Personality disorder

Definition A very rigid pattern of inner experience and outward behavior that differs from the expectation of ones culture and leads to dysfunctioning. DSM CHECKLIST Personality disorder 1. An enduring pattern of inner experience and behavior that deviates markedly the expectation of the individuals culture, with at least two of the following areas affected: *cognition *affective *inter personal functioning * impulse control. 2. Pattern is inflexible and pervasive across a broad range of personal and social situations. 3. Pattern is stable and long lasting and its onset can be traced back at least to adolescence or early adulthood. 4. ignificant distress or impairment.

Types of Personality Disorder

Cluster A: 1. Paranoid personality disorder 2. 3. Cluster B: chi!oid personality disorder chi!otypal personality disorder

1. Antisocial personality disorder 2. "orderline personality disorder 3. #istrionic personality disorder 4. $arcissistic personality disorder

Cluster C: 1. Avoidant personality disorder 2. %ependent personal disorder 3. &bsessive' compulsive personality disorder

Paranoid Personality Disorder

A personality disorder marked by a pattern of distrust and suspicious. A person with paranoid personality disorder will nearly always believe that other people(s motives are suspect or even malevolent. )ndividuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation. )ndividuals with Paranoid Personality %isorder are generally difficult to get along with and often have problems with close relationships. )ndividuals with Paranoid Personality %isorder lack trust in others, they have an excessive need to be self'sufficient and a strong sense of autonomy. *hey also need to have a high degree of control over those around them. *hey are often rigid, critical of others, and unable to collaborate, and they have great difficulty accepting criticism. People with a paranoid personality disorder are usually unable to acknowledge their own negative feelings towards others but do not generally lose touch with reality. *hey will not confide in people, even if they prove trustworthy, for fear of being exploited or betrayed. Symptoms uspicion

+oncern with hidden motives ,xpects to be exploited by others

 )nability to collaborate ocial isolation

Poor self image %etachment #ostility

Poor sense of humor People with this disorder typically exhibit a strong need for self' sufficiency, are rigid and often litigious. "ecause of their avoidance of closeness with others, they may appear calculating and cold. -sually men are diagnosed with it more than women. How is Paranoid Personality Disorder Dia nosed! *here are no laboratory, blood or genetic tests that are used to diagnose paranoid personality disorder. .any people with paranoid personality disorder don(t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person(s life. *his most often happens when a person(s coping resources are stretched too thin to deal with stress or other life events. A diagnosis for paranoid personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. *hey will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis. Etiolo y *he specific cause of this disorder is unknown, but the incidence appears increased in families with a schi!ophrenic member. Paranoid personality disorder can result from negative childhood experiences fostered by a threatening domestic atmosphere. )t is prompted by extreme and unfounded parental rage and/or condescending parental influence that cultivate profound child insecurities. Treatment *reatment of paranoid personality disorder can be very effective in

controlling the paranoia but is difficult because the person may be suspicious of the doctor. 0ithout treatment this disorder will be chronic. .edications and therapy are common and effective approaches to alleviating the disorder.

Medi"ations .edications for paranoid personality disorder are generally not encouraged, as they may contribute to a heightened sense of suspicion that can ultimately lead to patient withdrawal from therapy. *hey are suggested, however, for the treatment of specific conditions of the disorder, such as severe anxiety or delusion, where these symptoms begin to impede normal functioning. .edications prescribed for precise conditions should be used for the briefest interval possible to successfully control them. Psy"#ot#erapy Psychotherapy is the most promising method of treatment for Paranoid Personality %isorder. People afflicted with this disorder have deep foundational problems that necessitate intense therapy. A confident therapist'client relationship offers the most benefit to people with the disorder, yet is extremely difficult to establish due to the dramatic skepticism of patients with this condition. People with paranoid personality disorder rarely initiate treatment and often terminate it prematurely. 1ikewise, building therapist'client trust re2uires great care and is complicated to maintain even after a confidence level has been founded.

*he long'term pro3ection for people with paranoid personality disorder is bleak. .ost patients experience predominant symptoms of the disorder for the duration of their lifetime and re2uire consistent therapy. Self Care elf'care approaches to paranoid personality disorder are not likely to be effective forms of treatment. *he high levels of suspicion and mistrust pervasive in people with this disorder make the work of support groups improbably helpful and potentially damaging.

S"#i$oid Personality Disorder

A personality disorder characteri!ed by persistence avoidance of social relationships and little expression of emotion.

chi!oid personality disorder is not the same as schi!ophrenia, though they share a few symptoms. )t is found that people with schi!oid personality disorder tend to function better than people with schi!ophrenia. )ndividuals with schi!oid personality disorder symptoms do not experience 4disconnection from reality,5 which is a characteristic of schi!ophrenia.

