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60 Cards in this Set
- Front
- Back
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List all the Personality Disorders and definitions
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Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent.
Schizoid Personality Disorder is a pattern of detachment from social relationships and a restricted range of emotional expression. Schizotypal Personality Disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. Antisocial Personality Disorder is a pattern of disregard for, and violation of, the rights of others. Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking. Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration, and lack of empathy. Avoidant Personality Disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Dependent Personality Disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of. Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism, and control. |
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What is a PD?
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enduring pattern of inner experience and behavior that
- deviates markedly from the expectations of the individual's culture, -is pervasive and inflexible, has an onset in adolescence or early adulthood, -is stable over time, and -leads to distress or impairment |
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Criteria for PD
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A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
(1) cognition (i.e., ways of perceiving and interpreting self, other people, and events) (2) affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) (3) interpersonal functioning (4) impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma). |
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Can you dx PD in teens?
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To diagnose a Personality Disorder in an individual under age 18 years, the features must have been present for at least 1 year.
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Essential Feature of Paranoid PD?
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essential feature of Paranoid Personality Disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
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Paranoid PD criteria
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A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her (2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates (3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her (4) reads hidden demeaning or threatening meanings into benign remarks or events (5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights (6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack (7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)." |
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Paranoid PD Mnemonic?
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GET FACT
5. Grudges held for long periods 1. Exploiting expected 2. Trustworthiness doubted 7. Fidelity of sexual partner questioned 6. Attacks on character perceived 3. Confides in others rarely 4. Threat perceived often SUSPECT Spousal Infedility Suspected Unforgiving (bears grudges) Suspicious Perceives attacks (and reacts quickly) Enemy or friend? Confiding in others feared Threats perceived in benign events |
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Schizoid PD?
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A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(1) neither desires nor enjoys close relationships, including being part of a family (2) almost always chooses solitary activities (3) has little, if any, interest in having sexual experiences with another person (4) takes pleasure in few, if any, activities (5) lacks close friends or confidants other than first-degree relatives (6) appears indifferent to the praise or criticism of others (7) shows emotional coldness, detachment, or flattened affectivity B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid). |
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Schizoid PD mnemonic
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SIR SAFE
2. Solitary lifestyle 6. Indifferent to praise or criticism 1. Relationships of no interests, including family 3. Sexual experience not interesting 4. Activities not enjoyed 5. Friends lacking 7. Emotionally cold and detached DISTANT Detached or flattened affect Indifferent to criticism or praise Sexual experiences of little interest Tasks done solitary Absence of close friends Neither desires nor enjoys close relationships Takes pleasure in few activities |
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Schizotypal PD?
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A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) ideas of reference (excluding delusions of reference) (2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations) (3) unusual perceptual experiences, including bodily illusions (4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) (5) suspiciousness or paranoid ideation (6) inappropriate or constricted affect (7) behavior or appearance that is odd, eccentric, or peculiar (8) lack of close friends or confidants other than first-degree relatives (9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizotypal Personality Disorder (Premorbid)." |
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Schizotypal PD criteria
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A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) ideas of reference (excluding delusions of reference) (2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations) (3) unusual perceptual experiences, including bodily illusions (4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) (5) suspiciousness or paranoid ideation (6) inappropriate or constricted affect (7) behavior or appearance that is odd, eccentric, or peculiar (8) lack of close friends or confidants other than first-degree relatives (9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizotypal Personality Disorder (Premorbid)." |
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Schizotypal PD Mnemonic
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UFO AIDER
Unusual perceptions Friendless except for family Odd beliefs, thinking, and speech Affct inappropriate, constricted Ideas of reference Doubts others - suspicious Eccentric - appearance/behaviour Reluctant in social situations, anxious ME PECULIAR Magical Thinking Experiences unusual perceptions Paranoid Ideation Eccentric behaviour or appearance Constricted or innappropriate affect Unusual thinking or speech Lacks close friends Ideas of reference Anxiety in social situations Rule out Psychosis or PDD |
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Antisocial PD criteria
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A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure (3) impulsivity or failure to plan ahead (4) irritability and aggressiveness, as indicated by repeated physical fights or assaults (5) reckless disregard for safety of self or others (6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B. The individual is at least age 18 years. C. There is evidence of Conduct Disorder (see page 98) with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode. |
