child and adolescent psychiatry
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NUR 448
Personality Disorders
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Definition
Extreme exaggerations of personality traits or styles.
Essential features are: chronicity pervasiveness maladaption
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Three clusters
Cluster A (Odd, eccentric) Paranoid, Schizoid, Schizotypal
Cluster B (Dramatic, erratic) Antisocial, Borderline, Histrionic, Narcissistic
Cluster C (Anxious, fearful) Avoidant, Dependent, Obsessive-compulsive
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Cluster A - Paranoid
Distrustful, suspiciousBears grudgesJealous, envious, hypersensitiveHypervigilent, ideas of referenceRestricted affect, controllingDefense mechanism—projectionOften racist
Paranoid Personality
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Cluster A - Schizoid
LonerOdd thoughts, perceptions & speechAloof, no social involvementIndifferent to praise or criticismBouts of mini psychosisCognitive impairment
Schizoid Personality
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Cluster A - Schizotypal
Odd, peculiar speechBizarre fantasies and behaviorMagical thinkingIdeas of referenceUnusual beliefs, clairvoyantFortune tellers, street people
Schizotypal Personality
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Cluster B - Antisocial
Disregard for the rights of othersInstant gratificationNo remorseLying, stealing, revengefulTruant as children, cruelty to animalsFiresetting, substance abuseRx. Restrictive settings (jail, prison)Qualitative difference to soci0pathic personality
Antisocial Personality
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Cluster B - Borderline
Theory-problems with separation-individuationBad mother-good motherUnstable and impulsive on eating, spending,
and sexualityUnstable personal relationshipsClinging, demanding, controlling
Borderline Personality
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Borderline
Difficulty being alone, mood swingsExplosive anger, self-mutilationMini-psychoses, eating disordersSplitting (pitting one person against another)Projection, suicide gesturesCutting, carving or other self abuse actions
(never the face)Rx: Small doses of antipsychotic medication
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Cluster B - Histrionic
Needs to be center of attentionSeductive, provocative behaviorShallow emotional expressionDramatic, theatricalSuggestibleFocused on physical appearanceOften show “la belle indifference”- disconcern
for personal problems
Histrionic Personality
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Cluster B- Narcissistic
Grandiose self importanceUnlimited fantasies of power, wealth, brilliance, beautyFeels special or unique-associates with people of
high statusDemands admiration, entitlement, special
treatmentAble to break laws-severe cases act as anti-social
personalitiesNarcissistic Personality
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Narcissistic
ExploitiveLacks empathyEnviousHaughty, arrogant
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Cluster C - Avoidant
Social inhibitionFear of close relationshipsAnxious, lonely, fearful of criticism or rejectionViews self as socially inept, reluctant to take risks
Avoidant Personality
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Cluster C - Dependent
Difficulty with decision makingSeeks excessive advice and reassurance Difficulty expressing disagreementFear of having to take care of selfExcessive lengths to obtain nurturanceFeels uncomfortable when alone
Dependent Personality
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Cluster C - Obsessive-compulsive
Preoccupied with details, rules, lists and orderPerfectionism that interferes with task completionOver-conscientious and inflexibleReluctant to delegateMiserly spendingRigid and stubborn
Obsessive Compulsive Personality
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Obsessive Compulsive Personality
Obsessive Compulsive Personality
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder
FastidiousNeatness and
orderlinessDemanding of othersAble to lead normal
lifeBehaviors: labeling,
measuring, things are the same
HoardingCompulsive actionsSeclusiveDisabling and anxiety
producingBehaviors: checking
the door, hand washing, counting, picking at face
Some Differences Between
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Treatment
Symptom specificSome improve with time (borderline and
antisocial)Group therapy helpful for some
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Questions
Which personality disorders are more disruptive?
What is the difference between schizoid and avoidant personalities?
What are the differences among obsessive- compulsive behavior, obsessive-compulsive personality, and obsessive-compulsive disorder?
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Which axis of the DSMIV includes personality disorders?
What are the culture issues of personality disorders?
What are the gender issues of personality disorders?