Personality Disorders PDF

Personality Disorders There’s a 7-12% prevalence, and such disorders vary by gender, and many will meet the crit...

Personality Disorders There’s a 7-12% prevalence, and such disorders vary by gender, and many will meet the criteria for more than one disorder. Personality trait: An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself. Ego-syntonic: feeling, thoughts, and behaviors that are acceptable and consistent to the self. Ego-dystonic: feelings, thoughts, and behaviors that are distressing, unacceptable or inconsistent with the self. Treatment is difficult as most lack insight > Psychotherapy.  Cluster A – the patients seem eccentric, peculiar, or withdrawn. And it has a familial association with psychotic disorders (schizophrenia) they’re weird (Accusatory, Aloof and Awkward). Paranoid Schizoid Schizotypal Epidemiology 1-4% ♂ >♀ 3-5% ♂ >♀ 4% Higher incidence of schizophrenia in family. Higher family schizophrenia Higher family 1st degree schizophrenia DSM-5 I. General distrust of others, beginning I. Voluntary social withdrawal and I. Social deficits marked by Criteria in early adulthood in varying restricted range of emotion at early eccentric. Cognitive, close contexts. adulthood in varying contexts. relationship in early adulthood II. At least 4 of the following, II. 4 or more of the following, in varying contexts. o Suspicion without evidence of others. o Neither enjoying nor desiring close II. 5 or more of following, o Preoccupation with doubts of loyalty. relationship. o Ideas of reference  o Reluctance to confide in others. o Generally choosing solitary activities. o Odd beliefs magical thinking. o Interpreting benign remarks as o Little if any interest in sexual. o Unusual perceptual experience. threatening. o Pleasure in few activities (if any). o Suspiciousness. o Persistence of grudges. o Few close friends or confidants (if any) o Inappropriate, restricted affect. o Perception of attacks on their o Indifference to praise or critism. o Odd eccentric appearance, behavior. character (quick to counterattack) o Emotional coldness, flattened. o Few close friends. o Suspicions regarding fidelity of o Odd thinking or speech. partners. o Excessive social anxiety. Course & ◘ PPD have a pervasive distrust and Chronic course, Chronic course some develop Prognosis suspiciousness of others and interpret ◘ Lifelong withdrawal, perceived as schizophrenia and it’s a premorbid motives as malevolent eccentric and reclusive, unsociable, personality disorder for schizophrenia. ◘ Blame their problems on others, jealous constricted affect, no desire for friends ◘ Eccentric peculiar thought pattern, and accusing others of cheating. or relationship and prefer to be alone strange/odd. Chronic, can cause psychosis under stressful DDx DDx events. Schizophrenia (no overt psychotic Schizophrenia (no frank psychotic, no DDx symptoms e.g. delusions, hallucinations) delusions) Schizophrenia (no fixed delusions and no Schizotypal (no magical thinking). Schizoid (eccentric behavior, magical frank psychotic), Social disinfrchsisment / thinking) social isolation (other close people may tell if suspicion or not). Treatment ᴥ Psychotherapy (choice), avoid group ᴥ Psychotherapy (day programs) , avoid ᴥ Psychotherapy therapy group therapy ᴥ Short Low dose 2nd generation ᴥ Antipsychotics for the transient ᴥ Antidepressant if comorbid major antipsychotics (for cognitive perceptual psychosis. depression. disturbances).  Cluster B – patients seem emotional, dramatic, erratic, impulsive and inconsistent and have familiar association with mood disorders and substance use. Wild (Bad, Borderline, Flamboyant, must be the best). Antisocial Borderline BPD Histrionic HPD Narcissistic NPD Epidemiology 1-4% ♂ > ♀ (3-5:1) 6% (most common personality disorder) ♂ (3:1) ♀ >♂ DSM-5 I. Pattern of disregard for and violation of I. Pervasive pattern of impulsivity and unstable I. Patterns of excessive emotionality I. Patterns of grandiosity, need for Criteria other’s rights since age of 15 years. relationship, affects, self-image, behaviors in early and attention seeking in early admiration, and lack of empathy in II. Must be at least 18 years old at time of adulthood in varying contexts. adulthood in varying contexts. early adulthood in varying contexts diagnosis, and history must be consistent II. At least 5 of the following, II. At least 5 of the following, II. 5 or more of the following, with conduct disorder in o Frantic efforts to avoid real or imagined abandonment. o Uncomfortable when not the center of o Exaggerated sense of self-importance. child/adolescence. o Unstable, intense relationship (love-hate) attention. o Preoccupation with fantasies (money III. 3 or more of the following, o Unstable self-image. o Inappropriately seductive or provocative. success). o Failure to conform to social norms (unlawful acts). o Impulsivity in at least 2 harmful ways (spending, sexual, o Rapidly shifting but shallow expression of o Belief in that they’re Special or unique. o Deceitful, lying, manipulation for personal gain. substance use, binge eating). emotion. o Require excessive admiration. o Impulsivity. o Recurrent