Session-13 Personality Disorders (Cluster C) Flashcards

Question

What are DSM-IV-TR: Dependent PD (#2): Differential Considerations?

Answer 1

In general, the early onset, chronic pattern of dependency must be distinguished from dependency that arises from an Axis I disorder or as the result of GMC Borderline PD: Both characterized by fears of abandonment; however, in BPD, those fears are managed by acting out, rage, entitled demands, whereas in DPD fears are managed by becoming overly appeasing and submissive and seeking replacement relationships Histrionic PD: Both characterized by need for reassurance and approval, but in HPD, the attention-seeking behavior is dramatic and flamboyant, whereas in DPD it is self-effacing and docile Avoidant PD: Both Avoidant PD and DPD are characterized by feeling of inadequacy and fears of rejection; however, in Avoidant PD, the person reacts to the fear by avoiding relationships, whereas in DPD, the person actively seeks relationships

Answer 2

Psychodynamic understanding of etiology: Pervasive pattern of parental reinforcement for dependency Families with low expressiveness and high control Enmeshed attachment relationships in which independence was discouraged

Answer 3

Core conflict: separation/individuation is bad and may destroy the object. Defenses and ego functioning: Mature and primitive defenses -reaction formation/compromise formation: dependent clinging may mask resistance to the expression of aggression Self functions: Poor: neediness of others for selfobject functions Sadomasochistic relationships function to soothe the self Object relations: Neediness, dependency, submissiveness

Answer 4

Characterized by a “preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency” (APA, 2000, p. 725). Attempts to maintain a sense of control (and self-cohesion) by way of excessive attention to rules, perfectionism, excessive devotion to work, and over-conscientiousness. Preoccupation with orderliness, perfection, and mental and interpersonal control. Characteristics of OCPD tend to be reinforced in situations that reward high performance -It becomes a disorder when these features are inflexible, maladaptive or persistent across a range of contexts Difficulties with decision-making, particularly if there are no clear rules or procedures -So much so that they may never begin tasks Become upset in situations where they are not able to maintain control, although they do not directly express their dissatisfaction; e.g., travel delays and ruminating about the letter they will write to the airline Highly controlled emotions undermine intimate relationships Occupational difficulties arise when they encounter situations in which flexibility or compromise are required

Answer 5

Diagnostic criteria: Excessive preoccupation with details, rules, lists, organization or schedules to the detriment of the major point of any activity Perfectionism that interferes with task completion Excessive devotion to work and productivity to the exclusion of leisure and relationships Over-conscientiousness and inflexibility about ethics, morality or values Inability to discard worn-out or worthless objects even when they have no sentimental value Reluctance to delegate tasks due to concern that they won’t be completed exactly as desired Excessive frugality Rigidity and stubbornness

Answer 6

Obsessive-Compulsive Disorder: People with OCD have true obsessions and/or compulsions, whereas people with OCPD do not Extreme hoarding: OCD should be considered Narcissistic PD: Also perfectionistic, but usually think they are superior and have achieved perfection, whereas people with OCPD are self-critical

Answer 7

Psychodynamic view of etiology: Centrality of issues associated with the anal stage Anger and aggression that arise in response to the experience of being controlled are introjected (instead of turned vs. the object) - The need to feel in control becomes important to the maintenance of self-esteem - Not feeling loved by parents gives rise to self-doubt - Understanding an excessive need for orderliness as reaction formation against the out-of-control feelings of aggression

