Rosenthal - Personality Disorders and Defense Mechanisms Flashcards
1
Q
What is regression?
A
- Acting in a way appropriate to an earlier stage of development, i.e., “I want my mommy”
- Needy, helpless, can’t do anything
- Common in inpatient situations where pt is acting more helpless and dependent than is justified by the medical problem
- DEFENSE MECHANISM
2
Q
What is denial?
A
- Not accepting the reality of the situation
- Some denial is healthy, if the sheer reality is too stark
- Too much denial stands in the way of taking care of one’s medical problems
- DEFENSE MECHANISM
3
Q
What is repression?
A
- “Cannot remember,” i.e., not accessible to conscious memory
- Truly unable to recall certain information, because the anxiety was too overwhelming
- May reveal itself in unexpected context, such as during invasive procedures
- DEFENSE MECHANISM
4
Q
What is intellectualization?
A
- Gaining control over an emotionally charged and frightening situation by engaging in intellectual mastery
- Excessively perusing scientific articles, books, internet
- Engaging on an intellectual level rather than processing or expressing emotions
- Excessive abstract thinking to avoid confrontation with conflicts or disturbing feelings
- DEFENSE MECHANISM
5
Q
What is distortion?
A
- Twisting the truth to be less painful or anxiety provoking; or to fit better into a schema
- May be a conscious OR unconscious process
- Often happens as pt tries to recall events that led up to a lawsuit -> in that scenario, pts may really believe what they seem to recall
- DEFENSE MECHANISM
6
Q
What are the 3 adolescent defense mechanisms? Describe them.
A
- PROJECTION: accusing others of things one is doing or feeling oneself, projecting blame on others; not owning up
- Unconscious; what is emotionally unacceptable in the self is rejected and attributed to others
- DENIAL: not accepting the reality of the situation
- RATIONALIZATION: making up “plausible” reasons for one’s behavior, after the fact
7
Q
What is a defense mechanism?
A
- Unconscious cognitive strategies serving to provide relief from emotional conflict and anxiety, helping us to deal with things that are too uncomfortable to contemplate
- Conscious efforts frequently made for same reasons, but true defense mechanisms are unconscious
8
Q
What is dissociation?
A
- Splitting off of clusters of mental contents from conscious awareness
- Mechanism central to hysterical conversion and dissociative disorders
- Also used to describe separation of idea from its emotional significance and affect, as seen in the inappropriate affect of schizophrenic pts
- DEFENSE MECHANISM
9
Q
What is introjection?
A
- Unconscious mechanism whereby loved or hated external objects are symbolically absorbed within oneself (converse of projection)
- May serve as defense against conscious recognition of intolerable hostile impulses -> in severe depression, for example, pt may unconsciously direct unacceptable hatred or aggression toward him or herself
- DEFENSE MECHANISM
10
Q
What is projection?
A
- Unconscious mechanism in which what is emotionally unacceptable in the self is rejected and attributed (projected) to others
- May explain irrational outbursts and accusations when pt feels wronged and vulnerable, even though no-one meant them any harm
- DEFENSE MECHANISM
11
Q
What is reaction formation?
A
- Pt unconsciously adopts affects, ideas, and behaviors that are in opposition of impulses harbored either consciously or unconsciously
- EX: excessive moral zeal may be reaction to strong, but repressed asocial impulses
- DEFENSE MECHANISM
12
Q
What is sublimation?
A
- Consciously unacceptable instinctual drives are unconsciously diverted into personally and socially acceptable channels
- DEFENSE MECHANISM
13
Q
What is substitution?
A
- Unattainable or unacceptable goal, emotion, or object is unconsciously replaced by one that is more acceptable or attainable
- DEFENSE MECHANISM
14
Q
What is the definition of a personality disorder?
A
- Enduring pattern of inner experience and behavior that deviates markedly from expectations of the individual’s culture,
- Is pervasive and inflexible,
- Has its onset in adolescence or early adulthood,
- Is STABLE OVER TIME,
- And leads to clinically significant distress or impairment in social, occupational, or other important areas of function
- Present in a VARIETY OF CONTEXTS
- NOTE: traits are NOT a disorder (we all have these, and there is a wide normal range) -> never seize on one or two symptoms to make a dx
15
Q
What is the epi of personality disorders?
A
- 9-16% of population
- Starts in late adolescence, often with signs in childhood, but is not dx’d until adulthood, where we see established patterns
- Symptoms wax and wane in response to life stress
- Late-onset personality changes are suggestive of undiagnosed “other” problem -> dementia, substance abuse, medical illness, neurological problem
16
Q
What are some lasting trait dimensions that cut across cultures? Why are they important?
