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80 Cards in this Set
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His view is that there are brain-based dsyfunctions of thinking and impulse that lead to persistent patterns of personality and behavior that betray trust and destroy relationships.
These are personality disorders |
FATAL FLAWS: A book on personality disorders by Stuart C. Yudofsky, M.D
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Eight personality disorders that most frequently lead to violated trust, broken commitments, dangerous behaviors, and destructive relationships
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1. Schizotypal
2. Obsessive compulsive 3. borderline 4. Antisocial 5. Paranoid 6. Addictive 7. Hysterical 8. Narcissitic |
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A psychiatrist
Noted authority on personality disorders Said that origins of personality are a combination of inheritance (genetics) and environmental influences (life experiences) |
Dr. Robert Cloninger
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People with flaws of personality and character have severe problems along the _______ of the continuum of temperament
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right side
risk taking, intrusiveness, indulgence, fanaticism |
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Temperament is the component of personality that is most subject to _________ and to the influence of _____ in the environment
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genetic predispositions
and biological factors |
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If there is impairment in this constellation of patterns so that the pattern of an individual's inner experience and outward behavior deviates significantly and persistently from the person's culture and leads to significant distress and relationship problems, then the person has a
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personality disorder
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people with what two personality disorders usually have histories of sexual abuse as children?
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borderline
antisocial personality disorders |
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Ten distinct personality disorders grouped into THREE CLUSTERS. what are they?
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Cluster A: Odd/eccentric
Cluster B: Dramatic/erratic Cluster C: Anxious/fearful |
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Tend to be detached and distrustful
Involve use of fantasy and projection Associated with tendency toward psychotic thinking Cognitive disorganization when stressed what cluster? |
Cluster A: Odd/eccentric
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Individuals tend to be emotionally unstable, impulsive and intense.
what cluster? |
Cluster B: Dramatic/erratic
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Individuals tend to be nervous, fearful, passive or rigid and preoccupied
Use isolation, passive aggression, and hypochondriasis what cluster? |
Cluster C: Anxious/Fearful
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Dependent Personality
Avoidant Personality Obsessive-compulsive personality what cluster? |
Cluster C: Anxious/Fearful
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are so self-absorbed that they distort reality
They are often conflicted about their own angry and sexual feelings, that they unconsciously project onto others Result is they feel threatened and persecuted for no substantiated reason what two disorders? |
Paranoid personality disorder and
Schizotypal personality disorder |
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Take the credit for the accomplishments of others
Exaggerate their own achievements Ignore people whom they believe cannot advance their status - Exploit others to enhance their self-image and self-esteem |
narcisstic personality disorder
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As a rule they are highly suggestible and have characteristic styles of thinking that are impressionistic and deficient in logic- mental states that are likely brain based and genetically determined
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histrionic personality disorder
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what are 1st line tx for most people with personality disorders?
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insight-oriented and CBT
Anxiety and mood disorders commonly coexist with personality disorders so medication may be a component of treatment |
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Biological determinants sometimes seen
Impulsive traits associated with increased levels of? |
testosterone
17estradiol estrone |
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when do the first signs of personality disorder come up?
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first evidence in late adolescene of early adulthood
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Serve to bring a visual object of interest to the foveal region of the eye
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saccadic eye movements
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Abnormal saccadic eye movements associated with ?
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1. low self esttem
2. introversion 3. social withdrawal 4. schizotypal personality disorder |
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Low levels of ____ associated with suicide attempts, impulsiveness, and aggressions
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5 HIAA serotonin
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Early neurological soft signs are associated with
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antisocial and borderilne personality disorders
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in addition to neuropsychological testing, what sort of projective testing can we do when testing for personality disorders?
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1. Minnesota Multiphasic Personality Inventory: MMPI-2
2 Draw a person test 3. Rorschach (ink blot) 4. Thematic apperception test TAT |
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Diagnosis of paranoid personality disorder requires 4 or more of the following:
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Suspects without sufficient basis, that others are exploiting, harming, or deceiving him/her
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her Suspicious about partner's fidelity Responds by counterattacking Perceives attacks on his or her character and is quick to react angrily Persistently bears grudges Reads hidden demeaning or threatening meanings into benign remarks or events |
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classic defenses of paranoid personality disorder include?
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projection, denial, rationalization
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a pervasive mistrust so that the motives of others are interpreted as being deliberately hurtful.
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paranoid personality disorder
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These patients have difficulty maintaining friendships because of their continual accusations or thoughts of malevolence, exploitation, deception, and humiliation toward them
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paranoid personality disorder
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in paranoid personality disorder is ther reality perception intact?
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yes
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What is the TOC for paranoid personality ?
