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Flashcards in Personality Disorders Deck (34):
1

Personality 

A relatively stable & enduring set of characteristic behavioral & emotional traits 

2

What are the 4 determinants of personality?

How are they defined? 

  • Temperament
    • “nature”
    • Apparent before traditional learning occurs
    • 50% of personality is related to temperament
  • Development
    • Effect of “nurture” on biology
    • Negative events in early childhood (typically repeated, chronic abuse or neglect) can physiologically alter the limbic system & cause permanent effects on emotional arousal, etc.
  • Character – “nurture”
  • Psyche – self-awareness (the ability to learn, adapt, change) 

3

What are defense mechanisms?

Unconscious mental processes that the ego uses to resolve conflicts 

4

Defense mechanisms are between________, reality, important persons, and ___________.  

When they remain rigid, despite changing, they _______ _______. 

Changing it increases ______.  

instinct (id)

conscience (superego)

don't work 

anxiety 

5

What are 3 examples of defense mechanisms?

  • Denial 
  • Dissociation
  • Suppression

6

Ignoring reality
Adaptive dealing w/ serious illness
Can get in the way of treatment 

Denial 

7

Mentally separating part of one’s consciousness from real life events 

Dissociation

8

Intentionally (consciously) pushing down to deal w/ now 

Suppression

9

Define personality disorder 

  • Relatively stable & enduring set of characteristic behavioral & emotional traits
  • Normally flexible & adaptable
  • When disordered, it is maladaptive, deeply ingrained & often distressing for both the patient & significant others 

10

Personality is "disordered" when....

  • It’s ingrained & inflexible
  • It gets in the way of relationships/functioning
  • It’s relatively stable
  • It distresses people around them 

11

Ego-syntonic vs. Ego-dystonic 

ego-syntonic > ego-dystonic

  • Ego-syntonic
    • “acceptable to the ego”
    • It doesn’t bother them, it bothers others
  • Ego-dystonic – uncomfortable 

12

OCPD is (ego-syntonic/ego-dystonic)

OCD is (ego-syntonic/ego-dystonic)

OCPD = ego-syntonic 

OCD = ego-dystonic

13

Personality Disorders

______% prevalence in general population (office)
______% prevalence in psychiatric outpatient populations
>____% on inpatient psychiatric unit 

10-18% prevalence in general population (office)
30-50% prevalence in psychiatric outpatient populations
>50% on inpatient psychiatric unit 

14

What are the gender trends in personality disorders?

What diseases are more common in men? women?

Men = Women

  • Females: borderline, histrionic
  • Males: Narcissistic, anti-social
  • Some validity, some stereotype 

15

Personality Disorders

  • Cluster A
  • Cluster B
  • Cluster C 

  • Cluster A = more detached, eccentric
  • Cluster B = more dramatic, impulsive 
  • Cluster C = more anxious 

16

What are some examples of Cluster A disorders?

  • Schizoid PD
  • Schizotypal PD
  • Paranoid PD

17

Schizoid PD

Definition

Prevalence

Difference from Schizophrenia

  • Emotionally detached, loners
  • Don’t want relationships
  • Prevalence – anywhere from “uncommon” to 7.5% of general population
  • Males 2X as much as females
  • Higher incidence of psychosis in relatives
  • Differentiated from schizophrenia by absence of psychotic symptoms (hallucinations, delusions, thought disorder) 

18

Schizotypal PD

Definition

Prevalence

  • cognitive, perceptual & behavioral eccentricities…frequently embrace beliefs, such as telepathy, clairvoyance & magical thinking, to a degree that exceeds cultural & subcultural norms”
  • 3% of population
  • Highly genetic
  • 33% monozygotic twins
  • 4% dizygotic twins
  • Increased risk in biological relatives of schizophrenics 

19

Paranoid PD

Definition

Prevalence

Differentiation from Schizophrenia 

 

  • Long-standing suspiciousness & mistrust of people
  • No basis for this mistrust
  • Read threats into non-threatening situations
  • Pathologically jealous if in a relationship
  • 0.5-2.5% of population
  • Rarely seek treatment themselves
  • Males > Females
  • Differentiated from schizophrenia by absence of hallucinations or though disorder, higher functioning & non-bizarre paranoia 

20

What are some examples of Cluster B disorders?

