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Lecture

PSYCH257 Lecture Notes - Diagnostic And Statistical Manual Of Mental Disorders, Personality Disorder, Cognitive Therapy


Department
Psychology
Course Code
PSYCH257
Professor
Uzma Rehman

Page:
of 6
CHAPTER 12: PERSONALITY DISORDERS
DSM IV AXES REVIEW
o Axis I acute (right now) psychological problems
o Axis II Personality Disorders (in axis II: the disorder is more chronic, the diagnosed people don’t know they
have disorder, often something hard to characterize or talk about, things/characteristics with a long
standing history, treatment is longer/ prognosis of treatment is difficult, egocentonic- usually a part of the
person)
o Axis III physical health
o Axis IV psychosocial issues
o Axis V Global Assessment of Function
Personality Disorders
o Axis II in the DSM- IV
o Patients usually don’t seek help for personality disorders!
o Personality Disorders are often diagnosed after long treatment effort is not effective and provider becomes
discouraged
DSM IV General criteria for Personality Disorder
A. Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations. Manifested
in two or more of the following areas:
o Cognition
o Affectivity
o Interpersonal functioning
o 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
o Lack insight into PD (seek treatment for Axis I problem or relationship problems)
o PD symptoms are ego syntonic = feels like a normal part of oneself
o Most have interpersonal problems
o Can be difficult to diagnose in initial session
o Intractable, difficult to treat; can affect treatment of other disorders
Controversies in the Diagnosis of PDs
o Dimensional versus categorical?
o 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
o Gender bias?
Given the controversies surrounded, why are there still criteria for DSM IV?
o PD influence course or outcome of other mental disorders
o PD diagnoses allow for a rationale for longer-term treatment
Personality Disorder Clusters
o Cluster A: Odd or eccentric cluster
Paranoid, Schizoid, and Schizotypal
o Cluster B: Dramatic, emotional, or erratic cluster
Histrionic, Narcissistic, Antisocial, and Borderline
o Cluster C: Fearful or anxious cluster
Avoidant, Dependent, and Obsessive-Compulsive
CLUSTER A: DISORDERS CHARACTERIZED BY ODD OR ECCENTRIC BEHAVIOURS
1. 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 outcome studies showing that treatment is efficacious
2. CLUSTER A: SCHIZOID PERSONALITY DISORDER
Overview and Clinical Features
Pervasive pattern of detachment from social relationships
Very limited range of emotions in interpersonal situations
The Causes
Etiology is unclear
Preference for social isolation in schizoid personality resembles autism
Treatment Options
Few seek professional help on their own
Focus on the value of interpersonal relationships, empathy, and social skills
Treatment prognosis is generally poor
Lack good outcome studies showing that treatment is efficacious
3. CLUSTER A: SCHIZOTYPAL PERSONALITY DISORDER
Overview and Clinical Features
Behaviour and dress is odd and unusual
Most are socially isolated and may be highly suspicious of others
Magical thinking, ideas of reference, and illusions are common
Risk for developing schizophrenia is high in this group
Many also meet criteria for major depression
The Causes
Schizoid personality A phenotype of a schizophrenia genotype?
Left hemisphere and more generalized brain deficits
Treatment Options
Main focus is on developing social skills
Treatment also addresses comorbid depression
Medical treatment is similar to that used for schizophrenia
Treatment prognosis is generally poor
CLUSTER C: Disorders characterized by anxious or fearful behaviors
1. CLUSTER C: AVOIDANT PERSONALITY DISORDER
Overview and Clinical Features
Extreme sensitivity to the opinions of others
Highly avoidant of most interpersonal relationships
Are interpersonally anxious and fearful of rejection
The Causes
Numerous factors have been proposed
Early development a difficult temperament produces early rejection
Treatment Options
Several well-controlled treatment outcome studies exist
Treatment is similar to that used for social phobia
Treatment targets include social skills and anxiety
2. CLUSTER C: DEPENDENT PERSONALITY DISORDER
Overview and Clinical Features
Excessive reliance on others to make major and minor life decisions
Unreasonable fear of abandonment
Tendency to be clingy and submissive in interpersonal relationships
The Causes
Still largely unclear
Linked to early disruptions in learning independence
Treatment Options