others)
o No remorse for wrongdoing and no empathy.
o Easily irritable and often aggressive.
o Marked readiness to blame others or to offer plausible rationalizations for their behavior.
o History of conduct disorder before age 15 years.
o Hyperactive, irresponsible, impulsive
o there might be frequent job changes, lying, theft, drug and alcohol abuse.
o using aliases conning others
o openly violating laws or finding a niche in the government or law enforcement
persons with ASPD may come off as superficially charming and facile communicators but in reality, they lack empathy and are insensitive callous and contemptuous of others deep down

Question 30

what is the HIGHEST RISK related to in antisocial personality disorder?

Answer 30

is in the key attribute of having NO EMPATHY!! they are indifferent to hurting or mistreating others and they may even totally justify it

Question 31

can persons under the age of 18 be diagnosed with ASPD?

Answer 31

o persons under the age of 18 cannot be diagnosed with ASPD (as I said previously, they must have some kind of conduct disorder)
§ one example of a conduct disorder is ODD or oppositional defiant disorder
some of the behaviors we may see in a conduct disorder in a child or similar such as violating the rights of animals or arson is another example and perhaps even abusing the rights of others like their peers in school, they may get in fights deliberately or be bullies

Question 32

what is doctor Hares Hare psychopathy checklist??

Answer 32

§ doctor Hare does not like the description because it only lists behaviors such as lack of empathy or guilt etc. that he considers to be core features of the psychopathic syndrome
§ he developed a psychopathy checklist as a tool instead and according to her constructs do not overlap fully
· for example a teenage boy who falls in with a rough crowd or grows up in an antisocial environment could be easily diagnosed as having antisocial PD on the basis of having met a number of observed behaviors but this doesn’t mean that he actually has the characteristic of a lack of empathy that hallmarks as a psychopath rather he is more product of that particular environment

Question 33

sociopathy preferred to psychopathy??

Answer 33

o sociopathy is preferred to psychopathy as a term because it is less likely to be confused with psychosis think about sociopathy as being against society or against people and that’s what antisocial means is against society or against people
o sometimes we attribute antisocial to being more introverted or shy correct term would be asocial
o sociopathy more reflects the cause due to social factors in early environment whereas psychopathy is preferred by those who believe that there are psychological biological & genetic factors involved in addition to environmental factors

Question 34

what is antisocial personality disorder strongly associated with?

Answer 34

drug and alcogol abuse, more prone to alcohol related aggression

Question 35

etiology of ASPD?

Answer 35

• biologic–> genetic component (first-degree relatives)
• -> biochemical, not well understood
• psychological
• -> insecure attachments
• -> difficult temperament
• social
• ->chaotic families
• -> abuse

Question 36

nursing management of clients with ASPD?

Answer 36

• Rarely seek help directly for ASPD (usually mandated). Don’t believe they have a problem.
• the person with ASPD often comes to the attention of health care many other reasons beyond their personality disorder (example they may seek help for substance abuse anger management or some other forensic or criminal behavior in fact in many cases they will be compelled by a court order to engage in some kind of program or treatment)
• people with ASPD never accept responsibility for their actions and most often blame others
• people with ASPD often make great first impressions & are quite charming they may employ this strategy for their own personal gain or to manipulate staff members
• This is why it is very important for the nurse to determine the quality of the relationship and also ensure that they have self-awareness when interacting with the patient with ASPD
• true authentic therapeutic relationships are difficult if not impossible to establish therefore a superficial alliance is usually formed but result in a lack of patient commitment

Question 37

people with ASPD have thoughts and feelings and behaviours that are EGO-_______??

Answer 37

ego-syntonic!! their instincts/their ideas are acceptable to the self (ego). they are compatible with who they are (persons fundamental beliefs, values and their overall personality) deeply ingrained in who they are.

Question 38

what is ego-dystonic??

