Personality Disorders

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Personality Disorders

• 7.24.2007

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Personality Disorders

• Axis II
• Personality Disorders and Mental Retardation
• Diagnosed separately from Major Mental Disorders
  on Axis I
• Designed so consideration can be given to
  prevailing personality patterns, which may be
  less obvious than Axis I disorders
• Egosyntonic - the symptoms are part of who you
  are, this is who you are meant to be

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Personality Disorders

• Personality patterns
• Maladaptive
• Inflexible
• Pervasive
• Enduring
• Deviant
• Cause significant distress or impairment

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Personality Disorders

• An enduring pattern of inner experience and
  behavior that deviates markedly from the
  expectations of the individuals culture. This
  pattern is manifested in two (or more) of the
  following areas
• Cognition (ways of perceiving the self, others,
  and events)
• Affect (range, intensity, lability, and
  appropriateness of affect)
• Interpersonal Functioning
• Impulse Control
• The enduring pattern is inflexible and pervasive
  across a broad range of personal and social
  situations

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Personality Disorders

• C. The enduring pattern leads to significant
  distress or impairment in functioning
• D. The pattern is stable and of long duration,
  and its onset can be traced back at least to
  adolescence or early adulthood
• E. Not better accounted for by another mental
  disorder
• F. Not due to a GMC or substance

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Types of Personality Disorders

• Paranoid Personality Disorder
• Schizoid Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder

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Clusters

• Cluster A
• Paranoid Personality Disorder
• Schizoid Personality Disorder
• Schizotypal Personality Disorder
• Cluster B
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Cluster C
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder

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Cluster A

• Odd, eccentric ways of thinking or behaving
• Paranoid Personality Disorder
• Pervasive distrust and suspiciousness of others
  such that their motives are interpreted as
  malevolent
• Schizoid Personality Disorder
• Pattern of detachment from social relationships
  and a restricted range of expression of emotions
  in interpersonal settings, beginning by early
  adulthood and present in a variety of contexts
• Schizotypal Personality Disorder
• Pattern of social and 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

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Paranoid Personality Disorder

• Four or more of the following
• Suspects, without sufficient basis, that others
  are exploiting, harming, or deceiving him or her
• Is preoccupied with unjustified doubts about the
  loyalty or trustworthiness of friends or
  associates
• Is reluctant to confide in others because of
  unwarranted fear that the information will be
  used maliciously against him or her

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Paranoid Personality Disorder

• Four or more of the following (continued)
• Reads hidden demeaning or threatening meanings
  into benign remarks or events
• Persistently bears grudges
• Perceives attacks on his or her character or
  reputation that are not apparent to others and is
  quick to react angrily or to counterattack
• Has recurrent suspicions, without justification,
  regarding fidelity of spouse or sexual partner

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Paranoid Personality Disorder
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Facts about Paranoid PD

• Prevalence 0.5-2.5
• 10-30
• 2-10
• Gender
• Can begin as

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Schizoid Personality Disorder

• Four or more of the following
• Neither desires nor enjoys close relationships,
  including being part of a family
• Almost always chooses solitary activities
• Has little, if any, interest in having sexual
  experiences with another person

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Schizoid Personality Disorder

• Four or more of the following (continued)
• Takes pleasure in few, if any, activities
• Lacks close friends or confidants other than
  first-degree relatives
• Appears indifferent to the praise or criticism of
  others
• Shows emotional coldness, detachment, or
  flattened affect

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Schizoid Personality Disorder
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Facts about Schizoid PD

• Prevalence
• Gender
• Can begin as
• Note

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Schizotypal Personality Disorder

• Five or more of the following
• Ideas of reference
• Odd beliefs or magical thinking that influences
  behavior and is inconsistent with subcultural
  norms
• Unusual perceptual experiences including bodily
  illusions
• Odd thinking or speech (vague, metaphorical,
  etc.)
• Suspiciousness or paranoid ideation

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Schizotypal Personality Disorder

