Theories of Personality
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| This is described by a relatively stable and enduring set of characteristic behavioral and emotional traits that characterize a person's adaptation to life | Personlity
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| list some frontal lobe functions | judgement, foresight, perseverence, delaying gratification, inhibiting socially inappropriate responses, self governance, concentration, planning, ability to organize
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| list some behaviors in frontal lobe syndromes | apathetic indifference vs. explosive emotional lability, abulia vs. environmental dependency, akinesia vs. distractibility, perseveration vs. impersistence, mutism vs. confabulation, depression vs. mania, hyposexuality vs. hypersexuality
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| what is the significance of Phineas Gage? | he had a stick go through his frontal lobe and his personality changed. First time people realized how the frontal lobe affects personlity
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| describe the psychoanalytic theory of personality | there is an Id, Ego, superego which all work together and sometimes create defense mechanisms to deal with problems.
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| these are ideas, thoughts, and feelings of which we are aware | conscious
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| these are materials that can easily be recalled | preconscious
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| these are ideas well below the surface of awareness | unconscious
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| this is your ego ideal moral guardian | superego
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| this is your pleasure center responsible for your unconscious urges and desires | id
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| this is your self reality principle which works with the superego and id and balances them | ego
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| what is a defense mechanism that occurs when your ego is trying to balance the id and superego? | anxiety
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| coping styles and response to stress. |
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| in this category, the response to stress is that it does not exist and the associated clinical state is psychotic state | primitive
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| in this category the response to stress is: "the problem exists but is neither my fault nor my responsibility to address" and results in personality disorders | immature
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| in this coping style, the response to crisis is "the problem exists and is my responsibility but i am not fully able to integrate cognitive and affective components in a way that works toward a satisfying solution. | neurotic. associated clinical state is mild depression, PTSD, adjustment disorder, and much of "normal" adult population
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| in this coping style, the response to crisis is "the problem exists and is my responsibility, and i am able to work toward a solution that brings resolution and perhaps helpful contact with others. there is no impairment in associated clinical state | mature
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| what is the five factor model for personality? | "OCEAN": openness, conscientiousness, extraversion, agreeableness, neuroticism
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| this theory of personality describes the self actualizing tendency=striving to fulfill innate capacities and capabilities and to become everything in their genetic potential will allow them to become. real self vs. idealself | humanistic theories
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| this theory of personality states that personality is a set of learned responses or habits. everything a person does is a response to some environmental stimulus that has been reinforced. ex: classic vs. operant conditioning | Behavioral theories
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| describe a personality disorder | inflexible and maladaptive responses to stress. it is global, affecting work and relationships. non-psychotic, except under severe stress. Ego-syntonic, but distressing to others, and multiple complicaitons are present.
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| describe the DSM-V general criteria for a personality disorder | an ENDURING pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture. the pattern is manifested in 2 or more of the following areas: cognition, affect, interpersonal functioning, impulse control.
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| describe the enduring pattern in personality disorder | it is inflexible and pervasive, cause of clinically significant distress or impairment, stable and long duration, not better accounted by other mental disorder, not due to effects of substance abuse
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| now will talk about specific personality disorders |
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| Describe the type of personality disorders in cluster A | odd/Eccentric
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| list the personality disorders in cluster A | schizoid, paranoid, chizotypal
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| are personality disorders temporary? | NO! they are lifelong disorders
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| personality disorders have a tendency to develop disorders of which axis? | Axis I.
