Personality Disorders

Содержание

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Personality Disorders (PD) Longstanding, pervasive, inflexible patterns of behavior and inner

Personality Disorders (PD)

Longstanding, pervasive, inflexible patterns of behavior and inner experience
Patterns

present in at least 2 areas:
Cognition
Emotions
Relationships
Impulse control
Coded on Axis II
Ego syntonic (others are the root of all problems)
Often comorbid with Axis I disorders
More severe symptoms and poorer outcome when comorbid
50+% of people diagnosed with a personality disorder meet criteria for another personality disorder
More than two-thirds meet lifetime criteria for an Axis I disorder
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What is a personality?? A generally consistent (but personal) style of

What is a personality??

A generally consistent (but personal) style of interacting

with the world and other people
Our ‘character’ is reflected in how we think, what and who we like, and how we respond to life
It is generally stable over time?allows some predictability
No trait or style is automatically indicative of disorder or disease (don’t confuse eccentricity with disorder)
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What is a disorder? Implies functional impairment / failure to achieve

What is a disorder?

Implies functional impairment / failure to achieve what

is expected and/or significant and persistent emotional distress
In the case of Personality Disorders this is by definition a result of a ‘maladaptive’ personality style

Personality characteristics that are unchanging and occur in most settings

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How does a personality disorder develop? Genetic predispositions + environmental influences

How does a personality disorder develop?

Genetic predispositions + environmental influences (including

parenting, life experiences) + time = Personality formation
Begins to take shape in childhood
Become fixed by early 20s
Some occur after organic insult to brain (trauma)
Some have biologic and/or genetic component
E.g., schizotypal and borderline personality disorders
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Classifying Personality Disorders Classifies in 3 clusters: Cluster A Odd/Eccentric Cluster

Classifying Personality Disorders

Classifies in 3 clusters:
Cluster A Odd/Eccentric
Cluster B Dramatic/Erratic
Cluster C

Anxious/Fearful
Gender bias
Certain diagnoses applied more often to men, others to women
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Classification of Personality Disorders Cluster A: Odd/Eccentric Schizotypal Personality Disorder Schizoid

Classification of Personality Disorders

Cluster A: Odd/Eccentric
Schizotypal Personality Disorder
Schizoid Personality Disorder
Paranoid Personality

Disorder
Cluster B: Dramatic/Erratic
Histrionic Personality Disorder
Narcissistic Personality Disorder
Borderline Personality Disorder
AntiSocial Personality Disorder
Cluster C: Anxious/Fearful
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
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Rates of DSM-IV Personality Disorders in the Community and in Treatment Settings

Rates of DSM-IV Personality Disorders in the Community and in Treatment

Settings
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Heritability of personality disorders Torgerson, S, et al 2000 A twin

Heritability of personality disorders
Torgerson, S, et al 2000 A twin study

of personality disorders. Comp psych 41:416-425
Coolidge F et al. 2001 Heritability of personality disorders in childhood: A preliminary investigation. J person dis 15:33-40
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CLUSTER A

CLUSTER A

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Paranoid Personality Disorder A. pervasive pattern of distrust and suspiciousness of

Paranoid Personality Disorder

A. pervasive pattern of distrust and suspiciousness of other

such that their motives are interpreted as malevolent beginning in early adulthood and indicated by four or more of the following:
-suspects, without sufficient basis, others are exploiting, deceiving, or harming him
-preoccupied with unjust doubts about loyalty of friends or associates
-won’t confide in others lest info be used against him
-reads hidden demeaning or threatening meanings into benign remarks or events
-bears a grudge, is unforgiving of slights
-perceives attacks on his character that others don’t and is quick to counterattack
-recurrent suspicions about fidelity of spouse or sexual partner
B. Does not occur exclusively within schizophrenia
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Characteristics of Paranoid Personality Disorder Aloof, emotionally cold Unjustified suspiciousness, hostility

