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Personality Disorders

Marc A. Schuckit, M.D.University of California, San

DiegoVA San Diego Healthcare

System

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GREEK TEMPERAMENTS

Sanguine

Melancholic

Choleric

Phlegmatic

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FREUD

Oral

Anal

Phallic

Genital

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DEFINITIONS Personality - Usual Emotional +

Behavioral Characteristics Personality Traits - Components of

Personality Temperament - Affective Tone,

Intensity, Reactivity Character - Moral + Personality Traits

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PERSONALITY DISORDERS Totality of Emotional +

Behavioral Traits Onset Teens Enduring, Inflexible, Consistent,

Maladaptive Causes Significant Impairment

and/or Distress

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DSM IV PDAxis II10 Diagnoses + NOS +

AppendixPolytheticClusters

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DSM IV PERSONALITY DISORDERS

ParanoidSchizoidSchizotypalAntisocialBorderline

HistrionicNarcissisticAvoidantDependentObsessive-

Compulsive

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CLUSTERSA. Odd or Eccentric

Paranoid Schizotypal

Schizoid

B. Dramatic or ErraticAntisocial Histrionic

Borderline Narcissistic

C. AnxiousAvoidant Obsessive - Compulsive

Dependent

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CHARACTERISTICS OF PD Relation to Axis I 10% - 20% of General Population Gender : ASPD, Schizoid

Avoidant, Dependent Etiological Theories

DynamicBiological / Genetic

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PERSONALITY DISORDERS

Totality of emotional + behavioral traits

Onset teens Enduring, inflexible, consistent,

maladaptive Causes significant impairment

and/or distress

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PARANOID PDPervasive Distrust + Suspiciousness,

Interpret Motives as Evil

4 + of :

Suspicious Feels Attacked

Preoccupation with Distrust Jealous

Won’t Confide Grudges

Misinterprets Motives

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SCHIZOID PDDetached + Few Emotions

4 + of :

Eschew Closeness No Close Friends

Solitary Indifferent

No Sex Interest Cold

Not Enjoy Activities

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SCHIZOTYPAL PDDiscomfort with Relationships, Cognitive

Distortions + Eccentric

5 + of :Ideas of Reference Odd Magical Beliefs

Perceptual Disturbances Odd Thoughts/Speech

Paranoia Inappropriate Affect

Odd Behavior/Appearance Loner

Anxious Socially

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ANTISOCIAL PD (ASPD)

Disregard Rights of Others (and meet Conduct Disorder)

3 + of :

Unlawful Reckless

Deceitful Irresponsible

Impulsive Lack Remorse

Aggressive

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BORDERLINE PDUnstable Relationships, Affect, Self-Image

Plus Impulsiveness

5 + of :Fears Abandonment Mood Shifts

Unstable Relationships Feels Empty

Changing Self-Image Anger

Impulsive Sex, Spending, Temporary Etc Paranoia

Suicidal Behavior

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HISTRIONIC PDExcessive Emotionality, Attention

Seeking

5 + of :

Needs Attention Preens

Seductive Dramatic

Mood Shifts Suggestible

Impressionistic, Exaggerates Vague Speech Relationships

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NARCISSISTIC PDGrandiose, Needs Admiration, Without

Empathy

5 + of :

Self Important Exploitative

Fantasies of Success Lacks Empathy

Feels Special Envious

Needs Admiration Arrogant

Entitled

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AVOIDANT PDInhibited, Inadequate, Sensitive

4 + of : Avoids Social Activity

Reluctant Relationships

Fears Intimacy

Fears Criticism

Avoids New Activities

Sees Self Inferior

Fears Embarrassment

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DEPENDENT PDNeeds to be Taken Care of, Fears Separation

5 + of :

Indecisive Seeks Nurturance

Avoids Responsibility Fears Solitude

Avoids Frantic for Disagreements Relationships

Lacks Initiative Fears Abandonment

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OBSESSIVE-COMPULSIVE PD

Orderliness, Perfectionist, Inflexible

4 + of :

Detail Oriented Unable to Discard

Perfectionism Can’t Delegate

Work Oriented Miserly

Over Conscientious Rigid

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PASSIVE-AGGRESSIVE PD

Negative Attitudes with Passive Resistance to Demands

4 + of :Passive Envious, Resentful

Misunderstood, Exaggerated Unappreciated Complaints

Sullen, Argumentative Defiant then Contrite

Scorns Authority

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PERSONALITY DISORDERS Totality of Emotional +

Behavioral Traits Onset Teens Enduring, Inflexible,

Consistent, Maladaptive Causes Significant

Impairment and/or Distress

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SUMMARY PART IParanoid Suspicious, Jealous, But Not

Psychotic or Unlawful

Schizoid Unemotional, Cold, Indifferent

Schizotypal Odd + Magical Beliefs, Behaviors, Not Paranoid

ASPD Aggressive, Unlawful, Impulsive

Borderline Unstable, Chaotic, Impulsive Not Aggressive or Unlawful

Histrionic Dramatic, Seductive But Not Chaotic

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SUMMARY PART IINarcissistic Self-Centered, Entitled, Lacks

Empathy But Not Unlawful or Chaotic

Avoidant Needs People But Fears Relationships

Dependent Needs Relationships, Indecisive, Fears Abandonment

Obsessive- Rigid, Perfectionist + Inefficient

Compulsive

Passive- Negative Attitudes with Passive Aggressive Resistance to Demands

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INSTRUMENTS FOR PD

Mostly Current StatusSome Focus on

Temperament or Personality Components

Few Consider Full Diagnostic Syndrome