  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic 

21

“repetitive unlawful acts & socially irresponsible behaviors that began prior to age 15…so unconcerned w/ the feelings & rights of others that they are morally bankrupt & lack of a sense of remorse”

Antisocial Disorder

22

Antisocial

Definition

 

  • Deceitful, impulsive
  • Irritability & aggressiveness
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility (doesn’t honor financial obligations)
  • Lack of remorse
  • Often confused in lay terms, taken to mean “antisocial”
  • Antisocial = sociopath 

23

Antisocial

Prevalence 

  • 3% of male population, 1% of female population
  • High genetic load
  • 5X more common in relatives w/ disorder 

24

Getting distraught if a spouse is 5 min late getting home from work

Placing dozens of phone calls to one’s therapist before the therapist goes on vacation 

Borderline Disorder

 

25

Borderline 

Definition

Relationships

Mood 

  • Frantic efforts to avoid real or imagined abandonment (interpersonal)
  • A pattern of unstable & intense interpersonal relationships characterized by alternating btwn extremes of idealization & devaluation (interpersonal, affective)
  • Affective instability due to marked reactivity of mood
    • “mood swings”
    • Argumentative one moment, depressed the next
  • Later complain of having no feelings (affect)
  • Chronic feelings of emptiness
  • Recurrent suicidal behavior, threats or self-mutilating behavior (impulse control) 

26

Borderline

Prevalence 

  • 1-2% of population
  • Females > Males
  • High genetic load
  • More MDD & substance abuse in relatives
  • Multiple suicide attempts (up to 10% complete) 

27

Histrionic

Definition

Prevalence

  • “…pervasive overconcern w/ appearance & attention, exaggerated & emotional response, poor frustration tolerance that ends in outbursts, & impressionistic speech that lacks detail”
  • “View physical attractiveness as the core of their existence”
  • Believed to occur in 2-3% of the population
  • Females > Males 

28

Narcissistic 

Definition

Preoccupations

  • Characterized by a heightened sense of self-importance, grandiose feelings & lack of empathy
  • Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
  • Arrogant, entitled & often envious
  • Require excessive admiration
  • Take advantage of others to achieve their own ends 

29

What are some examples of Cluster C disorders?

  • OCPD
  • Avoidant
  • Dependent

30

OCPD

Definition

  • Become so preoccupied w/ details & rules that the major point of an activity is lost
  • Display perfectionism that interferes w/ task completion (taking hrs to do notes because it has to be perfect)
  • Have inflexible values & are overly conscientious 

31

OCPD

Prevalence

Defenses 

Difference from OCD

  • Males > Females
  • More common among 1st degree relatives w/ OCPD
  • Tend to be oldest children
  • Defenses – rationalizing, intellectualizing, reaction formation, undoing, controlling
  • NOT the same as OCD – ego dystonic
  • However, under stress, can develop OCD symptoms 

32

Avoidant 

Definition

 

  • Show extreme sensitivity to rejection which may lead to a socially withdrawn life
  • Although shy, they have a great desire for relationships
  • Differentiates from schizoid PD 

33

Dependent 

Definition

Prevalence

  • Subordinate their own needs to those of others
  • Lack self-confidence & can’t make decisions w/o excessive advice & reassurance
  • Doesn’t speak up b/c may lose support or approval
  • Uncomfortable being alone
  • Urgently seeks another relationship when a close one ends
  • Females > Males
  • Youngest children

34

What are the available treatments for personality disorder? 

  • Psychodynamic psychotherapy to change the defenses
  • Supportive if too unstable or minimal insight
  • Behavioral (DBT) if self-destructive behavior
  • Psychopharm
    • Target symptoms
    • Serotonin – impulse control, rejection sensitivity, mood stabilizer for lability, affect dysregulation