Characteristics of Paranoid Personality Disorder

Aloof, emotionally cold
Unjustified suspiciousness, hostility
Hypersensitivity to slights,

jealousy
Blames others when things go wrong
Rigid, unforgiving, sarcastic, litigious
No hallucinations or full blown delusions
Prevalence: 1-2%; M>F
Cormorbidity high for
Schizotypal
Borderline
Avoidant
Therapy, including meds, of little value – trusting relationship is key but hard to come by b/o ‘self-fulfilling prophecy’
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Treatment of Paranoid Personality Disorder Medications Pimozide (very selective, postsynaptic antidopaminergic

Treatment of Paranoid Personality Disorder

Medications
Pimozide (very selective, postsynaptic antidopaminergic agent used

in treating delusions
Effective in treating blaming, low tolerance for frustration, hypersensitivity to criticism
Fluoxetine (effective in reducing suspiciousness)
CBT
Cognitive restructuring (for hypervigilance)
Relaxation training
Note: no longer considered an “untreatable” disorder
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Case 1- Paranoid Personality Disorder U. is 40 y/o male. Recently

Case 1- Paranoid Personality Disorder

U. is 40 y/o male. Recently divorced.

Furiously hateful of his ex- wife, sure that she’d cheated on him. Although he was unable to procure any proof of her cheating- he still believes in it. The ex- wife claims that she left U. because he has always been emotionally cold, aloof, never supported her, always blaming her, but U. keeps blaming her solely for the divorce, thinks that he’s been a perfect husband while his ex has been a lying monster and a cheater. Also, he distrusts his boss, always questions his secret agenda, and is planning to sue him for disregarding the workers’ rights. U. always writes complaint letters to authorities, has sued different authorities several times, he has only one close friend and doesn’t fully trust this friend either. He looks quiet and reserved to others, has little interest in other’s activities and blames other people for his problems.
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Schizoid Personality Disorder A. Pervasive pattern of detachment from social relationships

Schizoid Personality Disorder

A. Pervasive pattern of detachment from social relationships and

restricted range of emotions in interpersonal settings beginning in early adulthood and indicated by 4 or more:
-Almost always chooses solitary activities
-Has little interest in sex
-Takes pleasure in few if any, activities
-Lacks close friends or confidants (other than family)
-Appears indifferent to praise or criticism
-Neither desires nor enjoys close relationships, including family
-Shows emotional coldness, detachment, or flattened affect
B. Does not occur exclusively within schizophrenia
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Characteristics of Schizoid Personality Disorder Can perform well in solitary activities

Characteristics of Schizoid Personality Disorder

Can perform well in solitary activities (computers,

night watchman)
Limited emotional range, detached, daydream a lot
Experiences anhedonia
NO increased risk for schizophrenia but many may actually suffer from autism-spectrum disease
Comorbidity high for
Schizotypal
Avoidant
Paranoid
“Loners” not necessarily schizoid, unless functioning impaired (traits vs disorder)
Treatment of little help
Prevalence 2%; M>F
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Treatment for Schizoid Personality Disorder SSRIs Fluoxetine Behavioral Social skills training Group therapy High dropout rate

Treatment for Schizoid Personality Disorder

SSRIs
Fluoxetine
Behavioral
Social skills training
Group therapy
High dropout rate


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A. is a 50 y/o male. Never married. Works as a

A. is a 50 y/o male. Never married. Works as a

night shift guard. Has no friends. Has never been in a relationship and tells people he is not interested in relationships because they are “messy”, and that he doesn’t desire sex, so “why bother?”. In his free time he likes walking alone in the forest. He visits his elderly parents once in a few months, and talks to his sister on the phone 2 times a year. He states that he loves his family but isn’t interested in people outside the family. He has 8 cats and has recently adopted a dog.