Answer 38

ego-dystonic which refers to the thoughts impulses and behaviors that are felt by the person to be distressing unacceptable or repugnant to the person’s identity or their self-concept that is it would be inconsistent with the persons identity values and sense of self
we might see ego-dystonic thoughts in a person who is experiencing psychosis where they might get intrusive thoughts to harm others but will not act on them because it is not consistent with who they are or their values and most likely they’ll feel revolted by them

Question 39

of UTMOST IMPORTANCE IN the relationship with an ASPD patient, is going to mitigation of…

Answer 39

violence risk!! keeping the nurse and everyone else safe! including patient.
-nurse promotes self-responsibility, holding pt responsible for their behaviour and consequences if not met,behavioural care plan

Question 40

key assessments in ASPD patient with nurse?

Answer 40

• quality of relationship
• impulsivity
• violence risk

Question 41

nursing daignosis for ASPD?

Answer 41

• ineffective role performance
• ineffective individual coping
• impaired communication
• impaired social interactions
• low self-esteem
• risk for violence

Question 42

facilitate what in an ASPD patient?

Answer 42

• self-responsibility
• self-awareness
• impulse control
• effective communication
• social skills
• angel management
• help families establish boundaries and remain safe
• help families recognize the pts responsibility for their actions

Question 43

borderline personality disorder?? tell me about it!!

Answer 43

unstable relationships, self image, and affect

• impulsivity and antagonism
• mood lability
• unstable and intense interpersonal relationships, fear of rejection/abandonment
• recurrent suicidal behaviour, gestures, threats, self-mutilation
• parasuicidal behaviour!! common–> non-fatal serious deliberate self-harm with or without suicidal intent
• impulsivity–> spending, sex, drug abuse, binge eating, reckless driving, reckless relationships
• long-standing underlying irritability and anxiety

Question 44

etiology of BPD?

Answer 44

DONT really know but… § Neurobiological and genetic factors.
· Abnormalities associated with affective instability, transient psychotic episodes, and impulsive, aggressive, and suicidal behavior
§ Psychosocial risk factors.
· Physical and sexual abuse
· Childhood neglect
§ Psychological factors.
· Psychoanalytic theories (separation-individuation, projective identification
§ 5x more common among first degree biological relatives
§ They appear to have abnormal serotoninergic functions impulsive or aggressive symptoms
§ FMRI’s have revealed dysfunctional fronto-limbic networks
§ maltreatment during childhood appears to be a significant risk factor for BPD with childhood neglect being correlated with an increase in BPD symptoms
§ considering intense fear of abandonment or rejection is a central feature of BPD can you see the relationship between childhood neglect and that there may be maladaptive cognitive processes that happen during childhood which causes a misinterpretation of their environmental stimuli which then leads to a rigid and inflexible behavior pattern in response to new situations and people they may become anxious and fearful in response to new people or situations
§ they may be conditioned to anticipate rejection and disappointment
fear that disaster is going to strike at any moment a large portion of this may be attributed to a chaotic and unpredictable household environment

Question 45

intense fear of abandonment or rejection=central feature of BPD!! what is this connected to??

Answer 45

childhood neglect, may be maladaptive cognitive processes that happen during childhood whch causes a misinterpretation of their environmental stimuli, leads to rigid and inflexible behaviour pattern in response to new situations and ppl
-may be conditioned to anticipate rejection and disappointment

Question 46

ppl with BPD often fear that disaster is going to strike at any moment, a large portion of this may be attributed to?

Answer 46

chaotic and unpredictable household environment!!

Question 47

psychoanalytic theories with BPD?

Answer 47

§ one psychoanalytic theory hypothesizes that behaviors exhibited by the primary caregiver have been inconsistent or insensitive to the needs of the child which then leads the child to not having a developed understanding of their own needs and their own feelings as well as not having a predictable or stable caregiver and environment
another psychoanalytic theory for the development of BPD is related to the development of identity and hypothesizes that the child lacks the ability to separate from their primary caregiver and develop their own separate or distinct self-image

Question 48

biosocial theories viewed BPD as…

Answer 48

a distinct disorder!!develops as a result of both biological and psychological factors the child’s interaction with their environment and learning and experience could greatly affect their biologic predisposition he believes there was a biologically based pattern of sensitivities and behavioral dispositions that shaped their experiences  this viewpoint presents BPD as a multifaceted problem a combination of the persons in an emotional vulnerability and also their inability to control that emotion in social interactions emotional dysregulation in the environment

Question 49

risk factors for BPD??

