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PSYB32 Lec 9 Nov 20 2012.docx

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University of Toronto Scarborough
Konstantine Zakzanis

Substance Related Disorders & Personality Disorders Wednesday, November 21, 2012 7:49 PM  Know what Axes of the DSM will have for FINAL  When we talk about personality disorders, try not to self diagnose  Personality Disorders:  Heterogeneous group of disorders  Long, standing, invasive/pervasive and inflexible patterns --> very difficult to treat, probably more so than Axis 1 disorders  Personality Disorders are on Axis 2  Have to do with the way we deal with life's circumstances and challenges  Deviate from the expectations of a person's culture  e.g. Avoidant personality might be quite normal in some parts of the world.  Must impair social and occupational functioning  Extremes of several traits  Age related decline as people get older - over time, tend to fizzle out  A lot of the acute symptoms will go away once the person gets older  e.g. Borderline personalities with suicidal tendencies - these tendencies tend to fade  Great deal of co-morbidity  Ego dystonic - person may be unaware of the fact that they have a personality disorder  Some diagnostic issues to be aware of :  Reliability of different diagnostic disorders that DSM has  Easiest to recognize - highest inter rater reliability - Narcissistic Personality disorder and Avoidant Personality Disorder  Worst inter rater reliability - dependent personality disorder - because person can look really depressed  Obsessive Compulsive Personality Disorder can also be misdiagnosed as Obsessive Compulsive Disorder  Test-Retest Reliability :  Most Stable: Anti-Social Personality Disorder  High recividism rate of committing another crime  Most Unstable: Schizo-typal Personality Disorder - often misdiagnosed as schizophrenia or can evolve into a full blown psychotic state AND Dependent Personality Disorder (be familiar with Table in textbook)  Paranoid Personality Disorder  One of the more common ones  People or persons who expect to be mistreated and exploited by others  Very secretive and always on the look out for signs of abuse and trickery  May misinterpret the most random things  Extremely jealous  Most often diagnosed in men  Most often co-morbid with schizo-typal personality disorder, borderline PD and avoidant PD Has to be to the extent that it impedes with the person's normal functioning   Schizoid Personality Disorder  Person does not desire or enjoy social relationships  Dull, bland, aloof, don’t experience any strong emotions, no interest in sex, anhedonic , indifferent to praise, described most simply as loners  Prevalence of 1%  More common in men  Typically co-morbid with schizotypal, avoidant and paranoid personality disorders  Characteristic signs of schizoid PD + eccentric thoughts (odd beliefs or magical thinking - Schizotypal PD  Attenuated form of schizophrenia (milder form)  Patients will look like patients with schizophrenia in the prodromal and residual phases of schizophrenia  Magical beliefs -- illusions (feels presence of a dead person) - this is NOT a hallucination. They feel rather than see. (an attenuated schizophrenic symptom)  Engage in magical thinking - believe they can read the thoughts of others  May have paranoid ideation  Borderline Personality Disorder  More common  Rapid shifts of emotions in very short periods of time.  Emotions erratic, shift abruptly , argumentative, sarcastic, hard to live with, unpredictable, impulsive behaviour, may engage in indiscriminate sexual activities, cannot bear to be alone, demand attention  Great deal of co-morbidity - little bit of all the symptoms from all the other PDs  Can have chronic depression (dysthymia)  Often suicidal  1-2% More common in women   More likely than anyone else with a PD to have an Axes 1 disorder - e.g. a full blown major depressive or anxiety disorder  Co-Morbidity is very high - a lot will have - PTSD, substance abuse and eating disorders  Video Clip  Histrionic PD  Overly dramatic and attention seeking  Do nothing but draw attention to themselves  Always have to be the center of attention  Show or display emotions extravagantly  Emotionally shallow  Self Centered even though they make it seem you come first  Easily influenced by others  State very strong opinions  Little thought or support for these opinions  Try to talk over other people (seeking attention)  More common in women  Depression is common  Borderline PD is often co-morbid  Video Clip  Narcissistic Personality Disorder  Person with histrionic PD does not actually think much of themselves  Narcissistic persons - overwhelming grandiose view of their uniqueness & abilities  Pre-occupied with fantasies of great success  Self centered  Also require constant attention  Require excessive admiration  People will lack empathy  Very arrogant  Have a great sense of entitlement  1% prevalence  Co-occurs with histrionic PD and borderline PD  Video Clip - Charles Manson  Anti Social Personality Disorder  Only PD that requires a previous diagnosis present - a conduct disorder diagnosed before the age of 15  Conduct disorder- breaking rules and laws, shoplifting, harming animals, setting fire to property that doesn't belong to them  When they grow older, if this behaviour continues into adulthood (emphasis on behaviour displayed) - criminal behaviour, irresponsible, break laws, irritable , physically aggressive, reckless, impulsive, fail to plan ahead, and typically show no remorse  Last 3 symptoms are characterized by executive functioning - frontal lobes - a lot of patients show executive functioning deficits - reduced function in frontal lobes  Emphasis on behaviour  Video clip - Paul Bernardo  Avoidant PD  Sensitive to possibility of criticism, rejection and disapproval  Low self esteem  Feel inferior to others  Reluctant to take any kind of risks  Highly co-morbid with dependent personality disorder. Only difference between the two is that avoidant personality disorder patients have difficulty approaching and initiating social relationships.  Dependent PD  Unlike avoidant PD, these people seek social situations  Lacks self confidence & autonomy  Feel weak  Feel others are more powerful than them  Feel a need to be taken care of  Keep in mind cultural factor
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