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66 Cards in this Set
- Front
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A personality disorder involves enduring behavior that deviates from what is expected in their culture. What are the 3 categories of personality disorders?
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Cluster A: Odd & Eccentric (Schizoid, Paranoid, Schizotypal)
Cluster B: Dramatic, Eratic, & Overemotional (antisocial, borderline, histrionic, narcissistic) Cluster C: Anxious & Fearful (dependent, avoidant, obsessive compulsive) |
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What is compromised/altered in a person diagnosed with a personality disorder?
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2 or more:
cognition affect interpersonal functioning impulse control (thinking, feeling, behaving, & perceiving) |
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A Personality Disorder is all of the following EXCEPT:
a. inflexible b. enduring c. distressful to the individual d. all of the above |
c. distressful to the individual
It is distressful to those around them |
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What is sociocentric personality structure?
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When identification is centered in the group so that the individual is subordinate to the group and lack personality outside of it. An example of how culture can impact which traits we adopt/value
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What is egocentric personality structure?
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Personality is centered in the self and thus the person sees themself as autonomous. In this case culture values traits promoting autonomy and devaluing dependence.
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How do hierarchies within a culture impact us?
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determine whether the individual or the group is more im portant
what traits to stigmatize how we deal with stigma |
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What does
Axis II: w/borderline features mean? |
there are several symptoms suggesting some borderline symptoms
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What are the properties of psychological defenses?
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-they manage instinct & affect
-are unconscious -are discrete from each other -often indicate certain kinds of psychiatric difficulties -are adaptive as well as pathological |
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What are some narcissistic psychological defenses?
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Denial, distortion, primitive idealization, projection, projective identification, splitting
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What are some of the immature psychological defenses?
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acting out, identification, projection, regression, somatization, passive-aggressive
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What are some of the neurotic psych defenses?
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controlling, displacement, dissociation, inhibition, intellectualization, isolation, rationalization, reaction formation, repression, sexualization, undoing
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What are the more mature psychological defenses?
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altruism, anticipation, humor, sublimation
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What are the features of Cluster A: Odd & Eccentric PDs?
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Paranoid, Schizoid, Schizotypal,
-overlap w/psychotic disorders -considered to be in the schizophrenic spectrum of disorders -genetic &/or environmental factors that are related to more serious conditions (i.e., schizophrenia or schizoaffective) may be present to a lesser degree |
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What are the features of Cluster B: Dramatic, Erratic, & Overemotional PDs?
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Borderline, histrionic, narcissistic, anti-social
-overlap w/mood & impulse control disorders - considered to be disorders w/externalizing symptoms |
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What are the features of Cluster C: Anxious & fearful PDs?
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Dependent, obsessive compulsive, avoidant
- overlap with anxiety disorders - considered to be disorders w/internalizing symptoms |
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Paranoid Personality Disorder
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A. Distrust/suspicious of others. Interprets motives as malevolent. 4 or more:
1) suspect w/o evi that others are exploiting, harming, or deceiving 2) Doubt loyalty of others 3) Reluctant to confide 4) Reads hidden demeaning/ threats into benign remarks 5) bears grudges 6) Quick to react/counterattack to perceived attacks 7) Worries about fidelty of partner B. R/O Delusional & schizo conditions Diff than Delusional b/c general suspiciousness, not a small set of well-developed delusions |
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Schizoid PD
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A. Detachment from social relationships & restricted range of emotional expression in interpersonal settings. 4 or more:
1) Neither enjoys or desires close relationships 2) Chooses solitary activities 3) Little interest in sexual experiences 4) Takes pleasure in few, if any activities 5) Lacks close friends or confidants 6) indifferent to praise/criticism 7) emotional coldness/ detached/ flat affect B. R/O other disorders & GMC. if criteria met prior to onset of Schizophrenia add Premorbid SPD |
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Schizotypal PD
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A. Social/interpersonal deficits including acute discomfort with/inability for close relationships & by cog + perceptual distortions/ eccentricities. 5 or more:
1) ideas of reference 2) odd beliefs/ magical thinking 3) unusual perceptual experiences 4) odd thinking & speech 5) suspicious/ paranoid ideation 6) inappropriate/ constricted affect 7) Bx/ appearance that is odd, eccentric, peculiar 8) lack of close friends/ confidants 9) excessive social anxiety B. R/O another disorder |
