Personality Disorders (Exam 3)
Questions with Complete Solutions
Schizotypal Case Example - ANSWER-Matthew, age 37, works the night shift for a
large security firm. He has been there for 13 years but seldom interacts with others.
He is left alone by his co-workers until he is observed to be muttering things to
himself and cutting the skin on the back of his hand. He is referred to Human
Resources, where on interview he says he this is part of his belief that self cutting
frees him of toxic vapors that are acquired in our modern diet. He frequently goes to
the health food store where he buys a complicated regimen of vitamins and juices
that correct an internal imbalance acquired through years of living in the city. He has
few friends and does not feel comfortable socializing with others. He is willing to go
to the hospital to have his hand treated, but cannot promise he will stop cutting
himself
Schizoid Personality Disorder - ANSWER-*Essential Features*
Lack of interest and detachment from social relationships, apathy, and restricted
emotional expression.
Paranoid Personality Disorder - ANSWER-*Phenomenology*
- The capacity for trust is impaired.
- They perceive others as threatening rather than supportive. They see themselves
as victims of a cruel world with cruel people in it.
- They seek information that confirms their fears, and distort data to fit their
perception. They see hidden meaning in what may be innocuous statements or
events.
- This forms a self-reinforcing cycle of fear, distortion of facts, and more fear which
may lead to paranoid delusions.
- The paranoid patient reacts to the perception of danger by becoming detached,
distant, and hypervigilant.
- However, unlike the schizoid patient, he may not be comfortable with isolation, and
he may seek the company of others who have similar beliefs, and a cult is formed
(e.g., Jim Jones in the 1970's)
- The paranoid patient is angry about being persecuted, and may act out his anger
*Essential Features*
Pattern of *distrust and suspiciousness* such that others' motives are interpreted as
malevolent.
*Etiology: Constitutional Causes*:
-have high sympathetic discharge
-hyperaggressive; An aggressive child may elicit reactive abuse from the parents,
thereby setting up a cycle of hostility that may leave the child feeling persecuted.
*Etiology: Environmental Causes*
, -Early physical/sexual abuse may be a major factor. Paranoid patients learn to
mistrust rather than trust their environment.
-A family may scapegoat the paranoid patient, attributing negative qualities to him or
her the family would like to disown (McWilliams, 1994).
-There is often an environment of severe criticism which constitutes verbal abuse.
The patient guards against such abuse by hypervigilance, avoidance, and a
defensive retreat into a grandiose self image.
-There may be an atmosphere of excessive shame, guilt, and envy. The patient
incorporates these experiences into his supereg
Paranoid Personality Disorder Case Example - ANSWER-Mr. Lyon is a 32 yo
married white male graduate student at the Yale Business School who presents to
the Mental Hygiene Clinic saying he is afraid his professors don't like him. He says
he sometimes disagrees with them in class, and he believes they are talking
amongst themselves and are going to fail him. He believes they have communicated
with his old college, where he was disliked for writing a negative article in the school
newspaper about the low graduation rates of student athletes. His developmental
history is remarkable for an alcoholic father who regularly came home drunk, called
him a lazy bum, and beat him up.
Cluster B Personality Disorder - ANSWER-*Generally more extraverted and appear
dramatic, emotional, or erratic.*
Antisocial
Borderline
Histrionic
Narcissistic
Essential Features: Antisocial - ANSWER-*Phenomenology*
*Essential Features*
Pattern of disregard for, and violation of, the rights of others
Essential Features: Borderline - ANSWER-*Phenomenology*
- The core feature is an intense *ambivalence* about interpersonal relationships
such that the patient cannot find a comfortable, acceptable, optimal distance.
- Borderline patients have intense needs for intimacy, fear abandonment, and are
*exquisitely sensitive to rejection*.
- They need the structure of a relationship in order to feel stable. Without it they feel
empty and depressed. They are very insecure.
- They impose their need for relationship on others and often drive them away, after
which the borderline patient feels guilty, ashamed, and regretful
- They hate themselves for having lost loved ones and exposing themselves to
feelings of abandonment and rejection. They hate the loved one for leaving.
- They often deal with their rage by *acting out* against themselves or others.
Borderline patients are notorious for engaging in *self-destructive behavior*, whether
it be substance use or more directly dangerous behavior like self-mutilation.
- If someone is perceived as supportive, he or she may be idealized. But if perceived
as unsupportive he or she is devalued and rejected, sometimes with paranoid
hostility.
