Personality Disorders Chapter 8 PDF

Prepared by: Prof. Reyxielle F. Tomas  persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships.  Longstanding, pervasive, inflexible, extreme, an...

Prepared by: Prof. Reyxielle F. Tomas  persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships.  Longstanding, pervasive, inflexible, extreme, and persistent patterns of behavior and inner experience – Unstable positive sense of self – Unable to sustain close relationships  DSM-5 retains 3-cluster format of the DSM-IV-TR  Alternative DSM-5 Model for Personality Disorders included in the appendix of the DSM-5 > currently undergoing study for possible inclusion in a future revision of DSM-V a. Negative Affectivity – display negative emotions frequently and intensely b. Detachment – people who manifest detachment tend to withdraw from other people and social interactions c. Antagonism – behave in ways that put them at odds with other people d. Disinhibition – behave impulsively, without reflecting on potential future consequences e. Psychoticism – have unusual and bizarre experiences  Recognizable during adolescence or early adult life For PD to be diagnosed in an individual younger than 18 years old, it has to be present for at least 1 year When an individual has a persistent mental disorder that was preceded by a preexisting PD, the PD must also be recorded, followed by “premorbid” When personality changes after exposure to extreme stress, PTSD should be considered  Some similarity to, CLUSTER A but less severe 01 ODD ECCENTRIC than, schizophrenia Pattern of CLUSTER B irresponsible 02 DRAMATIC/ ERRATIC behaviors 03 CLUSTER C Highly comorbid to ANXIOUS/ FEARFUL depressive disorder 01 Cluster A: Odd Eccentric Excessively mistrustful and suspicious of others, without any justification Slightly more common among the relatives of people who have schizophrenia Early mistreatment or traumatic childhood experiences may play a role in the development May be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, and interpersonal hypersensitivity Associated with prior history of childhood mistreatment, externalizing symptoms, bullying, and adult appearance of interpersonal aggression Treatment: CBT Show pattern of detachment from social relationships and a limited range of emotions. > Schizoid – describe people who have the tendency to turn inward and away from the outside world > Childhood Shyness is reported as a precursor to later adult schizoid personality disorder > Abuse and neglect in childhood are also reported among individuals Treatment: Social Skills Training Typically socially isolated and behave in ways that would seem unusual to many of us, and they tend to be suspicious and to have odd beliefs  Have “ideas of reference”  Have odd beliefs or engage in “magical thinking”  Clinicians must be aware that different cultural beliefs or practices may lead to a mistaken diagnosis of this disorder  Increased prevalence of schizotypal personality disorder among relatives of people with schizophrenia who do not also have schizophrenia themselves  02 Cluster B: Dramatic/Erratic  Characterized as having history of failing to comply with social norms Tend to be irresponsible, impulsive, and deceitful Completely lacking in conscience and empathy, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest guilt or regret Has chronic course but may become less evident or remit as the individual grows older, often by age 40 Cannot be diagnosed before age 18 years old Given only if there is evidence of conduct disorder before age 15 years  Antisocial behavior that occurs exclusively during schizophrenia or bipolar disorder should not be diagnosed Underarousal Hypothesis – psychopaths have abnormally low levels of cortical arousal Fearlessness Hypothesis – psychopaths possess a higher threshold for experiencing fear than most other individuals Treatment: Parent Training  Moods and relationships are unstable, and usually they have poor self-image Often feel empty and are at a great risk of dying by their own hands Often engage to suicidal behaviors Tend to have turbulent relationships, fearing abandonment but lacking control over their emotions Often intense, going from anger to deep depression in a short time  Dysfunction in the area of emotion is sometimes considered one of the core features of borderline personality disorder Prevalent in families who have history of mood disorders Adolescents as young as 12 or 13 years can meet full criteria Impulsive symptoms remit the most rapidly, while affective symptoms remit at a substantially slower rate Recovery is more difficult to achieve and less stable over time Often co-occurs with mood disorders, so if both criteria are met, both are diagnosed Treatment: Dialectical Behavior Therapy ~43% Percentage of the world’s population that knows at least two languages  Tend to be overly dramatic and often seem almost to be acting, attention seeker Express emotions in an exaggerated manner Histrionic PD and Antisocial PD co-occur more often  They consider themselves different from others and deserve a special treatment Unreasonable sense of self-importance and are so preoccupied with themselves that they lack sensitivity and compassion for other people Grandiosity – exaggerated feelings and their fantasies of greatness Child may be fixated at self-centered, grandiose stage of development 03 Cluster C: Anxious/Fearful Extremely sensitive of the opinion of others and although they desire social relationships, their anxiety leads them to avoid Extremely low self-esteem causes them to be limited in their friendships and dependent on those who they feel comfortable with Feel chronically rejected by others and are pessimistic about their future Often starts in infancy or childhood with shyness, isolation, and fear of strangers and new situations Avoidant PD frequently occurs in the absence of SAD Treatment: Behavioral Intervention Techniques  Rely on others to make ordinary decisions as well as important ones, which results in an unreasonable fear of abandonment Agree with other people’s opinion just for them to be not rejected Feel uncomfortable or helpless when alone cause of exaggerated fears of being unable to take care of themselves  Fixation on things being done “the right way” This preoccupation with details prevents them from completing much of anything Need to control all aspects of their life When criteria for both OCD and OCPD are met, both diagnoses should be recorded Treatment: CBT  A P, S, S PERSONALITY DISORDERS B AS, B, H, N C A,D, O