Week 1 Flashcards

Question

Schizotypal Personality Disorder - Associated Features Supporting Diagnosis

Answer 1

- may experience transient psychotic episodes (particularly in response to stress) - 30-50% have a concurrent diagnosis of major depressive disorder

Answer 2

~ 0.6%-4.6%

Answer 3

- relatively stable course | - may be first apparent in childhood and adolescence

Answer 4

- pervasive culturally determined characteristics (particularly those regarding religious beliefs or rituals) can appear schizotypal

Answer 5

- slightly more common in males

Answer 6

A. 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 the 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 with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizo¬phrenia or bipolar disorder.

Answer 7

- tend to be callous, cynical, and contemptuous of the feelings, rights, and suffering of others - inflated and arrogant self-appraisal - lack of empathy - may have history of many sexual partners and may never sustain a monogamous relationship - may be irresponsible as parents - may fail to be self-supporting, may become impoverished or even homeless, or may spend many years in penal institutions

Answer 8

~ .2%-3.3%

Answer 9

- chronic course - may become less evident or remit as they grow older - cannot be diagnosed before age 18

Answer 10

- consider SES, as antisocial behavior may be part of protective survival strategies

Answer 11

- much more common in males | - might be underdiagnosed in females

Answer 12

- when SUD is present, antisocial PD is only diagnosed when signs of it were already present in childhood/ adolescence - should not be diagnosed if it only occurs in the course of schizophrenia or a bipolar disorder - must be distinguished from criminal behavior undertaken for gain

Answer 13

Diagnostic Criteria 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 alternat¬ing 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.

Answer 14

- Pattern of undermining themselves at the moment a goal is about to be realized - Some have Psychotic symptoms in response to stress - May feel more secure with transitional objects - Suicide is more common - Recurrent job losses, interrupted education, and separation/ divorce is common - Physical and sexual abuse, neglect, hostile conflict, and early parental loss are more common in their childhood histories

Answer 15

~ 1.6%-5.9% Prevalence may increase in older age groups

Answer 16

- Most common pattern: chronic instability in early adulthood - Impairment from disorder and risk of suicide wane with advancing age - During 30s and 40s the majority attains greater stability in their relationships and vocational functioning

Answer 17

Predominantly diagnosed in females (~75%)

Answer 18

A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adult¬ hood 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 expressions 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.

Answer 19

- Diff. achieving emotional intimacy in romantic relationships - Often act out a role (e.g., victim or princess) - Seek to control their partner while displaying marked dependency on them - Problems with same-sex friends due to their sexually provocative interpersonal style - Upset when they aren’t the center of attention - Become bored with their usual routine

Answer 20

- In clinical settings more often diagnosed in females | - But some studies suggest the same ratio in males and females

Answer 21

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.

Answer 22

- Sensitive to criticism - May lead to feeling humiliated, degraded, or empty - May cause social withdrawal - May disrupt Performance - Impaired interpersonal relationships due to their problems with entitlement, need for admiration, and the disregard for sensitivities of others

Answer 23

- Narcissist traits may be common in adolescents but do not necessarily lead to a narcissistic personality disorder - Narcissists may have problems facing their own aging process

Answer 24

50-75% of those diagnosed are male

Answer 25

- most useful feature in discriminating a narcissistic PD from other disorders is the grandiosity characteristic - grandiosity can also emerge as part of manic or hypomanic episodes: the assoc. with mood change or functional impairments helps to distinguish

Answer 26

A. A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to neg¬ative 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.

Answer 27

- Major problems in social and occupational functioning - Low self-esteem and hypersensitivity to rejection: restricted interpersonal contacts - May avoid situations which would be important for their jobs demand - Often diagnosed with dependent personality, borderline, and Cluster A PDs

Answer 28

- Often starts in infancy or childhood with shyness, isolation, and fear of strangers/ new situations - Become increasingly shy and avoidant during adolescence - Some studies suggest that this may remit with age

Answer 29

- Some variation between cultures | - Most avoidant behavior due to problems in acculturation after immigration

Answer 30

- Equally frequent in males and females

Answer 31

A. 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 re¬lationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Answer 32

- Characterized by pessimism and self-doubt - Tend to belittle their abilities - Seek overprotection and dominance from others - Avoid positions of responsibility

Answer 33

~ 0.49% - 0.6%

Answer 34

Gender-Related Diagnostic Issues - In clinical settings, more frequent in females - Some studies suggest the same rates among males

Answer 35

- Must be distinguished from dependency arising due to another mental/ medical condition

Answer 36

- Age and cultural factors need to be considered

Answer 37

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.