• Five or more of the following (continued)
• Inappropriate or constricted affect
• Behavior or appearance that is odd, eccentric, or
  peculiar
• Lack of close friends or confidants other than
  first degree relatives
• Excessive social anxiety that does not diminish
  with familiarity and tends to be associated with
  paranoid fears rather than negative judgments
  about self

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Schizotypal Personality Disorder
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Facts about Schizotypal PD

• Prevalence 3
• 15
• 50
• Gender
• Can begin as

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Cluster B

• Dramatic, emotional, or erratic
• Antisocial Personality Disorder
• Pervasive pattern of disregard for and violation
  of the rights of others
• Borderline Personality Disorder
• Pervasion pattern of instability of interpersonal
  relationships, self-image, and affects, and
  marked impulsivity
• Histrionic Personality Disorder
• Pervasive pattern of excessive emotionality and
  attention seeking, beginning by early adulthood
  and present in a variety of contexts
• Narcissistic Personality Disorder
• Pervasive pattern of grandiosity, need for
  admiration, and lack of empathy

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Antisocial Personality Disorder

• A. Three or more of the following recurring
  since age 15
• Failure to conform to social norms with respect
  to lawful behaviors as indicated by repeatedly
  performing acts that are grounds for arrest
• Deceitfulness, as indicated by repeated lying,
  use of aliases, or conning others for personal
  profit or pleasure
• Impulsivity or failure to plan ahead

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Antisocial Personality Disorder

• A. Three or more of the following recurring
  since age 15 (continued)
• Irritability and aggressiveness, as indicated by
  repeated physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility, as indicated by
  repeated failure to sustain consistent work
  behavior or honor financial obligations
• Lack of remorse, as indicated by being
  indifferent to or rationalizing having hurt,
  mistreated, or stolen from another

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Antisocial Personality Disorder

• B. At least 18 years old
• C. Evidence of Conduct Disorder with onset before
  age 15
• D. Not exclusively during the course of
  Schizophrenia or a Manic Episode

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Antisocial Personality Disorder
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Antisocial Personality Disorder

• Requires symptoms of Conduct Disorder before age
  15 (Childhood Disorder)
• Only disorder that requires symptoms of another
  disorder to be present

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Facts about Antisocial PD

• Prevalence 1-3
• 3-30
• 66-75
• Gender

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Borderline Personality Disorder

• Five or more of the following
• Frantic efforts to avoid real or imagined
  abandonment
• Pattern of unstable and intense interpersonal
  relationships characterized by alternating
  between extremes of idealization and devaluation
• Identity disturbance markedly and persistently
  unstable self-image or sense of self
• Impulsivity in at least two areas that are
  potentially self-damaging

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Borderline Personality Disorder

• Five or more of the following (continued)
• Recurrent suicidal behavior or self-mutilating
  behavior
• Affective instability due to a marked reactivity
  of mood
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty
  controlling anger
• Transient, stress-related paranoid ideation or
  severe dissociative symptoms

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Borderline Personality Disorder
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Facts about Borderline PD

• Prevalence 2
• 10
• 20
• Gender
• Associated w/

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Histrionic Personality Disorder

• Five or more of the following
• Is uncomfortable in situations in which he or she
  is not the center of attention
• Interaction with others is often characterized by
  inappropriate sexually seduction or provocative
  behavior
• Displays rapidly shifting and shallow expression
  of emotions
• Consistently uses physical appearance to draw
  attention to self

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Histrionic Personality Disorder

• Five or more of the following (continued)
• Has a style of speech that is excessively
  impressionistic and lacking in detail
• Shows self-dramatization, theatrically, and
  exaggerated expression of emotion
• Is suggestible
• Considers relationships to be more intimate than
  they actually are

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Histrionic Personality Disorder
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Facts about Histrionic PD

• Prevalence 2-3
• 10-15
• Gender
• Note

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Narcissistic Personality Disorder

• Five or more of the following
• Has a grandiose sense of self-importance
• Is preoccupied with fantasies of unlimited
  success, power, brilliance, beauty, or ideal love
• Believes that he or she is special and unique
  and can only be understood by, or should
  associate with, other special or high-status
  people
• Requires excessive admiration

