personality disorers

personality disorders

• enduring patterns of perceiving, relating to and thinking about the environment and oneself that cause impairment and/or distress

• presumably evidence by adolescence and stable over the adult lifespan

what makes a PD a disorder

• personal distress

• causes others distress

how are PDs different from other disorders

• other disorders = ego-dystonic

• personality disorders = ego-syntonic

egodystonic

• dissonant with person’s self image

• personal distress, discomfort with ones symptoms

egosyntonic

• consistent with persons self image

• they do not bother the person

why is it important to treat PDs

• significant impairment

• risk factor for other mental disorders

• treatment implications

PD clusters

cluster A: odd and eccentric

cluster B: dramatic, emotional, or erratic

Cluster C: Anxious, fearful, or avoidant

cluster A: odd and eccentric

• paranoid PD

• schizoid PD

• schizotypal PD

cluster B: dramatic, emotional, or erratic

• narcissistic PD

• antisocial PD

• borderline PD

• histrionic PD

cluster c: anxious, fearful, or avoidant

• avoidant PD

• dependent PD

• obsessive compulsive PD

narcissistic PD

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

symptoms of narcissistic PD

need five or more:

• grandiose sense of self importance

• preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love

• believes that he or she is special and unique

• requires excessive admiration

• sense of entitlement

• interpersonally exploitive

• lacks empathy — unwilling to recognize or identify with the feelings and needs of others

• often envious of others or believes others are envious of him/her

• shows arrogant, haughty behaviors or attitudes

NPD associated features

• unrealistically high self view

• overly sensitive to criticism or defeat

• ambitious and confident

• relationship problems

treatment for NPD

evidence base is small and progress tends to be slow, long term, and requires a strong therapeutic alliance

antisocial personality disorder

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

symptoms of antisocial personality disorder

need 3 or more of the following:

• repeatedly breaks the law

• deceitfulness

• impulsivity / failure to plan ahead

• irritability or aggressiveness

• reckless disregard for safety of self or others

• consistent irresponsibility

• lack of remorse

psychopathy

emotional/interpersonal

social deviance

• not in the DSM 5

• subset of antisocial personality disorder

• predicts recidivism: reoffending

• better predictor of future bad behavior

emotional/interpersonal psychopathy

• glib & superficial

• egocentric & grandiose

• shallow emotions

• lack of remorse and guilt

• deceitful & mainpulative

social deviance psychopathy

• impulsive

• poor behavior controls

• need for excitement

• lack of responsibility

• early behavior problems

• adult antisocial behavior

borderline PD

pervasive pattern of instability in personal relationships, self-image, and affects, and marked impulsivity

symptoms of borderline PD

five or more:

• frantic efforts to avoid abandonment

• pattern of unstable and intense personal relationships

• identify disturbance

• self-damaging impulsivity

• recurrent suicidal behavior, gestures, threats

• affective instability

• chronic feelings of emptiness

• inappropriate, intensive anger, or difficulty controlling anger

• transient, stress-related paranoid ideation or severe dissociation

treatment for borderline PD

dialectical behavior therapy (DBT)

Dialectical Behavior Therapy (DBT)

• DBT reconceptualize Borderline PD as dysregulation of sense of self, relationships and emotions

• main treatment goal is to address emotional dysregulation

etiology of cluster B / borderline

people with childhood maltreatment

• more likely to develop personality disorders

• especially borderline PD