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What is a Personality Disorder?

Explore the characteristics, diagnosis, and treatment of personality disorders, how they differ from general personality traits, and their impact on daily functioning. Learn about the three clusters of personality disorders and the specific types within each cluster.

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What is a Personality Disorder?

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  1. What is a Personality Disorder? • Personality characteristics that are unchanging and occur in most settings • Deviate from cultural norms • Cause poor life functioning • Long term traits; feel “natural” to the pt • Many pts display only when under stress

  2. How is it different from Personality? • The more general term, personality, is a consistent style of behavior • It is uniquely recognizable in EACH individual

  3. What Axis does a Personality Disorder fall under? • Axis II

  4. How does a personality disorder develop? • Begins to take shape in childhood • Become fixed by early 20s • Some occur after organic insult to brain (trauma) • Some have biologic and/or genetic component • E.g., schizotypal and borderline personality disorders

  5. What may facilitate diagnosis? • Psychological Testing • WAIS • MMPI • Bender-Gestalt • Rorschach ink blot

  6. What can a PD be confused with? • An Axis I disorder. Why??? B/C: • Atypical and mixed types are common • Some may grade into or be confused with Axis I dx • Ex: Paranoid PD may appear to be paranoid schizophrenia

  7. How do PD pts deal with treatment? • PD pts often resist treatment • Change slowly • Occasionally respond to some treatment: • Individual or group therapy • Short-term use of antianxiety meds • Low doses of major tranquilizers • Some may require inpatient tx during periods of decompensation

  8. Can children be dx with a PD? • Yes -- Adolescents (under 18) and children may receive PD dx except for one. • Which one can they not be diagnosed with? • Antisocial PD

  9. What are the guidelines for diagnosing a child with a PD? • The personality pattern must be stable and clear • Must be incompatible with an Axis I childhood disorder

  10. How many personality Disorders are there? • Ten • Divided into three clusters • Name the clusters: • Odd eccentric • Dramatic, emotional, and erratic • Anxious, fearful

  11. Name the three types of PD in the Odd Eccentric Cluster • Paranoid Personality Disorder • Schizoid Personality Disorder • Schizotypal Personality Disorder • Mnemonic: OPSS

  12. What are characteristics of a pt with Paranoid PD? • Aloof; emotionally cold • Unjustified suspiciousness • Hostile; hypersensitive to slights • Jealous; fears intimacy • Grandiose, rigid, unforgiving, sarcastic, contentious, litigious • Isolated and disliked • Accept criticism poorly; blame others

  13. What disorders can Paranoid PD be associated with? • Chronic CNS impairment • Drug abuse (amphetamines) • Depression • OCD • Precursor to schizophrenia

  14. What is the tx of Paranoid PD? • If psychotic decompensation occurs, major tranquilizers may be needed • Otherwise, these pts rarely seek tx and therapy, including medication, is of little value

  15. What are the characteristics of Schizoid PD? • Seclusive • Little desire/capacity to form interpersonal relations • Derive little pleasure from social/sexual contexts • Prefer and perform well at solitary activities • Have limited emotions; experience little pleasure • Daydream excessively • Humorless and detached • “Loners” are not necessarily schizoid unless they have imparied functioning • DO NOT have increased risk of developing schizophrenia!

  16. How is Schizoid PD treated? • Treatment is of little help.

  17. What are characteristics of Schizotypal PD? • They have features of schizoid pd: • Isolated, anhedonic, aloof • In addition, these pts are “peculiar.” • Relate strange intrapsychic experiences • Have odd and magical beliefs; strange speech • Frequently anxious • Difficult to “get to know”

  18. What is the incidence of Schizotypal PD? • 3% of population • Commonly co-occurs with Major Depression • Associated with increased incidence of schizophrenia in family members

  19. What biological sx can occur with Schizotypal PD? • Impaired eye tracking • Increased CSF homovanillic acid What is the treatment for Schizotypal PD? • Low dose antipsychotics – may reduce flamboyant sx’s

  20. What are the 4 PDs of the Dramatic, Emotional, and Erratic Cluster? • Antisocial PD • Borderline PD • Histrionic PD • Narcissistic PD

  21. What are characteristics of Antisocial PD? • Begins in childhood or early adolescence: • Aggressiveness; fighting • Poor peer relationships • Irresponsibility, lying, theft, truancy • Poor school performance • Runaway, inappropriate sexual activity • Drug and alcohol use

