Dual Diagnosis Test II

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Anonymous
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224831
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Dual Diagnosis Test II
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2013-06-24 05:08:00
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Sroka Dual diagnosis borderline personality disorder
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Dual diagnosis test II for Eric Schmidt LCSW, MBA
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  1. Define personality Disorder
    Enduring patterns of perceiving, relating to, and thinking about the environment and oneself
  2. What percentage of substance abusers have Personality Disorder
    80%
  3. ___% of the general populations struggle with some aspect of personality disorder
    11-23%
  4. How many population have BPD
    • 2%
    • 2-3x as many women
    • 2/3 of adults with BPD have experienced abuse
  5. What treatment works best for treating personality disorders
    • Integrated Treatment Approach-Minkoff
    • Harness therapeutic relationship
    • Develop empathy
    • holding environment
    • understand countertransference
    • honor complexity of interactions
  6. Shared traits of Substance abuse and personality disorders are
    • Antisocial tendencies
    • Impulsitivity
    • Intense relationships
    • Multi-generational patterns
    • congnitive distortions (thinking errors)
  7. Materson contends what about BPD
    defenses will discontinue but intrusive feelings and avoidant behaviors continue when trauma is the central issue
  8. many argue...
    genetics contributes at least 50/50 compared to environmental factors
  9. Brain grows....
    2.5x in first 2 years of life
  10. Cerebrum
    most highly evolved part of the brain
  11. Occipital Lobe
    integrates visual perceptions and memories
  12. Parietal Lobe
    interprets sensory information from rest of body
  13. Frontal Lobe
    complex intellectual processes, consciousness, judgment, planning, and emotional responses
  14. Temporal Lobe
    Integrates memory and emotions, stores long-term memories; categorizes; allows recognition of people and objects
  15. Cerebral cortex "Gray Matter"
    Cortex contains nerves, which transmit messages between gray cells, nerve centers in the brain, and spinal cord
  16. Prefrontal Cortex
    • controls concentration, planning, problem solving, and complex emotional regulation
    • Soloff found diminished response to serotonergic stimulation
    • Goyer found in PET scan studies reduced activity in BPD patients (true also for SA)
  17. Limbic System "the emotional Brain"
    • Dopamine rich
    • Dopamine disregulation in limbic system maintains addiction
    • monitors internal homeostasis
    • processes memory (A role in this function)
    • mediates learning
    • experiences emotion
    • drives aspects of sexual behavior, motivation and feeding behaviors
    • communicates with the temporial lobe of cerebrum
  18. Limbic system contains reward "Centers" of the brain
    • Nucleus accumbens
    • Amygdala (emotional functioning and social behavior)
    • Venral tegmental area (VTA)
  19. Amygdala
    • Related to emotional functioning and social behavior
    • 7.5 smaller in BPD studies (Goyer)
    • Similar results for substance abuse (especially alcoholics)
  20. Hypothalamus
    • Involved in appetite, libido, and sleep
    • pleasure center
  21. Hippocampus
    • The memory librarian, filing short-term and long-term memories.  With the Temporal Lobe assimilates experience into prefrontal cortex.
    • -16% smaller in BPD studies
    • Especially affected by Methamphetamine
    • PD&SA Hinders integration of emotional experiences with sensory information
    • Isolation of responses limbic system with diminished fronal cortex activity
  22. Low serotonin levels...
    reduce impulse control
  23. Field dependence
    over reliance on context, rather than one's internal compass
  24. Define Splitting
    • defense against abandonment depression
    • all or nothing thinking
    • the failure in a person's thinking to bring together both positive and negative qualities of the self and others into a cohesive, realistic whole.
  25. What are the pathways contributing to developmental arrest and impairments of the self
    • Nature
    • nurture
    • fate
  26. maladaptive traits usually/can...
    turn into personality disorders
  27. developmental arrest:
    when people are coping in ways that are maladaptive
  28. Mahler: Phases of normal preoedipal Development
    Autistic phase
    • 0-2 months
    • absolute primary narcissism
    • basic life-sustaining reflex activities aimed at achieving physiological homeostasis 
    • -lacking cognitive awareness of external agents capable of responding to needs
    • unable to differentiate between internal and external stimuli
    • whatever reduces tension is good and whatever increases or fails to reduce is bad
    • caretaker's task=gratification of basic needs in support of physiological stabilization
  29. Mahler: Phases of normal preoedipal Development
    Symbiotic Phase
    • 2-5 months
    • dual oneness
    • psycholigical fusion with the primary caretaker with no perceived differentiation between self and other
    • a dim awareness of a need-gratifying external object is developing but is experienced as a psychological component of the self
    • dichotomous (good- bad) affective states are attributed to the fused, undifferentiated self-object.