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| describe the course of personality disorders | they have a very variable course. some show improvement, some stay the same, some get worse
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| list some diagnostic issues in personality disorders | abrupt change in personality (think organic problem), clinicians feelings are a major source of data, beware diagnosing out of social/cultural context. diagnosis may be complicated by an existing Axis I disorder
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| describe the general treatment of personality disorders in the medical setting | establish and maintain a stable doctor-patient relationship, consider referral to a mental health professional
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| describe the general treatment for personality disorders in the mental health setting | group therapy is the treatment of choice, individual psychotherapy, and pharmacological therapy can be used when indicated
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| Cluster A personality disorders are desribed as what? | odd/Eccentric
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| describe the symptoms of paranoid personality disorder | "SUSPECT": spouse fidelity suspected, unforgiving (bears grudges), suspicious of others, perceives attacks (and reacts quickly), enemy or friend, confiding in others feared, threats perceived in benign events.
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| describe how someone with paranoid personality disorder may act in the medical setting | may keep complaints to themselves, may be highly suspicious of medical treatment, be nonadherent with treatment, sensitive to intrusions of medical history taking and procedures
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| describe the medical intervention of paranoid personality disorder | give straightforward explanations, want patients of possible side effects of treatments, get explicit consent to speak to family members or others
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| describe schizoid personality disorder | "DISTANT" detached, indifferent to criticism and praise, sexual experiences of little interest, tasks done solitarily, absence of close friends, neither desires nor enjoys close friendships, takes pleasure in few activities, don't have a wide range of emo
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| describe schizoid personality disorder in the medical setting | may not present for treatment until illness is far advanced due to reluctance to engage with health care professionals, emotional detachment may make alliance with a physician difficult
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| describe schizotypal personality disorder | "MEPECULIAR" magical thinking or odd beliefs, experiences unusual perceptions, pranoid ideation, eccentric behavior or appearance, constricted affect, unusual thinking or speech, lacks close friends, ideas of reference, anxiety in social situations,
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| how do you differentiate schizoid from schizotypal personality disorder? | schizoids do not desire friendships, schizotypals want the close relationships, but cannot get them ebcause they are so odd.
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| describe the schizotypal personality disorder in the medical setting | guidelines for schizoid PD apply, odd beliefs, magicla thinking or paranoid ieation may be mistaken for psychosis, when in doubt, consult a mental health professional
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| describe the interentions of schizotypal personality disorder | same as schizoid PD, antipsychotics may help with anxiety, but generally produce less dramatic responses than is seen in true psychotic axis I disorders
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| describe the management of cluster A types PD | work gradually toward the establishment of rapport, provide consistent demonstration of concern for the patient's well being, respect the patient's privacy.
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| cluster B personality disorders are characterized as what? | dramatic/Erratic
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| list the cluster B personality disorders | APD, borderline PD, histrionic PD, narcicisstic PD,
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| describe APD | "CORRUPT": conformity to law lacking, obligations ignored, reckless disregard for the safety of self or others, remorse lacking, underhanded (deceitful, lies), planning indufficient (impulsive), temper (irritable and aggressive),
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| most people with APT in our society are where? | in prison, or are really successful CEOs
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| describe APD in the medical setting | often involved with medical care because of drug use and trauma, may lie about their history, may try to manipulate prescriptions, may make persistent inappropriate demands
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| describe the intervention for APD | straightforward confrontation with a reasonable tratment plan, provide clear boundaries, be aware that patient may make physician feel guilty for not giving into demands, do not try to manage substance abuse
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| describe borderline personality disorder | "AMSUICIDE": abandonment, mood instability, suicidal behavior, unstable and intense relationships, impulsivity, control of anger, identify disturban, dissociative symptoms that are transient, emptiness. instabilityin emotions andinterpersonalrelationships
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| describe borderline personality disorder in the medical setting | relationship with providers unstable and intense, "splitting may occur between members of the treatment team, treatment complication by self destructive behavior, may have chronic suicidal behavior
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| describe the intervention in borderline personality disorder | understand there is a stable pattern of instability, provide lcearand consistent boundaries and limits, communication should be simple and straightfoward, do not underestimate the significance of going on vacation