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Narcissistic Personality Disorder

• Five or more of the following (continued)
• Has a sense of entitlement (i.e. unreasonable
  expectations of favorable treatment or others
  complying to their expectations)
• Takes advantage of others
• Lacks empathy is unwilling to recognize or
  identify with the feelings and needs of others
• Is often envious of others or believes that
  others are envious of him/her
• Shows arrogant, haughty behaviors or attitudes

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Narcissistic Personality Disorder
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Facts about Narcissistic PD

• Prevalence lt1
• 2-16
• Gender
• Associated w/

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Cluster C

• Anxious or fearful
• Avoidant Personality Disorder
• Pervasive pattern of social inhibition, feelings
  of inadequacy, and hypersensitivity to negative
  evaluation
• Dependent Personality Disorder
• Pervasive and excessive need to be taken care of
  that leads to submissive and clinging behavior
  and fears of separation
• Obsessive-Compulsive Personality Disorder
• Pervasive pattern of preoccupation with
  orderliness, perfectionism, and mental and
  interpersonal control, at the expense of
  flexibility, openness, and efficiency

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Avoidant Personality Disorder

• Four or more of the following
• Avoids occupational activities that involve
  significant interpersonal contact, because of
  fears of criticism, disapproval, or rejection
• Is unwilling to get involved with people unless
  certain of being liked
• Shows restraint within intimate relationships
  because of the fear of being shamed or ridiculed

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Avoidant Personality Disorder

• Four or more of the following
• Is preoccupied with being criticized or rejected
  in social situations
• Is inhibited in new interpersonal situations
  because of feelings of inadequacy
• Views self as socially inept, personally
  unappealing, or inferior to others
• Is unusually reluctant to take personal risks or
  to engage in any new activities because they may
  prove embarrassing

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Avoidant Personality Disorder
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Facts about Avoidant PD

• Prevalence 0.5-1
• 10
• Gender
• Can begin as

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Dependent Personality Disorder

• Five or more of the following
• Has difficulty making everyday decisions without
  an excessive amount of advice and reassurance
  from others
• Needs others to assume responsibility for most
  major areas of his or her life
• Has difficulty expressing disagreement with
  others because of fear of loss of support or
  approval
• Has difficulty initiating projects or doing
  things on his or her own (because of a lack of
  self-confidence rather than a lack of motivation
  or energy)

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Dependent Personality Disorder

• Five or more of the following (continued)
• Goes to excessive lengths to obtain nurturance
  and support from others, to the point of
  volunteering to do things that are unpleasant
• Feels uncomfortable or helpless when alone
  because of exaggerated fears of being unable to
  care for himself or herself
• Urgently seeks another relationship as a source
  of care and support when a close relationship
  ends
• Is unrealistically preoccupied with fears of
  being left to take care of himself or herself

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Dependent Personality Disorder
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Facts about Dependent PD

• Prevalence 2
• Gender
• Tend to

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Obsessive-Compulsive Personality Disorder

• Four or more of the following
• Is preoccupied with details, rules, lists, order,
  organization, or schedules to the extent that the
  major point of the activity is lost
• Shows perfectionism that interferes with task
  completion
• Is excessively devoted to work and productivity
  to the exclusion of leisure activities and
  friendships
• Is overconscientious, scupulous, and inflexible
  about matters of morality, ethics, or values

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Obsessive-Compulsive Personality Disorder

• Four or more of the following (continued)
• Is unable to discard worn-out or worthless
  objects even when they have no sentimental value
• Is reluctant to delegate tasks or to work with
  others unless they submit to exactly his or her
  way of doing things
• Adopts a miserly spending style toward both self
  and others, money is viewed as something to be
  hoarded for future catastrophes
• Shows rigidity and stubornness

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Obsessive-Compulsive Personality Disorder
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Facts about Obsessive-Compulsive PD

• Prevalence 1
• 3-10
• Gender
• Associated w/