Personality Disorders

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Personality Disorders
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Definitions

• Personality trait
• a stable, recurring pattern of human behavior
• Personality type
• a constellation of personality traits
• recognizable as a frequent and familiar
  combination

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Definitions

• Personality disorder
• a constellation of personality traits that are
• Inflexible
• Maladaptive
• lead to difficulties in work or interpersonal
  relations, subjective distress, and usually both.
  (Global Criteria)

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Why Should We Care?
as doctors
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Presentation

• In Medical Settings
• doctor-patient relationship
• Noncompliance
• Difficulty coping
• Hospitalization
• Disability
• medical restrictions

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Presentation

• In the Family
• Marital conflicts
• Sexual dysfunction
• Child rearing
• Domestic violence

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Presentation

• Within the individual
• Anxiety
• Depression
• External problems/losses
• resulting from maladaptive behavior
• Divorce
• job loss
• legal troubles
• poor outcome from a medical condition
• When circumstances prevent living according to
  usual personality style

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Comorbidity
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Making a Personality Diagnosis

• Collateral sources
• Social and developmental history
• Personality tests (ex. MMPI)
• current strengths and weaknesses

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Speculations on Etiology
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DSM-IV Personality disorders
PCategorical PArranged by clusters
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The Clusters

• A Odd
• B Dramatic
• C Anxious

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A The Odd Cluster
PParanoid PSchizoid PSchizotypal
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B The Dramatic Cluster

• Narcissistic
• Antisocial
• Borderline
• Histrionic

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C The Anxious Cluster

• Avoidant
• Obsessive-Compulsive
• Dependent

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The Odd Cluster
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Paranoid Personality Disorder

• Paranoid personality
• mistrustful of everyone
• but still able to test reality

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Schizoid personality

• lacks intimate relationships
• frightened by closeness
• incapable of warmth
• Anxious about any closeness

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Schizotypal personality

• odd and eccentric ideas
• influence daily behavior
• but not psychotic

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The Anxious Cluster
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Avoidant personality

• Social inhibition
• Feelings of inadequacy
• Hypersensitivity to criticism

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Obsessive-Compulsive Personality

• preoccupied w/ work/duty
• not enjoying life
• Often rigid and inflexible

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The Dependent Personality

• clings to stronger person
• Submissive
• seeks help/advice
• anxious when having to make decision

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The Dramatic Cluster

• Narcissistic
• Antisocial
• Borderline
• Histrionic

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Narcissistic personality

• Exaggerated sense of self-importance, Unrealistic
  fantasies, Wants recognition for being special
• Arrogant, Entitled, Requires admiration
• Exploitative, Unempathic towards others
• Envious of others
• Unconcerned about effect on others

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Antisocial personality

• the "psychopath
• violates laws/social conventions
• Dishonest
• unconcerned about effect on others

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Borderline personality

• emotionally intense
• unstable
• impulsive behavior
• self-destructive
• inner emptiness
• intolerance of being alone

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Histrionic personality

• Dramatic
• attention-seeking
• caricature of femininity/masculinity

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Treatment
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Treatment Psychotherapy

• Acute symptom focused
• Ex. Dialectic behavioral therapy
• Fundamental
• Focused on changing personality
• Long term psychotherapy

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Treatment Pharmacotherapy

• Symptom Focused
• Ex.
• Depression
• Anxiety
• Psychosis
• More fundamental treatment?
• Forme frustre approach

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Treatment In Medical Settings

• Identify and treat problems acute symptoms
• Separate medical diagnosis from behaviors