In-Depth Notes on Personality Disorders

Personality Disorders Overview

• Personality Disorders: Enduring patterns of thoughts, feelings, and behaviors that deviate from cultural norms, leading to distress or impairment in functioning.
• Prevalence: Affects about 3%-15% of the general population; higher in clinical settings.
• Origins: Typically start in childhood and can be chronic with high comorbidity.

DSM-5 General Criteria for Personality Disorders

• Enduring Behavior Patterns: Inflexible and pervasive across personal and social situations.
• Clinically Significant Distress: Causes impairment in functioning and significant distress.
• Manifestation: Must be present in at least two areas:
  • Cognition: Patterns of thinking.
  • Affectivity: Range and intensity of emotional responses.
  • Interpersonal functioning: Relationships with others.
  • Impulse control: Managing urges and compulsions.

Clusters of Personality Disorders

• Cluster A (Odd/Eccentric): Includes Paranoid, Schizoid, and Schizotypal.
• Cluster B (Dramatic/Erratic): Includes Antisocial, Borderline, Histrionic, and Narcissistic.
• Cluster C (Fearful/Anxious): Includes Avoidant, Dependent, and Obsessive-Compulsive.

Cluster A Disorders

1. Paranoid Personality Disorder

• Characteristics: Suspiciousness, distrust towards others; sees threats everywhere.
• Core Beliefs: "People are untrustworthy and dangerous."
• Mnemonic: SUSPICIOUS (suspicion, unforgiving, social isolation).

2. Schizoid Personality Disorder

• Characteristics: Emotional detachment and limited emotional expression; prefers solitary activities.
• Core Beliefs: "Intimacy is unneeded and complicates life."
• Mnemonic: DISTANT (detached, indifferent, solitary).

3. Schizotypal Personality Disorder

• Characteristics: Acute discomfort in relationships, eccentric behaviors, and distorted thinking.
• Core Beliefs: "I am an outsider; the world is unsafe."
• Mnemonic: MEPECULIA (magical thinking, eccentricity, paranoid ideation).

Cluster B Disorders

1. Antisocial Personality Disorder

• Characteristics: Disregard for others' rights; lack of remorse.
• Core Beliefs: "People are merely tools for my objectives."
• Mnemonic: CORRUPT (cannot follow law, remorseless).

2. Borderline Personality Disorder

• Characteristics: Instability in relationships, self-image, and emotions; marked impulsivity.
• Core Beliefs: "I am unlovable; I need others for survival."
• Mnemonic: AM SUICIDE! (abandonment fears, mood instability).

3. Histrionic Personality Disorder

• Characteristics: Excessive emotionality and attention-seeking.
• Core Beliefs: "I must be the center of attention to be happy."
• Mnemonic: PRAMES EM (provocative behavior, must be center of attention).

4. Narcissistic Personality Disorder

• Characteristics: Grandiosity, need for admiration, lack of empathy.
• Core Beliefs: "I am special and deserve special treatment."
• Mnemonic: SPECIAL (special, entitled, conceited).

Cluster C Disorders

1. Avoidant Personality Disorder

• Characteristics: Social inhibition and feelings of inadequacy; hypersensitivity to critique.
• Core Beliefs: "I am unworthy of love and incapable."
• Mnemonic: AVOIDED (avoids activities, views self as inferior).

2. Dependent Personality Disorder

• Characteristics: Excessive need for care; submissive and clinging behaviors.
• Core Beliefs: "I cannot function without someone to care for me."
• Mnemonic: DEPEND (difficulty making decisions, needs reassurance).

3. Obsessive-Compulsive Personality Disorder

• Characteristics: Preoccupation with orderliness, perfectionism, and control.
• Core Beliefs: "If I am not perfect, I am a failure."
• Mnemonic: LAW FIRMS (loses point of activity, cannot discard items).

Causes and Treatment of Personality Disorders

• Causes: Often involve a mix of genetic, environmental, and psychological factors; early life experiences significantly impact the development of these disorders.
• Treatment: May include psychotherapy (like CBT or DBT), medication for co-occurring symptoms (anxiety, depression), and skill training for social competence.

Consequences of Diagnostic Issues

• Under-diagnosis: Leads to missed treatment opportunities, increased social and occupational difficulties.
• Over-diagnosis: Causes stigma, affects future diagnoses, and alters provider interactions with patients.