PERSONALITY DISORDERS By

Salina Chan, R32013

Personality

Everyone has traits Distress/illness = regression ≠

personality d/o Defer till sure Document observations non-

judgementally

Personality Disorders: General Criteria Enduring, inflexible, pervasive pattern Must cause problems Must have little insight

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

Cognition - ways of perceiving and interpreting self, other people, and events

Affectivity - the range, intensity, lability, and appropriateness of emotional response

Interpersonal functioning Impulse control

Clusters (Mad, Bad, Sad)

Cluster A: “Mad” Paranoid Schizoid Schizotypal

Cluster B: “Bad” Borderline Narcissistic Histrionic Antisocial

Cluster C: “Sad” Avoidant Dependent Obsessive-Compulsive

All 1-2% except Narcissistic = 5% OCPD = 4% Cluster A total = 1-2%

Guess the PD…

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

Paranoid Personality Disorder(SUSPECT) 4/7

Spouse fidelity suspected Unforgiving (bears grudges) Suspicious of others Perceives attacks (and reacts

quickly) “Enemy or friend” (suspects

associates and friends) Confiding in others feared Threats perceived in benign events

The Paranoid

The person who corners you in the drugstore about his petition to remove another neighbour’s hedge

The dread client of any lawyer – everyone is against him, multiple, spurious lawsuits planned and numerous 12-page letter written and the last 6 lawyers wouldn’t take his case

Guess the PD…

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

Schizoid Personality Disorder(DISTANT) 4/7

Detached (or flattened) affectIndifferent to criticism and praiseSexual experiences of little interestTasks (activities) done solitarilyAbsence of close friendsNeither desires nor enjoys close relationsTakes pleasure in few activities

Schizoid

Cold & Aloof – no longing for emotional ties

Solitary interests not involving people

Isolated jobs Restricted range of affect

The Schizoid

Forest ranger who volunteers for exile 6/12 and is aloof, grumpy and taciturn when his replacement comes

Unmarried night watchman who is very skilled with the video surveillance equipment but has no interest in what the people in the offices are doing

Guess the PD…

A pervasive 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

Schizotypal Personality Disorder(PECULIAR ME) 5/9

Paranoid ideation Eccentric behavior or appearance Constricted (or inappropriate) affect Unusual (odd) thinking and speech Lacks close friends Ideas of reference Anxiety in social situations Rule out psychotic disorders and pervasive

developmental disorder

Magical thinking or odd beliefs Experiences unusual perceptions

The Schizotypal

Woman walking down street pushing her duck in baby carriage with tarot cards around the edges

Man who lives alone, not delusional in any other way, who believes that the actors on TV are interacting with him

Cluster A Treatment

Poor candidates for psychotherapy except supportive

Social skills training Treatment of co-morbid illnesses

Guess the PD…

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years

Antisocial Personality Disorder(CORRUPT) 3/7

Conformity to law lacking Obligations ignored Reckless disregard for safety of self

or others Remorse lacking Underhanded (deceitful, lies, cons

others) Planning insufficient (impulsive) Temper (irritable and aggressive)

The Antisocial

The handsome lawyer who is sleeping with the senior partner, stealing ideas from peers and is overspending his expense account

The dentist who fondles his patients under sedation, has written fraudulent Rx for narcotics and has an impaired driving charge

Guess the PD…

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity

Borderline Personality Disorder(AM SUICIDE) 5/9

AbandonmentMood instability (marked reactivity of mood)

Suicidal (or self-mutilating) behaviorUnstable and intense relationshipsImpulsivity (in two potentially self-damaging areas)Control of angerIdentity disturbanceDissociative (or paranoid) symptoms that are

transientand stress related

Emptiness (chronic feelings of)

The Borderlines

The Ex who waits in the car in front of your house, yells profanity at you, and then sends you a valentine saying ‘you are my one true love’

The woman in your book club who monopolizes the meeting by crying and calls between meeting to tell you she is suicidal

Guess the PD…

A pervasive pattern of excessive emotionality and attention seeking

Histrionic Personality Disorder(PRAISE ME) 5/8

Provocative (or sexually seductive) behavior Relationships (considered more intimate than

they are) Attention (uncomfortable when not the center of

attention) Influenced easily Style of speech (impressionistic, lacks detail) Emotions (rapidly shifting and shallow)

Made up (physical appearance used to draw attention to self)