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| what is the minimum age required in order to diagnose a personality disorder? | 18
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| describe histrionic personality disorder | "PRAISEME": provocative/sexually seductive behavior, relationships considered more intimate than really are, attention whore, influenced easily, style of speech, emotions rapidly shifting and shallow, emotions exaggerated
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| APD is more common in which sex? | men
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| describe the medical setting for histrionic PD | may have exaggerated concerns or worries nad are prone to be hypochondriacal, provides vague nonfactual histories, may display seductiveness, experience sillness as a threat to attractiveness, medical history can be made up, excessively dramatic
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| describe the intervention with histrionic personality disorder | appreciate the threat that illness poses to a person to whom attractiveness is so important, maintain a professional stance, understand seductive behavior as a response to distress and reassure patient of an interest in taking care of the illness
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| describe narcicisstic personality disorder | "SPECIAL" special, grandiosiy, believes he/she is special and unique, preoccupied with fantasis, envious of others, or believes others are envious of him, entitlement, excess admiration required, conceited, interpersonal exploitation, arrogant, no empathy
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| describe narcissistic PD in the medical setting | experiences a damaged sense of superiority in accepting the sick role, may make disparaging remakrs about providers as a defense, often demands referral to a "specialist", may get into power struggles
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| describe the intervention with narcicisstic personality disorder | maintain a balance between appearing too controlling and not appearing self confident, do not get defensive...maintain sense of confidence
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| describe the general mangement of cluster B personality types: | expect a show of emotional extremes, expect pressure to bestow emotional and material favors as well as medical care, maintain equinamity int he face of patients' emotional excess, avoid defensiveness in teh face of patients' emotional excess,
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| describe the cluster C personality diosrders | anxious/fearful
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| list the cluster C personality disorders | avoidant PD, dependent PD, obsessive compulsive PD,
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| describe avoidant personality disorder | "CRINGES": certainty, rejection preoccupies ones' thought in social siutations, intimate relationships due ot fear of being shamed, is inhibited in new interpersonal relationships, gets around occupational activity involving significant contact,embarasse
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| describe avoidant PD in the medical setting | may develop symptoms justifying regular visits to alleviate their loneliness, may be easily embarassed and anxious in the medical setting, may be predisposed to chronic anxiety and social phobias
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| describe the intervention of avoidant PD in the medical setting | consistent support, reassurance, and encouragement, consider use of medication to address chronic anxiety or social pohobia (SSRIs)
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| describe dependent personality disorder | "RELIANCE": reassurance, expressing disagreement difficult, life responsibilities, initiating projects are difficult, alone, goes XS lengths to obtain nurturing, companionship sought ugently, exaggerated fears of being left to care for self
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| describe dependent personality disorder in the medical setting | needs excessive reassurance, needs others to assume responsibility, has difficulty expressing disagreement due to fear of loss of support or approval, may make frequent unnecessary visits or phone calls
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| describe dependent PD interventions | avoid becoming annoyed with excessive demands, set up regular times for visits, set limits in a way that does not feel punitive to patient
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| describe obsessive compulsive personalty disorder | "LAWFIRMS": loses point of activity D/T preoccupation with detail, ability to complete tasks, unable to discard worthless objects, friendships and leisure activities excluded, inflexible, scrupulous, over conscientious, reluctant to delegate, stubborness
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| describe treatment of OC PD in the medical setting | may be non-compliant as a way of keeping control, may be indecisive or inflexible regarding treatment
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| describe the intervention with Obsessive Compulsive personality disorder | allow patient to participate in treatment decisions, engage patients in treatment by asking them to monitor their own BP or initiate an exercise program, be responsive to concerns or complaints, avoid detailed descriptions of insignificant side effects
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| describe the general mangement of Cluster C types | recognize that in times of stress, patients may become excessively needy, regular brienf visits helpful so pt feel they have to make new complains to gain access, give advance notice when going on vacations, treatment for GAD, phobias may be needed insome
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| list the process of personality assessment | interview, projective tests, behavioral assessments, personality inventories
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