Answer 49

§ physical and sexual abuse (55-80%)
§ parental abandonment issues
§ Households with alienation of affection or neglect

Question 50

suicide and BPD?

Answer 50

70% of those w BPD with have at least one suicide attempt in their lifetime
10% will have completed suicide!!! (often by accident)
more than 50% the rate of suicide in the general population

Question 51

there should be no distinction between self-damaging behaviours and…

Answer 51

SUICIDE ATTEMPTS. ALL SELF-DAMAGING behaviours taken seriously!!!!!

Question 52

characteristics of BPD?

-explain affective instability and identity disturbances

Answer 52

§ Affective instability.
· present as rapid extreme shift in mood
· erratic emotional response to situations
· intense sensitivity to criticism
· failure to recognize own emotional responses
· extremely hyper reaction
· a lot of it is irrational  can’t understand own emotions  emotional dysregulation  cannot module own emotions  affects relationships
· constant push & pull in relationships  erodes relationships even HCP
§ Identity disturbances.
· Lack’s aspects of their personal identity or poorly developed
· Narrow definition of self in single role
· Lack of consistency
· Lack in coherence of thought, feelings and action
· No direction  chronic feelings of emptiness and boredom
· Will direct their actions & goals in accordance to the wishes of other people  they almost meld into the other person
Different identities with different people

Question 53

characteristics of BPD?

-explain unstable interpersonal relationships, cognitive dysfunction, and dysfunctional/maladaptive behaviours

Answer 53

§ Unstable interpersonal relationships.
· Extreme fear of abandonment /rejection
· Usually related to early childhood development
· Unstable / insecure attachments
· Always need reassurance and validations
· Tend to idolize others & develop intense relationships that violates boundaries  leads to rejection  when doesn’t live up to expectations  devalues person  self-hate & hate of the other person
· Push pull in relationships. Idolization & demonization.
§ Cognitive dysfunction.
· Black & white thinking. All good or all bad. mis-interpret or without evidence make choices  dichotomous thinking not limited to relationships, also forms part of cognitive schema
· Extreme interpretations of events.
· Disorganized thinking  irreverent or bizarre scattered thoughts occasionally there could be delusions or hallucinations if the person dissociates or depersonalizes and realizes
§ Dysfunctional/Maladaptive behaviors.
the person will engage in dysfunctional or maladaptive behaviors this is a result of the impulsivity or unpredictability of their personality they often will act in the moment and sometimes will engage in self destructive or self-injurious behaviors this is especially likely to occur if the person feels like they are being abandoned

Question 54

nursing diagnosis for BPD? lots!

Answer 54

§ Ineffective coping
		§ Self-harm
		§ Risk for self-harm
		§ Risk for suicide
		§ Impaired communication
		§ Impaired social interactions
		§ Risk for violence
		§ Low self-esteem
		§ Disturbed thought process.
		§ Risk for injury r/t reckless/impulsive behaviour
		§ Disturbed sleep pattern
Ineffective therapeutic regimen management

Question 55

what is parasuicidality and significance in BPD?

Answer 55

§ Deliberate self-injury with the intent to harm oneself (43-67%).
§ Examples: cutting, burning, hair-pulling, head banging.
§ Episodic  every so often
§ Numb or empty  behaviour ends the detachment dissociative state, dampens pain, releases endorphins. Active pleasure center  relives anxiety
§ Maladaptive/habitual coping, releases endorphins (opioid type dampens pain perception and activates pleasure center, relieves anxiety and feel a sense of control).
§ some examples: overdosing on medications, choking self-embedding of objects, self-harm related to eating disorders like bingeing and purging  the pleasure centre is activated the person feels better their anxiety and stress is decreased and they feel a sense of control
repetitive self-mutilation & occasional self-injury turns into an overwhelming preoccupation the patient describes themselves as being addicted to self-harm this is of course much more serious

Question 56

the beaviours that someone with BPD exhibit directly because of the outcome that they fear the most which is???

