psych wk 2-personality disorders Flashcards
t or f personality disorders are unstable and flexible
f they are stable and inflexible and pervasive
t or f the pts personality disorder can be asymptomatic and then flare up when under stress
t
common fts and diagnostic criteria of Personaty disorder
Maladaptive cognitive schema
Affectivity and emotional instability
Impaired self-identity and interpersonal functioning
Impulsivity and destructive behaviour
what are maladaptive cognitive schema
their perception/interpretation of the world is skewed. They misinterpret the world incorrectly eg make assumptions that are incongruent witht he reality
• They often have dysfunctional responses to things. Misinterpret innocent gesture and have extreme reaction
t or f women are more likley to have personality disorders
f. it is seen to be equal in both genders
what kind of impulsive behav might a pt with personality disorder display and why do they often end up being seen by drs
often suicide attempts
often seen by drs due to destr behaviour
what are speculated et of personality disorders
- Temperament
- Environment
- Co-morbidity
- Genetic
- Emotional/Behavioural
what is temperament and how will they look at this
pt can have anxious, attached, relaxed, mellow temperament). Temperament has to do with adaptability. They will look all the way back to the infant and often temperamnt will show at this time
what kind of childhood might result in personality disorder
maltreatemet and childhood neglect. It significantly inc the risk of personality disorder
which meds indicate that there is a biologic influence in PDisorders
SSRIs–pts on these tend to have dec incidence of PDs
people w schizotypal PD can espond to atypical antipsychotics
what is one of the more common PDs we see in hospital
borderline PD
Cluster a b or c
Which has anxious, fearful thinking or behavior
Cluster c
Cluster a b or c
Odd or eccentric and often socially awkward or withdrawn
Cluster a-
a is for awkward and alone
Cluster a b or c
Orderly and anxious when in isolation
May display passive aggression
Cluster c
Cluster a b or c
Dramatic emotional and erratic
Cluster b
Cluster a b or c
Which is characterized by distorted thinking and what does this entail
A
Delusional or paranoid thoughts
What are general feat of cluster b
Dissociation or denial
Abusive behav both physical and emotional
Splitting or dichotomous thinking–no grey area just black and white
Emotional dysregulation-react before thinking and don’t modulate emtitions well
How might aggression manifest differently in cluster b and c
Cluster b
Abusive behav that is verbal and physical
Cluster c
Passive aggression-indirect displays of hostility
Beyond being orderly, anxious, fearful and passive aggressive what characteristics might you see in cluster c
Self chosen failure-they’ll take on things they know they can’t complete
Masochistix
Dysthymic-mild depression symptoms but can still fx in daily life
Cluster a disorders are
Paranoid PD
Schizoid
Schizotypal PD
Cluster A-pss
cluster B disorders
cluster B
-bhan
borderline PD..
histrionic
antisocial
narcissistic
cluster c disorders
avoidant PD
dependent PD
obsessive compulsive PD
OCPD vs OCD which would be more perfectionistic and orderly
OCPD
char of OCPD
- inhibited stubborn, rigid and -perfectionist\preoccpied w orderliness or perfection
- excess devotion to work-excluding recreation and friendships
- reluctant to delegate to tohers
- might have difficulty discarding worthless object
when something doesnt go their way does OCPD get anxious or angry
likely more angry than anxious
which PD might adapt their personality to please others and often needs excessive advice or reassurance
dependent personality disorder
dependent personality disorder how do they present
they have diff making own decisions and seek out help of others for all trivial decisions
-have a need to be taken care of
-submissive behav
-urgently ned to replace on relationship when another one ends
-will adapt their personality to please others
why are dependent PD pts submissive and what does this put them at risk of
they are submissive because they fear loss of support ordisapproval and abandonment
this puts them at risk of abuse
which PD is desperate for relationships but does not engage in social contact d/t shyness and sense of inadequacy
avoidant PD
which cluster is avoidant PD
C
char of avoidant PD
socially inhibited, shy and lonely
- sense of inadequacy w low self esteem
- desperate for relationships but avoid social contact
- reluctant to take risks or try new activities as they might be embarassed
are avoidant PD avoidant d/t performance anxiety
no. they are avoidant and their default is just not to deal with things as a maladaptive way to avoid the world
what is parasuicide
the deliberate self-injury w the intent to harm oneself
- compulsive self injurious behav
- episodic self-injurious behav
- repetitive self-mutilation
is parasuicide a way of showing their needs tothe world
no its an intimate private way of self soothing.
