Personality Disorders What is a Personality Disorder DSM-IV Personality Disorders General Criteria Personality Disorders: Facts in addition to Statistics Specific DSM-IV Personality Disorders
Daigneault, Gary, Co-Owner;News Director;Morning Host has reference to this Academic Journal, PHwiki organized this Journal Personality Disorders Michael McCloskey, Ph.D. Assistant Professor Clinical Neuroscience & Psychopharmacology Research Unit The University of Chicago What is a Personality Disorder A pattern of inner experience & behaviour that deviates markedly from expectations of the individuals culture in 2 or more of the following areas -cognition -affect -interpersonal functioning -impulse control DSM-IV Personality Disorder General Criteria DSM-IV Personality Disorders General Criteria The pattern is inflexible in addition to pervasive across a broad range of personal in addition to social situations. Clinically significant distress or impairment (occupational, social). The pattern is stable in addition to of long duration in addition to its onset can be traced back at least to adolescence or early adulthood.
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Personality Disorders: Facts in addition to Statistics Prevalence of Personality Disorders About 10% of the general population Rates are higher in inpatient in addition to outpatient settings Origins in addition to Course of Personality Disorders Thought to begin in childhood Run a chronic course Comorbidity rates are high 0 Specific DSM-IV Personality Disorders Odd/Eccentric Schizoid Schizotypal Paranoid Dramatic, Emotional, or Erratic Borderline Narcissistic Antisocial Histrionic Anxious or Fearful Avoidant Obsessive-compulsive Dependent Cluster A: Odd or Eccentric Personality Disorders Paranoid: Is characterized by a pervasive tendency to be inappropriately suspicious of other peoples motives in addition to behaviors.
Mnemonic as long as Paranoid PD (4/7) S – Spouse infidelity suspected U – un as long as giving (bears grudges) S – suspicious (of others) P – perceives attacks ( in addition to reacts quickly) E – enemy in everyone – suspects associates, friends C – confiding in others feared T – threats seen in very benign events Pinkofsky HB. Mnemonics as long as DSM-IV personality disorders. Psychiatr Serv. 1997 Sep;48(9):1197-8. Paranoid PD Description SELF-VIEW: Vulnerable VIEW OF OTHERS: Adversaries BELIEFS: Core beliefs: The world is threatening in addition to I must protect myself I can only rely on myself, no one else THREAT: EVERYONE!!!!! STRATEGY: Dont trust anyone, social isolation AFFECT: Hostile, anxious, dysphoric Paranoid PD Associated Features: During high stress transient psychotic symptoms may occur (Do not warrant additional diagnosis) Predispose to Delusional Disorder in addition to Schizophrenia, Paranoid Type Substance Abuse, Depression common
Cluster A: Odd or Eccentric Personality Disorders Schizoid: A pattern of detachment from social relationships in addition to a restricted range of affect. Mnemonic as long as Schizoid PD (4/7) D Detached affect I Indifferent to praise or criticism S Sexually uninterested T Tasks done solitarily A Absence of close friends N Neither desire nor enjoys close relationship T Takes pleasure in few activities Schizoid PD Description SELF-VIEW: Different, Empty VIEW OF OTHERS: More trouble than worth, impediment to freedom BELIEFS: Core beliefs are “Relationships are problematic ,” “Life is less complicated without other people I need plenty of space THREAT: Compliance, complications STRATEGY: Isoloation AFFECT: Flat (not to be confused with depressed)
Cluster A: Odd or Eccentric Personality Disorders Schizotypal: A pattern of acute discom as long as t in close relationships, cognitive or perceptual distortions, in addition to eccentricities of behavior. Mnemonic as long as Schizotypal PD (5/9) M – magical thinking E – eccentric behavior or appearance P – paranoid ideation E – experiences unusual perceptions C – constricted (or inappropriate) affect U – unusual thinking & speech L – lacks friends I – ideas of reference A – anxiety (socially) (R) – rule out psychosis & PDD Schizotypal PD Description SELF-VIEW: Outsider, defective VIEW OF OTHERS: Strange, scary, yet desire as long as social contact BELIEFS: Core beliefs: I do not fit in, I must protect myself from threats There are reasons as long as everything. Things don’t happen by chance THREAT: World (dont underst in addition to ) STRATEGY: Social isolation Retreat into delusional ideas AFFECT: Anxiety, Depression