A
- Emotional stability vs. neuroticism (anxiety-prone)
- Agreeableness vs. antagonism
- Extraversion (seeks stimulation and excitement; short attention span) vs. introversion (avoids stimulation, and likes being left alone; long attention span)
- Conscientiousness: plans ahead, gets things done
- Openness to experience
- These traits FEATURE IN PREDICTING: health and mortality, academic success, job performance, capacity for lasting relationships, drug abuse and criminality
17
Q
Why are early experiences so important, according to Freud and Erickson?
A
- Freud: fixation at early stage prevents healthy personality development
- Erickson: certain tasks need to be mastered at certain stages of development for healthy behavior to progress
- TRUST/MISTRUST: people who were raised in chaos and/or abuse are, understandably, deficient in basic trust, and this carries into adulthood
- NATURE/NURTURE: chaotic families beget chaotic offspring (genetic or envo?)
18
Q
How does early trauma affect development?
A
- Extended early emotional trauma and abuse have been shown to adversely affect coping skills and brain development
- Traumatized pts are over-represented in medical pop
- Many of these ppl have serious devo issues as far as coping with early trauma when they were not able to process what was going in
- Early trauma often repressed, i.e., not accessible to conscious memory
19
Q
What are the Cluster A personality disorders?
A
- Weird: odd and eccentric
- Paranoid
- Schizoid
- Schizotypal
- NOTE: biological relatives of people with schizophrenia are often cluster A
20
Q
What are the features of paranoid personality?
A
- Always looking for wrong-doings and hidden malicious meaning
- Rigid, defensive, and self-righteous
- Preoccupied with doubts of others’ motives
- SUSPICIOUS of partner’s fidelity
- Very unforgiving of mistakes
- Often uses defense mechanism of “PROJECTION,” blaming others for everything that is not going right
21
Q
What are the features of schizoid personality?
A
- Solitary loner
- DOES NOT WANT OR SEEK CLOSE RELATIONSHIPS (IMPORTANT)
- Chooses solitary jobs and night shifts
- Takes pleasure in few, if any, activities
- Emotionally cold, detached
- May be the PREMORBID PHASE OF SCHIZOPHRENIA, but you CAN’T PREDICT this transformation
22
Q
What are the differences between schizoid personality and social phobia?
A
- SCHIZOID: does NOT DESIRE social relationships; loner
- SOCIAL PHOBIA (anxiety): DESIRES friends, but is afraid
- Can’t speak in public
- Sweaty palms, stomach flip-flops, voice cracks
- Avoids social contacts BECAUSE OF ANXIETY
23
Q
What are the features of schizotypal personality?
A
- Cognitive and perceptual distortions and eccentricities (not while on drugs)
- ODD appearance and speech (vague, methaphorical, over-elaborate)
- No close friends or associates
- Suspicious, MAGICAL thinking
- Often odd enough that psychosis is suspected, but pt. is NOT PSYCHOTIC (i.e. still in touch with reality)
- Can be the PREMORBID PHASE OF SCHIZOPHRENIA; UNKNOWN until time elapses
24
Q
Describe the cluster B people.
A
- Impulsive, ERRATIC mood swings: often very “entitled”
- Life-long pattern of instability
- High on “extraversion” dimension
- Short attention span
- Intense, stormy relationships
- Multiple marriages and divorces
- Frequently display SOMATIZATION: somatic complaints you can’t get to the bottom of
- Common defense mechanisms are denial, projection, and somatization
- Often from chaotic families
- NOTE: these disorders are NOT distinct entities; look for OVERLAPPING CRITERIA
25
Q
How are cluster B folks similar to and different from ppl with bipolar disorder?
A
- Chaotic lifestyle often mistaken for bipolar, but can coexist with bipolar disorder
- Personality disorder pts will NOT improve with meds alone; personality and social problems must be addressed in PSYCHOTHERAPY or counseling
26
Q
What are the 4 cluster B subgroups?
A
- Antisocial
- Borderline
- Histrionic
- Narcissistic
27
Q
What are the features of antisocial personality disorder?
A
- Pt “defies social rules:” has nothing to do with not being sociable, as in social parlance
- Must be 18 OR OLDER for dx, and have shown evidence of CONDUCT DISORDER with onset before age 15
- EX: cruelty to animals, lack of respect for rules, lying, truancy, criminal acts
- Not your run of the mill, boys will be boys, but really a defiance of the rules
- Don’t have a conscience, moral compass -> tend to be CHARMING and MANIPULATIVE, creating a lot of heartache in other people
28
Q
What are some of the “characteristics” of antisocial personality disorder folks?
A
- Life-long pattern of taking advantage of others
- Never feel at fault, guilt, remorse, except when cornered
- Embezzlers, impostors, manipulators; may end up in prison if poor; may get record expunged if well-connected (no evidence of criminal record may not mean much)
- Substance abuse not uncommon
- Attracted to other Cluster B partners -> multiple marriages bc superficial charmers
29
Q
What are the features of borderline personality disorder?