T#e top fi%e s"#i$oid personality disorder symptoms are: Appearing distant and detached Appearing dull and humorless ,ngaging in excessive daydreaming including creating vivid fantasies of complex inner lives $ot wanting and avoiding close relationships, including those with family "eing indifferent to praise or criticism and exhibiting little observable change in mood. People suffering from schi!oid personality disorder are not depressed, but indifferent. *hey do not show emotions of happiness, anger, or sorrow. *his limits others from understanding what is going on inside their minds. )n short, the disorder is marked by emotional coldness, detachment, and long'term social withdrawal. American psychologist *heodore .illon contends that this disorder has four sub'types, with an individual exhibiting none or one of the following: languid 6with depressive aspects7, remote 6with avoidant, schi!otypal characteristics7, depersonali!ed 6with schi!otypal characteristics7, and affectless 6with compulsive characteristics7. Dia nosis 6% .7 *he %iagnostic and tatistical .anual of .ental %isorders fourth edition, a widely used manual for diagnosing mental disorders, categori!es schi!oid personality disorder in Axis )), +luster A *he criteria can be found on behavenet )t is characteri!ed by at least four of the following criteria: ,motional coldness, detachment or reduced affect. 1imited capacity to express either positive or negative emotions towards others. +onsistent preference for solitary activities.

8ery few, if any, close friends or relationships, and a lack of desire for such. )ndifference to either praise or criticism. *aking pleasure in few, if any, activities. )ndifference to social norms and conventions. Preoccupation with fantasy and introspection. 1ack of desire for sexual experiences with another person. )t is a re2uirement of )+%'9: that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. Millon&s su'types *heodore .illon identified four subtypes of schi!oid.Any individual schi!oid may exhibit none or one of the following: Su'type Lan uid s"#i$oid 6including depressive features7 )emote s"#i$oid 6including avoidant, schi!otypal features7 Depersonali$e d s"#i$oid 6including schi!otypal features7 Affe"tless s"#i$oid 6including compulsive features7 Causes (eatures .arked inertia; deficient activation level; intrinsically phlegmatic, lethargic, weary, leaden, lackadaisical, exhausted, enfeebled.

%istant and removed; inaccessible, solitary, isolated, homeless, disconnected, secluded, aimlessly drifting; peripherally occupied.

%isengaged from others and self; self is disembodied or distant ob3ect; body and mind sundered, cleaved, dissociated, dis3oined, eliminated.

Passionless, unresponsive, unaffectionate, chilly, uncaring, unstirred, spiritless, lackluster, unexcitable, unperturbed, cold; all emotions diminished.

*here is some evidence to suggest that there is an increased prevalence of schi!oid personality disorder in relatives of people with schi!ophrenia or schi!otypal personality disorder. <enetic and environmental factors both come into play for schi!oid personality disorder. ome mental health professionals speculate that a bleak childhood lacking in warmth and emotion contributes to this disorders development. ome schi!oid disorder case studies suggest patients may be unable to respond to normal social cues, making them inept at initiating or maintaining relationships. *he literature does indicate a slightly increased rate of schi!oid personality disorder among first'degree relatives of schi!ophrenia or schi!otypal personality disorder patients. #owever, the familial pattern link remains ambiguous. .any researchers contend that schi!oid disorder signs typically appear in adolescence or late childhood. &thers maintain that the onset is in early childhood with some schi!oid personality disorder symptoms appearing in childhood, continuing through adolescence, and into early adulthood. *he defining schi!oid personality disorder symptom is the desire for social isolation. *his is usually in con3unction with a diminished range of emotional expression and experience, all of which may be present in a variety of contexts. =schi!oid personality has a constitutional, probably genetic, basis.= &ther researchers had hypothesi!ed that unloving, neglectful, or excessively perfectionist parenting could play a role. Treatment *he medication most recently used to treat the negative symptoms is risperidone. "efore this, there was no psychotropic medication that made an impact on the negative symptoms.>?@A 1ow doses of risperidone or olan!apine also work for the social deficits and blunted affect, 0ellbutrin 6bupropion7 for anhedonia. social anxiety may not be a main concern for the people who have P%. upportive psychotherapy is also used in an inpatient or outpatient setting by a trained professional that focuses on areas such as coping skills, improvement of social skills and social interactions, communication, and self'esteem issues. ociali!ation groups may help these people with P%. ,ducational strategies in which people who have P% identify their positive and negative emotions also are effective. uch identification helps them to learn about their own emotions and the emotions they draw out from others and to feel the common emotions with other people with whom they relate. *his can help people with P% create empathy with the outside world.