Schizotypal PD Associated Features: Interpersonal relatedness impaired w/rare reciprocation of the expressions or gestures of others Few close friends Features of Borderline Personality are often present in addition to may justify both diagnoses History of MDD common (> 50%) Cluster B: Dramatic, Emotional, or Erratic Personality Disorders Antisocial: A pattern of disregard as long as , in addition to violation of, the rights of others. Mnemonic as long as Antisocial PD (3/7) C – cannot follow law O – obligations ignored R – remorselessness R reckless disregard as long as safety U underh in addition to ed (deceitful) P – planning deficit (impulsive) T – temper (irritable, aggressive) + Childhood conduct disorder
Antisocial PD Description SELF-VIEW: Superior, unconcerned VIEW OF OTHERS: Suckers, inferior, means to an end BELIEFS: Core beliefs are People are there to be taken,” “If I want something, I should do whatever is necessary to get it If people can’t take care of themselves, that’s their problem I can get away with things so I don’t need to worry about bad consequences THREAT: STRATEGY: Take what you want. AFFECT: Irritability, anger when blocked from goals. Antisocial PD Associated Features: Diminishes in midlife Substance abuse in addition to early sex experiences High levels of criminality 0
Cluster B: Dramatic, Emotional, or Erratic Personality Disorders Borderline: A pattern of instability in, self-image, interpersonal relationships, in addition to affect, in addition to marked impulsivity. Mnemonic as long as Borderline PD (5/9) A – Ab in addition to onment fears M – Mood instability S – Suicidal / self-injurious behavior U – Unstable, intense relationships I – Impulsivity C – Control of anger poor I – Identity disturbance D – Dissociative / paranoid symptoms E – Emptiness Borderline PD Description SELF-VIEW: Unstable in addition to fragmented, helpless, victims VIEW OF OTHERS: The cause of in addition to answer to all lifes problems BELIEFS: Core beliefs are I am unlovable,” “No one is ever there to meet my needs, to be strong as long as me, to care as long as me I can’t cope on my own. I need someone to rely on THREAT: Ab in addition to onment STRATEGY: Dem in addition to love, test love AFFECT: Anger, Depression, Anxiety
Borderline PD Associated Features: Up to 10% of persons with BPD eventually die by their own h in addition to High co-morbidity with Mood Disorders Marked mood shifts, unpredictable Undermining ones own success some symptoms may improve by midlife Over 50% report childhood maltreatment Cluster B: Dramatic, Emotional, or Erratic Personality Disorders Histrionic: A pattern of excessive emotionality in addition to attention seeking. Mnemonic as long as Histrionic PD (5/8) P – provocative (or seductive) behavior R – relationships, considered more intimate than they are A – attention, must be at center of I – influenced easily S – speech (style) – wants to impress, lacks detail E – emotional lability, shallowness M – made-up (physical appearance get attention) E – exaggerated emotions (theatrical)
Histrionic PD Description SELF-VIEW: VIEW OF OTHERS: Objects to be won over BELIEFS: Core beliefs are In order to be happy I need other people to pay attention to me ,” “Unless I entertain or impress people, I am nothing It is awful as long as people to ignore me THREAT: Being ignored, as long as gotten STRATEGY: Entertain, draw attention to self AFFECT: Anxiety, depression when ignored Histrionic PD Associated Features: Attempts to control other persons while establishing dependent relationship Often overly trusting Comorbidity with somatization Cluster B: Dramatic, Emotional, or Erratic Personality Disorders 4. Narcissistic: A pattern of gr in addition to iosity, need as long as admiration, in addition to lack of empathy.
Consequences of under-diagnosis Prevalence of PD = 10% + 2% PD Associated with Increased suicide risk Increased violence/criminality risk Increased social /occupational difficulties Poorer response to treatment as long as Axis I disorders Consequences of over-diagnosis STIGMA, STIGMA, STIGMA Permanent Record Influences future diagnoses Influences how mental health provider interacts with patient
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