  30. Mahler: Phases of normal preoedipal Development
    Separation-Individuation Phase
    • 5-36 months
    • a slow process of disengagement whereby the child achieves a state of psychological separatenss from the caretaker and develops boundaries to the self and independent ego functioning in the areas of perception, memory, reality testing, and affect management
    • requires development and maintenance of "confident expectations" of the caretaker's availability for support
    • the separation-individuation process consists of three subphases differentiaton, practicing, rapprochement
    • (Explore the world, not afraid of abandonment)
    •  
  31. Mahler: Phases of normal preoedipal Development
    Differentiation Subphase
    • 5-9 months
    • psychological hatching
    • establishes body distinction between self and caretaker and between caretaker and others
    • characterized by visual and tactile explorations
    • develops recognition memory as evidenced by a social smile, unhappiness with the absence and joy at the return of the caretaker, and stranger anxiety
    • Caretakers task- reinforcement of exploration and recognition
  32. Mahler: Phases of normal preoedipal Development
    Practicing Subphase
    • 9-18 months
    • development of significant autonomous functioning, particularly in the area of locomotion 
    • exploring the world at large with exuberance and excitement that temporarily enables the child to ignore the caretaker
    • development of the grandiose self characterized by omnipotence, as a defense against separation fears (make environment come to them)
    • periodic returns to the caretaker for "emotional refueling"
    • The caretaker's availability for consistent sport, comfort, and encouragement remains critical
    • Caretakers Task-Maintain empathy as the child moves away and openness to the child's need for periodic returns
  33. Mahler: Phases of normal preoedipal Development
    Rapprochement Subphase
    • 18-30 months
    • experiences of separateness are accompanied by realization of one's own vulnerability to abandonment, loneliness and helplessness
    • diminishing of the "grandiose self"
    • conflict between the urge to separate and the fear of loss
    • heightened anxiety related to the caretaker's presence or absence
    • ambicalence toward the caretaker as evidenced by "shadowing" and "darting away"... the wish for reunion and the fear of engulfment
    • child may mediate sepearaton anxiety with transitional objects and an increased investment in auxiliary relationships
    • Caretaker's Task- Acceptance of intense ambivalence and support of autonomous functioning.
  34. What is object constancy
    the ability to mentally and emotionally experience self and others as whole (both good and bad) and separate entities irrespective of frustration or satisfaction
  35. Development of object constancy requires:
    • attachment to a significant other
    • the ability to differentiate self from others
    • integration of polarized images of self and others and acceptance of ambivalent position
    • "evocative memory"-the ability to evoke a stable comforting mental representation of the significant other even during absences and frustration
  36. What is the desired outcome of Healthy separation/Individuation
    • Trust
    • core sense of self
    • Autonomous Functioning
    • Diminishing of Grandiosity
    • Ego Control over Drives and impulses
    • Reality Testing
    • Mastery of Separation Anxiety
    • Decreased Splitting, Projection 
    • Decreased Projective Identification (projecting personal motives and traits onto someone else)
    • Healthy repression
  37. Antisocial Personality Disorder:
    • Failure to conform to social norms, unlawful behavior
    • deceitfulness, conning
    • impulsivity
    • irritability, aggression
    • disregard for safety
    • consistent irresponsibility
    • lack of remorse 
    • *evidence of pre-existing conduct disorder before age 15
  38. Borderline Personality Disorder:
    • avoidance of abandonment
    • pattern of unstable relationships, idealization and devaluation
    • identity disturbance
    • impulsivity
    • recurrent suicidal behavior, gestures, or threats, or self-mutilating
    • affective instability, reactivity of mood
    • chronic emptiness
    • inappropriate, intense anger
    • transient, paranoid ideation or severe dissociation
  39. Histrionic Personality Disorder
    • center of attention
    • sexually seductive or provocative behavior 
    • instability of mood, shallow emotions
    • uses physical appearance to gain attention
    • speech is excessively impressionistic and lacking in detail
    • dramatic, theatrical
    • suggestible
    • perceives relationships to be more intimate than they actually are
  40. Narcissistic Personality Disorder:
    • Grandiose sense of self
    • preoccupied with fantasies or self-importance
    • believes they are special and unique, only understood by special people
    • requires admiration
    • sense of entitlement
    • interpersonally exploitative
    • lacks empathy
    • envious of others, believes others envious of them
    • arrogant, haughty
  41. Substance dependence:
    • tolerance
    • withdrawal
    • substance taken in larger amounts over a longer time than intended
    • persistent unsuccessful attempts to decrease or control use
    • persistent desire, cravings
    • considerable time devoted to attaining substance, using substance, or recovering
    • Important activities are forfeited or reduced
    • continuation of use despite knowledge of having physical or psychological problem caused or exacerbated by the substance
  42. Substance Abuse:
    • Failure to fulfill major role obligations resultant of substance use
    • recurrent use in hazardous situations
    • recurrent substance-related legal problems
    • continued use despite persistent social or interpersonal problems

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