personality disorders symptoms diagnosis frequency
TRANSCRIPT
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Personality Disorders
SymptomsDiagnosisFrequency
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Personality: enduring patterns of thinking and behavior that define the person and distinguish him or her from other people.
Personality disorder - emphasizes the duration of the pattern and the social impairment associated with the traits in question.
Disorders characterized by extreme and rigid personality traits that cause impairment
Axis II disorders Ego syntonic
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The concept of social dysfunction plays an important role.
If the personality characteristics typically interfere with the person’s ability to get along with other people and perform social roles, they become more than just a collection of eccentric traits or peculiar habits.
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Social MotivationMotives describe the way that the person would like things to be, and they help to explain why people behave in a particular fashion.
Two of the most important motives in understanding human personality areaffiliation—the desire for close relationships with other people.
power—the desire for impact, prestige, or dominance.
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Social MotivationMany of the symptoms of personality disorders can be described in terms of maladaptive variations with regard to needs for affiliation and power.
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Cognitive Perspectives Regarding Self and OthersOne central issue involves our image of ourselves.Is the self-image stable?Is self-esteem maintained by external validation?
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Prevalence in Community and Clinical SamplesThe overall lifetime prevalence for
having at least one personality disorder varies between 10% and 14%.
Highest prevalence rates for OCPD, ASPD, and APD.
75% of patients with Axis II disorder also have Axis I disorder.
Low rates for NPD may not recognize the nature of their own problems.
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Gender DifferencesThe overall prevalence of
personality disorders is approximately equal in men and women.
Antisocial personality disorder: 5% reported for men and 1% for women
Gender Bias and DiagnosisCritics contend that the definitions
of some categories are based on sex role stereotypes and therefore are inherently sexist.
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Stability of Personality Disorders over TimeTemporal stability is one of the most
important assumptions about personality disorders.
The long-term prognosis is less optimistic for schizotypal and schizoid personality disorders. People with these diagnoses are likely to remain socially isolated and occupationally impaired.
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Cluster A are people who are perceived as odd or eccentric
Includes paranoid, schizoid, and schizotypal personality disorders
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Cluster B are people whose behavior is overly dramatic, emotional, or erratic
Includes antisocial, borderline, histrionic and narcissistic personality disorders
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Cluster C are people who often appear anxious or fearful
Includes avoidant, dependent, and obsessive-compulsive personality disorders
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Paranoid Personality Disorder
Personality traits involving extreme distrust and suspiciousness.
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Paranoid Personality Disorder Includes four or more of the following:
Suspiciousness of others Unjustified doubts about disloyalty Reluctance to confide in others Reading threatening meanings into benign events Persistent tendency to bear grudges Tendency to feel attacked and counterattack Unjustified suspiciousness about infidelity of partner
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Schizoid Personality DisorderPersonality traits involving detachment from social relationships and a restricted range of emotional expression
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Schizoid Personality Disorder Include four or more of the following:
Neither desires nor enjoys close relationshipsAlmost always chooses solitudeLittle if any interest in sexual relationshipsTakes pleasure in few activitiesLacks close friendsIndifferent to praise or criticismEmotional coldness, detachment or flatness
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Schizotypal Personality Disorder
Personality traits involving eccentricities of behavior, cognitive or perceptual distortions, and acute discomfort in close relationships
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Schizotypal Personality DisorderFive or more of the following:
Ideas of referenceOdd beliefs or magical thinkingUnusual perceptual experiencesOdd thinking and speechSuspiciousness or paranoid ideasInappropriate or constricted affectOdd, eccentric or peculiar behavior or appearanceLack of close friendsExcessive social anxiety
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Antisocial Personality DisorderPersonality traits
involving profound disregard for, and violation of, the rights of others
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Antisocial Personality DisorderIncludes three or more of the following:Failure to conform to lawful behaviorDeceitfulnessImpulsivityIrritability or aggressivenessReckless disregard for safety of self and
othersConsistent irresponsibilityLack of remorse
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Borderline Personality Disorder
Personality traits involving instability in interpersonal relationships, self-image, and emotions, impulsivity, and self-destructive behavior
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Borderline Personality Disorder
Five or more of the following:
Frantic efforts to avoid abandonmentUnstable and intense relationshipsUnstable self imageImpulsivity (self destructive)Suicidal behaviorAffective instabilityChronic feelings of emptinessInappropriate, intense anger
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One of the most perplexing, most disabling, and most frequently treated forms of PD.