Answer 56

ABANDONMENT

Question 57

nursing management of BPD requires the entire health care team … tell me more…

Answer 57

CONSISTENCY!! · Primarily focused on the relationship with the nurse & the quality of the interface between the pt. and entire team
· at its core empathy is extremely important as well as respect honesty transparency trust
· a large piece to the relationship will be limit setting and boundary setting by the nurse or the team for the patient again similar to aspd the nurse will need a strong sense of self-awareness
· while working with a person who has BPD the team should carry out comprehensive care planning in collaboration with the patient this should highlight expectations for both sides that are reasonable and geared towards healing
· even more important than the care plan itself is following that care plan to A T and making sure that there is consistency among staff with no diversion people with BPD need that consistency it is crucial that the staff do not engage in any kind of splitting behaviors with the patient

Question 58

other key components to caring for a pt with BPD?

Answer 58

• empathy and honesty
• limit-setting/boundaries
• self awareness
• care planning and consistency in following it by all staff
• pharmacotherapy (ideally short term)
• psychotherapy

Question 59

pharmacotherapy for BPD?

Answer 59

ideally short term!!

• mood stabilizers for emotional dysregulation and impulse-aggressive symptoms
• second generation antipsychotics for cognitive-perceptual symptoms and impulse-aggressive symptoms

Question 60

what is dialectical behavioural therapy (DBT) used for BPD??

Answer 60

· form of CBT (combines numerous cognitive-behavioral approaches)
· requires monitoring and long-term commitment by the patient
· interpersonal effectiveness
· mindfulness skills
· emotion regulation
· distress tolerance skills
· Dialectical behavioral therapy this was developed by Marsha linahan and is a form of CBT DBT uses CBT strategies but also draws on Zen principles behavioral science
· dialectical philosophy which is a method for resolving disagreement that has been central to European and Indian philosophy
· the word dialectic originated in ancient Greece and was made popular by Plato in the socratic dialogues, a dialectical method is discourse between two or more people holding different points of view about a subject who wish to establish the truth of the matter guided by reason
· now in the case of a person with BPD engaging in dialectical behavioral therapy it really encourages a conversation with oneself sort of purposeful discussion between the reasonable mind and the unreasonable mind

Question 61

four treatment components of DBT?

Answer 61

• individual one-on-one therapy
• group skills therapy
• telephone coaching
• a therapist consultation team which is essentially therapy for the therapist

Question 62

goals and main components to DBT?

Answer 62

· one of the goals is to work with the clients as partners and be willing to focus on interconnected behaviors and not a single diagnosis
· the patient is to collect information identify behaviors to change and work with therapist to change them
· there is also skills training reinforcement of positive behavior and cognitive modification such as elimination of cognitive distortions
· skills groups are an integral part of DBT members practice emotional regulation interpersonal effectiveness core mindfulness skills and distress tolerance
· they practice skills to manage intense and labile moods analyze the context of the emotion and use strategies to reduce emotional vulnerability
· they describe emotions without judging or blocking them the therapist will work with the person on developing interpersonal effectiveness skills such as the development of assertiveness and problem solving skills within an interpersonal context is one of the key differences between CBT and DBT where the focus is on interpersonal relationships and being effective in them
· the mindfulness skills component of DBT are psychological and behavioral versions of meditation skills aimed to help the person focus their mind and awareness on the current moments activity and not jump to conclusions or not immediately succumbing to their feelings distress
· tolerance tries to help the individual tolerate and accept distress as a part of their normal life self-management skills focus on helping clients learn how to control manage or change their behaviors thoughts or emotional responses to events

Question 63

psychopharmacology for BPD continued??

