Download Personality Disorders

PERSONALITY
DISORDERS
By
Salina Chan, R3
2013
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”
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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) affect
Indifferent to criticism and praise
Sexual experiences of little interest
Tasks (activities) done solitarily
Absence of close friends
Neither desires nor enjoys close relations
Takes 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
 Paranoid ideation
(PECULIAR
ME) 5/9
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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
Abandonment
Mood instability (marked reactivity of mood)
Suicidal (or self-mutilating) behavior
Unstable and intense relationships
Impulsivity (in two potentially self-damaging areas)
Control of anger
Identity disturbance
Dissociative (or paranoid) symptoms that are transient
and 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
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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 of
him or her)
Entitlement
Excess admiration required
Conceited (grandiose sense of self importance)
Interpersonal exploitation
Arrogant (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
 Narcissistic
 Psychodynamic
 Usually want relief of
 Group
internal distress or solving
interpersonal difficulties
 Usually little insight but if
has some may respond to
psychodynamic
 Dialectic behaviour
 Histrionic
 Behaviour techniques
(neg/pos reinforce)
 Assertiveness training
 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) 4/7
Certainty (of being liked required before willing to
get involved with others)
Rejection (or criticism) preoccupies ones’ thoughts in
social situations
Intimate relationships (restraint in intimate relationships
due 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 risks
Self 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) 5/8
Reassurance (required for decisions)
Expressing disagreement difficult (due to fear of loss
of support or approval)
Life responsibilities (needs to have these assumed by
others)
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 urgently
when 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 PD
LAW 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 a
preoccupation 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 exact
guidelines)
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
 Histrionic vs Borderline
 Identity, chaos
 Narcissistic vs.
vs Scz
Antisocial
 Hallucinations
 legal
 Thought d/o
 Function
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