Personality Disorders Notes

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Onset begins in

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adolescence or early adulthood and is generally stable over time.

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Another reason for why they are difficult to treat include

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their limited ability to receive, accept, or benefit from corrective feedback.

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antisocial personality disorder or borderline personality disorder.

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People with these personality disorders tend to be either court-ordered to attend therapy

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paranoid personality disorder or dependent personality disorder.

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Those who are treated may be pushed into it by family and friends

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Prevalence rates for PD is about

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10-15% of the general population

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along with 50% in clinical settings

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and 50% in the inmate population meet the criteria for ASPD

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The presence of other mental disorders such as mood, anxiety, and psychotic disorders

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can worsen the course and severity of Personality Disorders.

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In clinical practice,

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clients will often have more than one PD and might have features of many

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Those who suffer from the Cluster A disorders may act

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socially detached, suspicious, and distrustful.

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These disorders are the closest PDs to the stereotypical

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psychiatric disorders

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With cluster A we see very odd behaviors, and a distinct separation from reality.

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However, this is not occurring on a sensory level as can be seen in the psychotic disorders.

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The major reason for the distinction is the relationship between schizotypal personality and schizophrenia.

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There is a much higher prevalence of schizophrenia among first degree relatives of patients with schizotypal personality than among relatives of people with any other personality disorder.

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Cluster C
This cluster includes the disorders where the individual appears anxious or fearful.

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In this specific instance, these disorders resemble Anxiety Disorders

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Personality disorders affect about

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15 million adults in the United States.

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Approximately

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10 to 13 percent (10 to 13 people out of a 100) of the U.S. population meets the diagnostic criteria for a personality disorder at some point in his or her life.

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These disorders, however, have

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the highest rate of misdiagnosis than any other categories.

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an onset

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in adolescence (12+) or early adulthood (18-24)

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Personality disorders are usually only diagnosed for person's over the age 18.

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There is the exception that if the individual shows symptoms for at least, or above, 1 year then they can be diagnosed.

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minors cannot be diagnosed with

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antisocial personality disorder.

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DSM-IV-TR

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A. At least two of the following:

1. cognition (the ways of perceiving and interpreting self, other people, and events; people with PPDs think people are out to get them)

2. affectivity (the range, intensity, ability, and appropriateness of emotional response; know when to laugh, cry, show emotions appropriately, etc.; people with STPD laugh and talk unappropriately)

3. interpersonal functioning (establishing bonds with others, etc.; people with PPDs avoid intimacy and relationships; people with SPDs are happily being alone)

4. impulse control (people with BPDs may gamble, shop uncontrollably, or have sex with random people, etc.)

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DSM-IV-TR

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B. The enduring pattern is INFLEXIBLE and PERVASIVE across a broad range of personal and social situations.

C. The enduring pattern leads to clinically significant DISTRESS or IMPAIRMENT in social, occupational, or other important areas of functioning.

D. The pattern is stable and continues for LONG DURATIONS, and its onset can be traced back to as far as ADOLESCENCE or EARLY ADULTHOOD.

E. The enduring pattern is NOT better accounted for as a manifestation or CONSEQUENCE of ANOTHER mental disorder.

F. The enduring pattern is NOT due to the direct PHYSIOLOGICAL EFFECTS of a SUBSTANCE (e.g., drug abuse, medication) or a (GMC) general medical condition (e.g., head trauma).

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Identity integration

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Poorly integrated sense of self or identity

(e.g., limited sense of personal unity and continuity; experiences shifting self-states; believes that the self presented to the world is a false appearance

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Integrity of self-concept.

