Personality Disorders

how are personality disorders distinct from other disorders?

Enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture, is pervasive and inflexible, and onset in adolescence/early adulthood…

primary symptom domains of personality disorders

• Cognition

• Emotions

• Interpersonal fx

• Impulse control

prevalence of personality disorders

9% for at least one personality disorder

• lots of comorbidity

course of personality disorders

◦Onset usually in adolescence or early adulthood

◦Less likely to remit with age

◦Some diagnosed more in men (antisocial) and others more in women (dependent)

schizotypal may exist on a continuum with…

schizophrenia

biological causes of schizotypal disorder

Genetic

• moderately heritable

• may be same genetic vulnerability as schizophrenia

brain

• alterations to left hemisphere or frontal lobes (based on cognitive testing)

what do cluster A disorders have in common?

odd/eccentric

paranoid personality disorder (A)

pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

• often confused with delusional disorder; however paranoid disorder starts early in life and persists constantly over time

what cluster is paranoid personality disorder?

A

schizoid personality disorder (A)

a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

what cluster is schizoid personality disorder?

A

schizotypal personality disorder (A)

a pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationiships, as well as by cognitive or perceptual distortions and eccentricities of behavior

what cluster is schizotypal personality disorder?

A

what do cluster B disorders have in common?

dramatic, emotional, or erratic disorders

antisocial personality disorder (B)

a pervasive pattern of disregard for and violation of the rights of others

2 main symptoms of cluster A disorders

1. social detatchment/inhibition

2. odd beliefs

paranoid disorder is marked by…

specific odd beliefs (about harm)

schizotypal disorder is marked by…

• broader odd beliefs (not just harm, like in paranoid)

• social detachment/inhibition

schizoid disorder is marked by…

social detachment/inhibition

borderline personality disorder (B)

a pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses

histrionic personality disorder

a pervasive pattern of excessive emotion and attention seeking

narcissistic personality disorder

a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy

list cluster A disorders

1. paranoid

2. schizoid

3. schizotypal

list cluster B disorders

1. antisocial

2. borderline

3. histrionic

4. narcissistic

list cluster c disorders

1. avoidant

2. dependent

3. obsessive-compulsive

what do classifies cluster C disorders?

anxiety or fear

avoidant personality disorder

pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

dependent personality disorder

a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

obsessive-compulsive personality disorder

a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency

which disorder is marked by instability?

borderline personality disorder

social/cultural causes of schizotypal

• childhood maltreatment in men

• low SES/Poverty + stressful life events

treatment of schizotypal

• combination of antipsychotic meds, community support services, and social skills training

• may seek treatment for depression

2 components of psychopathy

1. Affective/interpersonal – lack of remorse, guilt, empathy

2. Behavior – antisocial and impulsive actions

antisocial is commonly comorbid with…

substance use

rates of antisocial behavior _______ after 40 yo

decline

genetic causes of antisocial

moderate genetic risk in context of environmental stressors

neurobiological causes of antisocial

◦Underarousal theory – low levels of arousal lead to risk taking

◦Abnormal amygdala limits fear conditioning and detecting emotions

◦Imbalance between behavioral inhibition system (serotonin) and reward system (dopamine)

underarousal theory

low levels of arousal lead to risk taking

psychological causes of antisocial

difficulty processing and understanding emotions

social/cultural causes of antisocial

◦Early deprivation/loss

◦Parenting

• Poor monitoring

• Coercive family process – kid learns they get their way if they don’t give in

treatment for antisocial

◦Prevention is best option

◦Parent training when children show antisocial behaviors

common comorbidities of borderline

• depression

• biplar

• eating disorders

• substance use

genetic causes of borderline

twin studies show high concordance

neurotransmitter causes of borderline

low serotonin- related to impulsivity, mood regulation

brain causes of borderline

limbic system (smaller amygdala and hippocampus)

psychological causes of borderline

◦Emotional biases towards shame

◦Cognitive biases towards abandonment

social/cultural causes of borderline

early physical/sexual abuse (seen in 90% of BPD cases)

are medications helpful in treating borderline?

help mildly

treatment of borderline

◦Medications help mildly

◦Dialectical Behavior Therapy (type of CBT)

• Hierarchical focus

- Self-harm

- Behaviors that interfere with therapy

• Behaviors that interfere with quality of life

◦Focus on…

• Distress tolerance

• Interpersonal skills

• Processing trauma

borderline treatments focus on…

◦Distress tolerance

◦Interpersonal skills

◦Processing trauma

feelings of inadequacy are seen in which 2 cluster C disorders?

1. dependent

2. avoidant

what disorder is characterized by social inhibition and feelings of inadequacy?

avoidant

what disorder is characterized by need to be taken care of and feelings of inadequacy?

dependent

how many symptoms are required for schizotypal diagnosis?

5 (pervasive, over lifetime)