Personality Disorders PDF

Personality Disorders What is personality: Is the sum of an individual's emo onal, cogni ve, and behavioral traits as demonstrated under ordinary living condi ons, Personality is rela vely stable and leads to more or les...

Personality Disorders What is personality: Is the sum of an individual's emo onal, cogni ve, and behavioral traits as demonstrated under ordinary living condi ons, Personality is rela vely stable and leads to more or less predictable a ec ve, cogni ve and behavioral responses to everyday events. Personality Traits: Are pa erns of perceiving, rela ng to, and thinking about the environment and one self that are exhibited in a wide range of social and personal contexts. The way a par cular person usually responding to a variety of situa ons or context It re ects his or her personality traits. Are neither helpful nor harmful per se. They may be adap ve, maladap ve, or both depending upon the situa on or context in which they are expressed. For example, obsessive compulsive trait may be adap ve for a physician in his work but maladap ve in his family life and interpersonal rela onships Factors that help to determine an individual's personality: It is a bio psychosocially determined. It is a combina on of interrelated and interac ng factors that include: 1)innate temperament, as determined by cons tu on, heredity and biology. 2) developmental within one's family. ti ti ti ti ti ti ti ti tt fl ff ti ti ti ti ti ti ti ti ti ti ti  3) role models, including family members, friends and teachers 4)culture and societal in uences, such as socioeconomic status, living environment, educa onal opportunity role models, religious and cultural heritage, na onal character. What is a personality disorder? personality disorder is an enduring pa ern of inner experience and behavior that has an onset in adolescence or early adulthood, is in exible and pervasive across a broad range of personal and social situa ons, is stable and of long dura on, and leads to clinically signi cant distress or impairment in social, occupa onal, or other important areas of func oning. General Diagnos c Criteria for Personality Disorders 1.Deviates markedly from cultural expecta ons 2.Is in exible and personally and socially pervasive 3.Causes distress or social or work impairment 4. Is a stable pa ern of experience and behavior of long dura on ("stably unstable") 5. Cannot be explained by another mental illness 6. Is not caused by substance use or medical condi on Cluster A Disorders (Odd and eccentric) ti fl ti tt fl ti fl ti ti fi ti tt ti ti ti ti  DSM-5 Diagnos c Criteria for Paranoid Personality Disorder A. A pervasive distrust and suspiciousness of others such that their mo ves are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Suspects, without su cient basis, that others are exploi ng, harming, or deceiving him or her. 2. Is preoccupied with unjus ed doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to con de in others because of unwarranted fear that the informa on will be used maliciously against him or her. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6. Perceives a acks on his or her character or reputa on that are not apparent to others and is quick to react angrily or to countera ack. 7. Has recurrent suspicions, without jus ca on, regarding delity of spouse or sexual partner. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psycho c features, or another psycho c disorder and is not a ributable to the physiological e ects of another medical condi on. Epidemiology: 0.5% - 2.5% of the general popula on Rela ves of pa ents with chronic schizophrenia and pa ents with persecutory delusional disorders show an increased prevalence of paranoid personality disorder. DSM-5 Diagnos c Criteria for Schizoid Personality Disorder A. A pervasive pa ern of detachment from social rela onships and a restricted range of expression of emo ons in interpersonal se ngs, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Neither desires nor enjoys close rela onships, including being part of a family. 2. Almost always chooses solitary ac vi es. 3. Has li le, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, ac vi es. 5. Lacks close friends or con dants other than rst-degree rela ves. 6. Appears indi erent to the praise or cri cism of others. 7. Shows emo onal coldness, detachment, or a ened a ec vity. ti ti tt tt ti ti ff ff ti ti tt fi ti ffi tt fi ti tti fi ti ti ti ti ti ti ti ti fi ti ti fl fi tt ti ti ti ti ff ti fi ti ti ti tt ti  B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psycho c features, another psycho c Epidemiology: 7.5% of the general popula on evidence to suggest increased prevalence of schizoid personality disorder in rela ves of persons with schizophrenia Di eren al Diagnosis 1: Avoidant and socially phobic persons desire and may seek rela onships, but their anxiety handicaps their capacity to achieve relatedness while schizoid individuals do not desire rela onships 2:Schizophrenia 3: au s c disorder, and Asperger's disorder ( less severe variant of au sm). DSM-5 Diagnos c Criteria for Schizotypal Personality Disorder A. A pervasive pa ern of social and interpersonal de cits marked by acute discomfort with, and reduced capacity for, close rela onships as well as by cogni ve or perceptual distor ons and eccentrici es of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by ve (or more) of the following: 1. Ideas of reference (excluding delusions of reference). 