Answer 8

Core Conflict: rage at being controlled vs. fear of being punished Defenses and ego functioning: -Punitive superego and demands for perfection -Primarily mature defenses -Organizing defenses Obsessive: Isolation of affect (if higher functioning, more mature versions like rationalization, compartmentalization, intellectualization) Compulsive: Undoing Obsessive and compulsive: both isolation and undoing Displacement (particularly of anger) onto a legitimate target reduces feelings of shame associated with anger -Overvaluation of cognition and mentation Feelings are viewed as indicative of weakness, childishness, loss of control and are excessively avoided Fear of shame associated with revealing vulnerability results in an overly cognitive and rational approach to relationships This significantly undermines relationships, including the therapeutic one Questions about emotional responses are met with exceedingly rationale , emotionally distancing or impassive responses -Behavioral defenses (a/w compulsive personalities) Undoing: Compulsive actions aimed at undoing a thought or action Compulsions are defined by their drivenness – the sense that they MUST be performed in order to maintain control Sense of omnipotent control in compulsions – overestimation of the degree to which the person’s actions defined the outcome -Reaction formation Overcontrolled conscientiousness and excessive need for orderliness represents a reaction formation against wishes to be messy, rebellious and aggressive Object relations: -Control is a central issue in families of origin: Caregivers who were rigid, controlling: Control expressed through induction of guilt: I expected more from a smart kid like you.” :Modeling of moralization: “It hurts me to do this, but it’s for your own good” High standards of behavior and expectations of conformity by parents or caregivers result in the development of harsh superego Wish to gain love by perfection Need to control others in relationships and fear of getting out of control Counter-dependency evident in excessive individualism Self functions: - Profound concern with control and morality - Themes of dependency and aggression: Righteous behavior is equated with keeping aggressive and needy parts of the self contained - Self-esteem is maintained by meeting the demands of a internalized objects who have high standards for behavior - Paralyzing fear of making the wrong choice and things turning out badly as a result Limited insight into the extent to which, by trying to keep all their options open (and, in so doing, to maintain control over all possible outcomes, with the goal of the perfect solution), they end up undermining their options, which results in a forced outcome that was not necessarily their choice

Answer 9

Good patients – conscientious, hard-working, motivated Rambling speech pattern with frequent retraction of thoughts or feelings that have been verbalized Transference: - May perceive therapist as the demanding and judgmental parent resulting in conscious compliance and unconscious oppositionality - Critical, overcontrolling - Great difficulty acknowledging feeling irritated or unsatisfied with the therapist – we create the space for it to exist and help hold it until they are able to hold it themselves Countertransference: Irritated Discouraged Bored or distanced by intellectualizing defense

Answer 10

No Change: Cluster A: odd or eccentric Paranoid Schizoid Schizotypal ``` Cluster B: dramatic, erratic and emotional antisocial borderline histrionic narcissistic ``` Cluster C: anxious or fearful avoidant (#1) dependent (#2) obsessive compulsive (#3)

Answer 11

A. An enduring pattern of inner experience and behavior that deviates markedly from person’s culture. Pattern demonstrated in two or more of the following: 1. cognition 2. affectivity. 3. interpersonal functioning 4. impulse control B. Inflexible and pervasive pattern C. Clinically sig. distress and disability D. Pattern stable and long duration and onset can be traced to adolessence or early adulthood. E. Not explained by another mental dx. F. Not accounted by substance or GMC

Answer 12

A. Pervasive pattern of social inhibition , feelings f inadequacy, and hypersensitivity to negative evaluation, beginning from early adulthood. Four or more of the following: 1. avoids occupational activity that involve sig. interpersonal contact because of fears of criticism etc. 2. unwilling to get involved with people unless certain of being liked. 3. restrained in intimate relationships bc. Of being shamed or ridiculed 4. preoccup. With rejection or criticism in social sit. 5. inhibition in new social sit. Because of feeling inadequate. 6. views self as socially inept and inferior to others 7. reluctant to take personal risks or engage in new activities because of fears of possible embarrassment.

Answer 13

A. Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood. Five or more of the following: 1. difficulty making everyday decisions without excessive amount of advice and reassurance from others 2. needs others to assume responsibility for most major areas of his or her life 3. difficulty expressing disagreement with others because of fear of loss of support or approval (note: Do not include realistic fears of retribution). 4. difficulty initiating projects or doing things on own bc. Of lack of self-confidence in judgment or abilities rather then lack of motivation or energy 5. excessive lengths to obtain support from others to the point of doing unpleasant things 6. uncomfortable or helpless when alone bc. Of fears of unable to take care of self 7. seeks another relationships as support or care if one relationship ends 8. unrealistically preoccupied with fears of being left to take care of self

Answer 14

A. Preoccupation with orderliness, perfection and control at the expense of flexibility or openness and efficiency, beginning from early adulthood. Four or more of the following: 1. preoccupied with details, rules, lists to the extent that major point of the activity is lost. 2. perfectionism interferes with task completion 3. excessive devotion to work etc. to the exclusion of leisure (not accounted by obvious eco. Reasons) 4. inflexibility about morality ad ethics (e.g. not accounted by cultural or religious values) 5. unable to discard worthless objects even when they have no sentimental value 6. difficulty delegating tasks 7. miserly spending style towards self and others; money hoarded for future catastrophes 8. rigid or stubborn