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PSY240H1 Lecture Notes - Personality Disorder

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Lecture 10: Personality Disorders December 1, 2009
Features of Personality Disorders (PDs)
(They all are maladaptive)
Pattern is manifested in
-Cognition (perception of themselves or world or others), affect (range,
appropriateness, lability, and intensity of emotions), interpersonal functioning
(difficulty in maintaining/initiating relationships, paranoia about others, fear of
abandonment), and/or impulse control
-Evident across a wife range of personal, social, and occupational situations
People from all aspects of this person’s life will probably observe personality
disorder traits – not just friends or not just family, but both
Clinically significant impairment
-Personal distress or impairment in social and occupational functioning
Personal distress is not necessary – such as with people who have anti-social
personality disorder, they don’t feel distressed at all
Early onset and stability
-Symptoms evident since at least late adolescence (usually early adolescence to
late adulthood) and stable (over time but not necessarily at the same intensity –
stressors may increase intensity)
Classification of PDs
-PDs are long standing, maladaptive, inflexible ways of relating to the world
-They are diagnosed on Axis-II of DSM
-Many problems with classification (can be really difficult to distinguish from
normal and abnormal/maladaptive like dependent personality disorder – when
does dependence in older people cross threshold into disorder)
hard to distinguish from Axis-I type disorders
-Low reliability in terms of diagnosis (esp. compared to Axis-I) – usually don’t
diagnose a person with Axis-II disorders because of the stigma and may just label
them as ‘Axis-II traits
-Much less research compared to Axis-I disorders hence don’t know much about
treatment either
DSM-IV Personality Disorders
Cluster A: Odd or Eccentric
-paranoid, schizoid, schizotypal
Cluster B: Dramatic, Emotional, or Erratic
-histrionic, narcissistic, borderline, antisocial
Cluster C: Fearful or Anxious
-avoidant, dependent, obsessive-compulsive

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Clusters based on superficial similarities, not really by number of traits shared or stats
People can easily have disorders w/ characteristics across more than one cluster
Paranoid PD
A pervasive distrust and suspiciousness of others motives
Plus about four of the following…
-Suspects that others are exploiting, harming, or deceiving him/her
-Perceives attacks on his or her character or reputation
-Has recurrent suspicions regarding fidelity of partner
-Preoccupied with doubts about the loyalty or trustworthiness of others
-Reluctant to confide in others
-Misinterprets neutral comments or events
-Persistently bears grudges (and fear that others may use grudges against them)
-Affects about 10-30% of
-More commonly diagnosed in males
-Tends to stay stable over time
-Hard to achieve therapeutic alliance since patient may be suspicious of treatment
Schizoid PD
A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings
- Neither desires nor enjoys close relationships
- Almost always chooses solitary activities
- Has little, if any, interest in sexual relationships
- Takes pleasure in few, if any, activities (even solitary activities)
- Lacks close friends or confidants
- Appears indifferent to the praise or criticism of others
- Shows emotional coldness, detachment, or flattened affectivity
Focus on impairment and not distress since they aren’t distressed by it
People seeking treatment for this is almost unheard of, since they have no desire to.
Hence, prevalence is pretty much unknown
Relatively stable over life
Lack of interest (not embarrassment or fear of rejection) causes them to avoid social
relationships/activities/etc, but these symptoms look the same as social anxiety
Schizotypal PD
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with,
and reduced capacity for, close relationships as well as by cognitive or perceptual
distortions or eccentricities of behaviour

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Kinda hard to diagnose, since it shares symptoms with schizophrenia; it’s like a mild
form of schizophrenia
-Ideas of reference
-Odd beliefs or magical thinking
-Unusual perceptual experiences
-Odd thinking and speech
-Suspiciousness or paranoid ideation (of others)
-Inappropriate or constricted affect (as in schizoid)
-Behaviour or appearance that is odd, eccentric, or peculiar
-Lack of close friends or confidants (related to paranoid/suspicious thinking)
-Excessive social anxiety that is associated with paranoid fears
Prevalence is about 3% in population and more prevalent in males
May stay stable, but for many people, may transition into schizophrenia (higher
chance of developing schizophrenia in people with schizotypal disorder)
If there is a period of 1 month or more with active symptoms, then that would be
considered schizophrenia
Histrionic PD
A pervasive pattern of excessive emotionality and attention seeking
-Uncomfortable in situations in which he/she is not the centre of attention
-Interaction with others Is often characterized by inappropriate seductive or
provocative behaviour
-Displays rapidly shifting and shallow expressions of emotion
-Consistently uses physical appearance to draw attention
-Show self-dramatization, theatrically, and exaggerated expression of emotion
-Is suggestive – easily influenced by others
-Considers relationships to be more intimate than they are
These symptoms must be really marked to be part of diagnosis
2-3% in population; 10—15% in clinical population
One criticism is that it is gender stereotyped; females more likely to be diagnosed;
so females are more often diagnosed (since the criteria isn’t as easily applied to
Thought to decrease with age
Narcissistic PD
A pervasive pattern of grandiosity, need for admiration, and lack of empathy
- Has a grandiose sense of self-importance
- Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
- Believes that he or she is special or unique and can only be understood by other
special people
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