Epidemiolo y P% is uncommon in clinical settings and occurs slightly more commonly in males. )t is rare compared with other personality disorders, with a prevalence estimated at less than 9B of the general population.

S"#i$otypal personality disorder

A personality disorder characteri!ed by extreme discomfort in close relationships, odd forms of thinking and perceiving, and behavioral eccentricities. Symptoms

Dia nosis *he American Psychiatric Association defined chi!otypal Personality %isorder as a =pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts=. C C C )nappropriate or constricted affect 6the individual appears cold and aloof7; "ehavior or appearance that is odd, eccentric or peculiar; Poor rapport with others and a tendency to social withdrawal;

C &dd beliefs or magical thinking, influencing behavior and inconsistent with subcultural norms; C uspiciousness or paranoid ideas;

C &bsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents; C -nusual perceptual experiences including somatosensory 6bodily7 or other illusions, depersonali!ation or dereali!ation; C 8ague, circumstantial, metaphorical, over'elaborate or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence; C &ccasional transient 2uasi'psychotic episodes with intense illusions, auditory or other hallucinations and delusion'like ideas, usually occurring without

external provocation. *he disorder runs a chronic course with fluctuations of intensity. &ccasionally it evolves into overt schi!ophrenia. *here is no definite onset and its evolution and course are usually those of a personality disorder. )t is more common in individuals related to people with schi!ophrenia and is believed to be part of the genetic =spectrum= of schi!ophrenia.

] Subtypes
Theodore Millon proposes two subtypes of schizotypal.[3][7] ny indi!idual with schizotypal personality disorder "ay e#hibit either one of the followin$ so"ewhat different subtypes (%ote that Millon belie!es it is rare for a personality with one pure !ariant& but rather a "i#ture of one "a'or !ariant with one or "ore secondary !ariants() Sub type Insi pid schi zoty pal Tim oro us schi zoty pal Description structural e#a$$eration of the passi!e*detached pattern. +t includes schizoid& depressi!e& dependent features. Personality Traits ,ense of stran$eness and nonbein$- o!ertly drab& slu$$ish& ine#pressi!e- internally bland& barren& indifferent& and insensiti!e- obscured& !a$ue& and tan$ential thou$hts.

structural e#a$$eration of the acti!e*detached pattern. +t includes a!oidant& ne$ati!istic .passi!e* a$$ressi!e( features. ETI*L*+,

/arily apprehensi!e& watchful& suspicious& $uarded& shrin0in$& deadens e#cess sensiti!ityalienated fro" self and others- intentionally bloc0s& re!erses& or dis1ualifies own thou$hts.

+eneti":Although listed in the % .')8'*D on axis )), schi!otypal personality disorder is widely understood to be a =schi!ophrenia spectrum= disorder that is on axis ). Dates of schi!otypal P% are much higher in relatives of individuals with schi!ophrenia than in the relatives of people with other mental illnesses or in people without mentally ill relatives. *echnically speaking, schi!otypal P% may also be considered an =extended phenotype= that helps geneticists track the familial or genetic transmission of the genes that are implicated in schi!ophrenia. So"ial and en%ironmental *here is now evidence to suggest that parenting styles, early separation, trauma/maltreatment history 6especially early childhood neglect7 can lead to the development of schi!otypal traits.

&ver time, children learn to interpret social cues and respond appropriately but for people with this disorder, they have a hard time in going past this process successfully so this might lead to irrational beliefs. )t(s been known that during this process, childhood abuse can alter the brain functioning. chi!otypal personality disorders are characteri!ed by a common attentional impairment in various degrees. tudy suggest that attention deficits could serve as a marker of biological susceptibility to schi!otypal personality disorder.>9EA *he reason is that an individual who has difficulties taking in information may find it difficult in complicated social situations where interpersonal cues and attentive communications are essential for 2uality interaction. *his might eventually cause the individual to withdraw from most social interactions, thus leading to asociality. T)EATME-T Psy"#ot#erapy According to *heodore .illon, the schi!otypal is one of the easiest personality disorders to identify but one of the most difficult to treat with psychotherapy. Persons with *P% usually consider themselves to be simply eccentric, creative, or nonconformist. As a rule, they underestimate maladaptiveness of their social isolation and perceptual distortions. )t is not so easy to develop rapport with people who suffer from *P% due to the fact that increasing familiarity and intimacy usually increase their level of anxiety and discomfort. )n most cases they do not respond to informality and humor. Pro nosis *here are do!ens of studies showing that individuals with schi!otypal P% score similar to individuals with schi!ophrenia on a very wide range of neuropsychological tests. +ognitive deficits in patients with schi!otypal P% are very similar to, but 2uantitatively milder than, those for patients with schi!ophrenia.