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Antisocial PD Mnemonic
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CALLOUS MAN
Conduct Ds before age 15 y, current age at least 18 Antisocial acts/Arrests Lies frequently Lacunae/Lacks a superego Obligations not honored Unstable - can't plan ahead Safety of self and others ignored Money problems Aggressive, Assaultive Not occuring during Sz/Mania CORRUPT Cannot conform to law Obligations ignored Reckless disregard for safety Remorseless Underhanded Planning insufficient Temper (irritable and aggressive) |
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Borderline PD
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A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. (2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (3) identity disturbance: markedly and persistently unstable self-image or sense of self (4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. (5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) (7) chronic feelings of emptiness (8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) (9) transient, stress-related paranoid ideation or severe dissociative symptoms |
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Borderline PD mnemonic
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I RAISED A PAIN
Identity disturbance (3) Relationships are unstable (2) Abandonment frantically avoided (1) Impulsivity is self-damaging (e.e.g spending, sex, substance abuse, reckless driving, binge eating) Suicidal Gestures (threats, self-mutilation (5) Emptiness (7) Dissociative Sx (9) Affective instability (6) due to a marked reactivity Paranoid Ideation (stress-related and transient) (9) Anger is poorly controlled (8) Idealization followed by devaluation (2) Negativistic or self-defeating DESPAIRER Disturbance of identify EMotional lability Suicidal behaviour Paranoia or dissociation Abandonment fear Impulsive Relationships unstable Emptiness Rages IMPULSIVE Impulsive Moody Paranoia Unstable self Labile intense relations Suiidal Gestures Inappropriate anger Vulnerability to abandonment Emptiness |
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Histrionic PD
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A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) is uncomfortable in situations in which he or she is not the center of attention (2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior (3) displays rapidly shifting and shallow expression of emotions (4) consistently uses physical appearance to draw attention to self (5) has a style of speech that is excessively impressionistic and lacking in detail (6) shows self-dramatization, theatricality, and exaggerated expression of emotion (7) is suggestible, i.e., easily influenced by others or circumstances (8) considers relationships to be more intimate than they actually are |
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Histrionic PD Mnemonic
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I CRAVE SIN
Inappropriate behaviour - seductive or provocative Center of attention Relationships are seen as closer than they really are Appearance is most important Vulnerable to others' suggestions Emotional expression is exaggerated Shifting emotions, shallow Impressionistic manner of speaking, lacks details Novelty is craved PRAISE ME: Provocative behaviour; Relationships considered intimate; Attention needed; Influence easily; Style of speech impressionistic; Emotions shift rapidly; Make up (physical appearance to draw attention); Emotions exag ACTRESSS Appearance focused Centre of attention Theatrical Relationships (believed to be more intimate than they are) Easily influenced Seductive behaviour Shallow emotions Speech Impressionistic or vague |
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Narcissitic Personality Ds
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A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) (2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love (3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) (4) requires excessive admiration (5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations (6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends (7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others (8) is often envious of others or believes that others are envious of him or her (9) shows arrogant, haughty behaviors or attitudes |
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Narcissitic PD Mnemonic
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A FAME GAME
Admiration required in excessive amounts Fantasizes about unlimited success, brilliance, etc. Arrogant Manipulative Envious of others Grandiose sense of importance Associates with special people Me first attitude Empathy lacking for others GRANDIOSE Grandiose Requires attention Arrogant Need to be special Dreams of success and power Interpersonally explotive Others feelds not recognized Sense of entitlement Envious |
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Avoidant PD Criteria
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A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(1) avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection (2) is unwilling to get involved with people unless certain of being liked (3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed (4) is preoccupied with being criticized or rejected in social situations (5) is inhibited in new interpersonal situations because of feelings of inadequacy (6) views self as socially inept, personally unappealing, or inferior to others (7) is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing |
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Avoidant PD Mnemonic
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RIDICULE
Restrained within relationships Inhibited in interpersonal situations Disapproval expected at work Inadequate view of self, self as socially inept, personally unappealing, or inferior to others Criticism is expected in social situations and becomes preoccupied by this Unwilling to get involved/avoid personal risks unless certain of being liked Longs for attachment to others Embarrassment is the feared emotion CRINGES Criticism or rejection preoccupies thoughts or social situations Restraint in relationships due to fear of shame Inhibited in new relationships Needs to be sure of being liked before engaging socially Gets around occupational activiteis with need for interpersonal contact Embarassement prevents new activity or taking risks Self viewed as unappealing or inferior |
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Dependent PD
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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 and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others (2) needs others to assume responsibility for most major areas of his or her life (3) has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution. (4) has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) (5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant (6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself (7) urgently seeks another relationship as a source of care and support when a close relationship ends (8) is unrealistically preoccupied with fears of being left to take care of himself or herself |
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Dependent PD mnemonic?