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Psychotheraphy
Not group Anti anxiety meds for agitation and anxiety CBT sometimes low antipsychotics |
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in paranoid personalities they are hypervigilent, suscpicious and self-referential but fall short of having delusions. Their behavior is not _______ it is ______ throughout most if not all their interactions with others
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not encapsultated, it is pervasive
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Observe bizarre delusions and/or hallucinations and a formal thought disorder (loosening of associations)
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Schizophrenia, paranoid type
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Often perceived as eccentric and introverted
Isolated lifestyles Lack of interest in social interaction Affects 7.5% of population |
schizoid personality disorder
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dx of schizoid personality disorder includes 4 or more of the following:
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Neither desires nor enjoys close relationships
Almost always chooses solitary activities Has little, if any, desire for a sexual experience with another person Takes pleasure in few, if any, activities Lacks close friends or confidants other than first-degree relatives Appears indifferent to the praise or criticism of others Shows emotional coldness, detachment, or flattened affect |
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tx for schizoid personality disorder
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psychotherapy
low dose anti-psychotics, antidepressants group therapy |
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Prefer to do things alone
Why bother? Who cares? Withdrawn and reclusive May work below potential and/or may show considerable creativity Lacks interests or hobbies Little apparent desire to pursue relationships Goes through the motions but is aloof, distant, and cold Emotionally constricted |
schizoid personality
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SCHIZOTYPAL PERSONALITY DISORDER-DIAGNOSIS
FIVE or more of the following |
Ideas of reference
Odd beliefs or magical thinking Unusual perceptual experiences Odd thinking and speech Suspiciousness or paranoid ideation Inappropriate or constricted affect Behavior or appearance is odd, eccentric or peculiar Lack of close friends or confidantes other than first degree relatives Excessive social anxiety that does not diminish with familiarity |
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These people are overtly odd and eccentric
When test with Rorschach they answer like a person with a thought disorder |
schizotypal personality
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Abnormal saccadic eye movements with poor eye tracking
Diminished brain mass, especially in the temporal lobe |
schiztotypal personality disorder
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what are the pscyhdodynamics associated with schizotypal personality disorder?
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magical thinking, splitting, isolation of affect
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tx for schizotypal personality disorder
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1. psychotherapy
2. low dose anti-psychotics 3. antidepressants |
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antisocial personality disorder has three or more of the following:
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Failure to conform to social norms with respect to lawful behaviors
Deceitfulness Impulsivity or failure to plan ahead Irritable or aggressive Reckless disregard for safety of self and others Consistently irresponsible Has no remorse for behavior or its consequences Must be 18 years of age (If not, use Conduct Disorder) |
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The disorder involves maladaptive behavior in which the patient does not recognize the rights of others
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antisocial
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May appear trustworthy but commonly manipulative, cunning, and calculating
psychopathic feature is called? seen in what disorder? |
mask of sanity seen in antisocial personality disorder
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Lack remorse for actions
Impulse dyscontrol and failure to plan Characteristically show a lack of sensitivity to others Irritability and aggression are common Deceit and irresponsibility are a way of life Disregard for the safety of others and themselves |
antisocial
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what are two predisposing condition for antisocial personality disorder?
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ADHD
conduct disorder |
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Genetic factors involved
History of brain damage somewhat common (may see abnormal EEG and/or soft neurologic signs Perinatal brain injury Head trauma Encephalitis (Affecting the frontal lobe) History of parental abandonment or abuse very common |
antisocial
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Patients are impulse-ridden with associated ego deficits in planning and judgment
Superego deficits or lacunae Conscience is primitive or poorly developed Object relational difficulties are significant Failure with love, empathy(lack it), basic trust Aggressive features often prominent May see sadomasochism, narcissism, and depression |
antisocial
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Frantic efforts to avoid real or imagined
abandonment Unstable and intense interpersonal relationships (alternating between idealization and devaluation). Identity disturbance Inappropriate intense anger or difficulty controlling anger Transient, stress related paranoia or dissociation |
borderline
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Impulsivity in at least 2 areas that are potentially self-damaging
Recurrent suicidal behavior, gestures, threats or self-mutilating behavior Affect instability (Unstable mood) Chronic feelings of emptiness |
borderline
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Self mutilation common
Suicide attempts common |
borderline
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Separation-individuation problems
Affective, control problems Intense, personal attachments Self-image problems |
borderline personality
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Forever having a crisis
Mini-psychotic episodes, often with paranoia or transient dissociative symptoms Self-destructive, self-mutilating acts Suicidal threats ,gestures, or acts Relationships are tumultuous Intolerant of being alone and driven by object hunger |
borderline
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May be easily enraged
Often manipulative, sometimes transparently so Self-image and identity are unstable Impulsive with regard to money and sex Engage in substance abuse, reckless driving, or binge eating Mood reactivity |
borderline personality
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90% of patients with borderline personalities also have what type of dx?
