Prelims Ca (psych Part 2).docx

PERSONALITY DISORDER - an 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 A group of disorders characterized by a pervasive pattern of behavior and thinking PERSONALITY DEFINING SIGNS AND CAUSE DISORDER CHARACTERISTICS SYMPTOMS CLUSTER A - Individuals with these disorders often appear odd or eccentric Paranoid personality a pattern of mistrust Suspicion and distrust May be a result of disorder and suspiciousness of others motives inadequate or poorly [Neurotic] such that others' established parentmotives are Refusal to confide in child attachment interpreted as others hypersensitivity malevolent Inability to relax (hypervigilance) Need to be in control  Selfrighteousness  Detachment and social isolation

INTERVENTION

Offer persistent, consistent and flexible care Use a straightforward honest professional approach rather than a casual or friendly approach Use humor cautiously Avoid situations that threaten Respect patients need for physical and emotional distance Avoid challenging paranoid beliefs Individual psychotherapy

Schizoid personality disorder

a pattern of detachment from social relationships and a restricted range of emotional expression

Detachment

Possible genetics

Social withdrawal

Sustained history of isolation during infancy and childhood

Lack of strong emotions

MEDICATIONS: Antipsychotics SSRI Anxiolytics Respect patient’s need for privacy Give pt. ample time to express his feelings Cognitive restricting

Little observable change in mood Indifference in other’s feeling praise or criticism

Schizotypal personality disorder

a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

Lack of close friend Inability to experience pleasure Disturbed thinking: Odd belief or magical thinking Vague, circumstantial, metaphorical, overelaborate Unfounded suspicion Behavioral disturbances Odd or eccentric behavior and appearance

Godspeed – Tea

Parental modelling of interpersonal withdrawal, indifference and detachment

Self-help group MEDICATIONS: Atypical antipsychotics For pts with psychotic ideations

Genetic

Offer persistent care

Stress

Do not be a stressor

Poor regulation of dopamine pathways

Respect space

Inadequate parent skills

Keep in mind they may be overwhelmed by stress

Clothes are ill—fitting, do not match may be stainded or drity Affect is flat They wander CLUSTER B - Individuals with these disorders often appear dramatic, emotional, or erratic Antisocial personality a pattern of disregard Impulsive and reckless Poor serotinin disorder for, and violation of, regulation the rights Egocentricity of others Reduced autonomic Lack of remorse activity and acquired a pervasive pattern of abnormality in the disregard Repeatedly frontal lobe preforming unlawful acts possible genetic Deceitfulness Reckless disregard for owns safety Arrogant

Limit setting Promoting responsible behavior Decrease impulsivity Managing negative emotions like anger or frustration

RISK FACTORS CHILDHOOD Enuresis

Eliminate use of alcohol or drugs

Syntonic acts of cruelty

Consistent adherence to rules

ADOLESCENCE Lying, truancy Smoking, substance abuse

Borderline personality disorder

a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity

Impulsive and risky behavior Awareness of destructive behavior Wide mood swings

unstable interpersonal relationship

Sexual promiscuity Illegal activates Possibly genetic Dysfunction in brain’s limbic system or frontal lobe Decrease serotonin activity

Short but intense episode

Promoting client’s safety: No self-harm contract Self-expression of feeling and expression Cognitive restructuring: Thought stopping

Inappropriate anger and antagonistic behavior

Catastrophizing -changing perspective

Difficulty controlling emotions or impulses Suicidal behavior Feeling misunderstood, neglected RISK FACTOR History of poor school and work performance due to constantly changing career goals and shifts in identity Prolonged separation from parents

Histrionic personality disorder

a pattern of excessive emotionality and attention seeking

Other major losses early in life PRAISE ME Provocative behavior

Genetic Early childhood events

Relationships Women are more Attention

Godspeed – Tea

Rarely seeks treatment unless crisis occurs GOAL: to relieve the worst elements of the patients behavior;

Influenced easily

rather than to cure her

Style of speech

psychotherapy

Emotions Made up Exaggerated emotions

Intolerance of frustration, disappointment and delayed gratification; impatience Intolerance of being alone Dread of growing old Suppression or denial of internal distress, weakness

Narcissistic personality disorder

a pattern of grandiosity, need for admiration, and lack of empathy

Self-centeredness

Unknown

Lacking empathy

Psychodynamics – unmet basic needs

Typically takes advantage of people to achieve own ends Uses people without regard to their feelings Inflated sense of self Inflated need for admiration

Developed from idealized (over idealized self) Deep feelings of inferiority Received little support and encouragement during childhood

Matter-of-fact approach Avoid reinforcing either pathologic grandiosity or weakness Focus on the patient’s positive traits or on his feelings of pain, loss, or rejection Remain nonjudgmental Avoid defensiveness and arguing

CLUSTER C - Individuals with these disorders often appear anxious or fearful Avoidant personality a pattern of social Shyness, timidity, and Psychodynamic – disorder inhibition, feelings of social withdrawal overly critical inadequacy, behavior meant to parenting style and hypersensitivity to drive others away negative evaluation Environmental Factors Difficulty starting, and – rejection by parents maintain relationships or peers Reluctant to take personal risks or engage in new activities

a pattern of submissive and clinging behavior related to an excessive need to be taken care of

Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others Needs others to assume resp. for most major areas of his or her life

Godspeed – Tea

Teach and practice use of social skills

Genetic biological Take direct, involved approach to gain patient’s trust

Low self-esteem Dependent personality disorder

Help client explore self-aspects, positive responses from others, and possible reasons for self-criticisms

Childhood trauma

Monitor for signs of dependency Give patient as much opportunity as possible to control her treatment

Closed family system that discourages outside relationships

Encourage activities that require decisionmaking

Childhood physical/ sexual abuse

Help patients establish and work towards goals to

Authoritarian or over protective parenting

Has diff, expressing disagreement with other

promote sense of autonomy psychotherapy

Obsessivecompulsive personality disorder (not anxiety driven unlike OCD)

a pattern of preoccupation with orderliness, perfectionism, and control

Goes to excessive length to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant Is preoccupied with details, rules, lists, order, organization Unable to discard worn-out or worthless objects Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing thins

Possible genetic or familial cause Viewed as needing control as a defense against feelings of powerlessness

Use tolerance and ordinary kindness when dealing with patient Avoid informality as patient demands strict attention to detail Help client to accept or to tolerate lessthan-perfect work or decisions made Encourages to take risks

Godspeed – Tea

Godspeed – Tea