What is a Personality Disorder? <ul><li>Personality characteristics that are unchanging and occur in most settings </li></...
How is it different from Personality? <ul><li>The more general term, personality, is a consistent style of behavior </li><...
What Axis does a Personality Disorder fall under? <ul><li>Axis II </li></ul>
How does a personality disorder develop? <ul><li>Begins to take shape in childhood </li></ul><ul><li>Become fixed by early...
What may facilitate diagnosis? <ul><li>Psychological Testing </li></ul><ul><ul><li>WAIS </li></ul></ul><ul><ul><li>MMPI </...
What can a PD be confused with? <ul><li>An Axis I disorder.  Why??? B/C: </li></ul><ul><ul><li>Atypical and mixed types ar...
How do PD pts deal with treatment? <ul><li>PD pts often resist treatment </li></ul><ul><li>Change slowly </li></ul><ul><li...
Can children be dx with a PD? <ul><li>Yes -- Adolescents (under 18) and children may receive PD dx except for one. </li></...
What are the guidelines for diagnosing a child with a PD? <ul><li>The personality pattern must be stable and clear </li></...
How many personality Disorders are there? <ul><li>Ten </li></ul><ul><li>Divided into three clusters </li></ul><ul><li>Name...
Name the three types of PD in the Odd Eccentric Cluster <ul><li>Paranoid Personality Disorder </li></ul><ul><li>Schizoid P...
What are characteristics of a pt with Paranoid PD? <ul><li>Aloof; emotionally cold </li></ul><ul><li>Unjustified suspiciou...
What disorders  can  Paranoid PD be associated with? <ul><li>Chronic CNS impairment </li></ul><ul><li>Drug abuse (amphetam...
What is the tx of Paranoid PD? <ul><li>If psychotic decompensation occurs, major tranquilizers may be needed </li></ul><ul...
What are the characteristics of Schizoid PD? <ul><li>Seclusive </li></ul><ul><li>Little desire/capacity to form interperso...
How is Schizoid PD treated? <ul><li>Treatment is of little help. </li></ul>
What are characteristics of Schizotypal PD? <ul><li>They have features of schizoid pd: </li></ul><ul><ul><li>Isolated, anh...
What is the incidence of Schizotypal PD? <ul><li>3% of population </li></ul><ul><li>Commonly co-occurs with Major Depressi...
What biological sx can occur with Schizotypal PD? <ul><li>Impaired eye tracking </li></ul><ul><li>Increased CSF homovanill...
What are the 4 PDs of the Dramatic, Emotional, and Erratic Cluster? <ul><li>Antisocial PD </li></ul><ul><li>Borderline PD ...
What are characteristics of Antisocial PD? <ul><li>Begins in childhood or early adolescence: </li></ul><ul><ul><li>Aggress...
What are characteristics of Antisocial PD in adults? <ul><li>Criminality; assaultiveness </li></ul><ul><li>Self-defeating ...
More characteristics of Antisocial PD… <ul><li>Often spend time in jails and prisons </li></ul><ul><li>Half or more of pri...
What tests can help Dx Antisocial PD? <ul><li>No tests are diagnostic </li></ul><ul><li>MMPI can help </li></ul><ul><li>Ma...
What must be r/o before Dx Antisocial PD? <ul><li>Primary drug and alcohol abuse </li></ul><ul><li>Schizophrenia </li></ul...
How do you treat Antisocial PD? <ul><li>Pts are very  RESISTANT to treatment ;  very manipulative </li></ul><ul><li>Do not...
What are characteristics of Borderline PD? <ul><li>Socially adapted; complex presentations </li></ul><ul><li>Combinations ...
What other diagnoses can occur with Borderline PD? <ul><li>Depression </li></ul><ul><li>Brief Psychotic Disorder </li></ul...
How do you treat Borderline PD? <ul><li>Psych testing useful </li></ul><ul><li>R/O other organic states: </li></ul><ul><ul...
