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PSYCH 257 (141)

Personality Disorders Pt. 1

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Allison Kelly

LECTURE16 P ERSONALITY D ISORDERS –P ART 1 OF 2 C HAPTER 12 OF TEXTBOOK Today’s Questions 1. How do we know when a personality is “disordered”? 2. Are people with personality disorders aware of, and motivated to change, their personality problems? 3. Does it make sense to “treat” a personality disorder? Outline  The nature of personality disorders  Cluster A PDs  Cluster C PDs  Summary game – name that PD The nature of personality disorders DSM-IV Axes Review Axis I – Acute psychological problems AXIS II – PERSONALITY DISORDERS Axis III – Physical health Axis IV – Psychosocial issues Axis V – Global Assessment of Function General Criteria for a Personality Disorder (DSM-IV-TR)  Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations. Manifested in 2 or more of the following areas: o Cognition o Affectivity  Emotional reactions to people or in situations o Interpersonal functioning  Goals they have for themselves, types of relationships they have o Impulse control  Ability to regulate impulses 1  Pattern is inflexible and pervasive across a broad range of personal and social situations  Pattern leads to clinically significant impairment or distress o People around individual are usually the ones who are distressed  Pattern is stable and of long duration; onset can be traced to adolescence / early childhood  Pattern not better accounted for as a manifestation of another disorder  Not due to substance or medical condition 2 Other Common Features  Little insight: into the fact that they are different or the problems it is causing them – have it their whole life, don’t know anything different  Ego syntonic : Their way of seeing things fit with their goals, values and interests.  Interpersonal problems  Initially difficult to diagnose: People usually present with AXIS I Disorder: not on the clinicians mind to look for personality disorder – person doesn’t realize it  Intractable, difficult to treat – person doesn’t think anything is wrong Personality Disorder Clusters  Cluster A: Odd or eccentric o Paranoid, Schizoid, Schizotypal  Cluster B: Dramatic, emotional, or erratic o Histrionic, Narcissistic, Antisocial, Borderline  Cluster C: Fearful or anxious o Avoidant, Dependent, Obsessive-Compulsive Controversies in Diagnosis of PDs  Dimensional versus categorical o Generally studied dimensionally: levels. But PD grouped categorically  Reliability and validity o Reliability: A different person assessing the same client should make same diagnosis – high in relation to having a disorder, but agreement on which PD is not consistent. o Most common diagnosis: PDNOS o Comorbidity: 50% - 90%  Gender bias o Certain personality disorders are more prevalent in females (histrionic) o Antisocial: highly diagnosed in males o Were criteria written more for one gender than another o Do clinicians look for disorder in specific gender  Label that sticks o Making a conclusion about a person that will follow them throughout their lives. 3 CLUSTER A Disorders characterized by odd or eccentric behaviors Paranoid PD Overview and Clinical Features  General mistrust in people  Pervasive and unjustified mistrust and suspicion of other people  Expects to be mistreated or exploited  Hostile and easily angered o If perceive people as attacking them 4 Dsm Paranoid Symptoms Etiology  Genes?  Early mistreatment?  Early beliefs?  Cultural experiences? o Certain may be more likely: prisoners, elderly, refugees, people with hearing loss -- bit of research: not clear. Treatment  Common issues Schizoid PD Overview and Clinical Features  Social detachment o Low desire for social or sexual relationships o Prefer masturbation – or one night stands  Constricted emotions: apathetic, monot
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