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Chapter 13-18.docx

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John Stephens

Chapter 13 Personality DisordersPersonality DisordersHeterogeneous group of disorders coded on Axis II of the DSMRegarded asLongstanding pervasive and inflexible patterns of behaviour and inner experience thatDeviate from cultural expectations Causes impairment in social and occupationalCan cause emotional distressAn actual personality disorder is defined by the extremes of several traits and by the inflexible way these traits are expressed Personality disorders were placed on a separate axis Axis II to ensure that diagnosticians would pay attention to their possible presenceThe reliability of personality disorder diagnoses then has improved because of two developments1 the publication of specific diagnostic criteria and 2 The development of structured interviews specially designed for assessing personality disordersIt seems there is an overall agerelated decline over time in personality dysfunction as people get olderThe stability of personality dysfunction varies according to subtle but important differences in the nature of symptomsAcute symptoms ie selfharming are more likely to decrease over time while symptoms reflecting negative affect are quite stable and these chronic symptoms are likely a reflection of character and personality structure and organizationIt is often difficult to diagnose a single specific personality disorder because many disordered people exhibit a wide range of traits that make several diagnoses applicableDimensional differences exist when characterizing normal vs abnormal personality personality disorders reflect extreme and rigid response tendencies that differ in degree not in kind from the responses of people without disordersThe personality disorders can be construed as the extremes of characteristics we all posessLivesley identified three types of life tasks and proposed that failure with any one task is enough to warrant a personality disorder diagnosis 1 to form stable integrated and coherent representations of self and others 2 to develop the capacity for intimacy and positive affiliations with other people 3 to function adaptively in society by engaging in prosocial and cooperative behaviours Assessing Personality Disordersmany disorders are egosyntonic the person with a personality disorder is typically unaware that a problem exists and may not be experiencing significant personal distress they lack insight into their own personalitythe assessment and diagnosis of personality disorders are enhanced when the significant others in an individuals life become informantsa substantial proportion of patients are deemed to have a personality disorder not otherwise specified PDNOS and these patients do not fit into existing personality disorder diagnostic criteriaSome researchers described a set of MMPI2 scales that they developed to assess five dimensional personality constructs to reflect psychopathologyThis framework known as the PSY5 consists of dimensions assessing negative emotionalityneuroticism lack of positive emotionality aggressiveness lack of constraint and psychoticismPerhaps the most widely used measure of personality disorder symptoms is the Millon Clinical Multiaxial Inventory which includes many scales that reflect Millons recognition of the need to assess response biases and other selfreport tendencies that can undermine the data obtained via selfreport scalesPersonalized therapy in order to be more effective and meaningful for individuals therapies need to be modified to recognize each persons unique needs and personality styles 1 the various selfreport measures differ in their content and are not equivalent 2 A general concern involving selfreport measures including PD measures is that the cutoff points used to determine the presence of a personality disorder often overestimate the number of people who meet diagnostic criteria for particular disorders Personality Disorder ClustersCluster A Paranoid Schizoid and SchizotypalOddness and avoidance of social contactCluster BAntisocial Borderline Histrionic and NarcissisticDramatic emotional or erraticExtrapunitive and hostileCluster C Avoidant Dependent and ObsessiveCompulsiveAppear fearfulCluster A OddEccentric ClusterParanoid Personality DisorderCharacteristicsNormal characteristics except they are much more exaggerated Suspicious of others Expect to be mistreated or exploited by others and thus are secretive and always on the lookout for possible signs of trickery or abuseReluctant to confide in others Tend to blame others Can be extremely jealous Preoccupied with unjustified doubts about the trustworthiness or loyalty of others Prevalence and ComorbidityPrevalence about 1Occurs most frequently in men Comorbid with schizotypal avoidant and paranoid personality disorders Best represented as a continuous dimension rather than a discrete categorySchizoid Personality DisorderCharacteristicsNot to be confused with schizophreniaNo desire for or enjoyment of social relationshipsAppear dull bland and aloof No warmness tenderness towards othersThey do not put effort into warm relationshipsRarely report strong emotionsHave no interest in sexExperience few pleasurable activitiesIndifferent to praise and criticismPrevalence and ComorbidityPrevalence1Slightly more common in men Comorbid with schizotypal avoidant and paranoid personality disordersSchizotypical Personality DisorderCharacteristicsAttenuated form of schizophreniaInterpersonal difficulties of schizoid personalitysocial anxiety cognitive limitations and restrictions found in schizophrenia are also evidentEccentric symptoms identical to prodromal and residual phases of schizophrenia on the way to schizophreniaOdd beliefs or magical thinking Recurrent illusionsOdd speech Ideas of reference SuspiciousnessParanoid ideationEccentric behaviour and appearance Prevalence and ComorbidityPrevalence about 3Slightly more frequent among men than women Comorbid with borderline avoidant and paranoid personality disordersEtiology of Cluster AGenetically linked to schizophreniaPerhaps less severe variants of this Axis I disorderCould be linked to a history of PTSD and childhood maltreatment Enlarged ventricles natural spaces in the brain and less temporal grey matterCluster B DramaticEratic Cluster
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