Answer 38

- Difficulty to prioritize tasks - Become angry/ upset when unable to maintain control of their physical or interpersonal environment - Attentive to their relative status in dominance-submission relationships - Everyday relationships have a formal and serious quality

Answer 39

~ 2.1% - 7.9%

Answer 40

- Studies: about twice as often diagnosed in males

Answer 41

- OCD can be distinguished from OCPD by the presence of true obsessions and compulsions in OCD

Answer 42

A. A persistent personality disturbance that represents a change from the individual’s pre¬vious characteristic personality pattern. Note: In children, the disturbance involves a marked deviation from normal development or a significant change in the child’s usual behavior patterns, lasting at least 1 year B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. C. The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition). D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupa¬tional, or other important areas of functioning.

Answer 43

Which type: Labile type: If the predominant feature is affective lability. Disinhibited type: If the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc. Aggressive type: If the predominant feature is aggressive behavior. Apathetic type: If the predominant feature is marked apathy and indifference. Paranoid type: If the predominant feature is suspiciousness or paranoid ideation. Other type: If the presentation is not characterized by any of the above subtypes. Combined type: If more than one feature predominates in the clinical picture. Unspecified type

Answer 44

- Symptoms are characteristic of a PD but do not meet the full criteria of a PD - Used when a clinician chooses to communicate the specific reason why criteria are not met

Answer 45

- Symptoms are characteristic of a PD but do not meet the full criteria of a PD - Used when a clinician chooses NOT to communicate the specific reason why criteria are not met and when there is insufficient information to make a more specific diagnosis

Answer 46

Aim: - investigate the relationship between DMs and DSM-5 maladaptive personality domains among adults Methods: - 328 adults aged between 18 and 64 years old - completed measures on DMs and maladaptive personality domains Results: - immature defenses positively predicted maladaptive personality domain scores - mature defenses were related to better personality functioning - different defense patterns emerged as significant predictors of the maladaptive personality domains comprised in the alternative DSM-5 model for personality disorder Discussion: - defense patterns represent core components of personality and its disorders - suggest that increased use of immature defenses and reduced use of mature defenses have a negative impact on the development of personality

Answer 47

- by Sigmund Freud (1894, 1896) | - concept of a menta operation, usually unconscious, directed against the expression of drives and impulses

Answer 48

1. DMs may be defined as unconscious mental mechanisms that are directed against both internal drive pressures and external pressures, especially those threatening self-esteem or structure and integration of the self 2. Develop according to predictable sequences with the maturation of the child 3. are part of normal personality functioning 4. can lead to psychopathology, if one or more are used excessively 5. are distinguishable from one another

Answer 49

to protect the self from anxiety, conflict, shame, loss of self-esteem, or other unexpectable feelings and negative thoughts

Answer 50

Mature: - imply a greater ability to adapt to reality, so that they can effectively distance threatening feelings without distorting the reality - e.g., sublimation, humor, suppression, altruism Immature or even primitive: - characterized by severe alteration of painful mental contents and/or radical distortion of external reality - e.g., projection, splitting, acting out, and autistic fantasy

Answer 51

both in use of specific DMs and in overall defensive styles adopted by individuals Women: - tend to use more internalizing DMs (such as somatization) - find it more difficult to express aggression outwardly and are more likely to turn it against themselves by relying on defenses that modify inner thoughts and feelings Men: - men tend to use more externalizing defenses (such as acting out) - depend more on defenses that locate conflict in the external world, and tend to turn against the object

Answer 52

- related to mature DMs - especially to the ability to appropriately use a variety of DMs in different contexts - exclusive use of immature defense is a risk factor for the development of different forms of psychopathology

Answer 53

reflect the individual’s predominant psychological characteristics that are based on the individual’s identity integration, DMs, and reality testing

Answer 54

characterized by identity integration (object constancy), a conserved capacity for reality testing, and prevalent use of mature and neurotic DMs

Answer 55

characterized by a failure in identity integration (identity diffusion), a conserved reality testing when not in a condition of distress, and use of immature DMs

Answer 56

characterized by lack of ego boundaries, loss of reality testing, and use of immature and primitive DMs

Answer 57

1. negative affectivity (which includes personality features such as emotional lability and hostility) 2. detachment (which includes personality features such as intimacy avoidance and suspiciousness) 3. antagonism (which includes personality features such as grandiosity and manipulativeness) 4. disinhibition (which includes personality features such as impulsivity and risk-taking) 5. psychoticism (which includes personality features such as cognitive-perceptual dysregulation, unusual beliefs, and experiences)

