/Personality Disorder – Part 1

Personality Disorder – Part 1

Personality Trait

Enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.

Personality Disorder

Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture and is manifested in at least two of the areas

  • The pattern is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control
  • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
  • Leads to significant distress or impairment in social, occupational, or other important areas of functioning
  • The pattern is stable and of long duration, and its onset can be traced back to adolescence or early adulthood
  • The pattern is not better accounted for as a manifestation or consequence of another mental disorder
  • The pattern is not due to the direct physiologic effects of a substance or a general medical condition

Dimensions of Personality

Hippocrates – “Four humors”

  • Blood – Emotional lability
  • Black bile – Depression
  • Yellow bile – Anger
  • Phlegm – Slow, stolid, cold

Carl Jung – Psychological Types (1921)

  • Introvert-Extravert
  • Thinking-Feeling
  • Sensing-Intuiting
  • Judging-Perceiving

Assessment Instruments

  • Self-report inventories
  • Minnesota Multiphasic Personality Inventory (MMPI, 1937), CPI
  • Structured clinical interview for diagnosis (SCID) – Based on diagnostic criteria
  • Clinical interview

Projective tests – Not diagnostic, but show patterns of thought, dynamics, defenses, disorders of thought, etc.

    • Rorschach (ink-blot)
    • Thematic Apperception Test (TAT) – (tell stories about evocative pictures)
    • Sentence-Completion Test (SCT) – (“I like…”  “Sometimes I wish…”)
    • Draw-A-Person (DAP)

Prevalence

  • OCPD             2%
  • Paranoid        2%
  • Antisocial      1-4%
  • Schizoid         1%?
  • Schizotypal 1%
  • Avoidant 1-2%
  • Histrionic       2%
  • Borderline     2-3%
  • Dependent    0.5%
  • Narcissistic  .5-1%

Etiology

Genetic and biologic factors

  • Concordance rates of personality traits for monozygotic twins are higher than for dizygotic twins, even if they are raised apart

Genetic and Biologic Factors: Larry Siever

  • Cognitive disorganization (includes “interpersonal detachment”) – Cluster A
  • Impulsivity – Cluster B
  • Decreased 5-HT and 5-HIAA (5-HT metabolite)
  • Affective instability – Cluster B
  • Hyperresponsivity of noradrenergic system
  • Anxiety/Inhibition – Cluster C
  • High autonomic arousal from infancy

Robert Cloninger

  • Novelty seeking
  • Harm avoidance
  • Reward dependence

Environmental factors

  • Parenting and family style
  • Psychosocial milieu

Psychodynamic factors

  • Internal drives and defenses
  • Developmental tasks and stages

Three Clusters

  1. Cluster A (odd, eccentric, mad)
  • Paranoid
  • Schizoid
  • Schizotypal
  1. Cluster B (dramatic, emotional, bad, Erratic)
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
  1. Cluster C (anxious-fearful, sad)
  • Avoidant
  • Dependent
  • Obsessive-compulsive