Emotions exaggerated (theatrical)

The Histronic

The life-of-the-party who touches every man proprietarily – playing with their ties – and laughing uproariously

The woman in the coffee shop who sits down at your table and proceeds to tell you about her operations while you are clearly trying to write in your book

Guess the PD…

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

Narcissistic Personality Disorder - (SPE3CIAL) 5/9

Special (believes he or she is special and unique)Preoccupied with fantasies (of unlimited success,

power,brilliance, beauty or ideal love)

Envious (of others, or believes others are envious ofhim or her)

EntitlementExcess admiration requiredConceited (grandiose sense of self importance)Interpersonal exploitationArrogant (haughty)Lacks empathy

The Narcissist

The perfect couple who butts into the line saying “we need to be in the theatre first”

Your brother-in-law who tries to borrow your car saying “I’ll need it for this week because I have important clients”

Cluster B Treatment

Borderlines Psychodynamic Group Dialectic behaviour

Histrionic Behaviour

techniques (neg/pos reinforce)

Assertiveness training

Narcissistic Usually want relief of

internal distress or solving interpersonal difficulties

Usually little insight but if has some may respond to psychodynamic

Antisocial Little effect Incarcerated group may

have +ve outcome

Guess the PD…

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Avoidant Personality Disorder(CRINGES) 4/7Certainty (of being liked required before willing to

get involved with others)Rejection (or criticism) preoccupies ones’ thoughts in

social situationsIntimate relationships (restraint in intimate

relationshipsdue to fear of being shamed)

New interpersonal relationships (is inhibited in)Gets around occupational activity (involving significant

interpersonal contact)Embarrassment (potential) prevents new activity or

taking personal risksSelf viewed (as unappealing, inept, or inferior)

The Avoidant

A friend who longs to be in a relationship but feels unable to make any moves or any signals

Another friend didn’t apply to medicine because because he knew he wouldn’t get in even though his marks were consistently higher than yours and is now working at starbucks

Guess the PD…

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts

Dependent Personality Disorder(RELIANCE) 5/8Reassurance (required for decisions)Expressing disagreement difficult (due to fear of

lossof support or approval)

Life responsibilities (needs to have these assumed byothers)

lnitiating projects difficult (due to lack of self-confidence)

Alone (feels helpless and discomfort when alone)Nurturance (goes to excessive lengths to obtain

nurturance and support)Companionship (another relationship) sought

urgentlywhen close relationship ends

Exaggerated fears of being left to care for self

The Dependent

Your maiden great-aunt who lived her whole life with her parents and worked far below her intelligence. Now she wants to move in with your parents. You’re next.

Your nice friend who moves from one bad relationship to another and texts you every 5 mins while shoe shopping.

Guess the PD…

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

Obsessive - Compulsive PDLAW FIRMS 5/8

Loses point of activity (due to preoccupation with detail)

Ability to complete tasks (compromised by perfectionism)

Worthless objects (unable to discard)

Friendships (and leisure activities) excluded (due to apreoccupation with work)

Inflexible, scrupulous, over conscientious (on ethics,values, or morality, not accounted for by religion or culture)

Reluctant to delegate (unless others submit to exactguidelines)

Miserly (toward self and others)Stubbornness (and rigidity)

The OCPD’er

The accountant you fired for filing your income tax late because she needed it to be perfect before she sent it in

The medical student who scares you to death with his 30 page notes on Wilson’s disease but but runs out of time to study for depression

Cluster C Treatment

Brief adaptation psychotherapy Cognitive focus on maladaptive

interpersonal patterns and how it affectively manifests

Psychodynamic some effect

Which one is it?

Avoidant vs Schizoid Wish for contact

Paranoid, Schizotypal vs Scz Hallucinations Thought d/o Function

Histrionic vs Borderline Identity, chaos

Narcissistic vs. Antisocial legal

Q: What’s the difference between OCD and OCPD?

OCD: Ego Dystonic (People don’t like experiencing

or doing the OCD symptoms) Obsessions and compulsions

OCPD: A pattern of preoccupation with orderliness,

perfectionism and control Personality disorder = longstanding and

pevasive Ego syntonic (ingrained beliefs and ways of

doing things, can be annoying to others or cause dysfunction)

Complications

Substance Other psych illness Disruptive family life Disruption from work: abseenteeism

& decrease productivity Violation of law and disregard for

concerns/rights of others