Personality Disorders

Overview

• Personality trait
  • enduring patterns of behavior exhibited in a wide range of personal contexts
• Personality disorder
  • pervasive, inflexible, extreme, maladaptive personality trait causing impaired functioning or subjective distress
  • ego syntonic
    • patient has limited awareness of disorder
  • course is usually stable by early adulthood
• not usually diagnosed in children

Cluster A Personality Disorders

• Characterization
  • “weird”
  • odd or eccentric
  • no meaningful social relationships
  • no psychosis
  • genetic association with schizophrenia
• Types
  • paranoid 
    • excessive distrust and suspiciousness
  • schizoid 
    • voluntary social withdrawal
      • content with social isolation (vs. avoidant)
    • limited emotional expression
  • schizotypal  
    • eccentric appearance
• odd beliefs or magical thinking

Cluster B Personality Disorders

• Characterization
  • “wild”
  • dramatic, emotional, or erratic
  • genetic association with mood disorders and substance abuse
• Types
  • antisocial  
    • disregard for and violation of rights of others with lack of remorse
    • criminality
    • males > females
    • conduct disorder if < 18 years
    • commonly known as “psychopathy”
    • classic triad
      • set fires, torture animals, bed wetting
  • borderline 
    • unstable interpersonal relationships
    • impulsivity
    • sense of emptiness
    • fear of abandonment
    • females > males
    • splitting is a major defense mechanism
      • relationships are either all good (“my boyfriend is a perfect angel”) or all bad (“my boyfriend is evil and I hate him”)
    • self-mutilation
  • histrionic 
    • excessive emotionality and attention-seeking
    • sexually provocative
    • overly concerned with appearance
    • think “telenovelas”
  • narcissistic 
    • grandiosity
    • need for admiration
    • sense of entitlement
      • demands “the best”
    • lacks empathy
• reacts to criticism with rage

Cluster C Personality Disorders

• Characterization
  • “worried”
  • anxious or fearful
  • genetic association with anxiety disorders
• Types
  • 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
      • vs. OCD which is ego dystonic
  • dependent 
    • submissive and clingy
    • excessive need to be taken care of
    • low self-confidence