Personality Disorders April 21, 2010 1. Define Personality Disorders according to the DSM-IV a.

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture i. Inflexible ii. Pervasive iii. Leads to clinically significant disease or impairment of social, occupational, or other areas of functioning b. Manifested in 2 or more of the following: i. Cognition: ways of perceiving and interpreting self and others ii. Affectivity: appropriateness of emotional response iii. Interpersonal functioning iv. Impulse control c. *Can be traced back to adolescence or early adulthood d. It is not due to substance abuse or a general medical condition 2. Personality Disorders Table Disorder
Paranoid

Cluster
Odd/Eccentric

Definition
Pervasive distrust and suspiciousness of others Motives are interpreted as malevolent

Clinical features
4+ of the following: Suspects w/o sufficient basis that others are trying to harm or deceive him/her Unjustified doubts about loyalty of friends Cant confide in others Finds hidden demeaning/threatening meanings in benign remarks or events Persistently bears grudges Sees attacks on their character that isnt seen by others; quick to react angrily Recurrent suspicions w/o reason about partner cheating on them 4+ of following: doesnt desire/enjoy close relationships

Additional Info
Absence of fixed delusions No hallucinations or formal thought disorder Cant have overly involved tumultuous relationships w/ others Lack long hx of antisocial behavior Appears cold/aloof

Schizoid

Odd/Eccentric

Pervasive detachment from social relationships

Restricted range of emotional expression

Schizotypal

Odd/Eccentric

Acute discomfort w/ reduced capacity for close relationships Cognitive/perceptual distortions & eccentricities

Antisocial (Psychopat h)

Dramatic, Emotional, Erratic

Disregard for and violation of the rights of others; behavior since 15yo

chooses solitary activities little interest in sexual activites w/ others little pleasure in few activities no close friends/confidants indifferent to criticism flat affect 5+ of the following: odd beliefs/magical thinking (e.g. sixth sense) odd perceptions, including bodily illusions odd thinking/speech suspiciousness/paranoid ideation inappropriate affect lack of close friends excessive social anxiety associated w/ paranoid fears 3+ of the following: doesnt conform to social norms disobeys laws deceitful; use of aliases; con-artists! doesnt plan ahead aggressive/irritable disregards safety of others lack of remorse

Quiet, distant, seclusive, unsociable No delusional thinking

Odd, even to lay people Magical thinking, peculiar notions, ideas of reference, illusion, and derealization

Pt is at least 18yo Evidence of conduct disorder before 15yo Not synonymous w/ criminality *Show bilateral volume reductions in the amygdala Always look like theyre in crisis Mood swings are common May have short-lived psychotic episodes Behavior very unpredictable *Studies: pts inferred negative intentions in neutral faces Make everything sound more important than it really is

Borderline

Dramatic, Emotional, Erratic

Instability of interpersonal relationships, self-image, affect Marked impulsivity

Histrionic

Dramatic, Emotional, Erratic

Excessive emotionality and attention seeking

5+ of the following: frantic efforts to avoid real or imagined abandonment identity disturbance unstable self-image impulsivity in at least 2 of following: shopping, sex, substance abuse, reckless driving, binge eating recurrent suicidal behavior; self-mutilating behavior (visits ER often) Marked reactivity of mood affect instability chronic feelings of emptiness trouble w/ controlling anger stress-related paranoid ideation (transient) 5+ of following: uncomfortable when not the center of attention inappropriate sexually seductive or provocative

Narcissistic

Dramatic, Emotional, Erratic

Grandiosity in fantasy or behavior; need for admiration, lack of empathy

Avoidant

Anxious, Fearful

Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

Dependent

Anxious, Fearful

Excessive need to be taken care of; submissive; clingy; fear of separation

ObsessiveCompulsive

Anxious, Fearful

Preoccupation with orderliness,

behavior shifting and shallow expression of emotions uses physical appearance to get attention self-dramatization, theatricality, exaggerated expression of emotion easily influenced by others thinks relationships are more intimate than they really are 5+ of the following: grandiose sense of self-importance fantasies of unlimited success, power, brilliance, beauty, ideal love thinks they can only associate w/ other highstatus ppl needs excessive admiration takes advantage of others to achieve their own goals jealous of others OR thinks others are jealous of him/her arrogant excessive sense of entitlement 4+ of the following: avoids work activities that involve lots of ppl contactdont want to be criticized, disapproved, or rejected wont get involved w/ others unless they know for sure they will be liked restraint in intimate relationships due to fear of being shamed/ridiculed thinks they are socially inept, personally unappealing, inferior to others reluctant to take personal risks to not get embarrassed 5+ of the following: hard time making everyday decisions w/o advice from others needs others to assume responsibility for major areas of life wont disagree with others; fear of losing support hard time starting projects on their own feels helpless when alone 4+ of following: concerned w/ details, rules, lists, order,

Temper tantrums, tears, and accusations when not center of attention

Expect special treatment Handle criticism poorly; get angry or indifferent Want their own way Fragile self-esteem depression risk

Unlike schizoid, they WANT to be social! Most striking aspect: anxiety

Pessimism; self-doubt Belittle their abilities Call themselves stupid See criticism as proof of their worthlessness Constricted affect

perfectionism, mental and interpersonal control Inflexible, closed, not efficient

schedules to the point where objective is lost perfectionism that interferes w/ task completion (sets high standards for him/herself) excess devotion to work/productivity overconscientious, scrupulous, inflexible on matters of morality, ethics, or values wont get rid of worn-out/worthless objects wont delegate tasks because they think others wont do as good a job miserly spending style: hoards money for future events rigidity and stubbornness

Lack spontaneity Serious mood Anxiety when not in control Defense mechanisms: rationalization, isolation, intellectualization, reaction formation, undoing