suicidal threats or self-mutilation. o Use of appearance to draw attention. o Entitlement. o Irritability and Aggressiveness, fights. o Unstable mood/affect o Imppasionistic speech and lacking detail. o Lack of empathy. o Recklessness and disregards of other’s safety. o Chronic feelings of emptiness. o Theatrical exaggeration emotion. o Take advantage of others for self-gain. o Irresponsibility for work. o Difficulty controlling anger. o Easily influenced by others or situations. o Arrogant or haughty. o Lack of remorse for actions. o Transient, stress-related paranoid ideation, dissociative. o Perceives relationship as more inmate. o Envious of others or other are envy of them. Course & Chronic course but some improvement of symptoms Variable course many develop stability in middle age. Chronic course, with some improvement of Chronic course Prognosis as the patient ages. ◘ High risk of major depression, substance use disorder, symptoms with age. ◘ High incidence of depression, midlife crises. ◘ High morbidity with substance use, trauma, suicide (10%) ◘ Regression is most common defense. suicide and homicide ◘ Splitting is most common defense DDx ◘ Many develop somatic complains, major DDx DDx Antisocial (exploit others, and want status and depression. Schizophrenia (no frank psychosis, may transited under stress). BPD (more generally functional and less likely recognition; become depressed when they do Bipolar I/II (rapid, brief, moment-to-moment reactions to to have depression, brief psychotic episodes). not get such recognition; fragile self-esteem) triggers). Treatment Psychotherapy (ineffective) Dialectical behavior therapy DBT (choice) Psychotherapy Psychotherapy Pharmacology to treat comorbid anxiety, depression Pharmacology adjunct to psychotherapy (more useful in BPD Pharmacology for associated depression, Pharmacology for comorbid psychiatric or aggression (careful with substance use patients). than any other); mood stabilizers, low dose antipsychotics anxiety symptoms. disorders.  Cluster C – Patients seem anxioius, fearful, have genetic association with anxiety disorders, they’re Worried (Cowardly, Obsessive-Compulsive, Clingy) Avoidant Dependent DPD Obsessive-Compulsive OCPD Epidemiology 2% 2% ♀ >♂ 2-7% ♂ > ♀ (2:1) DSM-5 Criteria I. Pattern of social inhibition, hypersensitivity and feeling of I. Pattern of excessive need to be taken care of leading to I. Pattern of preoccupation with orderliness, control, inadequacy since early adulthood. submissive and clinging behavior. perfectionism at the expense of efficiency and II. At least 4 of the following, II. At least 5 of the following, flexibility at early adulthood in varying contexts. o Avoids occupation that involve interpersonal contacts (fear of critsism o Difficulty making everyday decisions without reassurance of II. At least 4 of the following, and rejection) others. o Preoccupation with details (major point of the activity is lost) o Unwilling to interact unless being liked. o Needs others to assume responsibilities for them. o Detrimental perfectionism. o Cautious with interpersonal relationship. o Difficulty of expressing disagreement. o Excessive devotion to work. o Preoccupied with being criticized or rejected in social situation. o Difficulty initiating projects due to lack of self-confidence. o Excessive about morals and ethics. o Feeling of inadequacy. o Goes to anything to obtain support from others. o Will not delegate tasks. o Feeling of being Socially inept and inferior o Feel helpless when alone. o Unable to discard worthless objects. o Reluctant to engage in new activities due to fear of embarrassment. o Urgently seeks another relationship when one ends. o Miserly spending style. o Preoccupied with fears of being left to take of self. o Rigid and stubborn. Course & Chronic, although may remit with age, Chronic, Unpredictable course Prognosis ◘ Increased depression and anxiety risk especially during teen years if ◘ Childhood medical illness or separation anxiety disorder may ◘ Most have comorbid OCD there’s no support system. increase the likelihood of DPD. DDx, ◘ Prone to depression especially after the loss of the person DDx, Schizoid (desire relationship but they’re shy and fear rejection). who’re dependent on, and have difficulties with employment. OCD (do not have recurrent obsessions, compulsions, the Social anxiety (fear and avoidance of social situations these symptoms are ◘ Regression is common defense mechanism. symptoms are ego-syntonic) integral of one’s personality since adolescence, overall fear of rejection) DDx, NPD (assertiveness and achievement but they’re motivated by Dependent (cling to relationship but slow to get involved). Avoidant (cling to perfectionism and work rather than status). relationship and actively and aggressively seek relationship) BPD, HPD (long-lasting relationship with one who they’re dependent on) Treatment Psychotherapy (assertiveness, social skills), group therapy may be beneficial. Psychotherapy (CBT, social skills) Psychotherapy (CBT) SSRIs for comorbid anxiety or major depression. Pharmacotherapy for comorbid anxiety and depression. Pharmacotherapy for comorbid disorders.