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DARN HURT
Disagreement is difficult to express Advice - needs excessive input Responsibility for major areas delegated to others Nurturance - seeks excessive degree from others Helpless when alone Unrealistically preoccupied with being left to care for self Relationships are desperately sought (when an established one ends) Tasks: has difficulty initiating projects RELIANCE Reassurance required Expressing disagreement difficult Life responsibilities assumed by others Initiating projects difficult Alone (feels helpless and uncomfortable when alone) Nurturance (goes to excessive lengths to obtain) Companionship sought urgently when a relationship ends Exaggerated fears of being left to care for self |
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OCPD criteria
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A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost (2) shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) (3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity) (4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) (5) is unable to discard worn-out or worthless objects even when they have no sentimental value (6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things (7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes (8) shows rigidity and stubbornness |
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OCPD mnemonic?
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LOW MIRTH
Leisure activity is minimal Organizational Focus Work and productivity predominate Miserly spending habits Inflexible around morals, values, etc. Rigidity and stubborness Task completion impaired by perfectionism Hoards items; cannot discard them SCRIMPER Stubborn Cannot discard worthless objects Rule obsessed Inflexible Miserly Perfectionistic Excludes leisure due to devotion to work Reluctant to delegate to others |
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Reminder: PD general criteria?
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A) Enduring pattern of inner experience and beh that deviates markedly fr pt’s cultural expectations. Manifest in 2+ of:
a. Cognition: ways of perceiving and interpreting: self/others/events b. Affectivity: range/intensity/lability/approp of emotional resp c. IP fxng d. Impulse Ctrl B) Enduring pattern is inflexible & pervasive across a broad range of personal & soc sitns C) Enduring pattern leads to clin distress/imprt in soc/occ/otherNB areas of fxng D) Pattern = stable & of long dur’n; onset traced back at least to adol/early adulthood E) Enduring pattern NBAF as a manisfestation or consequence of another mental d/o F) Enduring pattern not d/t direct physiologic fx of a subst or gmc |
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5 Factor Model for PD?
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1) Neuroticism
2) Closedness-openness to experience 3) Introversion-extroversion 4) Antagonism vs agreeableness 5) Conscientiousness |
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Paranoid PD DDX and how differentiate
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• Delusional d/o- persecutory type, Mood d/o w psychotic features, SZP-paranoid type: but PPD does not have persistent psychotic sx.
• Personality Change d/t gmc or subst use • Paranoid traits d/t px handicap (eg:hearing imprt) Other PD's • STPD: both suspicious, paranoia, both STPD has magical thinking, unusu perceptual experiences, odd thinking and speech • SPD: does not have prominent paranoid ideation • AvPD: reluctant to confide in others, but b/c embarrassed or feels inadeq • BPD, HPD: both have anger but not pervasive suspiciousness • ASPD: antisoc beh may be seen in PPD, but motivation is not to exploit/pers gain • NPD: has suspicousness, soc w/d: but usu b/c flaws have been exposed |
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Schizoid PD DDX?
