Download Personality Disorders

PERSONALITY DISORDERS
Rebecca Sposato, MS, RN
Overview of Personality Disorders

Personality: an enduring pattern of inner
experiences, emotional responses, attitudes and
behaviors in an individual
 Takes

years to change
Personality Disorders occupy Axis-II in the DSM-IV
 conduct
follows an inflexible, pervasive pattern that
significantly deviates from cultural expectations and
leads to distress and impairment
 Emerge during adolescence or young adulthood
Dimensional Models of Personality



Personality is seen as place of intersection of 5
major traits: openness, conscientiousness,
extraversion, agreeableness, neuroticism
For persons with disorders the intersection is not in
the middle
The DSM-IV has 3 categories of personality
disorders, based on their location on grid
Cluster A: Eccentric

Paranoid: hold others in distrust, interpret the
actions of peoples or entities as malevolent
without evidence.
 Conspiracy
theories, accuse others of plotting and hold
grudges for minor infractions
 vigilant for expected personal attacks
 Poor social relationships and interactions
 1% of general population, 20% of inpt. Psych pop.
Cluster A: Eccentric

Schizoid: Social detachment and bland emotional
range
 Strongly
introverted and indifferent to other’s opinions,
approvals or criticisms
 Few to none quality relationships/interactions
 Drifting life goals, passive to change or adverse events
 Considered too uncommon in clinical settings for
statistical comparisons
Cluster A: Eccentric

Schizotypal: Distorted interpretation of things,
events and actions by others
 Magical,
paranormal and superstitious
explanations
 Anxious social interactions and reduced capacity
for social relationships, ‘feel like an outsider’
 50% qualify for depression disorder
 3% of general population
Cluster B - Dramatic

Antisocial Personality: Inconsiderate, disregard or
violation of the rights, wishes and feelings of others
 Often
engage in high risk and illegal behaviors
 Resort to lying, intimidation, extortion and aggression
in achievement of goals
 Emotional chameleons in usury relationships with a
warped sense of victim and villain
 General population: 1-3% of general population
(more male than female) >25% of prison population
Cluster B: Dramatic

Borderline: unstable self-image, relationships,
emotional affect, values and interests
 Highly
charged emotions, attention seeking
 Labile Interpersonal patterns:
 Mentally
splitting person into ‘good’ and ‘bad’ versions
 Range clingy to pushing away
 Risky,
Reckless and impulsive actions
 Suicide
threats /attempts (10% complete suicide), selfmutilating and damaging
 2%
of general population, 20% of inpt psych
Cluster B: Dramatic

Narcissistic: View self as superior and special, seek
attention and approval with consistent devalue and
lack empathy for others
 Cover
for low self-esteem and will react strongly
when criticized, very sensitive to disproval
 Usury and unilateral relationships
 Overestimate their accomplishments, and
underestimate the accomplishments of others
Cluster B: Dramatic

Histrionic: excessive emotional expression and
attention seeking behaviors
 Gage
self-esteem by external measures of attention
and impressing others
 Engage in embelishing, provocative and seductive
behaviors when routine interventions do not yield
enough attention
Cluster C: Anxious

Avoidant: social inhibition, feeling inadequate and
hypersensitive to negative evaluation and rejection
 Assume
others are primarily critical and disapproving
 Do not take risks, try new things or expand comfort
zone
 Although they desire affection and friendship the end
result is self-isolating, limited social circle
 1% of general population
Cluster C: Anxious

Dependent: excessive need to be taken care of
leading to submissive and clingy behaviors
 Cannot
tolerate independence
 Will no take the initiative because they lack self
confidence they can do an adequate job
 Seek advice and reassurance for minor or
inconsequential decisions
 Will comply with wishes of others even when contrasting
their own
Cluster C: Anxious

Obsessive Compulsive Personality: preoccupation
with orderliness, perfection and control at the
expense of time, flexibility and efficiency
 Repeat
tasks and work in pursuit of inconsequential
details
 Limit and delay or try to control leisure time and
recreational pursuits
 Reluctant to delegate tasks or tolerate preferences of
others
Treatment
Identify and change behaviors limiting
quality of life
 Traditional management of depression,
hostility, anxiety, addiction and self harming
behaviors
 Psychoanalysis, CBT, REBT, DBT, milieu,
coping skills
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