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Impoverished and poorly differentiated sense of self or identity

(e.g., difficulty identifying and describing self attributes; sense of inner emptiness; poorly defined interpersonal boundaries; definition of the self changes with social context

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Self-directedness

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Low self-directedness

(e.g., unable to set and attain satisfying and rewarding personal goals; lacks direction, meaning, and purpose in life

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Failure to develop effective interpersonal functioning as manifested by one or more of the following:

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Empathy. Impaired empathic and reflective capacity (e.g., finds it difficult to understand the mental states of others)
Intimacy. Impaired capacity for close relationships (e.g., unable to establish or maintain closeness and intimacy; inability to function as an effective attachment figure; inability to establish and maintain relationships)
Cooperativeness. Failure to develop the capacity for pro-social behavior (e.g., failure to develop the capacity for socially typical moral behavior; absence of altruism, the sense of unselfish concern).
Complexity and integration of representations of others. Poorly integrated representations of others (e.g., forms separate and poorly related images of significant others)

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Empathy

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Impaired empathic and reflective capacity (e.g., finds it difficult to understand the mental states of others)

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Intimacy

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Impaired capacity for close relationships (e.g., unable to establish or maintain closeness and intimacy; inability to function as an effective attachment figure; inability to establish and maintain relationships)

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Cooperativeness.

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Failure to develop the capacity for pro-social behavior (e.g., failure to develop the capacity for socially typical moral behavior; absence of altruism, the sense of unselfish concern).

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Complexity and integration of representations of others.

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Poorly integrated representations of others (e.g., forms separate and poorly related images of significant others)

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Paranoid Personality Disorder

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is characterized by an extreme level of distrust and suspicion of others

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Sometimes PPD may appear antecedent of

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Delusional Disorder or Schizophrenia.

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Those with PPD may develop

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Major Depressive Disorder, and Substance Abuse or Dependence is frequent

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4 (or more) of the 7 items

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1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

2. Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends, family or associates.


3. Reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

4Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges, because they are unforgiving of insults, injuries, or practical jokes.

6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

7. Has recurrent suspicions, without justification, regarding fidelity of spouse or partner.

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Gender Differences in Presentation of Disorders

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Co-morbidity often occurs with Schizophrenia, Avoidant, and Borderline Personality Disorders.

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Cultural Differences in Presentation

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different cultural groups, symptoms and treatment may not be the same.

Members of minority groups, immigrants, refugees, or those of different ethnic backgrounds may be guarded or defensive because of unfamiliarity or perceived as neglect by the majority society.

These behaviors may produce anger in those who deal with these individuals, thus setting up a mutual mistrust, which would not be Paranoid Personality Disorder.

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Epidemiology

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0.5% to 2.5% (about 2/100)

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An increased prevalence of Paranoid Personality Disorder has a biological connection to relatives of chronic sufferers of

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schizophrenia and patients with persecutory delusional disorders, which is the presence of persistent delusions.

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Etiology

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due to negative childhood experiences in a threatening domestic atmosphere or caretakers having PPD

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In addition, the incidence of PPD appears to be increased in families with a member who suffer from

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Schizophrenia

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The developmental path of PPD predominantly involves environmental responses of

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criticism, blame, and hostility.

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Studies have linked this diagnosis to caregivers who treated the individual with PPD in a

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sadistic, degrading, or humiliating manner, imposing the belief that he or she was fundamentally bad.

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some therapists believe that the behavior that characterizes PPD might be

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learned and might be traced back to childhood experiences. According to this view, children who are exposed to adult anger and rage with no way to predict the outbursts and no way to escape or control them develop paranoid ways of thinking in an effort to cope with the stress.

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Genetic

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Studies of identical (or monozygotic) and fraternal (or dizygotic) twins suggest that genetic factors may also play an important role in causing the disorder.

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Medications:

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if the patient is very anxious, anti-anxiety drugs may be prescribed

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individual supportive psychotherapy

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is the treatment of choice for PPD

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low doses of neuroleptics should be used in this group of patients

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medications are not normally part of long-term treatment for PPD

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fluoxetine (Prozac) have been reported to make patients less angry, irritable and suspicious.

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Antidepressants may even make symptoms worse.