Case 2- Schizoid Personality Disorder

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Schizotypal Personality Disorder A. Pervasive pattern of social and interpersonal deficits,

Schizotypal Personality Disorder

A. Pervasive pattern of social and interpersonal deficits, reduced

capacity for close relationships, cognitive or perceptual distortions, eccentric behavior beginning and early adulthood indicated by 5 or more of the following:
-Ideas of reference
-Odd beliefs or magical thinking
-Unusual perceptual experiences
Superstitious
Telepathic
Illusions
Feels the presence of a force or person not actually present.
-Vague, metaphorical or stereotyped speech
-Suspiciousness or paranoid ideation
-Inappropriate or constricted affect
Odd/eccentric behavior or appearance
Wears strange clothes
Talks to self
-Lack of close friends or confidants
-Excessive social anxiety that does not diminish with familiarity
B. Does not occur exclusively during the course of schizophrenia
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Schizotypes First degree relatives of schizophrenics Often characterized by “negative” criteria

Schizotypes

First degree relatives of schizophrenics
Often characterized by “negative” criteria (odd speech,

inappropriate affect social anxiety)
Individuals who meet criteria for Schizotypal PD
Most often characterized by perceptual aberrations, magical ideation, and paranoid thinking
fragile X syndrome in women
3% incidence; M=F
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Etiology and Treatment Etiology Similar to that of schizophrenia Genetic predisposition

Etiology and Treatment

Etiology
Similar to that of schizophrenia
Genetic predisposition
Children of mothers who

had flu during 2nd trimester had higher schizotypy scores (Venables, 1996)
May be related to dysregulation of dopamine and other amines
Individuals with schizotypal PD show structural brain findings similar to those found in schizophrenia:
Cognitive and neuropsychological deficits
Enlarged ventricles
Less temporal gray matter
Treatment
Drugs proven more effective than psychotherapies
Low-dose antipsychotics
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L. is a 21 y/o female. She earns her money by

L. is a 21 y/o female. She earns her money by

working as a medium and predicting future with Tarot. She wears odd colorful clothes that she makes herself. She has very few friends and states that she also has several invisible friends from other dimensions, whose presence she can feel always and who protect her. Her speech is odd and difficult to understand. She giggles inappropriately in social situations. Her brother has been recently diagnosed with Schizophrenia.

Case 3- Schizotypal Personality Disorder

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CLUSTER B

CLUSTER B

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Pervasive pattern on instability of interpersonal relationships, self image and affects

Pervasive pattern on instability of interpersonal relationships, self image and affects

and marked impulsivity as indicated by 5 or more of the following:
Frantic efforts to avoid abandonment
Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance
Impulsivity in at least two areas that are potentially self-damaging
Recurrent suicidal behaviors, gestures or threats or self-mutilating behaviors
Affective instability due to a marked reactivity of mood
Chronic feelings of emptiness
Inappropriate anger
Transient, stress-related psychotic or dissociative symptoms <24H

Borderline Personality Disorder (BPD)

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Borderline Personality Disorder (BPD) Onset during adolescence or early adulthood Prognosis

Borderline Personality Disorder (BPD)

Onset during adolescence or early adulthood
Prognosis poor within

10 years of diagnosis
Later in life, most no longer meet diagnostic criteria (Paris, 2002)
“Borderline Burnout”
Comorbidity high with PTSD= complex PTSD, MDD, substance-related, and eating disorders
Comorbidity predicts symptoms 6 years later
Suicide rates high, Self-mutilation also a problem
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Etiology of Borderline Personality Disorder (BPD): Neurobiological factors Genetic component Highly

Etiology of Borderline Personality Disorder (BPD): Neurobiological factors

Genetic component
Highly heritable
Decreased functioning

of serotonin system
Frontal lobe dysfunction
Increased activation of amygdala
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Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors Parental separation

Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors

Parental separation
Verbal, physical,

sexual and emotional abuse during childhood
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Borderline PD: Management Beware of idealization, be realistic about treatment targets

Borderline PD: Management

Beware of idealization, be realistic about treatment targets as

well as risks and side effects
Treat presenting pathology
BUT: Know what you are dealing with, avoid “red herrings” eg. “depression” “voices in the head”
Be honest, consistent and non-judgmental
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Borderline PD: Treatment Psychotherapy (Mainstay) : DBT : suicide and affective

