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Lecture 10

Lecture 10. personality.doc

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Stephanie Cassin

Lecture 10: Personality Disorders 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 Pervasive - 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  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 CLUSTER A 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 treatmentSchizoid PDA 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  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 CLUSTER B 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 males)  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 love - Believes that he or she is special or unique and can only be understood by other special people - Has a sense of entitlement - Is interpersonally exploitive (take advantage of others to achieve ends) - Lacks empathy (not understanding where others are coming from) - Envious of others (who they may consider are of higher status) or believes that others are envious of him/her - Shows arrogant behaviours or attitudes (appear really confident/superior but underneath, self esteem is fragile)  Heterogeneity in terms of course between different people  Rarely does anyone seek treatment for narcissistic PD; usually occurs in conjunction with some other disorder like depression Borderline PD A pervasive pattern of instability of interpersonal relationships, self image, and affect, as well as marked impulsivity - Frantic efforts to avoid real or imagined abandonment - A pattern of unstable and intense interpersonal relationships - Identity disturbance (no idea what they like, unsure about self-identity, etc) - Impulsivity in areas that are potentially self damaging (like spending sprees, overdosing, bingeing, etc.) - Recurrent suicidal behaviour, gesture, or threats (cutting, burning, puncturing, etc)  could be precipitated by fears of abandonment (like argument with partner) or some intense feelings  may be form of self-punishment (‘I am fat’) - Affective instability due to a marked reactivity of mood (like one day, person may love something and the next, may hate it with a passion) - Chronic feelings of emptiness - Inappropriate, intense anger, or difficulty controlling anger (ties in with impulsivity) - Transient stress-related paranoid or dissociative (cut off from reality/no control) symptoms  Prevalence is ~2% in population; 20% in clinical population  Diagnosed a LOT more often in females  gender stereotypes? (with males, they had to have a much longer standing history of suicide attempts compared to females)  Stable over time from late adolescence to adulthood (or escalates a bit); but subsides when they are older (less suicidal/impulsive behaviours)  Diagnosed more often than other disorders[s] Antisocial PD (or sociopathy) Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 (i.e. must have conduct disorder as a child up to age 15) - Failure to conform to social norms with respect to lawful behaviours - Deceitfulness - Impulsivity or failure to plan ahead - Irritability and aggressiveness (start physical fights/arguments/assaults) - Reckless disregard for safety of self or others - Consistent irresponsibility (unable to hold job, cannot follow through with financial responsibilities, etc) - Lack of remorse (even if they did something bad, they have no sense of remorse)  3% in males, 1% in females; about 3-30% in clinical pop’n and also much higher in forensic setting  more commonly diagnosed in males; maybe because s
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