What characterizes Histrionic PD pts? <ul><li>Initially seem charming and likable </li></ul><ul><li>Later seen as emotiona...
What disorders are associated with Histrionic PD? <ul><li>Depression </li></ul><ul><li>Substance Abuse </li></ul><ul><li>C...
What are characteristics of Narcissistic PD? <ul><li>Often sx free and well functioning </li></ul><ul><li>Chronically diss...
How do you treat Narcissistic PD? <ul><li>Long-term psychotherapy may help </li></ul>
What are the three disorders in the Anxious Fearful Cluster? <ul><li>Avoidant PD </li></ul><ul><li>Dependent PD </li></ul>...
What are characteristics of Avoidant PD? <ul><li>Shy, lonely, hypersensitive </li></ul><ul><li>Low self-esteem </li></ul><...
How do you treat Avoidant PD? <ul><li>Group therapy may help </li></ul>
What are characteristics of Dependent PD? <ul><li>Excessively passive, unsure, pessimistic </li></ul><ul><li>Isolated and ...
What are characteristics of Obsessive-Compulsive PD? <ul><li>Pts are frequently successful men </li></ul><ul><li>Inhibited...
What disorders are Obsessive-Compulsive PD pts at risk for developing? <ul><li>Depression </li></ul><ul><li>Perhaps OCD </...
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Personality Disorders

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Personality Disorders

  1. 1. What is a Personality Disorder? <ul><li>Personality characteristics that are unchanging and occur in most settings </li></ul><ul><li>Deviate from cultural norms </li></ul><ul><li>Cause poor life functioning </li></ul><ul><li>Long term traits; feel “natural” to the pt </li></ul><ul><li>Many pts display only when under stress </li></ul>
  2. 2. How is it different from Personality? <ul><li>The more general term, personality, is a consistent style of behavior </li></ul><ul><li>It is uniquely recognizable in EACH individual </li></ul>
  3. 3. What Axis does a Personality Disorder fall under? <ul><li>Axis II </li></ul>
  4. 4. How does a personality disorder develop? <ul><li>Begins to take shape in childhood </li></ul><ul><li>Become fixed by early 20s </li></ul><ul><li>Some occur after organic insult to brain (trauma) </li></ul><ul><li>Some have biologic and/or genetic component </li></ul><ul><ul><ul><li>E.g., schizotypal and borderline personality disorders </li></ul></ul></ul>
  5. 5. What may facilitate diagnosis? <ul><li>Psychological Testing </li></ul><ul><ul><li>WAIS </li></ul></ul><ul><ul><li>MMPI </li></ul></ul><ul><ul><li>Bender-Gestalt </li></ul></ul><ul><ul><li>Rorschach ink blot </li></ul></ul>
  6. 6. What can a PD be confused with? <ul><li>An Axis I disorder. Why??? B/C: </li></ul><ul><ul><li>Atypical and mixed types are common </li></ul></ul><ul><ul><li>Some may grade into or be confused with Axis I dx </li></ul></ul><ul><ul><ul><li>Ex: Paranoid PD may appear to be paranoid schizophrenia </li></ul></ul></ul>
  7. 7. How do PD pts deal with treatment? <ul><li>PD pts often resist treatment </li></ul><ul><li>Change slowly </li></ul><ul><li>Occasionally respond to some treatment: </li></ul><ul><ul><li>Individual or group therapy </li></ul></ul><ul><ul><li>Short-term use of antianxiety meds </li></ul></ul><ul><ul><li>Low doses of major tranquilizers </li></ul></ul><ul><ul><li>Some may require inpatient tx during periods of decompensation </li></ul></ul>
  8. 8. Can children be dx with a PD? <ul><li>Yes -- Adolescents (under 18) and children may receive PD dx except for one. </li></ul><ul><li>Which one can they not be diagnosed with? </li></ul><ul><li>Antisocial PD </li></ul>