2. Odd beliefs or magical thinking that in uences behavior and is inconsistent with subcultural norms (e.g., supers ousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupa ons). 3. Unusual perceptual experiences, including bodily illusions. 4. Odd thinking and speech (e.g., vague, circumstan al, metaphorical, overelaborate, or stereotyped 5.Suspiciousness or paranoid idea on. 6. Inappropriate or constricted a ect. 7. Behavior or appearance that is odd, eccentric, or peculiar. 8. Lack of close friends or con dants other than rst-degree rela ves. 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than nega ve judgments about self. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psycho c features, another psycho c disorder, or au sm spectrum disorder ff ti ti ti ti ti ti ti tt ti ti ti ti fi ti ff ti fl fi ti ti ti ti fi ti ti ti ti ti ti ti fi ti  disorder, or au sm spectrum disorder and is not a ributable to the physiological e ects of another medical condi on Epidemiology: Life me prevalence is 3% of the general popula on. E ology: Gene c, especially among rst-degree rela ves of individuals with schizophrenia Cluster B Disorders (Drama c and emo onal) DSM-5 Diagnos c Criteria for An social Personality Disorder A. A pervasive pa ern of disregard for and viola on of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Decei ulness, as indicated by repeated lying, use of aliases, or conning others for personal pro t or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical ghts or assaults. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor nancial obliga ons. 7. Lack of remorse, as indicated by being indi erent to or ra onalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of an social behavior is not exclusively during the course of schizophrenia or bipolar disorder. Epidemiology: An social personality disorder is present in 3% of men and 1% of women. About half have been arrested; about half of those in prison have ASP. ti ti ti ti fi tf ti ti ti tt ti ti fi ti ti ti ff ti ti tt ti ti fi ff fi  Causes: ASP is more common among rst-degree rela ves of those diagnosed with ASP. In families of an individual with ASP, men show higher rates of ASP and substance abuse, whereas women have higher rates of soma za on disorder. A harsh, violent, and criminal environment also predisposes people to this disorder Di eren al Diagnosis Bipolar disorder substance abuse disorder DSM-5 Diagnos c Criteria for Borderline Personality Disorder A pervasive pa ern of instability of interpersonal rela onships, self-image, and a ects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by ve (or more) of the following: 1. Fran c e orts to avoid real or imagined abandonment. (Note: Do not include suicidal or self- mu la ng behavior covered in Criterion 5.) 2. A pa ern of unstable and intense interpersonal rela onships characterized by alterna ng between extremes of idealiza on and devalua on. 3. Iden ty disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are poten ally self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge ea ng). (Note: Do not include suicidal or self-mu la ng behavior covered in Criterion 5.) 5. Recurrent suicidal behavior, gestures, or threats, or self-mu la ng behavior. 6. A ec ve instability due to a marked reac vity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually las ng a few hours and only rarely more than a few days). 7. Chronic feelings of emp ness. Epidemiology: Life me prevalence is 1 - 2% of the general popula on. Causes: About ve mes as common among rst-degree rela ves of borderline pa ents. In addi on, this disorder shows increased rates in families of alcoholics and families of individuals with ASP, as well as in families with mood disorders. ff ti ti ff ti fi ti ti ti tt ti ti ti ff tt ti ti ti ti fi ti fi ti ti ti ti ti ti ti ti ti ti ti ti ti ti ff ti ti fi  Females with borderline personality disorder frequently have su ered from sexual or physical abuse or both. Di eren al Diagnosis Mood disorder substance abuse disorder DSM-5 Diagnos c Criteria for Narcissis c Personality Disorder A pervasive pa ern of grandiosity (in fantasy or behavior), need for admira on, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by ve (or more) of the following: 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or ins tu ons). 4. Requires excessive admira on. 5. Has a sense of en tlement (i.e., unreasonable expecta ons of especially favorable treatment or automa c compliance with his or her expecta ons). 6. Is interpersonally exploita ve (i.e., takes advantage of others to achieve his or her own ends). 