  22. What are characteristics of Antisocial PD in adults? • Criminality; assaultiveness • Self-defeating impulsivity • Hedonism • Promiscuity • Unreliability • Crippling drug and alcohol abuse • Fail at work and change jobs frequently • Go AWOL; dishonorable dc from service • Are abusing parents and neglectful mates • Cannot maintain intimate relationships

  23. More characteristics of Antisocial PD… • Often spend time in jails and prisons • Half or more of prisoners! • Typically are anxious and depressed • 5% commit suicide (impulsivity) • Behavior peaks in adolescence • Improves in 30s; but rarely recover • Males are more severely affected and more frequently than females • Childhood can be marked with criminal parents, neglect, poverty, desertion, inconsistent discipline, and alcoholic and/or unemployed parents

  24. What tests can help Dx Antisocial PD? • No tests are diagnostic • MMPI can help • May be nonspecific EEG abnormalities • Increased slow-wave activity

  25. What must be r/o before Dx Antisocial PD? • Primary drug and alcohol abuse • Schizophrenia • Pathological gambling, kleptomania, or pyromania

  26. How do you treat Antisocial PD? • Pts are very RESISTANT to treatment; very manipulative • Do not rely on info from pt; check your own data • Rarely seek help; tx is often difficult and unsuccessful • Best results follow closely supervised inpatient care (outpatient little value)

  27. What are characteristics of Borderline PD? • Socially adapted; complex presentations • Combinations of: • Anger, sarcasm, anxiety, intense and labile affect • Brief disturbances in consciousness • Chronic loneliness, boredom, emptiness • Unstable and volatile interpersonal relations • Identity confusion • Impulsive behavior like self-cutting and self-mutilation • Recurrent suicide attempts (death by suicide 8%) • Hypersensitivity to abandonment

  28. What other diagnoses can occur with Borderline PD? • Depression • Brief Psychotic Disorder • Other personality disorders • Substance-related disorders Note: There is sometimes a hx of childhood abuse

  29. How do you treat Borderline PD? • Psych testing useful • R/O other organic states: • Mild delerium, epilepsy, acute drug use • Long term, intermittent, supportive psychotherapy is often beneficial • Low dose antipsychotics, antidepressants (SSRIs), or Lithium • These pts may stabilize in 40s and 50s

  30. What characterizes Histrionic PD pts? • Initially seem charming and likable • Later seen as emotionally unstable, egocentric, immature, and manipulative • Excitement-seeking and shallow • Demand attention; exhibitionistic • Limited ability to maintain stable interpersonal relationships with either sex

  31. What disorders are associated with Histrionic PD? • Depression • Substance Abuse • Conversion and Somatization Disorders How do you treat this? • Lesser impaired pts may respond to psychotherapy

  32. What are characteristics of Narcissistic PD? • Often sx free and well functioning • Chronically dissatisfied due to a constant need for admiration • Have unrealistic self-expectations • Impulsive and anxious • Arrogant, envious, and lack empathy • Ideas of being a “special person” • Become quickly dissatisfied with others • Maintain superficial, exploitative relationships • May become depressed or rageful under stress and when others are not adequately admiring • Mixtures with other PDs common

  33. How do you treat Narcissistic PD? • Long-term psychotherapy may help

  34. What are the three disorders in the Anxious Fearful Cluster? • Avoidant PD • Dependent PD • Obsessive-Compulsive PD

  35. What are characteristics of Avoidant PD? • Shy, lonely, hypersensitive • Low self-esteem • Would rather avoid personal contact that face social disapproval, though desperate for personal involvement • Assume others will be critical; affects everyday life • Troubled by anxiety and depression; social phobia

  36. How do you treat Avoidant PD? • Group therapy may help

  37. What are characteristics of Dependent PD? • Excessively passive, unsure, pessimistic • Isolated and hypersensitive to criticism • Abnormally dependent on one or more persons • Subtly controlling of others • Anxiety and depression common (esp if relationship threatened)

  38. What are characteristics of Obsessive-Compulsive PD? • Pts are frequently successful men • Inhibited, stubborn, and perfectionistic • Judgmental, overly conscientious • Rigid and chronically anxious • Avoid intimacy; experience little pleasure from life • Indecisive and demanding • Perceived as cold and reserved

  39. What disorders are Obsessive-Compulsive PD pts at risk for developing? • Depression • Perhaps OCD How do you treat? • Psychotherapy

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