  9. 9. What are the guidelines for diagnosing a child with a PD? <ul><li>The personality pattern must be stable and clear </li></ul><ul><li>Must be incompatible with an Axis I childhood disorder </li></ul>
  10. 10. How many personality Disorders are there? <ul><li>Ten </li></ul><ul><li>Divided into three clusters </li></ul><ul><li>Name the clusters: </li></ul><ul><li>Odd eccentric </li></ul><ul><li>Dramatic, emotional, and erratic </li></ul><ul><li>Anxious, fearful </li></ul>
  11. 11. Name the three types of PD in the Odd Eccentric Cluster <ul><li>Paranoid Personality Disorder </li></ul><ul><li>Schizoid Personality Disorder </li></ul><ul><li>Schizotypal Personality Disorder </li></ul><ul><li>Mnemonic: OPSS </li></ul>
  12. 12. What are characteristics of a pt with Paranoid PD? <ul><li>Aloof; emotionally cold </li></ul><ul><li>Unjustified suspiciousness </li></ul><ul><li>Hostile; hypersensitive to slights </li></ul><ul><li>Jealous; fears intimacy </li></ul><ul><li>Grandiose, rigid, unforgiving, sarcastic, contentious, litigious </li></ul><ul><li>Isolated and disliked </li></ul><ul><li>Accept criticism poorly; blame others </li></ul>
  13. 13. What disorders can Paranoid PD be associated with? <ul><li>Chronic CNS impairment </li></ul><ul><li>Drug abuse (amphetamines) </li></ul><ul><li>Depression </li></ul><ul><li>OCD </li></ul><ul><li>Precursor to schizophrenia </li></ul>
  14. 14. What is the tx of Paranoid PD? <ul><li>If psychotic decompensation occurs, major tranquilizers may be needed </li></ul><ul><li>Otherwise, these pts rarely seek tx and therapy, including medication, is of little value </li></ul>
  15. 15. What are the characteristics of Schizoid PD? <ul><li>Seclusive </li></ul><ul><li>Little desire/capacity to form interpersonal relations </li></ul><ul><li>Derive little pleasure from social/sexual contexts </li></ul><ul><li>Prefer and perform well at solitary activities </li></ul><ul><li>Have limited emotions ; experience little pleasure </li></ul><ul><li>Daydream excessively </li></ul><ul><li>Humorless and detached </li></ul><ul><li>“ Loners” are not necessarily schizoid unless they have imparied functioning </li></ul><ul><li>DO NOT have increased risk of developing schizophrenia ! </li></ul>
  16. 16. How is Schizoid PD treated? <ul><li>Treatment is of little help. </li></ul>
  17. 17. What are characteristics of Schizotypal PD? <ul><li>They have features of schizoid pd: </li></ul><ul><ul><li>Isolated, anhedonic, aloof </li></ul></ul><ul><li>In addition, these pts are “peculiar.” </li></ul><ul><li>Relate strange intrapsychic experiences </li></ul><ul><li>Have odd and magical beliefs; strange speech </li></ul><ul><li>Frequently anxious </li></ul><ul><li>Difficult to “get to know” </li></ul>
  18. 18. What is the incidence of Schizotypal PD? <ul><li>3% of population </li></ul><ul><li>Commonly co-occurs with Major Depression </li></ul><ul><li>Associated with increased incidence of schizophrenia in family members </li></ul>
  19. 19. What biological sx can occur with Schizotypal PD? <ul><li>Impaired eye tracking </li></ul><ul><li>Increased CSF homovanillic acid </li></ul><ul><li>What is the treatment for Schizotypal PD? </li></ul><ul><li>Low dose antipsychotics – may reduce flamboyant sx’s </li></ul>
  20. 20. What are the 4 PDs of the Dramatic, Emotional, and Erratic Cluster? <ul><li>Antisocial PD </li></ul><ul><li>Borderline PD </li></ul><ul><li>Histrionic PD </li></ul><ul><li>Narcissistic PD </li></ul>