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Histrionic PD
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A. Pervasive pattern of excessive emotionality & attention seeking. 5 or more of the following:
1) uncomfortable when not center of attention 2) inappropriate sexually seductive/ provocative Bx 3) Rapidly Shifting & shallow expression of emotions 4) Uses physical appearance to draw attention 5) shallow & impressionistic speech 6) self-dramatization 7) suggestible 8) Considers relationships to be more intimate than they really are |
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Narcissistic PD
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A. Pervasive pattern of grandiosity, need for admiration, and lack of empathy. 5 or more:
1) sense of self-importance 2) preoccupied w/fantasies of unlimited wealth or power, brilliance, beauty, etc 3) believes that he is special and unique, and can only assoc w/other special and unique people 4) requires excessive admiration 5) sense of entitlement 6) Interpersonally exploitative 7) lacks empathy 8) envious of others 9) arrogant, haughty, behaviors or attitudes |
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Borderline PD
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A. Pervasive pattern of unstable relationships, self-image, and affect, and markedly impulsive. 5 or more:
1) frantically avoids real or imagined abandonment 2) unstable/intense interpersonal relationships (idealization/devaluation) 3) identity disturbance 4) Impulsivity in 2 areas 5) recurrent suicidal bx 6) affective instability 7) emptiness 8) intense anger 9) transient stress related paranoid ideation |
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Antisocial PD
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A. Pervasive pattern of disregard for and violation of others rights, since age 15. 3 or more:
1) failure to conform to social norms 2) deceitfulness 3) Impulsivity, failure to plan ahead 4) irratibility or aggressiveness 5) disregard for safety of self or others 6) consistent irresponsibility 7) lack of remorse B) AT least 18 yrs of age C) evi of conduct disorder with onset prior to age 15 D) R/O other disorders |
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Avoidant PD
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A. Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative eval. 4 or more:
1) avoids occupational act. w/a sig amount of interpersonal contact 2) unwilling to be involved w/people unless certain of being liked 3) restraint within interpersonal relationships 4) preoccupied w/being criticized or rejected 5) inhibited in new interpersonal situations 6) views self as socially inept 7) reluctant to take risks or engage in new activities |
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Dependent PD
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A. Pervasive & excessive need to be taken care of that leads to submissive & clinging bx and a fear of separation. 5 or more:
1) diff. making everyday decisions 2) needs others to assume responsibilty 3) difficulty expressing disagreement 4) diff. initiating projects or doing things 5) excessive lengths to obtain nurturance and supp 6) feels uncomfortable or helpless when alone 7) seeks a new relationship when another one ends 8) preoccupied w/fears of being left to take care of things by him or herself |
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Obsessive Compulsive personality Disorder
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A. Preocc w/orderliness, perfectionism, & mental & interpers control; inflexibility, inhibited openness & efficiency. 4 or more:
1) Preocc w/details, lists, rules, order, org, or schedules, & major pt of activity is lost 2) shows perfectionism that interferes w/task completion 3) excessive devotion to work/ productivity at expense of fun & friends 4) Overconscientious, scrupulous, inflexible re: morality/ethics/values 5) Unable to disregard worn out or worthless objects w/o sentimental value 6) reluctant to delegate tasks 7) miserly spending style 8) rigidity and stubborness |
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How does someone with Paranoid PD present?
Defense Mechanisms? |
Holds grudges w/o justification, expects to be exploited, sees threats and personal attacks where they don't exist, fears betrayal, questions spouse's fidelity w/o justifiable reason
- Attempts to appear unemotional - Common defense mechanism: PROJECTION, denial, splitting, reaction formation Holds grudges, abrasive, hostile Usually labile, but try to project that nothing bothers them |
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What are the psychodynamic & CBT techniques used for those w/Paranoid PD?
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1. Psychodynamic: trust needs to be established & do NOT question paranoid ideas or overanalyze
2. Cognitive: use action to establish trust by improving their coping skills |
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Paranoid PD -
Transference & Countertransference |
Transference: usually negative & see therapist as trying to expose them (projection, projective ID)
Countertransference: anxious/hostile & strong w/eventual dislike for client |
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How does someone w/ Schizoid PD present?
Defense Mechanisms? |
usually enter b/c of anxiety or depression;
Clipped responses w/indifference to praise & criticism; relationships/sex are of little to no interest; emotionally cold, detached, & restricted Defense: intellectualization, schizoid fantasy, projection |
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What are the psychodynamic & CBT techniques used for those w/ Schizoid PD?
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Psychodynamic: From paranoid-schizoid position; respond well to therapeutic limits (time, setting, ethics) and usually present b/c of Axis: I issues; desire relationships
CBT: limited self-disclosure & social skills & assertiveness training |
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Schizoid PD-
Transference & Countertransference |
Transference: generally appreciative & cooperative w/in therapeutic relationship
Countertransference: boredom, impatience, derision, & giving prematurely negative prognosis SSRIs might help process |
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How does someone w/ Schizotypal PD present?