Borderline PD: Treatment

Psychotherapy (Mainstay) :
DBT : suicide and affective

dysregulation
Transference-based psychotherapy
Mentalization-based psychotherapy
Schema-focussed therapy
General Principles
Focus on patient-therapist relationship in the “here and now”
Educate patients to recognise their affective reactions and what triggers them
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Borderline PD: Treatment Pharmacotherapy (adjunct) Cochrane Review (2010):SSRI’s not recommended for

Borderline PD: Treatment

Pharmacotherapy (adjunct)
Cochrane Review (2010):SSRI’s not recommended for as

first choice for affective dysregulation & impulsivity, nor low dose antipsychotics for cognitive-perceptual symptoms
SSRI only for MDD
Affective dysregulation: topiramate, valproate, lamotrigine, aripiprazole, olanzapine & haloperidol
Impulsive-behavioural: lamotrigine & topiramate, omega-3 fats, flupenthixol; aripiprazole
Cognitive-perceptual: olanzapine, aripiprazole
Self mutilation and suicidal behaviour: none. Olanzapine unfavourable effect
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T. is a 35 y/o woman. Divorced X3, unemployed. Was sexually

T. is a 35 y/o woman. Divorced X3, unemployed. Was sexually

abused as a child by her stepfather. Since age 13 has been drinking beer and smoking pot. On several occasions used hallucinogens. Since age 15 has started cutting her wrists in order to “relax” when tense. Has never been stable in a job as a result of continuous fights with co- workers. Her first husband left her after being unable to cope with her emotional swings. After he left her- T. tried to kill herself by swallowing pills, and made sure to text the ex-husband about her intentions before swallowing the pills. She’s unexpectedly left her second husband in order to marry her third husband, who left her after several month because she continuously cheated on him, smoked drugs, beat the kids and threatened to kill herself after every fight. T. has only one close female friend who is tired of her because “one day T. tells that they are like sisters, and the other day T. yells at her, calls her names and fights with her for no reason and also threatens to commit suicide”. T.’s mom has always had unstable moods and emotional swings, and both of T.s sisters cut their wrists in order to “relax” and claim not being suicidal while they do that.

Case 4- Borderline Personality Disorder

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A pervasive pattern of disregard for and violation of the rights

A pervasive pattern of disregard for and violation of the rights

of others occurring since the age of 15 years as indicated by 3 or more of the following:
Failure to conform to social norms with respect to lawful behaviors
Deceitfulness and conning others for personal profit or pleasure
Impulsivity or failure to plan ahead
Irritability or aggressiveness as indicated by repeated fights or assaults
Reckless disregard for safety of self or others
Consistent irresponsibility
Lack of remorse
There is evidence of Conduct Disorder with onset before age 15

Antisocial Personality Disorder

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Characteristics of Antisocial Personality Disorder Aggressive, irresponsible, truant as teens. Get

Characteristics of Antisocial Personality Disorder

Aggressive, irresponsible, truant as teens. Get into

fights, abuse substances, run away, cruel to animals, set fires, do poorly in school, repeated lying
As adults see criminality, assaultiveness, impulsivity, substance abuse
Sometimes- are charming, deceptive, manipulative, not easy to be identified as antisocials
More than 50% of prison population has ASPD, 3% of population, M:F 3-5:1
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Antisocial Personality Disorder 30% of fathers criminals, 50% of fathers alcoholics,

Antisocial Personality Disorder

30% of fathers criminals, 50% of fathers alcoholics, chronically

unemployed. Male first degree relatives have increased incidence of antisocial personality disorder, substance abuse
Female first degree relatives have increased incidence of Somatization Disorder
Possible genetic component – gender effects may be relevant (BPD in women)
Increased incidence of non-specific EEG changes (increased slow-wave activity)
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Antisocial Personality Disorder Substance abuse most common comorbid disorder More common

Antisocial Personality Disorder

Substance abuse most common comorbid disorder
More common among lower

SES groups
More than 50% of prison population has ASPD, 3% of population, M:F 3-5:1
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Etiology of Antisocial Personality Disorder Genetics Antisocial behavior heritable Estimates as

Etiology of Antisocial Personality Disorder

Genetics
Antisocial behavior heritable
Estimates as high as .96
Genetic

risk for APD, psychopathy, conduct disorder, and substance abuse related.
Family environment
Lack of warmth, negativity, and parental inconsistency predict APD
Poverty, exposure to violence
Family environment interacts with genetics
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Case 5- Anticosial Personality Disorder A N. is 20 y/o man.

