Personality Disorders

Question 1

Personality Disorders

DSM 5

Answer 1

Personality disorders are associated with ways of thinking and feeling about oneself and others that
significantly and adversely affect how an individual functions in many aspects of life.

They fall within 10 distinct types:

1. paranoid personality disorder,
2. schizoid personality disorder,
3. schizotypal personality disorder,
4. antisocial personality disorder,
5. borderline personality disorder,
6. histrionic personality,
7. narcissistic personality disorder,
8. avoidant personality disorder,
9. dependent personality disorder,
10. obsessive compulsive personality disorder.

Hybrid model (single axis) that included evaluation of impairments in personality functioning (how an individual typically experiences himself or herself as well as others) plus five broad areas of pathological personality traits.

Although this hybrid proposal was not accepted for DSM-5’s main manual, it is included in Section III
for further study. Using this alternate methodology, clinicians would assess personality and diagnose
a personality disorder based on an individual’s particular difficulties in personality functioning and on
specific patterns of those pathological traits.

The hybrid methodology retains six personality disorder types:
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Avoidant Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder
Each type is defined by a specific pattern of impairments and traits. This approach also includes a diagnosis of:

Personality Disorder—Trait Specified (PD-TS) that could be made when a Personality Disorder is
considered present, but the criteria for a specific personality disorder are not fully met. For this diagnosis, the clinician would note the severity of impairment in personality functioning and the problematic personality trait(s).

This hybrid dimensional-categorical model and its components seek to address existing issues with the
categorical approach to personality disorders.

Question 2

Paranoid PD

Schizoid PD

Schizotypal PD

Answer 2

Paranoid PD

1. pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent
2. suspects exploiting, harming or deceiving, unjustified doublts about trust
3. reluctant to confide, reads demeaning content into benign remarks, persistently suspicious.

Schizoid PD

1. pervasive pattern of indifference to interpersonal relationships and a restricted range of emotional expression in social settings
2. doesn’t desire/enjoy close relationships, chooses solitary activities, little sex interest,
3. takes pleasure in few activities, indifferent to praise/criticism, emotional coldness/detachment

Schizotypal PD

1. pervasive social and interpersonal deficits and eccentricities in cognition, perception, and behavior.
2. ideas of reference, odd beliefs/magical thinking, bodily illusions and other unusual perceptions, odd thinking/speech, suspiciousness
3. inappropriate or constricted affect, peculiarities in bx and appearance, soical anxiety.
4. may express a disire for close personal contacts, but they have few friends and seem to prefer being alone

Question 3

Antisocial PD

Borderline PD

Histrionic PD

Narcissistic PD

Answer 3

Antisocial PD

1. pattern of disregard for and violation of the rights of others
2. over 18, but history of Conduct Dx before 15yo
3. failure to conform to social norms (law), deceitfulness, impulsive, reckless disregard for safety of others/self, irresponsible, lack of remorse
4. inflated sense of self, lack of empathy, superficial charm
5. chronic, but symptoms often less evident/pervasive in the 40’s

Borderline PD

• pattern of instability in interpersonal relationships, self-image, affect, and very impulsive
• frantic efforts to avoid abandonment, unstable, intense interpersonal rx with fluctuations between idealization and devaluation
• instability in self-image/sense of self, impulsivity self-damaging, recurrent suicide threats/gestures; affective instability;chronic feelings of emptiness
• age 19-34, chronic and severe in early adulthood
• at age 40, 75% no longer meed criteria!
• impulsive symptoms resolve most quickly, affective symptoms are most chronic, cognitive/interpersonal symptoms intermediate

Etiology:

Stern: difficulties secondary to narcissism, serious disturbance in the mother-child relationship.

Object relations: disorder to the mother-child relationship (Mahler): fixation in the reapproachment phase of separation-individuation, resulting in a need for separation along with an overwhelming fear of abandonment.

Kernberg: adverse, unpredictable caregiver-child interactions that alternate between rejection and smothering. Insecure ego that relies on primitive defense mechanisms, splitting, dichotomizing self/others as all good or all bad.

Linehan: biosocial model: interaction between biology and environmental factors. emotion dysregulation is the core problem and is the result of excessive emotional vulnerability, an inability to modulate strong emotions, exposure to an invalidating enviornment.

Treatment:

1. DBT (Linehan): CBT with Rogerian assumption that acceptance of the client is vital.
2. group skills training to help client regulate their emotions and improve their social and coping skills
3. outpatient therapy to strengthen clients’ motivation and new skills
4. telephone consultation for additional support and coaching
5. DBT reduces premature termination from therapy, psychiatric hospitalizations, and parasuicidal bx.

Histrionic PD

• pervasive pattern of emotionality and attention-seeking
• discomfort when not center of attention, inappropriate sex seductive/provocative
• rapid shifting between shallow emotions, excessively impressionistic speech that lacks detail, exaggerated expression of emotions, easily influenced by others, considers rx to be more intimate than they are.

Narcissistic PD

1. pervasive pattern of grandiosity, need for admiration and lack of empathy
2. grandiose sense of self-importance, fantasies of unlimited success, power, beauty, love, believes they are unique, excessive admiration, sense of entitlement, exploitative, lack empathy

Question 4

Avoidant PD

Dependent PD

Obsessive-Compulsive PD

Answer 4

Avoidant PD

1. pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
2. avoids work/school activities with interpersonal contact due to fear of criticism, rejection or disapproval, unwilling to be involved with people unless certain of being liked
3. preoccupied with concerns about being criciized or rejected; views self as socially inept, inferior or unappealing to others, reluctant to take risks

Dependent PD

• pervasive and excessive need to be taken care of, which leads to submissive, clinging bx, fears of separation.
• difficulty making decisions w/o advice/reassurances from others, needs others to assume responsibility for most aspects of their life; fears disagreeing with others because it may lead to loss of support; difficulty initiating projects
• goes to great lengths to gain nurturance and support; feels helpless and uncomfortable alone

Obsessive-Compulsive PD

1. persistent preoccupation with orderliness, perfectionism, mental/interpersonal control; severely limiting flexibility, openness, and efficiency
2. preoccupied with details, rules so the major point of the activity is lost; perfectionism interferes with task completion; excessive devotion to work and productivity to the exclusion of leisure and friendships
3. overconscientious and inflexible with morality, ethics, and values; unable to throw out objects; reluctant to delegate work to others
4. does not involve true obsessions or compulsions.