  21. 21. What are characteristics of Antisocial PD? <ul><li>Begins in childhood or early adolescence: </li></ul><ul><ul><li>Aggressiveness; fighting </li></ul></ul><ul><ul><li>Poor peer relationships </li></ul></ul><ul><ul><li>Irresponsibility, lying, theft, truancy </li></ul></ul><ul><ul><li>Poor school performance </li></ul></ul><ul><ul><li>Runaway, inappropriate sexual activity </li></ul></ul><ul><ul><li>Drug and alcohol use </li></ul></ul>
  22. 22. What are characteristics of Antisocial PD in adults? <ul><li>Criminality; assaultiveness </li></ul><ul><li>Self-defeating impulsivity </li></ul><ul><li>Hedonism </li></ul><ul><li>Promiscuity </li></ul><ul><li>Unreliability </li></ul><ul><li>Crippling drug and alcohol abuse </li></ul><ul><li>Fail at work and change jobs frequently </li></ul><ul><li>Go AWOL; dishonorable dc from service </li></ul><ul><li>Are abusing parents and neglectful mates </li></ul><ul><li>Cannot maintain intimate relationships </li></ul>
  23. 23. More characteristics of Antisocial PD… <ul><li>Often spend time in jails and prisons </li></ul><ul><li>Half or more of prisoners! </li></ul><ul><li>Typically are anxious and depressed </li></ul><ul><li>5% commit suicide (impulsivity) </li></ul><ul><li>Behavior peaks in adolescence </li></ul><ul><li>Improves in 30s; but rarely recover </li></ul><ul><li>Males are more severely affected and more frequently than females </li></ul><ul><li>Childhood can be marked with criminal parents, neglect, poverty, desertion, inconsistent discipline, and alcoholic and/or unemployed parents </li></ul>
  24. 24. What tests can help Dx Antisocial PD? <ul><li>No tests are diagnostic </li></ul><ul><li>MMPI can help </li></ul><ul><li>May be nonspecific EEG abnormalities </li></ul><ul><ul><li>Increased slow-wave activity </li></ul></ul>
  25. 25. What must be r/o before Dx Antisocial PD? <ul><li>Primary drug and alcohol abuse </li></ul><ul><li>Schizophrenia </li></ul><ul><li>Pathological gambling, kleptomania, or pyromania </li></ul>
  26. 26. How do you treat Antisocial PD? <ul><li>Pts are very RESISTANT to treatment ; very manipulative </li></ul><ul><li>Do not rely on info from pt; check your own data </li></ul><ul><li>Rarely seek help; tx is often difficult and unsuccessful </li></ul><ul><li>Best results follow closely supervised inpatient care (outpatient little value) </li></ul>
  27. 27. What are characteristics of Borderline PD? <ul><li>Socially adapted; complex presentations </li></ul><ul><li>Combinations of: </li></ul><ul><ul><li>Anger, sarcasm, anxiety, intense and labile affect </li></ul></ul><ul><ul><li>Brief disturbances in consciousness </li></ul></ul><ul><ul><li>Chronic loneliness, boredom, emptiness </li></ul></ul><ul><ul><li>Unstable and volatile interpersonal relations </li></ul></ul><ul><ul><li>Identity confusion </li></ul></ul><ul><ul><li>Impulsive behavior like self-cutting and self-mutilation </li></ul></ul><ul><ul><li>Recurrent suicide attempts (death by suicide 8%) </li></ul></ul><ul><ul><li>Hypersensitivity to abandonment </li></ul></ul>
  28. 28. What other diagnoses can occur with Borderline PD? <ul><li>Depression </li></ul><ul><li>Brief Psychotic Disorder </li></ul><ul><li>Other personality disorders </li></ul><ul><li>Substance-related disorders </li></ul><ul><li>Note: There is sometimes a hx of childhood abuse </li></ul>
