PSY Personality disorders
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What is personality?
Derived from the latin term "persona" meaning theatrical mask...represents the person behind the mask
When was it first recognized that personality disorders were cause for concern? what were they called then? Can an individual behave irrationally even when their powers of intellect are intact? What were personality disorders previously termed?
- fist term was moral insanity
- previously termed "character disorders"
What are the 4 characteristics of personality disorders?
- 1: inflexible, maladaptive response to stress
- 2: disability in working and loving
- 3: ability to evoke interpersonal conflict
- 4: capacity to get under the skin of others
Where do personality disorders lie on the mental health spectrum? What axis are they?
- Right before psychosis
- they are axis 2
According to the DSM-5 how many personality disorders are there? What is cluster A? B? C?
- Cluster A: Odd or eccentric behavious
- Cluster B: Dramatic, erratic or emotional behaviour
- Cluster C: Anxious or fearful behavior
What disorders lie in cluster A?
- *Odd/ eccentric*
What disorders lie in cluster B?
What disorders lie in cluster C?
- Obsessive compulsive
What is the definition of Paranoid PD? Schizoid? Schizotypal
- Paranoid: People suspicious of others; more common in men
- Schizoid: people who do not enjoy social relationships, and usually have no close friends; more common in men
- Schizotypal: the same as schizoid, but the show eccentric thoughts and behaviours, which can be considered to be mild versions on the symptoms of schizophrenia. Often aloof, bizarre, superstitious, magical thinking (without hallucinations)
What does the DSM-5 say a person must have in order to be diagnosed with paranoid PD?
- Four of the following:
- expects exploitation
- questions loyalty and trustworthiness of friends
- reads hidden meaning into innocuous events
- holds grudges
- reluctant to confide
- easily slighter, quickly responds with anger
- questions spouse's fidelity
- may see: constantly on guard, overly sensitive, testing honest of others, hyper vigilant, tense, irritable
In Paranoid PD, what is the intense insecurity related too? What early childhood issue causes this?
What is the tx? Why do they rarely seek it?
- related to real or perceived inferiority
- caused by: lack of maternal bonding, often used as scapegoat, "chip on their shoulder"
Tx: ( rarely seek tx because they dont trust anyone
What does the DSM-5 say a person must have in order to be diagnosed with Schizoid PD?
- Four of the following:
- No desire for close relationships
- prefer solitary activities
- no strong emotions
- indifferent to praise/ criticism
- little interest for sexual contact
- no confidence
- flat affect
- inappropriately serious about everything, shy, aloof, no spontaneity
What does the DSM-5 say a person must have in order to be diagnosed with Schizotypal PD
- 5 of the following:
- ideas of reference (excluding delusions of reference)
- Odd beliefs/magical thinking that influences behavior and is inconsistent with norms
- unusual perceptual experiences-bodily illusions
- odd thinking and speech
- suspiciousness or paranoid ideation
What "causes" schizophrenia?
- Common among 1st degree relatives of people with schizophrenia
- close link between schizotypal and schizophrenia
- Lack of bonding, families were indifferent, formal, lead to discomfort with affection and closeness
- lack of social skills: shunned, overlooked, rejected, humiliated by others, begin to tune out of reality because fantasy is better. Low self esteem, distrust of interpersonal relationships
What are the interventions for Cluster A PDs?
- assign primary giver
- demonstrate trust in concrete manner
- give unconditional positive regard
- neither support nor refute beliefs
- avoid actions that reinforce client's suspiciousness
- praise pro social behaviors
- be aware of client isolation/suspiciousness
- avoid being too nice, over friendly
- use neutral, kind approach
- clear, straightforward explanations
- simple clear language
- give warning about changes, reasons for delay, medication side effects
What is borderline PD? Historionic? Narcissitic? Antisocial?
- Borderline: intense emotionality, *unstable identity and impulsivity. Typically, attitudes and feelings about other people considerably vary for no apparent reason
- Historionic: the key feature is overly dramatic and attention *seeking behavior
- Narcissistic: people that have a grandiose view of their abilities and are preoccupied with fantasies of great success. They want to be admired. *self centered
- Antisocial: Disregard for the rights of the others. Show irresponsible and antisocial behavior. Irritable and aggressive. Absence of empathy, and lack of feelings of guilt after transgression.
What does the DSM-5 say a person must have in order to be diagnosed with Antisocial personality disorder?
- History of conduct disorder with its onset prior to age 15
- at least 18 years old
- symptoms not due to another disorder
- since the age of 15 there has been disregard for nd violation of the rights of others, those right's considered normal y the local culture, as indicated y at least 3 of the following:
- Repeated acts that could lead to arrest; Conning for pleasure or profit, repeated lying or the use of aliases; failure to plan ahead or being impulsive; repeated assaults on others; reckless when it comes to their or others safety; poor work behavior or failure to honor financial obligations; rationalizing the pain they inflict on others
- (plus Four of the following characteristics DSM-5?)
- fails to conform to social norms
- irritable and aggressive
- fails to plan ahead (homeless)
- no regard for the truth
- irresponsible parenting style
- not ale to sustain monogamous relationship
- lacks remorse
What factors predispose someone to antisocial PD?
- absence of parental discipline/erratic discipline
- extreme poverty
- removal from the home
- growing up without parental figures of both sexes
- maternal deprivation
- being rescued every time they are in trouble-no consequences
What are the interventions for Anti social PD?
