PSY3 Personality disorders

Personality Disorders • Persistent maladaptive or culturally infrequent, [blank_start]thoughts, feelings, and behavior[blank_end], poor interpersonal [blank_start]relationships[blank_end] • Inflexible and pervasive across [blank_start]situations[blank_end] • Significant [blank_start]distress or impairment[blank_end] • Often traced back to [blank_start]adolescence[blank_end] • Categorically conceptualised - Psychiatric classification • Are dimensional - ranges from [blank_start]normality to severe[blank_end] • Normal vs. Abnormal traits - there are [blank_start]extreme[blank_end] variants of normal traits seen and sometimes abnormal traits that only exist in [blank_start]disordered[blank_end] individuals.

Personality disorders fall into three general clusters: • Cluster A – odd or eccentric [blank_start]Paranoid, schizoid, schizotypal[blank_end] • Cluster B – dramatic, emotional, or erratic Antisocial, [blank_start]borderline, histrionic, narcissistic[blank_end] • Cluster C – anxious or fearful [blank_start]Avoidant, dependent,[blank_end] obsessive-compulsive

Cluster A: Odd or Eccentric PDs. • People with these disorders display behaviors [blank_start]similar[blank_end] to, but not as [blank_start]extensive[blank_end] as, schizophrenia • Little known about [blank_start]treatment[blank_end] 1. Paranoid PD - 2% prevalence Deep suspicion or [blank_start]mistrust[blank_end] of others. Hypersensitivity, vigilance, and caution. Pathological [blank_start]jealousy[blank_end]. [blank_start]Control, anger/hostility.[blank_end] 2. Schizoid PD - <1% prevalence, more common in men Persistent [blank_start]avoidance[blank_end]. Limited [blank_start]emotional[blank_end] expression. [blank_start]Withdrawn[blank_end] and reclusive. 3. Schizotypal PD - 0.6% to 4% prevalence [blank_start]Psychoticism[blank_end] (odd beliefs, thoughts, speech, unusual perceptual experiences), [blank_start]paranoid[blank_end] ideation, excessive [blank_start]social anxiety/withdrawal[blank_end].

Cluster B: "Dramatic” PDs. Dramatic, emotional, or erratic behavior. Almost impossible to have satisfying [blank_start]relationships[blank_end]. 1. Antisocial PD - 1-3% prevalence, More common in men Disregard for [blank_start]social[blank_end] norms, [blank_start]reckless[blank_end] behavior, impulsive, irresponsible, prone to [blank_start]anger[blank_end]/aggression, deceitful and manipulative, lack of [blank_start]remorse[blank_end]. Evidence of Conduct Disorder before age 15. + Psychopathy symptoms (addition to APD): Interpersonal deficits, superficial [blank_start]charm[blank_end], grandiosity, social potency, [blank_start]low[blank_end] anxiety, shallow [blank_start]emotions[blank_end], lack of [blank_start]empathy[blank_end], guilt, and remorse, inability of form deep relationships, fearlessness 2. Borderline Personality Disorder - 3-4% prevalence, common in [blank_start]clinical settings and women[blank_end] Instability of self-image and relationships - [blank_start]Identity[blank_end] disturbance, intense interpersonal [blank_start]attachments[blank_end], idolization vs. devaluation (black/white thinking). Affective instability - Dysphoria and chronic feelings of [blank_start]emptiness[blank_end], extreme emotional response to [blank_start]abandonment[blank_end]. Impulsive, unpredictable, and destructive behavior.. [blank_start]anger/violence, substance abuse,[blank_end] etc. Biopsychosocial Theory - [blank_start]invalidating childhood environments[blank_end] could be the cause. [blank_start]CBT/DBT[blank_end] as Tx. (D = dialectal). 3. Histrionic PD. No research on etiology or treatment. Extremely dramatic, [blank_start]shallow[blank_end] emotions, [blank_start]attention[blank_end]-seeking behaviors. Vain, self-centered, and demanding. 4. Narcissistic Personality Disorder - uncommon Grandiose, need much admiration. [blank_start]Lack[blank_end] of empathy. Seldom interested in feelings of others. Expect constant [blank_start]attention and admiration[blank_end] from those around them. Association with superiority. Exaggerate achievements, appear arrogant/haughty. Causes? Psychodynamic theory = [blank_start]cold, rejecting[blank_end] parents. Behavioral and cognitive theorists = too much [blank_start]positive reinforcement[blank_end].

Cluster C: “Anxious” PDs. All more common in [blank_start]women[blank_end]. 1. Avoidant PD. 2% prevalence, 14% of those in treatment. Uncomfortable and inhibited in [blank_start]social[blank_end] situations. Feelings of [blank_start]inadequacy[blank_end]. Sensitive to [blank_start]negative[blank_end] evaluation. [blank_start]Few[blank_end] close friends. 2. Dependent PD. Uncommon. Central feature: difficulty with [blank_start]separation[blank_end]. Pervasive, excessive need to be taken [blank_start]care[blank_end] of. Clingy and obedient. Rely on others for [blank_start]decisions[blank_end]. Feel [blank_start]distressed, lonely, and sad[blank_end]; dislike selves. 3. Obsessive-Compulsive PD. (Different from OCD) 1-2% prevalence, 9% in treatment. Preoccupied with order, perfection, and [blank_start]control[blank_end], lose flexibility, openness, and efficiency. Unreasonably [blank_start]high standards[blank_end] for selves and others. Rigid and stubborn; trouble expressing [blank_start]affection[blank_end].

Limitations with DSM-5 system: • Excessive [blank_start]comorbidity[blank_end] exists • Inadequate coverage • Excessive within-diagnosis [blank_start]heterogeneity[blank_end] • No clear boundary between normal and pathological personality • Inadequate scientific base Solution? Dimensional personality traits define disorders = individuals vary in [blank_start]degree[blank_end] rather than in kind. Impairment in [blank_start]functioning[blank_end] due to extreme manifestation of personality traits results in disorder diagnosis.