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Personality Disorder – Part 2

Personality Disorder – Part 1

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.

Paranoid Personality disorder

  • A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
  • Suspects others are exploiting or deceiving him
  • Preoccupied with unjustified doubts about loyalty
  • Is reluctant to confide in others because he believes they will use the information against him
  • Reads hidden demeaning meanings into benign remarks
  • Perceives attacks on his character
  • Recurrent suspicions regarding fidelity of spouse or sexual partner
  • Prevalence:  2% of the population.
  • Sex ratio:  F:M=3:1
  • Comorbidity:  Brief reactive psychosis, delusional disorder, anxiety, substance abuse, depression, schizophrenia
  • Family:  Delusional disorder, schizophrenia, Cluster A disorders

Schizoid Personality Disorder

A pervasive pattern of detachment from social relationships and restricted expression of emotion with 4 or more the following:

  • Neither desires nor enjoys close relationships
  • Almost always chooses solitary activities
  • Little if any interest in sexual experiences with another person
  • Takes pleasure in few in any activities
  • Lacks close friends other than first-degree relatives
  • Appears indifferent to the praise or criticism of others
  • Shows emotional coldness or flattened affect
  • Sex ratio:  M>F
  • Comorbidity:  Delusional disorder, schizophrenia
  • Family:  Schizophrenia, Cluster A disorders, esp. schizotypal personality disorder

Schizotypal Personality Disorder

  • A pervasive pattern of social and interpersonal deficits with reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behavior with 5 or more of the following:
  • Ideas of reference
  • Odd beliefs or magical thinking
  • Unusual perceptual experiences including bodily illusions
  • Odd thinking and speech
  • Suspiciousness or paranoid ideation
  • Inappropriate or constricted affect
  • Behavior or appearance that is odd or eccentric
  • Lack of close friends other than first-degree relatives
  • Excessive social anxiety that does not diminish with familiarity
  • Sex ratio:  M>F
  • Comorbidity:  Depression, anxiety, brief reactive psychosis, delusional disorder, schizophrenia
  • Family:  Schizophrenia, Cluster A disorders.

Antisocial Personality Disorder

  • A pervasive pattern of disregard for and violation of the rights of others occurring since the age of 15 years as indicated by 3 or more of the following:
  • Failure to conform to social norms with respect to lawful behaviors
  • Deceitfulness and conning others for personal profit or pleasure
  • Impulsivity or failure to plan ahead
  • Irritability or aggressiveness as indicated by repeated fights or assaults
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility
  • Lack of remorse
  • There is evidence of Conduct Disorder with onset before age 15
  • Sex ratio:  M:F=3:1
  • Comorbidity:  Substance abuse, attention deficit disorder, depression, anxiety
  • Family:  Somatization disorder, substance abuse, Cluster B disorders, esp. antisocial personality disorder
  • Associations
  • Violence
  • Criminal behavior
  • Suicide

Borderline Personality Disorder

  • The pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity as indicated by 5 or more of the following:
  • Frantic efforts to avoid abandonment
  • Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Identity disturbance
  • Impulsivity in at least two areas that are potentially self-damaging
  • Recurrent suicidal behaviors, gestures or threats or self-mutilating behaviors
  • Affective instability due to a marked reactivity of mood
  • Chronic feelings of emptiness
  • Inappropriate anger
  • Transient, stress-related paranoia
  • Sex ratio:  F:M=3:1
  • Comorbidity:  Depression, substance abuse, eating disorders, brief reactive psychosis
  • Family:  Mood disorders, substance abuse, Cluster B disorders, esp. antisocial personality disorder
  • Associations
  • Suicide and self-mutilation
  • Splitting – seeing the world as all good or all bad
  • Psychosis
  • Childhood trauma (especially sexual)
  • Dissociation- depersonalization, derealization, amnestic episodes

Histrionic Personality Disorder

  • The pervasive pattern of excessive emotionality and attention seeking indicated by >5 of the following:
  • Uncomfortable in situations in which he is not the center of attention
  • Interaction with others often characterized by inappropriate sexually seductive behavior
  • Displays rapidly shifting and shallow expression of emotion
  • Consistently uses physical appearance to draw attention to self
  • Has a style of speech that is excessively impressionistic and lacking in detail
  • Shows self-dramatization and exaggerated emotion
  • Is suggestible
  • Considers relationships to be more intimate than they are
  • Sex ratio:  F>M
  • Comorbidity:  Somatization and conversion disorders, depression, anxiety
  • Family:  Cluster B disorders

Narcissistic Personality Disorder

  • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, lack of empathy as indicated by >5 of the following:
  • Grandiose sense of self-importance
  • preoccupied with fantasies of unlimited success, power, brilliance or beauty
  • Believes he is special and can only be understood or should associate with other special or high-status people
  • Requires excessive admiration
  • Has a sense of entitlement
  • Is interpersonally exploitive
  • Lacks empathy
  • Is often envious of others and believes others are envious of him
  • Shows arrogant, haughty behaviors or attitudes
  • Sex ratio:  50-75% male
  • Comorbidity:  Mood disorders, anorexia, substance abuse
  • Family:  Cluster B disorders

Avoidant Personality Disorder

  • A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation as indicated by >4 of the following:
  • Avoids social occupations that involve significant interpersonal contact
  • Is unwilling to get involved with people unless certain of being liked
  • Is preoccupied with being criticized in social situations
  • Shows restraint in intimate relationships because of fear of being shamed or ridiculed
  • Inhibited in new interpersonal situations because of feeling inadequate
  • Views self as socially inept and unappealing
  • Is unusually reluctant to take personal risks or engage in any new activities because they may prove embarrassing
  • Sex ratio:  M=F
  • Comorbidity:  Social phobia, depression, anxiety
  • Family:  Cluster C disorders

Dependent Personality Disorder

  • A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors and fears of separation as indicated by >5 of the following:
  • Has difficulty making everyday decisions without an excessive amount of reassurance
  • Needs others to assume responsibility for most major areas of his life
  • Has difficulty expressing disagreement with others because of fear of loss of approval
  • Difficulty initiating projects on his own because of lack of self-confidence
  • Goes to excessive lengths to obtain nurturance and support from others
  • Feels uncomfortable or helpless when alone
  • Urgently seeks another relationship as a source of care and support when a relationship ends
  • Is unrealistically preoccupied with fears of being left to take care of himself
  • Sex ratio:  F>M
  • Comorbidity:  Mood and anxiety disorders, adjustment disorders
  • Family:  Cluster C disorders