Case 5- Anticosial Personality Disorder A

N. is 20 y/o man. He

is currently in prison for robbery. This is his fifth imprisonment. He explains that he prefers robbing to holding a job, and feels absolutely no remorse. His father was an alcoholic and drug addict and has been executed for double murder. N. himself was a “problematic child” who was truant from school, picked fights, stole from shops, was cruel to animals and started using marihuana since age 10. N. states that after serving his current punishment he intends to continue his chosen life path of a criminal because “he likes it”.
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Case 6- Antisocial Personality Disorder B T. is a 41 y/o

Case 6- Antisocial Personality Disorder B

T. is a 41 y/o lady.

She is a second wife of a famous gynecologist and a mother to a 3 y/o girl, she is a president of a volunteer organization and actively volunteers on many occasions. She is always charming, pleasant and polite. One day, out of the blue, her husband discovers that T. actually steals the donations to the organization she heads, that their mutual daughter is actually not his but his brother’s, with whom T. has been having an affair for several years, and that T. has several ID cards and several passports, with different names and addresses. When the husband confronts T. an all of these- she pulls a gun out of her purse and coldly threatens to kill him, his parents and the child if he discloses the truth to anyone. Terrified, the husband keeps silence, especially after T. beats him with a chair. After a few months T. disappears, leaving the daughter and taking all of the gynecologist’s money, and rumors tell she’s run away abroad. The husband asks the police for help, but shortly after that he gets arrested after T. files a false complaint that he sexually abuses his patients.
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Histrionic Personality Disorder A pervasive pattern of excessive emotionality and attention

Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention

seeking, beginning in early adulthood and indicated by 5 or more:
Uncomfortable in situations where not the center of attention
Interaction with others is often characterized by inappropriate sexual behavior
Rapidly shifting and shallow expression of emotions
Consistently uses physical appearance to draw attention to self
Style of speech that is impressionistic and lacking in detail
Shows self-dramatization, theatricality, and exaggerated emotion
Is suggestible and easily influenced by others or circumstances
Considers relationships to be more intimate than they actually are
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Etiology/Treatment of Histrionic Personality Disorder Etiology Unknown but may include Genetic

Etiology/Treatment of Histrionic Personality Disorder

Etiology
Unknown but may include
Genetic contribution
Childhood incidents
May be

associated with low self-esteem
Treatment
Usually present for treatment due to depression
Sertraline (for impulsivity and depression symptoms)
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L. is a 37 y/o actress. She always wears tons of

L. is a 37 y/o actress. She always wears tons of

makeup and short colorful dresses. Every person she meets immediately becomes an object of her attention and is proclaimed to be her new best friend, she tells everyone every single detail of her life with great drama and exaggeration, and if people refuse to listen to her- she bursts into tears and hysterical sobbing, falls to ground and becomes a subject of ridicule. She explains that she doesn’t mind to be laughed at as long as people pay attention to her.

