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PSYCH257 Lecture Notes - Schizotypal Personality Disorder, Etiology, Avoidant Personality Disorder

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Uzma Rehman

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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:
*Interpersonal functioning
*Impulse control
B. Pattern is inflexible and pervasive across a broad range of personal and social
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
*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 outcome studies showing that treatment is efficacious
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
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
Cluster A: Schizotypal Personality Disorder
*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
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
Cluster C: Dependent Personality Disorder
*Overview and Clinical Features