- Set clear, realistic limits on specific ehaviour
- All limits adhered by *all staff
- Document objective physical signs of manipulation or aggression
- provide clear boundaries, consequences
- guard against letting client make you feel guilty
- guard against being manipulated
- screen for dangerous objects
What does the DSM-5 say a person must have in order to be diagnosed with borderline PD?
- 5 of the following
- Intense fear of abandonment
- unstable, intense personal relationships
- marked impulsivity
- affective instability
- anger problems
- chronic suicidal ideation, self mutilation
What does borderline PD look like? what do interactions with others look like?
- Intense unstable mood
- chronic, underlying depression
- anger-directed at self or others
- fear of abandonment
- Interactions look like: clinging and distancing, spilitting** manipulation, impulsivity
What is the biological and psychodynamic etiology of Borderline PD?
- Biological: relationship with the affective disorders; serotonin disturbance
- Psychodynamic: Borders between neurosis and psychosis
- Mahler's theory ofobject relations = child is awarded for dependent behavior and punished for independent ones
What is Mahler's theory of object relations?
A child is rewarded for dependent behaviors and punished for independent ones
What is the common defense mechanisms in borderline?
- Dichotomous thinking or splitting
- people/situations are either all good or all bad
- Cognitive distortions?
What are the interventions for Borderline PD?
- Set clear realistic goals
- be aware of manipulative behavior
- clear, consistent boundaries/limits
- for behavioral problems, review therapeutic goals and treatment boundaries
- avoid rejection, rescuing
- assess for suicidal, self mutilating behavior
What does the DSM-5 say a person must have in order to be diagnosed with Histrionic PD?
- 4 of the following-
- Constantly seeks attention
- inappropriately sexually seductive
- over concerned with appearance
- expresses emotion with exaggerations
- uncomfortable when not center of attention
- shifting and shallow emotions
- self centered
What is the mnemonic that can be used to remember the criteria for histrionic personality disorder?
- PRAISE ME
- P: provocative or seductive behavior
- R: relationships, considered more intimate than they are
- A: attention, must be at the center of it
- I: influenced easily
- S- speech (style)- wants to impress, lacks detail
- E: emotional labile, shallowness
- M: Makeup-physical appearance used to draw attention to self
- E: exaggerated emotions-theatrical
What does the DSM-5 say a person must have in order to be diagnosed with Narcissistic PA?
- 5 of the following
- Reacts to criticism with rage and humiliation
- Exploitative in relationships
- Believes their problems to e unique
- preoccupied with fantasies of greatness
- sense of entitlement
- lacks empathy
What are the interventions for Narcissistic PD?
- Stay neutral, avoid power struggles
- Don't be defensive when disparaged-(belittle)
- Convey self-confidence
What are the general interventions for Cluster B PDs?
- Focus on *safety
- Maintaining a stable mood
- Effective social interactions: NO primary nursing; Openly discuss manipulation; MUST communicate between shifts
- Limit setting-c;ear, consistent, enforceable; avoid power struggles
What is Avoidant personality disorder? Dependent? Obsessive compulsive PD? What does research of disorders in this cluster focus on?
- Avoidant: Fear of rejection and criticism
- Dependent: excessive reliability on others
- Obsessive Compulsive: Perfectionistic, detail-oriented style
- The research is on parenting: transmission of fear from parents to child (avoidant); Disruption of parents- child relations (Dependent)
What does the DSM-5 say a person must have in order to be diagnosed with avoidant PD?
- 4 of the following
- Easily hurt, insulted
- no close friends
- unwilling to get involved unless they will be liked
- socially uncomfortable, *sensitive to rejection
- fears being embarrassed
- exaggerates dangers/risks
What does Avoidant PD look like? What predisposes someone to this?
Individuals with this disorder are *awkward, their *speech is slow, with *fragmented sequences; they are *lonely and feel *unwanted
predisposed: parental rejection, reinforced by peers, reared in homes where they are belittled, abandoned, criticized. Feelings of low self esteem
What does the DSM-5 say a person must have in order to be diagnosed with Dependent PD?
- Unable to make decisions
- agrees with others, even if they are wrong
- Needs others to assume responsibility for major areas of their life
- Difficulty initiating anything on own
- Volunteers in order to gain acceptance
- unconformable being alone
- urgently seeks another relationship when one ends
- unrealistically preoccupied with being abandoned
What does Dependent PD look like?
- Have a lack of self-confidence that is apparent in their voice, posture and mannerisms. They are typically passive and acquiesce(accepts reluctantly but without protest) to the desires of others
- Assume the passive and submissive to role in a relationship, and will do anything to earn the acceptance of others, even if its unpleasant
What does the DSM-5 say a person must have in order to be diagnosed with Obsessive Compulsive PD?
- Five of the following
- details, rules, lists
- insists on doing it one way-their way
- excessive devotion to work
- restricts affection
- Lacks generosity, stingy
- Unable to discard old objects
What "causes" Obsessive compulsive PD? What do they become "experts" in?
- Punishment for not meeting parent's expectations;
- become experts in what they must do so as to avoid punishment rather then learn what they can do to achieve attention and praise
What interventions for cluster c PDs?
- Anxiety reduction
- social interaction
- problem solving skills
What is passive-aggressive PD? What is the Etiology of it?
- Negative attitudes and passive resistance
- People are passively expressing covert aggression
- Relatively common (being intentionally late)
Etiology: Inconsistent responses from parents; double-bind communication
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