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Axis I
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Patient attributes idealized positive or negative
features to another person, then seeks to engage the other in various interactions that confirm the patient's belief |
projective identification seen in borderline personality
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A cognitive behavioral model
Core mindfulness Interpersonal Effectiveness Emotion Regulation Distress Tolerance Develop strategies to self-soothe are all part of what type of therapy? what is it used for? |
Dialectical behavior therapy used in borderline personality
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intense aggressive needs, intense object hunger
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borderline personality disorder
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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
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histrionic personality disorder
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Patient is uncomfortable when he or she is not the center of attention
Sexually seductive or provocative Rapidly shifting and shallow expression of emotions. |
Histrionic
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Speech is excessively impressionistic and lacking in detail
Consistently uses physical appearance to draw attention to oneself Suggestible Considers relationships to be more intimate than they actually are |
histrionic
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Sense of entitlement
Interpersonally exploitative Lacks empathy Often envious of others or believes that others are envious of him/her Shows arrogant, haughty behavior or attitudes |
narcissistic
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More common in men
Thought to run in families Common cited factor is failure in maternal empathy with early rejection or loss |
narcissistic
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Lack empathy
Chronic, intense envy Handle criticism or defeat poorly- become enraged or depressed Fragile self-esteem and interpersonal relationships |
narcissistic
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Characterized by perfectionism, orderliness, inflexibility, stubbornness, emotional constriction, and indecisiveness
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obsessive compulsive personality disorder
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Preoccupied with details, rules, lists, order,
organization, etc Perfectionism that interferes with task completion Excessively devoted to work with the exclusion of leisure activities and friendships Over-conscientious, scrupulous and inflexible about matters of morality, ethics, or values |
obsessive compulsive personality
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Unable to discard worn-out or worthless objects even when they have no sentimental value
Reluctant to delegate tasks to others unless they submit to doing things exactly his or her way Hoards money (miserly spending) Rigid and stubborn Backgrounds of harsh discipline |
obsessive compulsive
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these psychodynamics ares seen in ?
Isolation, reaction formation, undoing, intellectualization, and rationalization Distrust of emotions Issues of defiance and submission psychologically important Fixation in anal period |
obsessive compulsive personality disorder
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Have stiff, formal and rigid demeanor
Lack spontaneity and have serious mood Preoccupied with rules, regulations, orderliness, neatness, and details Lack interpersonal skills Lack sense of humor, alienate people and difficulty compromising Eager to please powerful figures and carry out their wishes in authoritarian way |
obsessive compulsive
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does a patient with obsessive compulsive personality disorder have true obsessions and compulsions?
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NO that would be OCD
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Timid (shy) personality
Intense sensitivity to rejection NOT asocial and show great desire for companionship But strong need for reassurance and guarantee will be accepted and not criticized Often described as having inferiority complex |
avoidant personality
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Preoccupied with being criticized or rejected in social situations
Inhibited in new interpersonal situation because of feelings of inadequacy |
avoidant personality
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people with avoidant personality disorder view themselves as? (3)
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1. socially inept
2. personally unappealing 3. inferior to others |
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what is the difference between social phobia and avoidant personality?
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in social phobia specific situations rather than personal relationships are avoided
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Difficulty making everyday decisions without an excessive amount of advice or reassurance from others
Needs others to assume responsibility for major areas of his or her life Difficulty expressing disagreement because of fear of loss of support or approval Difficulty initiating new projects |
dependent
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50% of individuals with these two disorders also have depressive disorders and alcohol abuse
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dependent
passive agressive |
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Manifest aggression in passive ways by being obstructive, procrastinating, being stubborn or ineffective
Thought to result from learned behavior and parental modeling Have conflicts regarding authority, autonomy, and dependence |
passive-aggressive
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Envious and resentful of those they view more fortunate
Alternate between hostile defiance and guilt |
passive-agressive
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in what disorder to we use Dialectical Behavioral Therapy?
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Borderline personality disorder
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Introverted, passive, and strong sense of duty
pessimism, self-doubt, and chronic unhappiness. Psychodynamics- Unresolved separation issues Dependent stance defense against aggression Individuals complain of chronic feelings of unhappiness |
depressive personality
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Self-critical and derogatory- denigrate their work, themselves, and relationships with others
Low self-esteem Difficulty finding anything positive, hopeful, joyful in their lives |
depressive personality
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