Download Personality Disorders

Personality Disorders
Jacob Alexander
BV PRCC
Personality Disorders
•
Personality Disorders refer to long- standing,
pervasive and inflexible patterns of behaviour:
1. Depart from cultural expectations
2. Impair social occupational functioning
3. Cause emotional distress
• Personality disorders are coded on Axis II of
the DSM
Personality disorders can be a co-morbid
condition for an Axis I disorder
Fact sheet
• Prevalence of Personality Disorders
• About 0.5% to 2.5% of the general population
• Rates are higher in inpatient and outpatient clinical settings
• Origins and Course of Personality disorders
• Thought to begin in childhood
• Tend to run a chronic course if untreated
• Co-morbidity rates are high
• Gender distribution and gender bias in
Diagnosis
• Gender bias exists in the diagnosis of personality disorders
• Such bias may be a result of criterion or assessment gender bias
Personality Disorder Clusters
• Personality disorders fall into three general
clusters:
Persons in cluster A seem odd or eccentric
• Paranoid, schizoid, schizotypal
Persons in cluster B seem dramatic, emotional or
erratic
• Antisocial, borderline, histrionic, narcissistic
Persons in cluster C appear as anxious or fearful
• Avoidant, dependent, obsessive-compulsive
Personality disorder not otherwise specified
Odd/Eccentric Cluster
• Paranoid Personality disorder (PD)
involves suspicion of others, hostility,
jealousy
-no hallucinations and no full blown delusions are present
• Paranoid PD occurs more frequently in
men than women
• Lifetime prevalence is about 1%
Odd/Eccentric Cluster
•
Schizoid personality disorder involves
1.
2.
3.
4.
Reduced social relations and few friends
Reduced sexual desire and few pleasurable activities
Indifference to praise or criticism
Lonely life style
•
Prevalence of schizoid PD is less than
1% and occurs more commonly in men
than women
Odd/Eccentric Cluster
• Schizotypal personality disorder involves:
1.
2.
3.
4.
5.
An attenuated form of schizophrenia
Odd beliefs and magical thinking
Recurrent illusions (things not present)
Ideas of reference (hidden meanings)
Behaviour and appearance is eccentric
• Prevalence of schizotypal PD is about
3% and occurs slightly more commonly in
men than women
Etiology of the Odd/Eccentric
Cluster
•
These disorders are linked to
schizophrenia and may represent a less
severe form of the disorder:
1. Schizophrenia has clear genetic determinants
2. Family studies reveal that relatives of
schizophrenic patients are at increases risk for
developing schizotypal PD as well as paranoid
PD
3. No clear pattern for scizoid PD
Dramatic/Erratic cluster
•
Borderline personality disorder involves
1. Impulsivity (gambling, spending, sexual sprees)
2. Instability in relationships, mood and self-image
3. Borderline PD persons are argumentative and difficult
to live with
•
•
Prevalence of Borderline PD is about 1-2% and
occurs more commonly in women than men
Linehan’s diathesis-stress theory
1. Difficulty controlling emotions (biological diathesis)
2. Raised in “invalidating” family environment
Emotional
dysregulation
in the child
Emotional outbursts by
child to which parents
attend
Invalidation by the parents
through punishing or ignoring
the demands
Great demands on
the family
The cluster B personality disorders
•
•
•
•
Borderline personality disorders
Narcissistic personality disorder
Antisocial personality disorder
Histrionic personality disorder
Borderline Personality Disorder
1.
2.
3.
•
Unstable relationships- avoid abandonment
Poor self image- mood swings, feel empty
Impulsivity- substance abuse, sex, Suicidality
Causes
1.
2.
3.
•
1.
2.
3.
Runs in families
Connection with mood disorders
Contribution of early abuse
Treatment
Few controlled studies
Dialectical behavioural therapy
Medications- antidepressants, lithium, mood stabilisers
Histrionic Personality disorder
• Symptoms
1. People who are overly dramatic and attention
seeking
2. People who exhibit emotional displays but are
emotionally shallow
3. People who are self-centred and overly
concerned about physical attractiveness
• Prevalence of histrionic pd is about 2-3%
and occurs slightly more commonly in
women than men
Narcissistic Personality disorder
•
Involves
1.
2.
3.
A grandiose view of the person’s own importance
A strong sense of entitlement
A lack of empathy for others
•
Prevalence of narcissistic pd is less than
1% and this disorder co-occurs with
borderline pd
Antisocial Personality disorder
• Involves
1. The presence of conduct disorder before the
age of fifteen
2. Conduct disorder includes truancy, lying, theft,
arson, running away from home and
destruction of property
3. The continuation of these behaviours into
adulthood
• Prevalence of antisocial pd is about 3%
of men and 1% of women
Etiology of antisocial PD
•
Family issues may play a role in the
development of antisocial PD
1. Lack of affection
2. Severe parental rejection
3. Inconsistent (or no) discipline
•
•
•
Twin studies show a greater concordance for
antisocial PD in MZ twins relative to DZ twins
Adoption studies- adverse adoptive
environment may be the stressor triggering the
ASPD biological diathesis
Research studies on psychopaths
Antisocial Personality disorder
•
1.
2.
3.
Treatment
Many do not seek treatment
Poor prognosis
Focus on prevention
Anxious/Fearful cluster
• Anxious Avoidant personality disorder
• Dependent personality disorder
• Anankastic/obsessive personality disorder
Anxious avoidant personality
disorder
•
Involves:
1.
2.
People who are fearful in social situations
People who are keenly sensitive to criticism, rejection
or disapproval
People whose lives and job are restricted by their fear
of negative interactions
3.
•
Prevalence of avoidant pd is about 1%
and this disorder is co-morbid with
Dependent pd and Borderline pd
Anxious avoidant personality
disorder treatment
•
•
•
•
Several well controlled studies
Target anxiety and social skills
Treatment similar to social phobia
Treatment modalities include systematic
desensitization and behavioural rehearsal
Dependent Personality disorder
•
Symptoms:
1. A lack of self confidence
2. A lack of a sense of autonomy
3. A view that others are powerful while they are weak
•
•
Prevalence of dependent pd is about 1.5% and
occurs slightly more commonly in women than
men
May be related to insecure “anxious”
attachment
Anakastic/obsessive personality
disorder
• Preoccupied with rules, orderliness and control
• Inflexible, unwilling to show emotion or form
close relationships
• People with OCPD believe their thoughts are
correct while people with OCD have unwanted
thoughts
• Perfectionism interfering with ability to complete
tasks, because their standards are high and rigid
• Emotionally withdraw when unable to control the
situation
• Rx- SSRIs, CBT, Psychodynamic psychotherapy
Therapies for Personality Disorders
• Always look for co-morbid Axis I disorders
• Therapy modalities include:
-Anti-anxiety or antidepressant drugs
-Psychodynamic therapy aims to change the
person’s understanding of the childhood
problems that underlie the PD
-Behavioral and cognitive therapy focuses on
specific symptoms and issues (e.g. social skills)
• Overall therapeutic goal: change the “disorder”
into a “style”, except for ASPD