Case 7- Histrionic Personality Disorder

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Narcissistic Personality Disorder A pervasive pattern of grandiosity, need for admiration,

Narcissistic Personality Disorder

A pervasive pattern of grandiosity, need for admiration,

and lack of empathy, beginning in early adulthood and indicated by 5 or more of the following:
Grandiose sense of self-importance
Preoccupied with fantasies of success, power, beauty, or ideal love
Believes he is “special” and should only affiliate with high-status people or things
Requires excessive admiration
Has sense of entitlement
Is interpersonally exploitive (takes advantage of others)
Lacks empathy
Is often envious of others and believes others are envious of him
Shows arrogant, haughty behaviors or attitudes
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Characteristics of Narcissistic Personality Disorder F Become enraged at criticism Fragile

Characteristics of Narcissistic Personality Disorder

<1% of general population; M>F
Become enraged at

criticism
Fragile self-esteem, prone to depression
Their behavior produces interpersonal difficulties, rejection, loss, occupational problems, which they can’t handle
Chronic, difficult to treat
Aging is handled poorly
Treatment: psychotherapy; poor prognosis
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Treatment for Narcissistic PD SSRIs for depression CBT cognitive restructuring (for ego concerns)

Treatment for Narcissistic PD
SSRIs for depression
CBT
cognitive restructuring (for ego

concerns)
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A .is a 57 y/o surgeon. He has a successful private

A .is a 57 y/o surgeon. He has a successful private

practice, owns a yacht and wears very expensive clothes a an exclusive wrist watch. His friends are famous doctors like himself, businessmen, politicians. He treats his coworkers with disregard, openly claims that he’s is better than anyone else in every single aspect, is cruel to interns and residents and is perceived as an arrogant person. Lately he’s noticed that his hair is turning grey and that that he’s gained a little weight, and since that has become moody and continuously broods over getting old.

Case 8- Narcissistic Personality Disorder

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CLUSTER C

CLUSTER C

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Avoidant Personality Disorder A pervasive pattern of social inhibition, feelings of

Avoidant Personality Disorder

A pervasive pattern of social inhibition, feelings of


inadequacy, and hypersensitivity to negative evaluation,
beginning in early adulthood and indicated by 4 or more
Avoids occupations that involve social contact for fear of criticism or rejection
Is unwilling to get involved with people unless certain of being liked
Shows restraint in close relationships for fear of being shamed or ridiculed
Preoccupied with being criticized or rejected in social situations
Inhibited in new interpersonal situations because of feelings of inadequacy
Views self as socially inept, personally unappealing, or inferior
Is unusually reluctant to try new activities because they may prove embarrassing
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Characteristics of Avoidant Personality Disorder They have “an inferiority complex” 0.5-1.0%;

Characteristics of Avoidant Personality Disorder

They have “an inferiority complex”
0.5-1.0%; M=F
Often take

jobs “on the sidelines,” shy and eager to please
Subject to depression, anxiety, anger, phobic avoidance
Unlike schizoid, long for relationships
Treatment: Group or individual psychotherapy, SSRIs
Diagnosis overlaps greatly with Social Phobia
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Treatment of Avoidant Personality Disorder SSRIs CBT Graduated exposure Social skills

Treatment of Avoidant Personality Disorder

SSRIs
CBT
Graduated exposure
Social skills training
Systematic desensitization
CBT has been

found effective in changing behavior but does not improve loneliness
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S. is a 19 y/o male student. He is always shy,

S. is a 19 y/o male student. He is always shy,

turns red in social settings, always alone in the university. When asked why he doesn’t socialize- looks sad and explains that he wants to make friends so badly, but he’s sure that people will reject him because he is a loser. He has been in love with his neighbor for the past 4 years, but has never even tried to talk to her and is not sure she is aware of his existence. Every time he meets the neighbor, he turns red and runs away.

Case 9- Avoidant Personality Disorder

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Dependent Personality Disorder A pervasive and excessive need to be taken

Dependent Personality Disorder

A pervasive and excessive need to be taken care

of that leads to submissive and clinging behavior and fears of separation, beginning in early adulthood:
Difficulty making everyday decisions without excessive among of advice
Needs others to assume responsibility for most major areas of life
Has difficulty expressing disagreement because of fear of loss of approval
Has difficulty initiating projects or doing things on his own
Volunteers to do unpleasant tasks to obtain nurturance and support from others
Feels uncomfortable or helpless when alone
Urgently seeks new relationship as a source of care and support when one ends
Is unrealistically preoccupied with fears of being left alone to care
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Characteristics of Dependent Personality Disorder Persons with chronic physical illness in