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• Delusional Disorder / SCZ /
Mood disorder with psychotic features o Prd of persistent psychotic sx o only give additional dx of SPD if present when psychotic sx before onset of psychotic sx and persist when psychotic sx in remission o or can dx as “SPD, (premorbid)” • Autistic Disorder and Asperger’s o Have more severely impaired social interaction and stereotyped behave and interests • Personality Change d/t GMC • Sx that develop in assoc w/ chronic subst use (e.g. cocaine-rel d/o NOS) • Other PD’s o STPD –have more cognitive and perceptual distortions o PPD – suspiciousness and paranoid ideation o APD – d/t fear of being embarrassed or found inadequ and xs anticipation of rejection vs SPD where more pervasive detachment and lim desire for social intimacy o OCPD – apparent social detachment stemming from devotion to work and discomfort with emotions, but do have an underlying capacity for intimacy • “loners” – have schizoid traits BUT only when traits are inflexible and maladaptive and cause signif fn impairment or subj distress do they constitute SPD |
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Schizotypal PD DDX?
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• Delusional d/o/SZP/Mood w psychotic feature: but SzTPD does not have psychosis. Needs to have onset before these d/o to for dx: SzTPD (premorbid)
• Autistism, Aspergers: greater lack of soc awareness; stereotyped beh, lang d/o • Mixed-Rec-ExpLD, ExpLD: also may have soc isolation, but SzT does not have severity of lang; also in LD other forms of communication used • Pers Change d/t gmc or subt use • ParaPD, SzPD: these lack cog/perceptual distortions & oddness/eccentricity • AvPD: wants close relps but anxious/fears rejection; vs detachment, lack of desire • NPD: soc w/d, suspiciousness d/t fears of flaw exposure • BPD: transient, psychotic-like sx related to affective shifts w.r.t stress; soc isolation d/t angry outbursts etc, not lack of desire for relps • SzTP traits |
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Antisocial PD DDX?
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o SUD
• When AS behav is assoc with SUD, the dx is only given if signs of ASPD were also present in childhood and have cont into adulthood • When both started in childhood, both are dx in adult if they have continued, even though some antisocial acts may be consequ of SUD o Not dx if Antisocial behaviour occurs exclusively dur the course of SCZ or Manic epis o NPD • Both tough-minded, glib, superficial, exploitative, un-empathic • NPD not impulsive, aggressive of deceitful, lack hx of CD or criminal behav • ASPD not as needy of admiration and envy of others o HPD • Both impulsive, superficial, excitement seeking, reckless, seductive and manipulative • But HPD tend to be more exaggerated in their emotions and do not usually engage in antisocial behave o BPD • Manipulative to gain nurturance vs profit, power and other material gratification • ASPD less emotionally unstable and more aggressive o PPD • Not usually motivated by personal gain or to exploit – usually antisocial behave is for revenge o Adult Antisocial Behaviour • Criminal behave undertaken for gain but not accomp by personality features |
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Borderline PD DDX?
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• Mood: do not make x-sectional dx of BPD in context of MDE
• HPD: both have rapidly shifting emotions, may be attn seeking o BPD self-destructive beh, chronic emptiness, relp prob d/t anger • NPD, PaPD: hypersensitivity to perceived slights, angry rxn to minor stimuli o BPD: self-destructive, impulsive, abandonment fears, more unstable self • SzTPD: Paranoid Ideation/illusions o BPD: these are more transient, IP-reactive, responds to ext’l structuring • ASPD: manipulative for profit, power; BPD’s goal is to gain one’s concern/care • DepPD: fears abandonment, but becomes submissive and urgently seeks another relp; BPD reacts w anger, emotional emptiness, rage, demands • Pers Change d/t gmc/subst • Identity prob: eg) in adol. Is not a d/o |
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Histrionic PD DDX?
