Personality Disorders

What is a personality disorder?

when personality traits are so inflexible and maladaptive across a wide range of situations that they cause significant distress and impairment of social, occupational, and role functioning.

Diagnosing personality disorder two sets of criteria

• General characteristics of personality disorder

• features specific to individual

general characteristics of a personality disorder

An enduring, inflexible, pervasive patter, not originating from a physiologic cause or other mental disorder that is stable, of long duration and that deviates from cultural expectations and causes significant distress/impairment

features specific to individual personality disorder

Patient condition that meets criteria for a specific personality disorder meets the general criteria

disorders that fall under cluster A

• paranoid

• schizoid

• schizotypal

disorders that fall under cluster B

• Antisocial

• Borderline

• Histrionic

• Narcissistic

disorders that fall under cluster C

• avoidant

• dependent

• obsessive-compulsive personality disorder

cluster A

individuals may appear odd and eccentric

cluster B

Individuals often appear dramatic, emotional or erratic

cluster C

individuals often appear anxious or fearful

paranoid

Distrust and suspiciousness of others such that their motivesmare interpreted as malevolent

characteristics of paranoia

◦ Others plotting

◦ unjustified doubts

◦ Reluctant to confide in others

◦ Reads hidden demeaning or threatens

◦ Bears grudges

◦ Perceives attacks on their character or reputation

◦ Suspicion without justification

characteristics of schizoid

◦ Neither desires nor enjoys close relationship

◦ Solitary activities

◦ Has little if any interest in sexual experiences

◦ Takes pleasure in few, if any activities

◦ Lacks close friends or confidants

◦ Appears indifferent to the praise or criticism of others

◦ Shows emotional coldness, detachment or flattened affectivity

charateristics of schizotypal

◦ Ideas of reference

◦ Odd beliefs or magical thinking

◦ Unusual perceptual experiences

◦ Odd thinking and speech

◦ Suspiciousness or paranoid ideation

◦ Inappropriate or constricted affect

◦ Behavior or appearance that is odd, eccentric or peculiar

◦ Lack of close friends or confidant other than first degree relatives

◦ Excessive social anxiety

treatment of paranoia

individual Therapy; Cognitive Behavioral Therapy; Group Therapy, antipsychotics in small doses

treatment of schizoid

Supportive psychotherapy; psychopharmacological interventions are not useful for this disorders pure form

treatment of schizoid

Individual Psychotherapy, Cognitive Behavioral Therapy, Group Therapy, Family Therapy; Antipsychotics for schizophrenic symptoms

schizoid

Detachment from social relationship (aloofness) and a restricted range of expression of emotions in interpersonal settings.

schizotypal

Social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentric behavior

antisocial

•Disregard for and violating the rights of others, lying, stealing, defaulting on debts, neglect of children or other dependents.

•Behaviors include criminality and failure to conform to the law

•Failure to sustain consistent employment

•Manipulation of others for personal gain

•Failure to develop stable interpersonal relationships

•Lack of empathy for others

•Rarely experience remorse

•Failing to learn from negative results of one’s experience

treatment for someone antisocial

difficult to treat; family therapy for prevention; CBT; Therapeutic Residential Communities

Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationship, self image and affects and marked impulsivity beginning by early adulthood and present in a variety of contexts

Borderline Personality Disorder characteristics

• Problem maintaining interpersonal relationships

• Problem maintaining reality-based thinking

• Problem: avoiding impulsive or destructive behaviors regulating their moods

• Problem developing a self-identity

treatment of BPD

dialectical behavioral therapy

forms of childhood trauma

• sexual abuse

• physical abuse

• verbal abuse

• neglect

• early parental separation or loss

Dialectical Behavioral Therapy

Combines cognitive and behavior therapy strategies with acceptance based practice

core interventions under dialectical behavioral therapy

Problem solving

Exposure techniques

Skills training

Contingency management

Cognitive modification

emotional dysregulation

the inability to control emotions in social interactions and includes an instability of mood, marked shifts to or from depression, stress related and transient mood crashes, rejection sensitivity and inappropriate and intense outbursts of anger.

self-harm

deliberate self-injurious behavior

narcissistic

Grandiosity (in fantasy or behavior) need for admiration, and lack of empathy, superficial and exploitative relationships

what can contribute to the developement of NPD

parenting styles

avoidant

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.

avoidant characteristics

◦ Avoids occupational activities

◦ Need to be liked

◦ Restraint within intimate relationships

◦ Preoccupation with being criticized or rejected in social situations

◦ Feelings of inadequacy

◦ Feels socially inept, personally unappealing or inferior to others

◦ Reluctant to take personal risk

Dependent

Feels of inadequacy, inability to make own decisions, submissiveness, avoidance of confrontation for fear of losing source of support

dependent characteristics

◦ Difficulty making everyday decisions

◦ Others assume responsibility

◦ Difficulty expressing disagreement

◦ Difficulty initiating projects

◦ Excessive need for nurturance and support from others

◦ Feels uncomfortable or helpless when alone

◦ Need new relationship when a close relationship ends

◦ Unrealistically fear of being left to take care of themself

dependent treatment

Psychodynamic Therapy

Obsessive-Compulsive Personality Disorder

Preoccupation with perfectionism, mental and interpersonal control and orderliness at the expense of flexibility, openness and efficiency

Obsessive-Compulsive Personality Disorder

◦ Preoccupied with details, rules, lists, order, organization, schedules

◦ Perfectionisms interferes with task completion

◦ Excessively devoted to work and productivity

◦ Overconscientious, scrupulous and inflexible about matters of ethics or values

◦ Unable to discard worn out or worthless objects

◦ Reluctant to delegate tasks unless done exactly their way

◦ Miserly spending

◦ Rigidity and stubbornness

Obsessive-Compulsive Personality Disorder treatment

Psychodynamic Therapy; Psychoanalysis