Questions with Complete Solutions
Schizotypal Case Example - ANSWER-Matthew, age 37, works the night shift for a
large security firm. He has been there for 13 years but seldom interacts with others.
He is left alone by his co-workers until he is observed to be muttering things to
himself and cutting the skin on the back of his hand. He is referred to Human
Resources, where on interview he says he this is part of his belief that self cutting
frees him of toxic vapors that are acquired in our modern diet. He frequently goes to
the health food store where he buys a complicated regimen of vitamins and juices
that correct an internal imbalance acquired through years of living in the city. He has
few friends and does not feel comfortable socializing with others. He is willing to go
to the hospital to have his hand treated, but cannot promise he will stop cutting
himself
Schizoid Personality Disorder - ANSWER-*Essential Features*
Lack of interest and detachment from social relationships, apathy, and restricted
emotional expression.
Paranoid Personality Disorder - ANSWER-*Phenomenology*
- The capacity for trust is impaired.
- They perceive others as threatening rather than supportive. They see themselves
as victims of a cruel world with cruel people in it.
- They seek information that confirms their fears, and distort data to fit their
perception. They see hidden meaning in what may be innocuous statements or
events.
- This forms a self-reinforcing cycle of fear, distortion of facts, and more fear which
may lead to paranoid delusions.
- The paranoid patient reacts to the perception of danger by becoming detached,
distant, and hypervigilant.
- However, unlike the schizoid patient, he may not be comfortable with isolation, and
he may seek the company of others who have similar beliefs, and a cult is formed
(e.g., Jim Jones in the 1970's)
- The paranoid patient is angry about being persecuted, and may act out his anger
*Essential Features*
Pattern of *distrust and suspiciousness* such that others' motives are interpreted as
malevolent.
*Etiology: Constitutional Causes*:
-have high sympathetic discharge
-hyperaggressive; An aggressive child may elicit reactive abuse from the parents,
thereby setting up a cycle of hostility that may leave the child feeling persecuted.
*Etiology: Environmental Causes*
, -Early physical/sexual abuse may be a major factor. Paranoid patients learn to
mistrust rather than trust their environment.
-A family may scapegoat the paranoid patient, attributing negative qualities to him or
her the family would like to disown (McWilliams, 1994).
-There is often an environment of severe criticism which constitutes verbal abuse.
The patient guards against such abuse by hypervigilance, avoidance, and a
defensive retreat into a grandiose self image.
-There may be an atmosphere of excessive shame, guilt, and envy. The patient
incorporates these experiences into his supereg
Paranoid Personality Disorder Case Example - ANSWER-Mr. Lyon is a 32 yo
married white male graduate student at the Yale Business School who presents to
the Mental Hygiene Clinic saying he is afraid his professors don't like him. He says
he sometimes disagrees with them in class, and he believes they are talking
amongst themselves and are going to fail him. He believes they have communicated
with his old college, where he was disliked for writing a negative article in the school
newspaper about the low graduation rates of student athletes. His developmental
history is remarkable for an alcoholic father who regularly came home drunk, called
him a lazy bum, and beat him up.
Cluster B Personality Disorder - ANSWER-*Generally more extraverted and appear
dramatic, emotional, or erratic.*
Antisocial
Borderline
Histrionic
Narcissistic
Essential Features: Antisocial - ANSWER-*Phenomenology*
*Essential Features*
Pattern of disregard for, and violation of, the rights of others
Essential Features: Borderline - ANSWER-*Phenomenology*
- The core feature is an intense *ambivalence* about interpersonal relationships
such that the patient cannot find a comfortable, acceptable, optimal distance.
- Borderline patients have intense needs for intimacy, fear abandonment, and are
*exquisitely sensitive to rejection*.
- They need the structure of a relationship in order to feel stable. Without it they feel
empty and depressed. They are very insecure.
- They impose their need for relationship on others and often drive them away, after
which the borderline patient feels guilty, ashamed, and regretful
- They hate themselves for having lost loved ones and exposing themselves to
feelings of abandonment and rejection. They hate the loved one for leaving.
- They often deal with their rage by *acting out* against themselves or others.
Borderline patients are notorious for engaging in *self-destructive behavior*, whether
it be substance use or more directly dangerous behavior like self-mutilation.
- If someone is perceived as supportive, he or she may be idealized. But if perceived
as unsupportive he or she is devalued and rejected, sometimes with paranoid
hostility.