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Prognosis

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Unfortunately, many patients suffer the major symptoms of the disorder throughout their lives.

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Empirically Supported Treatments

The most successful form of treatment for this disorder is

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psychotherapy

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the primary approach to treatment for such personality disorders as PPD is

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psychotherapy

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Group therapy

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that includes family members or other psychiatric patients, not surprisingly, isn't useful in the treatment of PPD due to the mistrust people with PPD feel towards others.

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Schizoid Personality Disorder

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A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4

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Associated Features
There is highest Co-morbidity for

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Schizotypal, Avoidant, and Paranoid Personality Disorders.

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Child vs. Adult Presentation

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The symptoms that are needed for diagnosing SPD need to be shown by early adulthood

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One issue that is known is the similarity between SPD,

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autism and Asperger's disorder

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Gender and Cultural Differences in Presentation

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Immigrants are sometimes mistaken as cold, hostile, or indifferent.

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Schizoid Personality disorder has a prevalence rates in the general population between 1% and 3%

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This is the least diagnosed personality disorder in the general population, and is uncommon in clinical settings.

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Etiology

Family life seems to be the underlying cause of Schizoid PD.

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These families are reserved emotionally, have impersonal communication, and are very formal.

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Empirically Supported Treatments

Psychodynamically oriented therapies:

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When this treatment is used, it usually centers around building a therapeutic relationship with the patient that can act as a model for use in other relationships.

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Cognitive-behavioral therapy:

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Attempting to cognitively restructure the patient's thoughts can enhance self-insight.

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Group therapy:

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It can also provide a means of learning and practicing social skills in which they are deficient.

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Family and marital therapy:

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therapy may be recommended for family members to educate them on aspects of change or ways to facilitate communication.

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Medications

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there is to date no definitive medication that is used to treat schizoid symptoms.

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Prognosis

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Once treatment ends, it is highly likely the patient will relapse into a lifestyle of social isolation similar to that before treatment.

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Schizotypal Personality Disorder

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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, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more)

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Associated Features

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Symptoms pointing to Brief Psychotic Disorder, Schizophreniform Disorder, Delusional Disorder, or Schizophrenia may develop in clinical settings. Over half may have a Major Depressive Episode.

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Child vs. Adult Presentation

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As adults, presentation is similar but probably less severe such as less solitary activities because of boredom onset, and peer relationships are essential to advance in a life, such as with careers, friends and family.

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Gender and Cultural Differences in Presentation

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Females are more social and emotional than males in general, and they have the tendency to communicate more information to other people and to be more open about their feelings and emotions. Males tend to be more closed off and only share private information to those they trust the most.

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Epidemiology

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The prevalence of Schizotypal Personality Disorder is approximately 3%

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Genetics:

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There is a chance that genetic factors contribute to the cause of Schizotypal Personality Disorder.

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Environmental factors:

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Environmental factors are LESS LIKELY to contribute to this disorder than interpersonal factors because of interactions with people are social activities and may involve suspicion of others, odd beliefs and weird thinking, unusual perceptions or distortions of reality.

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Behavioral factors

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Oddities in children with STPD are reinforced when they are shunned and rejected by others, thus increasing their social anxiety and suspicion.

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pathogenic hypothesis

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suggests that the child was severely abused, limited in autonomy development and peer interactions while caregivers modeled illogical formulations of reality, leading the adult with STPD to claim an unusual ability of knowing or controlling events combined with paranoid withdrawal from others.

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Antisocial Personality Disorder

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Normally, an individual suffering from Antisocial Personality Disorder will display a pattern of lying, stealing, running away from home, and having difficulty upholding the law. They also tend to have problems with the abuse of illicit drugs and alcohol.

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fearlessness hypothesis

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states they psychopaths have a higher fear threshold, or the frightening things for most people, like a burning building, or gunshots, have little effect on these individuals

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passive avoidance earning

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learned in the face of cues that signal upcoming punishment