its a maladaptive form of coping that causes a numbing effct from endorphins and natural opiates
what is a common reason that people might use parasuicide as a coping method
people who have been sexually abused or abused in toher ways dont want to live in their bodies and dont feel anything. then they self harm and can feel something
what kind of compulsive self injurious behaviour is there and what is it often relieving
trichotillomania (hair pulling out), skin picking
these are often anxiety related
when someone has a parasuicide event what must you assess
the intent behind the action. do a suicide risk assessment
which personality disordr is often highly litigious and holds grudges
what cluster is it
paranoid PD
cluster a
paranoid PD char
pervasive distrust and suspiciousness of other people
- assume oters are out to get them, harm them or humiliate them
- hold grudges, are litigious, may display pathological jealousy
why are paranoid PD often brought in to mental health facility
because they call the police on someone else
why is Tx a challenge with paranoid PD
they mistrust everyone
in rder for Tx to be success they must have insight
what kind of med can work for some paranoid PD and why do they not work for others
antipsychotics
often dont work because the delusions are so entrenched that they cant get out
what personality disorder might be mistaken for schizophrenia, they get taken into hospital and put on antipsychotics but they dont improve
schizotypal PD
what characterizes schizotypal PD
whcih cluster is it
perceptual distortion and eccentricity
- ideas of reference
- odd beliefs or magical thinking
- flat or incongreunt emotional responses
cluster A
what do ideas of reference mean (schizotypal PD)
they might think that eg a news anchor is sending them some coded messages that only they can understand. they will take tiny bits of that info and make lg connections from it.
d/t their flat or incongruent emotional responses how might a schizotypal pt present
they might seem to be on autism spectrum. they can be avoidant and live in their own world
are schizotypal pts often overtly distressed
not gen
they mght get paranoid in a bout of distress and be hsopitalized
which PD is indifferent to praise or criticism and often lacks a desire for intimacy
schizoid
schizoid PD what characteristics does it have
pervasive social detachment-dont really have opinion of relationships
- tend to be socially isolated and often chose solitary activities
- indifferent to praise or critisism. they just dont care
- lacking a desire for intimacy
which PD often has difficulty appreciating pleasure and what is this called
schizoid PD
anhedonia
do schizoid pts often present in hospital
no
which PD can be describe relationships as more intimate than they are and thinks any attention is good even if the attention is for negative reasons
histrionic
char of histrionic
- inappropriate sexually seductive or provocative
- seek excitement and attn
- outwardly they may seem charming and lively but inwardly they have threatened self esteem and sense of attractiveness
- describe relationships as more intimate than they are
what could be a consequence of histrionic PD needing attn and reactions from others (in terms of what the pt might do)
they might self harm if not getting the validation theyneed
they might fall in love right awayand be too intensely focused on the relationship which pushes the othr person away
histrionic-what are they vulnerable to
coercion and higher risk behav
which PD is characteriazed by grandiosity
What does this mean
narcissistic PD
They expect recognition and think they should be seen as superior to others without cause or reason
Think they are special or unique and can only be understood by high status people or institutions
Why might a narcissistic PD not want to talk to the nurse
They think they an only be understood by high status people or institutions
What kind of people might narcissistic of pts surround themselves with
Pts with low self esteem who will validate their need for constant admiration
What char does narcissistic pd have
Grandiosity!!
Think they’re special and only understood by high status people or institutions
Sense of entitlement
Need constant admiration
Lack empathy and take advantage of others to achieve their own needs
What happens when narcissistic PD needs aren’t being met
They can react abusively
What approach to use w narcissistic PD
Be direct
Firm
Set limits around behaviour
Iron clad care plan!