  29. 29. How do you treat Borderline PD? <ul><li>Psych testing useful </li></ul><ul><li>R/O other organic states: </li></ul><ul><ul><li>Mild delerium, epilepsy, acute drug use </li></ul></ul><ul><li>Long term, intermittent, supportive psychotherapy is often beneficial </li></ul><ul><li>Low dose antipsychotics, antidepressants (SSRIs), or Lithium </li></ul><ul><li>These pts may stabilize in 40s and 50s </li></ul>
  30. 30. What characterizes Histrionic PD pts? <ul><li>Initially seem charming and likable </li></ul><ul><li>Later seen as emotionally unstable, egocentric, immature, and manipulative </li></ul><ul><li>Excitement-seeking and shallow </li></ul><ul><li>Demand attention; exhibitionistic </li></ul><ul><li>Limited ability to maintain stable interpersonal relationships with either sex </li></ul>
  31. 31. What disorders are associated with Histrionic PD? <ul><li>Depression </li></ul><ul><li>Substance Abuse </li></ul><ul><li>Conversion and Somatization Disorders </li></ul><ul><li>How do you treat this? </li></ul><ul><li>Lesser impaired pts may respond to psychotherapy </li></ul>
  32. 32. What are characteristics of Narcissistic PD? <ul><li>Often sx free and well functioning </li></ul><ul><li>Chronically dissatisfied due to a constant need for admiration </li></ul><ul><li>Have unrealistic self-expectations </li></ul><ul><li>Impulsive and anxious </li></ul><ul><li>Arrogant, envious, and lack empathy </li></ul><ul><li>Ideas of being a “special person” </li></ul><ul><li>Become quickly dissatisfied with others </li></ul><ul><li>Maintain superficial, exploitative relationships </li></ul><ul><li>May become depressed or rageful under stress and when others are not adequately admiring </li></ul><ul><li>Mixtures with other PDs common </li></ul>
  33. 33. How do you treat Narcissistic PD? <ul><li>Long-term psychotherapy may help </li></ul>
  34. 34. What are the three disorders in the Anxious Fearful Cluster? <ul><li>Avoidant PD </li></ul><ul><li>Dependent PD </li></ul><ul><li>Obsessive-Compulsive PD </li></ul>
  35. 35. What are characteristics of Avoidant PD? <ul><li>Shy, lonely, hypersensitive </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Would rather avoid personal contact that face social disapproval, though desperate for personal involvement </li></ul><ul><li>Assume others will be critical; affects everyday life </li></ul><ul><li>Troubled by anxiety and depression; social phobia </li></ul>
  36. 36. How do you treat Avoidant PD? <ul><li>Group therapy may help </li></ul>
  37. 37. What are characteristics of Dependent PD? <ul><li>Excessively passive, unsure, pessimistic </li></ul><ul><li>Isolated and hypersensitive to criticism </li></ul><ul><li>Abnormally dependent on one or more persons </li></ul><ul><li>Subtly controlling of others </li></ul><ul><li>Anxiety and depression common (esp if relationship threatened) </li></ul>
  38. 38. What are characteristics of Obsessive-Compulsive PD? <ul><li>Pts are frequently successful men </li></ul><ul><li>Inhibited, stubborn, and perfectionistic </li></ul><ul><li>Judgmental, overly conscientious </li></ul><ul><li>Rigid and chronically anxious </li></ul><ul><li>Avoid intimacy; experience little pleasure from life </li></ul><ul><li>Indecisive and demanding </li></ul><ul><li>Perceived as cold and reserved </li></ul>
  39. 39. What disorders are Obsessive-Compulsive PD pts at risk for developing? <ul><li>Depression </li></ul><ul><li>Perhaps OCD </li></ul><ul><li>How do you treat? </li></ul><ul><li>Psychotherapy </li></ul>

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