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• Personality Change d/y GMC
• Dx devel in assoc with Chronic Substance Use (e.g. cocaine d/o NOS) • BPD o Both attn seek, manipulate and have rapidly shifting emotions o BPD – self-destructiveness, angry disruptions in close rel’nships, chronic feelings of deep emptiness and identity disturbance • ASPD o Both impulsive, superficial, excitement seeking, reckless, seductive, and manipulative o HPD more exaggerated in emotions, not characteristically manipulative to gain profit, power or material gratification, but are to gain nurturance • NPD o Both crave attn, exaggerate intimacy with others o But NPD want praise of “superiority”, whereas HPD are willing to be seen as “fragile or dependent if that will get them attn, AND emphasize “VIP” connections, status and wealth in rel’nships • DPD o Xs’ly dep on others for praise and guidance, but w/o flamboyance, exagger emotions of HPD |
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Narcissitic PD DDX?
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• BPD: NPD lacks the impulsivity, self destructiveness, abandonment concern. May also have a more stable sense of self as per DSM.
• HPD: NPD has XS’v pride in achievements, relative lack of emotional display, disdain for other’s sensitivities. Needs attention to specifically be admiring. • ASPD: NPD does not nec have impulsivity, aggression, deceit; usu don’t have CD hx, criminal beh in adulthd. ASPD may not have the envy of NPD • OCPD: quest for perfectionism often w assoc self-criticism in OCPD, but NPD likely to think they have achieved perfection • SzTPD, ParaPD: suspiciousness and soc w.d in NPD derive mostly fr fear of flaws/imperfections being revealed • Mania, hypomania: characteristic sx incl mood change, fxnl imprt • SUD: note: DSM did not say gmc • Grandiose traits: not a d/o: needs to be inflexible, maladaptive, persistent and cause sigt fxnl imprt or subjective distress |
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Avoidant PD DDX
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• Social Phobia, generalized type
o May be alternative conceptualization of the same or similar cond’n • PDAg o Both have avoidance, but PDAg starts after PA’s, varies based on frequ and intensity of PA’s VS. APD wc has early onset, absence of clear precipitants and stable course • DPD o Both feelings of inadequacy, hypersensitivity to criticism, need for reassurance o APD focus is avoid humiliation and rejection VS DPD where focus on being taken care of o Very often co-occur • SPD and STPD o Both have social isolation o But APD want relationships with others and feel their loneliness deeply • PPD o Both have reluctance to confide in others but APD not paranoid, rather fear of embarrassment and inadequacy • Personality change d/t GMC • Sx that devel in assoc with chronic SUD • Normal avoidant traits that are not inflexible, maladaptive and persisting w/ fn’al impairment of distress |
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Dependent PD DDX?
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• Dependency arising as consequ of Axis I or III d/o
o Mood, PD, PDAg o Early onset, chronic course, behav not exclus dur course of another mental disorder • BPD o Both have fear of abandonment o BPD reacts to this w/ feelings of emotional abandonment, rage, demands VS DPD where incr appeasement and submissiveness and urgently seeks a replacement rel’nship for support o BPD unstable and intense rel’nships • HPD o Both have strong need for reassurance and approval and appear childlike and clinging o But DPD = self-effacing and docile o HPD = gregarious and flamboyant with active demands for attn • APD o Both have feelings of inadequacy, hypersensitivity to criticism, need for reassure o BUT APD have such strong frear of humil’n and rejec’n that they w/dr until certain of being accepted o VS DPD where seek and maintain connections not avoid • Personality change d/t GMC • Sx that devel in assoc with chronic SUD • N variant behaviour with depend features – not maladaptive, persistent, or inflexible and no impair’t or distress |
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OCD DDX?