What might narcissistic PD try to do
Split the staff for their manipulative needs
Bend the rules
How much insight do narcissistic PD pts have. Consequence of this
Very little
The Tx outlook is not hopeful for them because they don’t see anything wrong with themselves
Which PD has behaviour that is a self fulfilling cycle and causes exactly what thy fear- abandonment
Borderline pd
Which PD must have hx of conduct disorder before age 15
Antisocial pd
Antisocial PD how does it present
Disregard and violate the rights of others
-no remorse for wrongdoing and no empathy
-irritability and aggressiveness
-marked readiness to blame others or to offer plausible rationalization a for their behavior
History of a conduct disorder before age 15
Why can antisocial PD pass lie detector tests
They don’t care
They won’t get the Hr or BP inc
What might be a precursor to conduct disorder and when does it occur
Ages 6-11 they might have oppositional defiant disorder in which the kid struggles in school, gets in trouble and is aggressive
ODD can turn into conduct disorder
What is conduct disorder
Violent and criminal behaviour eg arson, property crimes, break and entering ABUSE AND TORTURE OF ANIMALS!
What is the difference between sociopathy and psychopathy
Psychopaths commit crimes against a particular person and sociopaths commit crimes against society in gen eg hurler
Does antisocial PD think anything is wrong with their health
No. Thy rarely seek help directly
What do interventions focus on for antisocial PD
Often treatment of addiction
Not curative treatment
The treatment is mandatory user parole (70% of inmates have this condition)
What are the key assessments to do for pt with antisocial PD
Quality of relationship that you’re having with that person
Impulsivity
Violence risk
What kind of impulsive behav might antisocial Pd pt have
Often other directed violence when pts needs aren’t being met
What could trigger violence in antisocial Pd
When pt perceives disrespect which occurs when they think that their needs aren’t being met
How is it best to manage antisocial PD
Structures consistent environment
Nurse must be self aware (pt might try to manipulate
Hold pt accountable to their behav
Sit down and write care plan with them..this is what the behaviour will be, this is what we hope the outcome will be. Disclose the rationale
Why is the hospital environ not great for borderline pd pt
They must continually make and end relationships
Borderline pd what characterizes this
Unstable relationships self image and affect
-impulsivity
-mood lability
Fear of rejection
-unstable and intense interpersonal relationships
Recurrent suicidal behav, threats self mutilation, and gestures
Borderline pd what does their impulsivity often lead to
Default is to hurt themselves
What is a significant risk factor for borderline
Other risk factors
Maltreatment eg physics and sexual abuse!
Parental abandonment and alienation
Et of borderline
Might be genetic link as it is more common in first degree relatives
- fmri shows frontal limbus dysfunction
- psychological theories suggest that if kids exposed to abusethy develop maladaptive cog processes
What is the priority for borderline
70% of borderline pts have suicide attempt in their lifetime and 10% conplete.
Self harm risk is always very high
Char of borderline
Affective instability Identity disturbances Unstable personal relationships cognitive dysfx Dysfx or maladaptive behav
what do borderline pd fear most
abandonment
how might borderine pt think of their nurse
they might idolize them youre my favoroite nurse
how does cognitive dysfx mandifest in borderline
black and white thinking extreme interpretation of events disorganzied thoughts misconstrue env pathologic jealousy mild dissociative
highly sensitive to criticism
struggle to find happiness internally
what kind of dysfunctional or maladaptive behav might borderline pt have
impulsivity and self injury or parasuicide
Tx of borderline PD
primary tx is Dialectical behav therapy
low dose antidepressant or mood stabilizer could be used
what is dialectical bheav therapy
dev from buddhist principles this aims to reconnect w body
- there is a skills roup which is often run by someone with BPD in recovery and they teach skills such as describing emotions without judgement
- interpersonal effectiveness skills-conflict mgmt, empowerment, self worth, self esteem
- mindfulness skills
- distress tolerance-helping them feel distress is a normal part of life
if pt self harms what do you do
put steri strips on it and move on