Otto Kernberg (1967, 1975)BPD refers to a set of personality
features or deficiencies that can be found in individuals with various disorders.
Common features/abnormal behaviors of BPDSplitting- alternately seeing people as
entirely good or entirely bad.Impulse control problemsSee Figure 9-1
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TreatmentMost difficult to treat.Between 1/2 to 2/3 of all patients with BPD
discontinue treatment prematurely.Marsha Linehan – Dialectical Behavioral
Therapy (DBT)Emphasis: Learning to be more
comfortable with strong emotions.Emphasis: Therapist’s acceptance of the
patient and their negative behaviors.
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Women treated with DBT tend to drop out of treatment at a lower rate; tend to experience more improvement than women in control groups.
Medication is frequently used adjunctively. AntipsychoticsAntidepressantsLithiumAnticonvulsants.
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Histrionic Personality Disorder
Personality traits involving excessive, superficial emotionalityand attention seeking
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Histrionic Personality Disorder Five or more of the following:Uncomfortable if not the center of attentionInappropriately seductive or provocativeRapidly shifting and shallow emotionsUse of appearance to draw attention Speech is impressionistic and lacking in detailSelf-dramatization, theatricalitySuggestibilityConsiders relationships more intimate than they
are
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Narcissistic Personality Disorder
Personality traits involving extreme grandiosity, need for admiration, and lack of empathy
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Narcissistic Personality DisorderFive or more of the following:
Grandiose sense of self-importance Preoccupied with fantasies of unlimited success, power,
brilliance, etc. Belief that he or she is “special” Requires excessive admiration Sense of entitlement Interpersonally exploitative Lacks empathy Often envious Arrogant or haughty
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Personality traits involving social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
• Avoidant Personality Disorder
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Avoidant Personality Disorder Four or more of the following:
Avoids activities due to fear of criticism, disapproval or rejection
Unwilling to get involved with people unless certain of being liked
Restrained in relationships due to fear of being shamed or ridiculed
Preoccupied with criticism or rejection in social situations
Inhibited in new situations due to feelings of inadequacy
Views self as inept, unappealing, inferior
Reluctant to take personal risks
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Dependent Personality Disorder
Personality traits involving submissive and clinging behavior related to an excessive need to be cared for by others
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Dependent Personality Disorder Five or more of the following:
Excessive need for advice and reassurance to make decisions Needs others to assume responsibility for most areas of life Difficulty expressing disagreement Difficulty initiating or doing things on own Goes to excessive lengths for nurturance or support Feels helpless when alone, due to exaggerated fears of being unable to care for self
Urgently seeks new relationship if close relationship ends
Preoccupied with fears of being left to care for self
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CAUSES TREATMENT
Little research on the etiology of DPD.
Overprotective, authoritarian parents are likely to foster development of dependency.
Insecurely or anxiously attached children are likely to become dependent.
Virtually no literature on the outcome of treatment for DPD.
Enter therapy for other reasons, such as depression, anxiety or substance use disorder.
Cognitive therapy Psychopharmacology
is typically not used.
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Obsessive-Compulsive Personality DisorderPersonality traits involving preoccupation with orderliness, perfectionism, and control at the expense of spontaneity, flexibility, and enjoyment
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Obsessive-Compulsive Personality DisorderFour or more of the following:
Preoccupation with rules, lists, order, schedules, etc.PerfectionismExcessive devotion to work and productivityOver-conscientious, scrupulous, inflexible about moralityInability to discard worn-out or worthless objectsReluctance to delegate tasks or work with others unless they submit to exactly his or her way of doing thingsMiserly spending styleRigidity and stubbornness