Personality Disorders Lecture Fall 2024

Overview of Personality Disorders

• Personality disorders (PD) are ingrained patterns of behavior diverging from social norms, typically manifesting since adolescence.
• Common characteristics include poor interpersonal relationships and lack of self-awareness regarding problematic behaviors.

Epidemiology and Background

• Affects 10-20% of the general population and 50% of psychiatric patients.
• Some disorders, like Antisocial PD, are more common in men, while Borderline PD is more prevalent in women.
• Risk factors include childhood neglect and genetic predispositions for certain PDs.

Pathophysiology

• Development of PDs is influenced by a combination of biological, temperamental, and social factors.
• Psychoanalytic theory suggests that maladaptive development stages (e.g., attachment, early nurturing) contribute to PD formation.

Classification of Personality Disorders

• Divided into three clusters:
  • Cluster A: Paranoid, Schizoid, Schizotypal (Odd/Eccentric)
  • Cluster B: Antisocial, Borderline, Histrionic, Narcissistic (Dramatic/Emotional)
  • Cluster C: Avoidant, Dependent, Obsessive-Compulsive (Anxious/Fearful)

Cluster A Disorders

• Paranoid PD: Distrustful of others, holds grudges, perceives unfair treatment, struggles with intimacy.
• Schizoid PD: Prefers solitude, lacks emotional expression, and has difficulty forming relationships.
• Schizotypal PD: Characterized by peculiar thoughts, odd behaviors, and unusual perceptual experiences.

Cluster B Disorders

• Antisocial PD: Involves chronic disregard for others' rights, impulsivity, and often begins with Conduct Disorder in youth.
• Borderline PD: Features unstable relationships, intense emotional swings, self-image issues, and a high risk of suicide (10% completion rate).
• Histrionic PD: Seeks attention through emotionality and often fails in relational contexts due to their extreme need for involvement.
• Narcissistic PD: Characterized by grandiosity, manipulation of others, lack of empathy, and a fragile self-esteem sensitive to criticism.

Diagnosis

• Based on DSM-5 criteria, focusing on inflexible behavior patterns that cause distress, abnormality in cultural context, and origins tracing back to adolescence.
• Tools for diagnosis include:
  • Millon Clinical Multiaxial Inventory (MCMI): Self-reported, 344 true/false questions.
  • Minnesota Multiphasic Personality Inventory (MMPI): Well-researched, 576 true/false questions for diagnostic aid.

Differential Diagnosis

• Overlapping symptoms can complicate diagnosis; co-occurrence with mood or anxiety disorders and substance abuse is common.

Management Strategies

• Primary approach is counseling (individual and family).
• Cognitive Behavioral Therapy (CBT) focuses on altering thoughts to improve mood/behavior.
• Dialectical Behavioral Therapy (DBT) highlights mindfulness and emotional regulation, originally developed for Borderline PD but useful for others.
• Medication may assist specific symptoms:
  • Antipsychotics for Cluster A
  • SSRIs for depressed patients with Cluster B
  • Lithium for emotionally unstable patients with Borderline PD
  • SSRIs for anxiety in Cluster C patients.

Key Focus Areas in Understanding PDs

• The complexity of diagnosing and managing PDs due to overlapping symptoms.
• Emphasis on ongoing counseling and appropriate therapeutic approaches tailored to individual disorder characteristics.

This quiz covers the key aspects of personality disorders, including their epidemiology, etiology, risk factors, and pathophysiology. Students will also assess clinical presentations and learn about diagnostic and treatment strategies relevant to personality disorders. Prepare to deepen your understanding of these complex conditions.