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Chapter 13

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Konstantine Zakzanis

Chapter 13: Personality Disorders Personality disorders: heterogeneous group of disorders that are coded on Axis II of the DSM  regarded as long-standing, pervasive, and inflexible patterns of behaviour and inner experience that deviate from the expectations of a person’s culture and that impair social and occupational functioning some but not all cause emotional distress CLASSIFYING PERSONALITY DISORDERS: CLUSTERS, CATEGORIES, AND PROBLEMS A study found that 55% of patients with borderline personality disorder also met the diagnostic criteria for schizotypal personality disorder, 47% for anti-social personality disorder, and 57% for histrionic personality disorder Livesley identified 3 types of life tasks and proposed that failure with any one task is enough to warrant a personality disorder diagnosis: To form stable, integrated, and coherent representation of self and others To develop the capacity for intimacy and positive affiliations with other people To function adaptively in society by engaging in prosocial and co-operative behaviours ASSESSING PERSONALITY DISORDERS Many disorders are egosytonic- person with a personality disorder is typically unaware that a problem exists and may not be experiencing significant personal distress, lack of insight of own personality The most widely used measure of personality disorder symptoms is the Millon Clinical Multitaxial Inventory, now in its 3 edition (MCMI-III) provides subscale measure of 11 clinical personality scales (schizoid, avoidant, depressive, dependent, histrionic, narcissistic, anti-social, aggressive, compulsive, passive-aggressive, and self-defeating) and 3 severe personality pathology scales (schizotypal, borderline, and paranoid) Personalized therapy: therapies need to be modified to recognize each person’s unique needs and personality styles PERSONALITY DISORDER CLUSTERS When a DSM-IV-TR criterion is involved, personality disorders are grouped into 3 clusters: Cluster A  paranoid, schizoid, and schizotypal  seem odd or eccentric  these disorders reflect oddness and avoidance of social contact Cluster B  Borderline, histrionic, narcissistic, and anti-social  Seem dramatic, emotional, or erratic  Behaviours are extrapunitive, and hostile Cluster C  Avoidant, dependent, and obsessive-compulsive  Appear fearful ODD/ECCENTRIC CLUSTER Comprises 3 diagnoses: Paranoid  Being suspicious of others  They expect to be mistreated or exploited by others and thus are secretive and always on the lookout for possible signs of trickery and abuse  Unwilling to confide in others & tend to blame others even when they themselves are at fault  Can be extremely jealous and may unjustifiably question the fidelity of a spouse or lover  Preoccupied with unjustified doubts about the trustworthiness or loyalty of others (neighbor’s dog deliberately barks to disturb him/her)  Hallucinations are NOT present  Occurs most frequently in men, and co-occurs most frequently with schizotypal  Co-occurs most frequently with schizotypal, borderline,& avoidant personality disorders Schizoid  they don’t appear to desire or enjoy social relationships & usually have no close friends  they appear dull, bland, and aloof and have no warm, tender feelings for others  rarely report emotions, have no interest in sex, & experience few pleasurable activities  indifferent to praise and criticism  loners with solitary interests  prevalence is less than 1%  slightly less common among women than men Schizotypal PDs  usually have the interpersonal difficulties of the schizoid personality and excessive social anxiety that doesn’t diminish as they get to know others  may have odd beliefs or magical thinking (superstitiousness, beliefs that they are clairvoyant and telepathic) and recurrent illusions (may sense the presence or force or a person not actually there)  in their speech, they may use words in an unusual and unclear fashion (“I’m not a very talkable person”)  their behaviour and appearance may be eccentric  they may talk to themselves  paranoid ideation, ideas of reference, and illusions were they symptoms most relevant for making a diagnosis  prevalence of this disorder is about 3%  slightly more frequent among men than women The lowest heritability estimate was found for schizotypal personality disorder and the largest heritability estimate was found for anti-social personality disorder Schizotypal personality disorder is associated with enlarged ventricles & less temporal-lobe grey matter Schizotypal personality disorder was linked with a history of post-traumatic stress disorder and childhood maltreatment DRAMATIC/ERRATIC CLUSTER Borderline personality: impulsivity and instability in relationships, mood, and self-image Ex: attitudes and feelings toward other people may vary considerably and inexplicably over short periods of time emotions are erratic & can shift abruptly, from passionate idealization to contemptuous anger argumentative, irritable, sarcastic, quick to take offence, and very hard to live with behaviour may include gambling, spending, spending, indiscriminate sexual activity, and eating sprees, and is thus potentially self-damaging they remain uncertain about their values, loyalties, and career choices can’t bear to be alone, have fears of abandonment, and demand attention subject to chronic feelings of depression and emptiness, they often attempt suicide (1 in 10 people with BDP commit suicide) and engage in self-mutilating behaviour (slicing legs with a razor blade) typically begins in early adulthood has a prevalence of 1-2% and is more common in women most clients with BDP recover over time runs in family suggesting it has a genetic component some data suggest poor functioning of the frontal lobes, which may play a role in impulsive behaviour when patients were given a drug to increase serotonin levels, their levels of anger decreased Histrionic personality: peo
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