Answer 63

• antidepressents for concurrent depression
• anxiolytics for anxiety
• mood stabilizers
• antipsychotics to dampen intense thoughts

Question 64

barriers to treatment of BPD?

Answer 64

person with BPD may feel they have nothing wrong with them at all and further to that should they seek treatment and engage in CBT and DBT and other forms of therapy they all require steady commitment an ongoing motivation and a considerable amount of effort they have to be willing to put in the time and work which unfortunately many persons with BPD do not do
· people can and do overcome borderline personality disorder but as with other personality disorders it is no easy feat to change our personality

Question 65

ClUSTER C personality disorders??

Answer 65

• anxious or fearful thinking or behaviour
• isolation
• indirect expression of hostility Procrastination, sarcasm, solemness, Deliberate or repeated failure to accomplish requested, defeatism or a self-defeat there is an element of masochism (so a pattern of self-defeating behavior) avoiding or undermining pleasurable experience is an often there drawn to situations or relationships in which the person will suffer and prevent others from helping ultimately they purposefully choose situations that will lead to failure or are more likely to lead to failure
• they may intentionally incite angry or rejecting responses from others like in a relationship or in a partnership and then often feel hurt or humiliated as a result of that there is often dysthymia, or the person has a dysthymic mood which is a chronic mild form of depression
• passive aggression–> self chosen failure, masochistic, dysthmic

Question 66

obsessive compulsive disorder??

Answer 66

-Inhibited, stubborn, rigid, and a perfectionist. Interferes with task completion.
-Preoccupied with orderliness or perfection.  rules, lists, organizations, schedules, details that have no meaning
-Hard to accept new ideas
-Uncomfortable with unstructured leisure time like vacations
- Excessively devoted to work and productivity and excludes recreation and friendships.
-Reluctant to delegate tasks to others.
Can have difficulty discarding worthless objects.

Question 67

dependent personality disorder??

Answer 67

o Difficulty making everyday decisions without significant advice and reassurance from others.
o Need to be taken care of.
o Submissive behavior as they fear disagreement and the loss of support/approval.
o Urgently needs to replace one relationship when another one ends.
o Caregivers, friends, family may report burnout.
o They feel they need to be taken care of even though they are able bodied
o undermine and undervalue their psychological and physical capabilities
o they tend to have a submissive behavior as they fear disagreement and confrontation as well as they loss of support and approval
o they urgently need to replace one relationship when another one ends
o family friends and caregivers may report burnout or compassion fatigue
o people with dependent PD are often passive
o need to assume responsibilities most areas of their life again even though that person is capable and fear of separation in the sense of helplessness they adapt their behavior as needed like a chameleon to please everyone they need excessive advice and reassurance they rarely disagree with others and are easily persuaded and gullible to take any of the other personality disorders which other one would you say would be most likely to gravitate towards a person with dependent personality disorder and vice versa?

Question 68

avoidant personality disorder?

Answer 68

o Socially inhibited, shy, and lonely.
o Sense of inadequacy with low self-esteem.
o Desperate for relationships but avoid social contact.
o Reluctant to take risks or try new activities as they might be embarrassed.
o hypersensitive to criticism from others and feel a sense of inadequacy
o they have an extreme fear of disapproval criticism or rejection
o they engage in interpersonal relationships only when they are absolutely certain they will receive approval & liked therefore it can be an extraordinarily long time before they form any bonds or relationships in fact, they are desperate for relationships, but they avoid social contact in most cases
o sometimes they will fantasize about having friendships and relationships it may become a means to gratify their needs or to feel confident sometimes they’ll withdraw into the fantasy an it is a means of dealing with any frustrations or anger that they have
o they are reluctant to take risks or try new activities as they might be embarrassed
you can probably infer a lot of crossover between anxiety depression and social phobia with these traits I’ve mentioned those diagnosis is actually extremely common with person with avoidant PD I think a good example to illustrate this is eor from Winnie the Pooh