Defense Mechanisms? |
Discomfort w/ close relationships, suspicious & guarded, constricted or inappropriate affect, odd beliefs/thoughts/speech, & eccentric appearance & Bx;
Usually present b/c of an acute stressor (possibly triggering micropsychotic episodes) or family member Defense Mech: ideas of reference, schizoid fantasy/depersonalization, magical thinking, projective, splitting (primitive or narcissistic) |
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Schizotypal PD-
Transference & counter transference |
Transference:detachment & withdrawal to test therapist's concern
Countertransference: counterdetachment, avoid unintentionally ridiculing! |
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What are the psychodynamic &CBT techniques used for those w/Schizotypal PD?
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Stuck in oral stage b/c object constancy not achieved
Psychodynamic: supportive focus on "here & now" & nonjudgmental stance w/minimal attempts at interpretation CBT: focus on increasing social appropriateness & evaluation of automatic assumptions Group therapy & SSRIs may help |
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How does someone w/ Histrionic PD present?
Defense Mechanisms? |
Sexually/provocative inappropriate, dramatic, superficial, paucity of detail, shallow emotions & so loquacious that closed-ended questions are necessary
Defense Mechanisms: repression, regression, dissociation, sexualization, denial |
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What are the Psychodynamic & Cognitive approaches to Histrionic PD?
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Psychodynamic: fixated at oral & oedipal; correct perception that you know all & encourage openness; explore resistance instead of challenging
Cognitive:Set systematic agenda, look at long-term cost of impulsivity, assertiveness training, role-playing w/element of rejection Group therapy is okay if realize help-rejecting complaints aren't useful; meds less useful |
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Histrionic PD:
Transference/Countertransference |
Transference: reenact oedipal conflicts (adoration/competition); eroticized transference to manage anxiety (egodystonic in healthier patients)
**Only make interpretations if it turns into resistance & then use 3 way connection Countertransference: flattery/attraction to client's interest & sexual overtures, voyeuristic enjoyment of fantasies, disgust at disclosures |
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What are some features you might expect to see in someone with Narcissistic PD?
Defense Mechanisms? |
Male; Need to be admired, talks at you, grandiose self-importance, interpersonally exploitative, overvalues others before finding weakness, COLD anger
Defense: Splitting, projection, introjection, idealization/devaluation, identification, projective identification (help deal w/envy) |
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What are the types of Narcissistic PD that Robinson IDs? Describe
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Type 1: Fits DSM (arrogant, oblivious, disinterest in others feelings)
Type 2: hypervigilant, thin-skinned, seemingly altruistic, self-effacing, appears to divert attention from self; almost looks like antithesis of what you'd expect; play martyr role |
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What do people w/NPD usually present with?
What are the psychodynamic and cognitive approaches for individuals with Narcissistic PD? |
Underdeveloped superego due to overindulgent/misunderstanding parents; depression/illness threatening grandiosity
Psychodynamic: focus is on self-acceptance w/o encouraging grandiosity, non-questioning approach in order to make up for parental empathetic failures Cognitive: systematic desensitization & emph on enjoying activities Avoid Group Therapy |
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Narcissistic PD:
Transference/ Countertransference |
Transference: projects own flaws onto you, envy, idealization/devaluation, little interest in reason for reactions
Countertransference: seduction, irritability, hostility, boredom |
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What are some of the features you might expect in a person w/Antisocial PD?
Defense Mechanisms? |
prev diagnosis of conduct disorder before age 15, frequent lies, no superego, unhonored obligations, can't plan, ignores safety, aggressive, malignant grandiosity (deliberately use others)
Defenses: controlling (for primary & 2ndary gain), dissociation, projective ID, acting out |
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What are the Psychodynamic & Cognitive approaches to Antisocial PD?
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Psychodynamic - lack meaningful attachment & exhibit primitive envy so no superego; Tx only if they show remorse, evi of compassion, 1 attachment; Tx must be direct & rigid not empathetic
Cognitive - exercises on dis/advantages of responses & impact on self & others Bx therapy may work best |
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Antisocial PD-
Countertransference/Transference |
Transference - projective identification, controlling
Countertransference - attempts to prove helpfulness/good intentions can lead to hostility, contempt, moral outrage, hate; fear & resignation |
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What Axis I disorders are each of the personality clusters associated with?
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Cluster A - Schizophrenia & other psychotic, Delusional Disorders
Cluster B - substance abuse, mood disorders, somatization Cluster C - anxiety disorders |
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When is ASPD activity most prevalent?
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In early adulthood
Decreases over the years |
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How might a client with Borderline PD present?