Characteristics of Dependent Personality Disorder

Persons with chronic physical illness in childhood

may be more prone to the disorder
Lack of self confidence
Excessive reliance on others
Behavior focused on maintaining relationships
May stay with an abusive, unfaithful or alcoholic partner rather than face being alone
Treatment: Psychotherapy, often successful
Prevalence: very common; M=F
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Treatment CBT cognitive restructuring (for self-esteem concerns) coping and social skills training SSRIs

Treatment

CBT
cognitive restructuring (for self-esteem concerns)
coping and social skills training


SSRIs
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M. is a 25 y/o woman. She is a housewife and

M. is a 25 y/o woman. She is a housewife and

fully depends on her husband. She never leaves home without her husband’s permission, and is always accompanied by him. Her husband drinks alcohol and beats M. on a daily basis. Once she was beaten so hard that she ended up hospitalized for rib fractures. She told in the hospital that “she’d fallen from stairs”, but no one believed and social worker was invited to assess domestic violence. M. admitted to the SW that her husband is violent, but refused to leave him and go to an asylum because “I’m not worth a lot without him”. When the SW suggested calling the police- M. refused again and told her that “If my husband goes to jail, I’ll be lost and no one will take care of me.”

Case 10- Dependent Personality Disorder

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Criteria for Obsessive-Compulsive PD A pervasive pattern of preoccupation with orderliness,

Criteria for Obsessive-Compulsive PD

A pervasive pattern of preoccupation with orderliness,

perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, beginning in early adulthood and indicated by 4 or more:
Preoccupied with details, rules, lists, order to the extent that the major point of an activity is lost
Shows perfectionism that interferes with task completion
Is excessively devoted to work to the exclusion of leisure activity and friendships
Is overconscientious and scrupulous about matters of morality, ethics, and values
Is unable to discard worn-out or worthless objects even with no sentimental value
Is reluctant to delegate tasks or work with others unless they do it his way
Adopts a miserly spending style toward self and others; hoards
Shows rigidity and stubbornness
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Characteristics of Compulsive Personality Disorder Prevalence unknown, more common and in

Characteristics of Compulsive Personality Disorder

Prevalence unknown, more common and in oldest

children; M=F
Backgrounds: harsh discipline
Stiff, formal and rigid demeanor, constricted affect. Formal, serious, may lack a sense of humor
Indecisive b/c afraid of making a mistake, ruminate concerning decisions
Do well with routines and poorly with changes
Unable to compromise in interpersonal relationships
More likely to seek treatment than those with other personality disorders
Does not have the obsessions/compulsions of OCD
Most frequently comorbid with Avoidant PD
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Treatment CBT cognitive restructuring (for dichotomous thinking) coping skills training SSRIs

Treatment

CBT
cognitive restructuring (for dichotomous thinking)
coping skills training
SSRIs

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D. is a 46 y/o male bank director. He is rigid,

D. is a 46 y/o male bank director. He is rigid,

perfectionist, hard working, detail- loving, extremely efficient, he seldom allows his staff do important things because he trusts only himself with these. He spends long hours at work and has very little time for his family. His wife complains that he’s never gone on a vacation with his family, ever. While at home, he is stubborn, criticizes his wife and kids, demands that they keep order and keep up to his very high moral standards, and also never throws away old clothes and shoes because he “may need these one day”.