Answer 58

denotes a high level of capacity to function despite emotional suffering

Answer 59

- Rely primarily on the more mature or second-order defenses - Presence of primary defenses does not rule out a diagnosis - Absence of mature defenses does rule out a diagnosis

Answer 60

transference neurosis = neurotic-level client maintains some more rational, objective capacities in the middle of whatever emotional storms and associated distortions occur - Strangers to hallucinatory or delusional misinterpretations of experiences - Much of their psychopathology is ego alien or capable of being addressed so that it becomes so - Neurotic-level people are ordinarily in solid touch with what most of the world calls “reality” - Patient and therapist live subjectively in more or less the same world - capacity for the “therapeutic split” between the observing and the experiencing parts of the self

Answer 61

function but strike one as confused and deeply terrified, and their thinking feels disorganized or paranoid

Answer 62

- people are much more internally desperate and disorganized - It is not difficult to diagnose patients who are in an overt state of psychosis, they express hallucinations, delusions, and ideas of reference, and their thinking strikes the listener are illogical - Psychotic breaks (by therapist) prevent suicides and homicides and keep people out of hospitals -- Not anchored in reality

Answer 63

- Withdrawal - Denial - Omnipotent control - Primitive idealization and devaluation - Primitive forms of projection and introjection - Splitting - Extreme dissociation - Acting out - Somatization

Answer 64

use of primitive defenses - Denial - Projective identification - Splitting

Answer 65

- when the therapist confronts a borderline patient on using a primitive mode of experiencing, the patient will show at least a temporary responsiveness - when the therapist makes a similar comment to a psychotically organized person - will become further agitated (internal terror)

Answer 66

- when the therapist confronts a borderline patient on using a primitive mode of experiencing, the patient will show at least a temporary responsiveness - when the therapist makes a similar comment to a psychotically organized person - will become further agitated (internal terror)

Answer 67

- Their experience of self is likely to be full of inconsistency and discontinuity (like psychotic-level) - Unlike patients with psychotic-level - rarely sound concrete or tangential to the point of being bizarre, but they tend to dismiss the therapist’s interest in the complexities of themselves and others - Insecurely attached and lack the “reflective function” that finds meaning in their own behavior and that of others - They cannot “mentalize” (cannot appreciate the separate subjectivities of other people, lack theory of mind)

Answer 68

Borderline clients, when interview thoughtfully, demonstrate an appreciation of reality no matter how crazy or florid their symptoms are

Answer 69

People whose personalities are organized at the neurotic level have: 1) intact reality testing, 2) a consistent sense of self and of other people, 3) generally rely on mature defense mechanisms when stressed People with a neurotic level of personality organization have a good sense of reality, so they can distinguish between what is real from what is not. For instance, they don't hear voices that are not there or believe other people are trying to harm them when this is not the case. They have a good sense of their own strengths and weaknesses. They know what their values are. They have a pretty consistent sense of purpose, direction, and life goals. They are able to deeply commit to, and care about, other people and view other people accurately, taking into account both their strengths and weaknesses. They successfully cope with stress in an effective and adaptive manner.

Answer 70

People with this level of personality organization have: 1) severely compromised reality testing, 2) an inconsistent sense of self and others, 3) utilize immature defenses Because their reality testing is compromised these people might hear or see things that are not really there, or have delusions, such as being convinced that they have special powers (for instance, the ability to read other people's minds or to fly). They may believe they receive special messages through the television (a phenomenon known as "Ideas of Reference" or "Delusions of Reference"). They don't have a clear sense of themselves and the boundary between themselves and other people is often blurred. As such, they have great difficulty distinguishing between experiences and perceptions that originate within their own mind, from those that originate in the real world. Their ability to cope with stress is extremely poor and they do not function well in society.

Answer 71

Along the middle of this dimension are personalities organized at the borderline level. At this level, reality testing is generally intact (unlike the more severe psychotic level). However, people with a borderline level of personality organization have a fragmented sense of self and others (unlike the less severe neurotic organization with an integrated self). Because they possess a fragmented sense of self they don't have a consistent view of themselves or others, over time and across situations. This fragmented sense of self is the most significant and defining feature of the borderline level and results in severe and repetitive problems with interpersonal relationships. In addition, people with a borderline level of personality organization tend to rely on primitive defense mechanisms. Therefore, they don't manage stressful situations very well. One of the main primitive defense mechanisms used by people with borderline personality organization is called "splitting." This defense mechanism is characterized by a tendency to view the world and other people in a polarized manner, as "all good" or "all bad," flipping back and forth between these two extremes based on moment-to-moment perceptions.

Week 1 Flashcards

(108 cards)