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Can present better than they really are; past rptd crises, marked deval of past relationships, therapists, & otr attempts at help; very verbal, intense affect that changes quickly
Usually come in b/c of: depression, dissociative episodes, paranoia, substance abuse, |
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What are the defense mechanisms associated with Borderline PD?
Which PD is it most commonly comorbid with? |
Defense Mechanisms: splitting, projective identification, dissociation, denial
Comorbidity: ASPD though having a parent w/ a PD has greater impact than any Axis I pathology |
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When does Mahler say that development was interrupted in an individual with BPD?
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Mahler - 18 months during separation-individuation & parental engendering of separation fears; thus object permanence not attained & stuck in oral stage & have identity diffusion
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Borderline PD:
Transference/Countertransference |
Transference:when living out unsolved struggles from early dvlpmnt; idealization/devaluation
Countertransference- breaking boundaries, wanting to terminate Tx |
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Which personality disorders are often found in those with ADHD, learning disorders, and neurological soft signs?
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Borderline PD
Antisocial PD |
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What is the psychodynamic take on BPD?
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Psychodynamic: consistent reinforcement of parameters of Tx; empathize w/them when splitting happens & soft interp of their use of projective identification
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What is the cognitive take on BPD?
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Good w/ DBT, group therapy, possibly inpatient
-modification of dichotomous thinking helps curb impulse fulfillment |
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How might you expect someone with Dependent PD to present?
Reason for referral? |
Female, meek, seeks approval, sensitive to questions about submissiveness; subordinates self; frumpy clothes
Reason for referral: MDD, agoraphobia, panic disorder |
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Dependent PD
Transference/Countertransference |
Transference - idealization, see you as nurturing figure
Countertransference - to push them or run for the hills |
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What defense mechanisms are associated with Dependent PD?
What psychosocial phase are they stuck at? |
Defenses: idealization, reaction formation, projective identification, inhibition, somatization, regression
Phase: oral stage; hunger for attachment |
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What are the psychodynamic and cognitive approaches to Dependent PD?
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Psychodynamic: model patients w/longer idealization of therapist; goal is to alter dependent Bx
Cognitive: guided discovery & Socratic questioning, hwk & an agenda Good: group So-So: meds ONLY for Axis I |
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How might you expect someone with OCPD to present?
What brings them in? |
Emotional constriction, pedantic/detailed, dominate interview, overly objective
Reason for referral: mid-life depression, somatoform or illness from stress, |
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OCPD-
Transference/Countertransference |
Transference- project superego (demanding/judgmental parent), irritability, oppositional, see therapist as having high expectations
Countertransference - boredom at intellectualization; temptation to badger/ridicule their affective restriction |
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What defense mechanisms are associated w/OCPD?
What psychosocial phase are they stuck at? |
Defenses: isolation, intellectualization, moralization, rationalization, undoing, reaction formation, displacement
Phase: anal |
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What are the psychodynamic & cognitive approaches to OCPD?
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Psychodynamic
-Tx must be accepting & emph feelings to limit intellectualization - show reaction formation in the last thing they say - goal is to alter superego/ease shame Cognitive- explore/alter assumptions Good: group therapy; Not: meds |
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How might you expect someone with Avoidant PD to present?
What usually leads them to seek treatment? |
M=F; underemployed, hyperalert to disapproval; open if see guarantee of acceptance; anxious
Seek Tx due to: anxiety disorder, substance abuse (overlap w/ DPD, social phobia, panic disorder w/agoraphobia; brain injury a common trigger) |
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What defense mechanisms are associated w/Avoidant PD?
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Defenses: repression, inhibition, isolation, displacement, projection, avoidance
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What are the psychodynamic and cognitive approaches to Avoidant PD?
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Psychodynamic: supportive-expressive approach
Cognitive: CBT is good here; focus on avoidant process using Socratic questioning to reduce dysphoria Bx: exposure therapy, role playing, relaxation training, assertiveness training Good: group, SSRIs, MAOIs, TCAs |
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Avoidant PD
Transference/Countertransference |
Transference: magical help, pleasers, avoid confrontation, seek acceptance
Countertransference: collusion w/guarantee of acceptance patient seeks & fear of hurting/offending |
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What are the 2 types of avoidant personalities that Robinson describes?
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Type A: constitutionally overanxious; more likely to have had a normal attachment history; benefit from Bx interventions, social skills training, & exposure Tx
Type B: Narcissistically vulnerable; more likely to come from intolerant or shaming parents w/neg attachmnt experience; Rx trad psychotherapy; Similar to hypervigilant/thin-skinned Type 2 NPD |