Case 11- Obsessive- Compulsive Personality Disorder

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Exercise What are the personality disorders that are Cluster A? paranoid

Exercise

What are the personality disorders that are Cluster A?
paranoid personality

disorder schizoid personality disorder schizotypal personality disorder
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Exercise If you FEEL like you don't want to interact with

Exercise

If you FEEL like you don't want to interact with a

person, what cluster are the probably categorized in?
Cluster A
What type of personality disorder is most likely to try to "test" you?
paranoid
If a person has gone to see two or three doctors before they come to see you, what type of Cluster A personality disorder might they have?
paranoid
Is paranoid personality disorder more common in men or women?
Men
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Exercise What type of personality disorder tends to be aloof and

Exercise

What type of personality disorder tends to be aloof and unemotional?


schizoid
How will a schizoid personality disorder behave toward a physician?
will act uninterested
What type of personality disorder will have very limited emotional response?
schizoid
What type of personality disorder will have no desire for sexual relationships?
schizoid
Is schizoid or schizotypal personality disorder on the spectrum of schizophrenia?
schizotypal
What type of personality disorder will often engage in erratic and odd functions in speech or manner of dress?
schizotypal
What chromosomal abnormality is associated with schizotypal personality disorder?
fragile X syndrome in women
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Which cluster is most commonly seen? Cluster B What are the

Which cluster is most commonly seen?
Cluster B
What are the

Cluster B personality disorders?
antisocial personality disorder histrionic personality disorder borderline personality disorder narcissistic personality disorder
What is the key component of human interaction with someone with antisocial personality disorder?
they LOVE to interact with people - motive is always for personal gain
What are the core behaviors of antisocial personality disorder?
deceit, impulsivity and manipulation
What two personality disorders go hand in hand but are commonly diagnosed based on gender?
antisocial = males borderline = females

Exercise

Слайд 63

What type of personality disorder is satisfied through negative attention (also

What type of personality disorder is satisfied through negative attention (also

positive)?
histrionic
What type of personality disorder depends on other people to tell them how to feel, they lack an internalized sense of self worth?
histrionic
What type of personality disorder is emotionally shallow and lacks intimacy?
histrionic

Exercise

Слайд 64

What is the most studied personality disorder? borderline What type of

What is the most studied personality disorder?
borderline
What type of personality

disorder deeply fears rejection and abandonment but will try to reject and destroy a relationship?
borderline
What type of personality disorder is linked to substance dependence and self- mutilation?
borderline

Exercise

Слайд 65

What type of personality disorder react to criticism with rage and

What type of personality disorder react to criticism with rage and

stress?
narcissistic
What will make a narcissistic person envious?
when they believe that someone is more special than they are
If you do not give someone with narcissistic personality disorder attention, what will they think about you?
think that you do not understand how special they are
What is of utmost importance for someone with narcissistic personality disorder?
physical appearance

Exercise

Слайд 66

What type of personality disorder will tend to be a perfectionist?

What type of personality disorder will tend to be a perfectionist?


obsessive compulsive personality disorder
Is O/C personality disorder more common in men or women?
men
What type of personality disorder will expect perfect care from a practitioner?
OCPD
What type of personality disorder is characterized by excessive need for caring and nurturing?
dependent
How does someone with dependent personality disorder make decisions?
they don’t
What type of personality disorder may be prone to being abused?
dependent

Exercise

Слайд 67

What type of personality disorder will avoid interpersonal contacts? avoidant What

What type of personality disorder will avoid interpersonal contacts?
avoidant
What

is the motivation for an avoidant personality disordered individual to avoid interpersonal contacts?
fear of criticism and rejection
What type of personality disorder will not apply for certain jobs or take certain risks?
avoidant

Exercise

Слайд 68

60 yo male referred by wife for depression Past Hx: negative

60 yo male referred by wife for depression
Past Hx: negative Soc Hx:

Fired due to poor peer relationships and starting conflicts, suing job for discrimination and slander
paranoid
40 yo female brought in by paramedics unconscious, OD on diazepam Past Hx: Husband's death 2 weeks ago, treated for anxiety in 20s. Soc Hx: Married 22 yrs, never employed, no children, or close relatives.
dependent
35 year old male brought in by police for trespassing and assault Past Hx: 2 suicide attempts, treatment for depression, methamphetamine abuse Social: Unemployed writer/actor. Divorced. Recent breakup with 18 y.o. girlfriend/victim. 2 year prison term for embezzlement.
borderline, antisocial

Exercise

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Собаки участники ВОВ
Следующая -
Строим сечение

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