7. Lacks empathy: is unwilling to recognize or iden fy with the feelings and needs of others Epidemiology: Life me prevalence is es mated at 1%. Up to 50% to 75% of those with this diagnosis are men. DSM-5 Diagnos c Criteria for Histrionic Personality Disorder A pervasive pa ern of excessive emo onality and a en on seeking, beginning by early adulthood and present in a variety of contexts, as indicated by ve (or more) of the following: 1. Is uncomfortable in situa ons in which he or she is not the center of a en on. 2. Interac on with others is o en characterized by inappropriate sexually seduc ve or provoca ve behavior. 3. Displays rapidly shi ing and shallow expression of emo ons. ff ti ti ti ti tt tt ti ti ti ft ti ti ti ti ft ti ti ti ti fi ti ti tt ti ti ti ff tt ti ti ti fi ti  4. Consistently uses physical appearance to draw a en on to self. 5. Has a style of speech that is excessively impressionis c and lacking in detail. 6. Shows self-drama za on, theatricality, and exaggerated expression of emo on. 7. Is sugges ble (i.e., easily in uenced by others or circumstances). 8. Considers rela onships to be more in mate than they actually are. Epidemiology: Life me prevalence is 2% to 3% of the general popula on. Causes: There appears to be a familial link to soma za on disorder and to ASP. Cluster C Disorders (Anxious and fearful) DSM-5 Diagnos c Criteria for Avoidant Personality Disorder A pervasive pa ern of social inhibi on, feelings of inadequacy, and hypersensi vity to nega ve evalua on, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupa onal ac vi es that involve signi cant interpersonal contact because of fears of cri cism, disapproval, or rejec on. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within in mate rela onships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being cri cized or rejected in social situa ons. 5. Is inhibited in new interpersonal situa ons because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new ac vi es because they may prove embarrassing. Epidemiology: 0.5% to 1% of the general popula on DSM-5 Diagnos c Criteria for Dependent Personality Disorder ti ti ti ti tt ti ti ti ti ti ti ti ti ti fl ti ti ti ti ti ti ti ti ti fi tt ti ti ti ti ti ti ti ti ti  A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separa on, beginning by early adulthood and present in a variety of contexts, as indicated by ve (or more) of the following: 1. Has di culty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has di culty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realis c fears of retribu on.) 4. Has di culty ini a ng projects or doing things on his or her own (because of a lack of self-con dence in judgment or abili es rather than a lack of mo va on or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. 7.Urgently seeks another rela onship as a source of care and support when a close rela onship ends. 8. Is unrealis cally preoccupied with fears of being le to take care of himself or herself. Epidemiology: Life me prevalence is 15% to 20%. Di eren al Diagnosis People with dependent personality disorder are similar to individuals with borderline personality disorder in their desire to avoid abandonment but do not exhibit the impulsive behavior, unstable a ect, and poor self-image of the borderline pa ent. DSM-5 Diagnos c Criteria for Obsessive- Compulsive Personality Disorder A pervasive pa ern of preoccupa on with orderliness, perfec onism, and mental and interpersonal control, at the expense of exibility, openness, and e ciency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Is preoccupied with details, rules, lists, order, organiza on, or schedules to the extent that the major point of the ac vity is lost. 2. Shows perfec onism that interferes with task comple on (e.g., is unable to complete a project because his or her own overly strict standards are not met). 3. Is excessively devoted to work and produc vity to the exclusion of leisure ac vi es and friendships (not accounted for by obvious economic necessity). fi ff ti ti ffi ffi ffi ti tt ti ti ti ti ti ti ti fl ti ti ti ti ti ti ti ti ffi ft ti ti ti ti ti ti fi ff  4. Is overconscien ous, scrupulous, and in exible about ma ers of morality, ethics, or values (not accounted for by cultural or religious iden ca on). 5. Is unable to discard worn-out or worthless objects even when they have no sen mental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness. Epidemiology: The es mated prevalence is 1 % in the general popula on. Men are diagnosed with obsessive-compulsive personality disorder twice as frequently as women MANAGEMENT: Psychotherapy: Because personality may have temperamental components and is developed over a life me of interac ng with the environment, personality disorders are generally resistant to treatment. Cogni ve, behavioral, and family therapies are also used to treat these disorders. Pharmacotherapy: Mood stabilizers may be used for mood instability and impulsiveness. Benzodiazepines are commonly used for anxiety, although the poten al for abuse and dependence is too o en overlooked. Beta-blockers are also used frequently selec ve serotonin-reuptake inhibitors (SSRIs) or others drugs for depression, obsessive- compulsive symptoms, and ea ng disturbances Psycho c or paranoid symptoms are commonly treated with low-dose an psycho cs. ti ti ti ti ti ti ft ti ti fl fi ti ti tt ti ti ti ti ti