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Chapter-12 PSYCH 257

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Uzma Rehman

Chapter 12: Personality Disorders DSM-IV Axes Review *Axis I – acute (right now) psychological problems *Axis II – Personality Disorders *Axis III – physical health *Axis IV – psychosocial issues *Axis V – Global Assessment of Function Personality Disorders *Axis II in the DSM- IV *Patients usually don’t seek help for personality disorders! *Personality Disorders are often diagnosed after long treatment effort is not effective and provider becomes discouraged DSM-IV General Criteria for Personality Disorder *Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations. Manifested in two or more of the following areas: *Cognition *Affectivity *Interpersonal functioning *Impulse control B. Pattern is inflexible and pervasive across a broad range of personal and social situations C. Pattern leads to clinically significant impairment or distress D. Pattern is stable and of long duration and onset can be traced to adolescence or early childhood E. Pattern not better accounted for as a manifestation of another disorder F. Not due to substance or GMC (e.g., head trauma) Person must meet the general criteria before a specific PD is diagnosed Other Features *Lack insight into PD (seek treatment for Axis I problem or relationship problems) *PD symptoms are ego syntonic = feels like a normal part of oneself *Most have interpersonal problems *Can be difficult to diagnose in initial session *Intractable, difficult to treat; can affect treatment of other disorders Controversies in the Diagnosis of PDs *Dimensional versus categorical? *Reliability and validity? *Heterogeneous categories; core features not clearly defined *Thresholds are not adequately justified *High degree of overlap between PDs *The most common PD diagnosis is not one of the ten described in the DSM – the most common PD is PD-NOS *Clinicians tend to be reliable in their assessment of whether a person has a PD, but not on the specific diagnosis *Gender bias? Given the controversies surrounding Personality Disorders, why are they still in the DSM-IV? *PD influence course or outcome of other mental disorders *PD diagnoses allow for a rationale for longer-term treatment Personality Disorder Clusters *Cluster A: Odd or eccentric cluster *Paranoid, Schizoid, and Schizotypal *Cluster B: Dramatic, emotional, or erratic cluster *Histrionic, Narcissistic, Antisocial, and Borderline *Cluster C: Fearful or anxious cluster *Avoidant, Dependent, and Obsessive-Compulsive Cluster A Disorders characterized by odd or eccentric behaviors Cluster A: Paranoid Personality Disorder *Overview and Clinical Features *Pervasive and unjustified mistrust and suspicion *Treatment Options *Few seek professional help on their own *Treatment focuses on development of trust *Cognitive therapy to counter negativistic thinking *Lack good outco
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