Psych 133D (Personality Disorders)

Personality Disorders Lecture by Annabel Kady

Non-disordered Personality Characteristics:

• Function autonomously and competently

• Not overly dependent on others

• Adjust effectively to social environments

• Flexible personality

• Generally content and satisfied (Millon, 2004)

Personality Disorders Defined

Definition: Enduring patterns of thought and behavior deviating from cultural norms.Characteristics:

• Inflexible and pervasive

• Present in at least 2 of:

  • Cognition (cognitive distortions)

  • Affectivity (mood issues)

  • Interpersonal functioning

  • Impulse control (risk to self or others)

• Causes distress or impairment

Ego Syntonic vs. Ego Dystonic

• Ego Syntonic: Aligns with self-image; no guilt feelings.

• Ego Dystonic: Against personal wills; feels intrusive; desire to change.

Clusters of Personality Disorders

• Cluster A: Odd/eccentric behavior

  • Paranoid, Schizoid, Schizotypal

• Cluster B: Dramatic/erratic behavior

  • Antisocial, Borderline, Histrionic, Narcissistic

• Cluster C: Anxiety/fear

  • Avoidant, Dependent, Obsessive-Compulsive

Prevalence of Personality Disorders

• General population: 10-15%, Clinical settings: >50%

• Most common: Borderline PD (inpatients), Antisocial PD (inmates)

Diagnosis of Personality Disorders

Cluster A: Odd and Eccentric Behavior

• Paranoid Personality Disorder: Distrust and suspicion of others.

• Schizoid Personality Disorder: Detachment from social relationships.

• Schizotypal Personality Disorder: Discomfort in close relationships and cognitive distortions.

Cluster B: Dramatic Behavior

• Borderline PD: Unstable relationships and self-image; impulsivity; need 5 or more symptoms.

• Histrionic PD: Excessive emotionality; need 5 or more symptoms.

• Narcissistic PD: Grandiosity; need 5 or more symptoms.

• Antisocial PD: Disregard for others' rights; need 3 symptoms; confirm Conduct Disorder before age 15.

Cluster C: Anxious Disorders

• Avoidant PD: Social inhibition; need 4 or more symptoms.

• Dependent PD: Need for others’ support; need 5 or more symptoms.

• Obsessive-Compulsive PD: Preoccupation with order and perfectionism; need 4 or more symptoms.

General Treatment Considerations

• Treatment difficulties due to denial, pessimism, and persistent symptoms.

• Combination of individual/group therapies and medications can be partially effective.

Study Guide for Exam

• Understand personality disorder definitions.

• Focus on etiology and treatment for Borderline, Narcissistic, Histrionic, Avoidant, Dependent, OCPD.

• Differentiate between various PDs, including OCD and OCPD.

References

• Bandelow B et al. (2023). World J Biol Psychiatry.

• Fava GA et al. (2001). Psychol Med.

• Millon, T. et al. (2004). John Wiley & Sons Inc.

• Tyrer P, Seivewright N. (1988). Clin Neuropharmacol.