Personality disorders (week 11) Flashcards
What are the 3 clusters of personality disorders?
Cluster A: Odd or eccentric
Cluster B: dramatic, emotional, erratic
Cluster C: anxious and fearful
What is a personality disorder?
- Persistent pattern of
emotions, cognitions,
behaviour resulting
in enduring emotional
distress for affected
person and others - distress may or may not be
subjective - difficulties with
relationships and work - DSM -5 lists 10 specific
ones
Commonalities across personality disorders
- symptoms begin in early adulthood
- fixed and consistent across situations
- NOT diagnosed in early childhood or adolescence
- lack of clear sense of self
- difficulty in relationships
- poor self awareness or insight into these difficulties
Histrionic personality disorder is biased against who?
females
antisocial personality disorder is biased against who?
males
What are the most common personality disorders?
borderline and antisocial
Cluster A disorder:
Odd/ eccentric (socially awkward, isolated, withdrawn)
What is Paranoid personality disorder?
- Suspicious, mistrustful of others without justification
- argumentative, may complain, quiet, hostile towards others, suicidal
- bears relationship to: paranoid type of schizophrenia and delusional disorder
DSM- 5TR criteria of paranoid personality disorder
A ) A pervasive distrust and suspiciousness of others such that their motives are interpreted
as malevolent, begins early adulthood, indicated by 4 (or more) :
* Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them
* Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends
* Is reluctant to confide in others because of unwarranted fear that the information will be
used maliciously against him or her
* Reads hidden demeaning or threatening meanings into benign remarks or events
* Persistently bears grudges (i.e. - is unforgiving of insults, injuries, or slights)
* Perceives attacks on his or her character or reputation that are not apparent to others and
is quick to react angrily or to counterattack
* Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual
partner
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder with
psychotic features or other psychotic disorder
causes of paranoid personality disorder
- Genetics
- relatives with schizophrenia
- mistreatment or traumatic childhood experiences
- cognitive cultural factors
Treatment for paranoid personality disorder
- cognitive therapy to change mistaken assumptions about others
clinical description of schizoid personality disorder
- detachment from social relationships, no desire to enjoy closeness with others, cold, aloof
- homelessness
- extreme social deficiencies
- social isolation, poor rapport and constricted affect
Schizoid DSM criteria
A) A pervasive pattern of detachment from social relationships and a restricted
range of expression of emotions in interpersonal settings, beginning by early
adulthood, indicated by 4 (or more):
* Neither desires nor enjoys close relationships, including being part of a family
* Almost always chooses solitary activities
* Has little, if any, interest in having sexual experiences with another person
* Takes pleasure in few, if any, activities
* Lacks close friends or confidants other than first-degree relatives
* Appears indifferent to the praise or criticism of others
* Shows emotional coldness, detachment, or flattened affectivity
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder
with psychotic features or other psychotic disorder
Causes of schizoid personality disorder
- childhood shyness, abuse, neglect, low-density dopamine receptors
Treatment for schizoid personality disorder
- social skills training
*role - playing - limited outcomes
clinical description of Schizotypal personality disorder
- Social deficits, psychotic-like symptoms, cognitive
impairments/paranoia - Report unusual perceptual experiences
- Hypersensitive to criticism as children
- Same spectrum as schizophrenia without debilitating
hallucinations and delusions - “Ideas of reference” and “Magical Thinking”
Schizotypal personality disorder DSM-5 criteria
A) A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close
relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, as indicated by 5+ :
* Ideas of reference (excluding delusions of reference)
* Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g. -
superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or
preoccupations)
* Unusual perceptual experiences, including bodily illusions
* Odd thinking and speech (e.g. - vague, circumstantial, metaphorical, overelaborate, or stereotyped)
* Suspiciousness or paranoid ideation
* Inappropriate or constricted affect
* Behavior or appearance that is odd, eccentric, or peculiar
* Lack of close friends or confidants other than first-degree relatives
* Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than
negative judgments about self
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder with psychotic features or other psychotic
disorder
causes of schizotypal personality disorder
- genetics, the prevalence of the disorder in relatives
- left hemisphere damage: brain abnormalities
(difficulty on tests of
memory or learning) - abnormalities in semantic association abilities
What is Cluster C?
Anxious/ fearful
treatment for schizotypal personality disorder
- antipsychotic medication, community treatment, social skills training
- CBT; treatment for depression
Avoidant personality disorder clinical description
- interpersonally anxious
- views self as socially inept, unappealing
- fear of rejection/shame
- pessimistic about their future
- restraint in personal relationships
DSM criteria for avoidant personality disorder
A) A pervasive pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation, as indicated by 4+ of the following:
* Avoids occupational activities that involve significant interpersonal contact
because of fears of criticism, disapproval, or rejection.
* Is unwilling to get involved with people unless certain of being liked
* Shows restraint within intimate relationships because of the fear of being
shamed or ridiculed
* Is preoccupied with being criticized or rejected in social situations.
* Is inhibited in new interpersonal situations because of feelings of inadequacy.
* Views self as socially inept, personally unappealing, or inferior to others.
* Is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing
* Psychopathology
causes of avoidant personality disorder
- Born with difficult temperament, parental rejection, uncritical love
* Low self-esteem, social
alienation persisting
into adulthood - Overreactive behavioural inhibition system
- Part of social anxiety spectrum?
Treatment for avoidant personality disorder
- Better evidence
- Social skills training
- CBT; Systematic desensitization; Behavioural rehearsal
- Medical interventions as for anxiety
Dependent personality disorder clinical description
- Interpersonally dependent, anxious
- Submissive, timid, and passive
- Feelings of inadequacy, sensitive to criticism, and need
reassurance - Cling to relationships
DSM criteria of dependant personality disorder
A) A pervasive and excessive need to be taken care of that leads to submissive and clinging
behavior and fears of separation, as indicated by 5+:
* Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others
* Needs others to assume responsibility for most major areas of his or her life
* Has difficulty expressing disagreement with others because of fear of loss of support or
approval (Note: Do not include realistic fears of retribution.)
* Has difficulty initiating projects or doing things on his or her own (because of a lack of
self-confidence in judgment or abilities rather than a lack of motivation or energy)
* Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant
* Feels uncomfortable or helpless when alone because of exaggerated fears of being unable
to care for himself or herself
* Urgently seeks another relationship as a source of care and support when a close
relationship ends
* Is unrealistically preoccupied with fears of being left to take care of himself or herself
causes of dependant personality disorder
- Disruptions in early childhood lead to fears of abandonment
- High in sociotropic traits
- Low on individualistic achievement traits
treatment for dependent personality disorder
- developing confidence; ensuring patient does not depend on therapist