Personality Disorders (Tobia) - 10/10/16

Question 1

What is a personality disorder?

Answer 1

• Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing distress and/or impaired functioning
• Person usually not aware of problem
• Usually presents by early adulthood
• Three clusters, A, B, and C
  
  • Weird, Wild, and Worried based on symptoms

Question 2

Cluster A Personality Disorders (Weird):

Paranoid

Schizoid

Schizotypal

Answer 2

“Weird”: Accusatory, Aloof, Awkward

• Inability to develop meaningful social relationships
• No psychosis; genetic association w/ schizophrenia

Paranoid

Pervasive distrust and suspiciousness

Projection = major defense mechanism

Schizoid (distant)

Voluntary social withdrawal

Limited emotional expression

Content with social isolation (vs. avoidant)

Schizotypal (magical thinking)

Eccentric appearance

Odd beliefs or magical thinking

Interpersonal awkwardness

Question 3

Cluster B Personality Disorders (Wild)

Antisocial

Borderline

Histrionic

Narcissistic

Answer 3

“Wild” = Bad to the Bone

• Dramatic, emotional, or erratic
• Genetic association with mood disorders and substance abuse

Antisocial (sociopath)

• Disregard for and violation of rights of others
• Criminality, impulsivity
• Males > Females
• Must be at least 18 years old and have history of conduct disorder before age 15

Borderline

• Unstable mood and interpersonal relationships
• Impulsivity
• Self-mutilation
• Suicidality
• Sense of emptiness
• Females > Males
• Splitting = major defense mechanism
  
  • Objects divided into “all good” and “all bad”
  • Rapid shifting from one extreme to another

Histrionic

• Excessive emotionality and excitability
• Attention seeking
• Sexually provocative
• Overly concerned with appearance

Narcissistic

• Grandiosity
• Sense of entitlement
• Lacks empathy and requires excessive admiration
• Often demands the “best” and reacts to criticism with rage

Question 4

Cluster C Personality Disorders (Worried)

Avoidant

Obsessive-Compulsive

Dependent

Answer 4

“Worried” (Cowardly, compulsive, clingy)

• Anxious or fearful
• Genetic association with anxiety disorders

Avoidant

• Hypersensitive to rejection
• Socially inhibited
• Feelings of inadequacy
• Desires relationships with others (vs. schizoid)

Obsessive-Compulsive

• Preoccupation with order, perfectionism, and control
• Ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD)

Dependent

• Submissive and clingy
• Excessive need to be taken care of
• Low self-confidence
• (Patients often get stuck in abusive relationships)

Question 5

Psychosocial Treatment

Answer 5

• Recommended for most personality disorders
• Dialectical behavioral therapy for BPD