A
- Unstable moods, mood swings
- Stormy relationships, poor choices
- Often confused with “bipolar disorder”
- All-or-nothing thinking is one of the hallmarks (no shades of grey): “SPLITTING”
30
Q
What are some of the characteristics of borderline personality disorder folks?
A
- Substance abuse or misuse
- History of severe physical, emotional, or sexual abuse, alcoholic or mentally ill parent
- Unstable households make it hard for kids to devo appropriately
- SELF-INJURIOUS behavior, especially wrist-slashing, self-stabbing, piercing, cutting to see blood
- Suicidal gestures and attempts
- Chronic FEELING OF EMPTINESS, relieved by pain, self-injurious behavior (perhaps by precipitating a release of endorphins), and by seeking relationships
- Episodes of despair, often quickly relieved when good things happen -> mood largely determined by external events
31
Q
What is splitting?
A
- Seeing the world in only black and white, all good or all bad
- Playing people against each other
- Causes discord and stress in environment
- Poor insight, poor judgment
- Defense mechanism: non-adaptive way of coping
- Despair and agitation
32
Q
Provide an “example” of a pt with borderline personality disorder.
A
- Patient in acute emotional distress who seems to require “SPECIAL” tx
- Causes a great deal of strife and confusion in social environment
- “SPLITTING“ (seeing things in all black or all white) and rapid shifts in mood and manner
- BOUNDARY ISSUES: becoming overly involved in other people’s business, and vice versa
33
Q
What are the features of histrionic personality disorder?
A
- Excessively emotional and attention-seeking
- Superficial and highly suggestible
- Multiple somatic complaints, often dramatic
- Sexually seductive, often unaware
- Emotionally labile
- Imprecise and global in verbal descriptions
- Poor insight
- Family history of Antisocial and Alcohol
34
Q
What are the features of narcissistic personality disorder?
A
- GRANDIOSE sense of self-importance and entitlement, overlaps with Antisocial
- Preoccupied with self (Narcissus Myth)
- May be arrogant, devalues others
- Demanding of SPECIAL TX
- Lacks empathy
- May become suicidal when rejected
35
Q
What are the 3 cluster C subgroups?
A
- Obsessive-compulsive
- Dependent
- Avoidant
36
Q
What are the features of obsessive compulsive personality?
A
- Rigid, orderly, miserly, “ANAL,“ controlling
- Difficult to be with
- Excessive devotion to work, humorless
- Hoards things, can’t throw anything away
- Preoccupied with details and RULES
- Schedules everything
- Gets upset when things don’t work out according to plan
- DRIVEN BY ANXIETY, rather than any kind of will
37
Q
What are the features of dependent personality?
A
- Excessive need to be cared for
- Urgently seeks attachments
- Cannot be alone
- Cannot make independent decisions
- Clinging and insecure
- COMORBID MOOD AND ANXIETY DISORDERS ARE COMMON
38
Q
What is avoidant personality disorder?
A
- Closely linked to anxiety disorders
- CANNOT TAKE RISKS
- Avoids conflict and responsibility
- Procrastinates
- Passive-aggressive behavior
- Goes to great lengths to AVOID BEING JUDGED
- Risk-averse
39
Q
How are personality disorders treated?
A
- Understand the patient’s “story,” esp. HISTORY OF TRAUMA, abuse -> many times is at the root of the problem
- Coping skills
- Be steady, calm, consistent; supportive/caring approach
- Communicate clearly
- SUSPEND JUDGMENT, don’t get angry
- Find and support the patient’s strengths
- Celebrate successes with the patient
- Maintain good, firm BOUNDARIES
- More complex issues need to be addressed in psychotherapy
- Medications may be helpful if the patient is also suffering from a mood or anxiety disorder, but are NOT to be seen as the only (or even primary) treatment
- NOTE: alcohol is frequently used (over-used), often in an effort to self-medicate
40
Q
What is intermittent explosive disorder?
A
- “Losing it:” failure to control aggressive impulses; out of proportion and out of character
- REMEMBER: other disorders include gambling disorder (compulsive addiction and disruptive disorder), internet addiction, and compulsive shopping disorder
41
Q
What is kleptomania?
A
- Stealing: may benefit from Naltrexone or one of the SSRI’s (e.g., Fluoxetine, Paroxetine)
- Self-imposed shopping ban may be the best short-term strategy to forestall stealing
- Consumer credit counseling may be beneficial
42
Q
What is pyromania?
A
- Fire-setting
- Child may benefit from fire safety training
- A visit to a burn center might be a graphic reminder of the harm he or she may cause others