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• OCD: has true obsessions and compulsions. If hoarding in OCPD ↑↑ (eg: to the degree it’s difficult to walk thru house/fire hazard); consider OCD
• NPD: they may actually think they’ve achieved pefection, while OCPD self-critical • ASPD: may lack generosity, but not for themselves (OCPD is globally miserly) • SzPD: formality and soc detachment stems fr discomfort and XS’v work devotion • d/t GMC, Subst: DSM didn’t specify, but hoarding often seen in dementias • Traits: not a d/o |
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Match these to Ds
Defenses: Projection, Projective Identification, Denial, Reaction Formation, Splitting Adaptive Capacity: devoted service to victims/underdogs, seek out political roles |
Paranoid PD defenses and adaptive capacities
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Defenses: Fantasy, Primitive defenses (projection, introjection, idealization/devaluation); Mature = intellectualization
Adaptive Capacity: philosphical inquiries, spiritual disciplines, theoretical science, creative arts |
Schizoid defenses and adaptive capacities
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Defenses: projection, denial, distortion, idealization, fantasy
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Schizotypal
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Acting Out, Controlling, Dissociation, Projective Identification
Adaptive Capacity: white collar crimes (charmers), stock brokers, corporate climbers |
Antisocial PD defenses
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Idealization/Devaluation, Projection, Identification, Splitting, Denial, Displacement
Adaptive Capacity: high level of success |
Narcissistic PD defenses
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Splitting, Distortion, Acting Out, Dissociation, Projective Identification
Denial |
Borderline PD defenses
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Defenses: repression, sexualization, , denial, regression, dissociation, acting out, dissociation,
Adaptive Capacity: high visibility professions (acting, dancing, politics, teaching) |
Histrionic PD
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Inhibition, isolation, displacement, projection, repression, self-effacement
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Avoidant PD
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Regression, Denial
Inhibition, Rationalization, Repression Idealization, Reaction Formation, Projective Identification, Somatization, |
Dependent PD defenses
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Intellectualization, Undoing, Displacement, Isolation of Affect (rationalization, intellectualization, moralization)
Reaction Formation Adaptive capacity: workaholics, attorneys |
OCPD defenses and adaptive capacities
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Counter-transference: anxious, hostile; intense, sense of vulnerability, defensiveness, helplessness
PD? |
Paranoid PD CT
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Counter-transference: detachment, omnipotence, tx feeling like respite from outside world
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Schizoid PD CT
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Counter-transference: helplessness, impotence, hostility, contempt, moral outrage, coldness, omnious fear, disbelief, collusion, rationalization of patient's behaviour
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Antisocial CT
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Counter-transference: intense, rescuer fantasy, guilt, boundary crossings, rage, hatred, anxiety, terror, helplessness
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Borderline PD CT
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Counter-transference: Boundary issues, infantalize pt (omnipotence), hard to empathize with "pseudo-affect", patronizing
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histrionic PD CT
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Counter-transference: impatience about resistance to share feelings, bored, distanced, touched by their efforts to do good; feeling like work not being done in room
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OCPD CT
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Counter-transference: caretaking, easy to empathize with feelings of embarassment/humilization
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Avoidant PD CT
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Counter-transference:
Contempt or disdain Feel highly relied upon by patient Frustration Omnipotence, infantalize pt (e.g. excessive advice giving, reassurance) |
Dependent PD
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OCPD Tx goals?
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Unhurried
Ordinary kindness Avoid power struggles Discourage intellectualization, Invite anger and criticism about therapy Quiet dedication to emotional honesty Want patient to grow experience that they will not be judged or controlled |
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Avoidant PD Tx goals?
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Supportive Psychotherapy
Exposure: Empathize with humilation at the same time, firm encouragement to still expose to feared situations Socialization Group Explore cognitive correlates of shame/affect |
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Dependent PD Tx goals?
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Pt must become dependent on therapist (and then later terminate well) ... a bit of a dilemma
Frustrating wishes of dependency and promoting independent thinking and action Tx may be longer term |
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Paranoid PD Tx?
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Respectful, tactful
authentic Primary goal: creating trusting relationship Work with AFFECT and PROCESS issues (versus defenses and content) avoid confronting pt's interpretation of experiences help patient sort out differences between ideas and actions |
