personality disorders

1

PERSONALITY PERSONALITY DISORDERSDISORDERS

2

Definition of Personality Definition of Personality Disorder - Axis IIDisorder - Axis II

• Enduring pattern of experience and behaviorEnduring pattern of experience and behavior– Cognition, Affect, Interpersonal Functioning, Cognition, Affect, Interpersonal Functioning,

Impulse ControlImpulse Control• Cross-situation stability - inflexibilityCross-situation stability - inflexibility• Leads to impaired functioning, distressLeads to impaired functioning, distress

3

Classifying Personality Classifying Personality DisordersDisorders

Personality disorders are grouped into three clusters based ondescriptive similarities.

Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders These persons appear odd or eccentric.

Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic These persons appear dramatic, emotional, or erratic.

Cluster C: Avoidant, Dependent, and Obsessive-Compulsive These persons appear anxious or fearful.

4

Etiology of Personality Etiology of Personality DisordersDisorders

GeneticsMonozygotic twins reared apart have nearly same personalities

Cluster A: more common in the biological relatives of patients withschizophrenia than among control groups.

Cluster B: Antisocial personality disorder is associated with alcohol use disorders; depression is common in family backgroundsof patients with borderline personality disorder; a strong correlation between histrionic and somatization disorders

5


Cluster C: Patients with avoidant personality often have high anxiety levels; obsessive-compulsive traits are more common in monozygotic twins than in dizygotic twins - they also show some signs of depression.

Neurotransmitters also seem to play a role. 5-HIAA, a metabolite of serotonin is low in people who are impulsive and aggressive.

6


Environmental FactorsChildren with minimal brain damage are at risk for antisocial personality disorder.

Link between fearful children raised by fearful mothers and avoidant personality disorder.

Cultures that encourage aggression may contribute to paranoid and antisocial personality disorders.

7

Cluster A Personality Cluster A Personality DisordersDisorders

Paranoid Personality DisorderMarked by a pervasive distrust and suspiciousness of others.Often misinterpret the motives and actions of others as malevolent.

Differentiated from delusional disorder by the absence of of fixed delusions. Unlike schizophrenics, they have no hallucinations or formal thought disorder.Differ from borderlines because they are mostly incapable of overly involved, tumultuous relationships with others.No long history of antisocial activity.Schizoids are withdrawn and aloof and do not have paranoid ideation.

8


Schizoid Personality DisorderA pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Do not have schizophrenic relativesMay have successful, but isolated work historiesNo thought disorder or delusional thinkingUnlike avoidant personalities, who are also isolated, schizoid personalities do not wish to participate in activities

9


Schizotypal Personality DisorderPronounced interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.

Will have family history of schizophreniaNo psychosis, or brief, fragmented psychosisSome involved in cults, strange religious practices, and the occultMay meet criteria for both schizotypal and borderlineMay have suspiciousness, but also have odd behavior

10

Cluster B Personality Cluster B Personality DisordersDisorders

Antisocial Personality DisorderA disregard for and violation of the rights of others occurring since age 15. Also marked by an inability to conform to the social norms that ordinarily govern many aspects of people’s adolescent and adult behavior.

May have a neurological or mental disorder that has gone undiagnosedCan be the byproduct of long-term substance abuse, but the primary (substance abuse) should be diagnosed rather than antisocial personality

When antisocial behavior is the only manifestation, patients are diagnosed in the category “additional conditions that may be the focus of clinical attention,”(adult antisocial behavior)

11


Borderline Personality DisorderPervasive pattern of unstable interpersonal relationships, self-image, and affects, and marked impulsivity by early adulthood.

Unlike schizophrenics they have no prolonged psychotic episodes, thought disorder, or other classic schizophrenic symptomsGenerally have chronic feelings of emptiness and short-

lived psychotic episodesAct impulsively and demand extraordinary relationshipsMay mutilate themselves and perform manipulative suicide

attempts

12


Histrionic Personality DisorderPattern of excessive emotionality and attention seeking, beginning by early adulthood.

Difficult to distinguish from borderline, but borderline will have suicide attempts, identity diffusion, and brief psychotic episodes.Patient can have bothSomatization disorder may also occurPatients with brief psychotic disorder and dissociative disorder may warrant a coexisting diagnosis of histrionic personality disorder

13


Narcissistic Personality DisorderA pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood.

Borderline, histrionic, and antisocial personality disorders often accompany narcissistic personality disorder, making a differential diagnosis difficultThey have less anxiety than borderlinesLives are less chaoticLess likely to attempt suicideLack history of impulsive behavior that get them into legal troubleDo show features of exhibitionism and interpersonal manipulativeness similar to those of histrionics

14

Cluster C Personality Cluster C Personality DisordersDisorders

Avoidant Personality DisorderShow an extreme sensitivity to rejection and may lead socially withdrawn lives. Appear shy and need unusually strong guarantees of uncritical acceptance. Often described as having an inferiority complex.

Schizoids want to be alone, avoidant personalities don’t Not as demanding, unpredictable, and irritable as borderlines or histrionicsSimilar to dependent personality disorder except that dependent personalities have a stronger fear of being abandoned or unloved, but it may be difficult to sort this out

15


Dependent Personality DisorderA pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

Traits of dependence are found in many disorders such as borderline and histrionic or agoraphobia Dependent personalities tend to have long-term relationships with one personNot overly manipulative

16


Obsessive-Compulsive Personality DisorderCharacterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness. The essential feature is a pervasive pattern of perfectionism and inflexibility.

When recurrent obsession or compulsions are present, obsessive-compulsive disorder should be noted on Axis IIn some cases, delusional disorder coexists

17

Cluster C Personality Cluster C Personality Disorders (Research)Disorders (Research)

Passive-Aggressive Personality DisorderA pervasive pattern of negative attitudes and passive resistance to demands for adequate performance.

• Passively resists fulfilling routine social and occupational tasks• complains of being misunderstood and unappreciated by others• is sullen and argumentative• unreasonably criticizes and scorns authority• expresses envy and resentment toward those more fortunate• voices exaggerated and persistent complaints of misfortune• alternates between hostile defiance and contrition

personality disorders

Health & Medicine