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Abnormal Psychology Ch. 13 Personality Disorders
Terms in this set (72)
A category of psychological disorders characterized by an enduring pattern of inflexible and maladaptive thoughts, emotional responses, interpersonal functioning, and impulse control problems that arise across a range of situations and lead to distress or dysfunction
-Affects - Refers to the range, intensity, and changeability of emotions and emotional responsiveness and the ability to regulate emotions.
-Behavior - Which refers to the ability to control impulses and interactions with others
-Cognition - refers to the perceptions and interpretations of events other people and oneself
Enduring characteristics that lead a person to behaving in relatively predictable ways across a range of situations.
Actions, attitudes and behaviors that a person possesses.
People with personality disorders see other people or situations as being the problem, not them selves.
Pattern of Complaints
Clinicians may diagnose a patient with a personality disorder based both on what the patient says, and on patterns in the way he or she says it.
Diagnostic Criteria for a Personality Disorder
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture. This pattern is manifested in two (or more) of the following areas.
-Cognition - ways of perceiving and interpreting self other people and events
-Affectivity - the range intensity liability appropriateness of emotional response
- interpersonal functioning
- impulse control
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
The enduring pattern Lee to clinically significant distress or impairment in social occupational or other important areas of functioning
The pattern is stable and for long duration and its onset can be traced back at least to adolescence or early adulthood
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder
The enduring pattern is not attributable to the psychological effects of a substance (a drug of abuse a medication) or another medical condition (head trauma)
Other Personality Disorder (non specific personality disorder)
Diagnosed along with an additional personality disorder. As with other categories of disorders, the non specific "other" diagnosis is used when a patients symptoms can cause distress or impair functioning but do not fit the criteria for any of the disorders within the relevant category. (the 10 specific personality disorders)
(MOST FREQUENTLY DIAGNOSED PERSONALITY DISORDER)
Cluster A Personality Disorderterm-8
Personality disorders characterized by odd or eccentric behaviors that have elements related to those of schizophrenia.
Affect - Easily feels betrayed and angry
Behavior - Hyper vigilant for betrayal
Cognition - Distrustful/suspicious of other reads malevolent meaning into neutral remarks
Social Functioning - Generally avoids relationships
Affect - Emotionally constricted or detached
Behavior - Avoids people when possible
Cognition - Views relationships as messy and undesirable
Social Functioning - Indifferent to praise or criticism, generally avoids relationships
Affect - Generally emotionally constricted, but displays inappropriate affect and anxiety
Behavior - Avoids people when ever possible
Cognition - Perceptual distortions ideas of reference and magical thinking
Social Functioning - Generally avoids relationships
Personality Disorder Facts
Researchers estimate that up to 14% of Americans will have at least one personality disorder over the course of their lives.
Upto 75% of those with a personality disorder will also be diagnosed with another type of physiological disorder. Common comorbid disorders are mood disorders and anxiety disorders and substance use disorders. Approximately 50% of people with a personality disorder will be diagnosed with at least 1 other personality disorder.
The DSM-5 diagnostic criteria require that symptoms are present by young adulthood.
For one personality disorder antisocial personality disorder a diagnostic criterian requires that symptoms are present before age 15.
Symptoms of personality disorders are often relatively stable but they may fluctuate are improve as people go through adulthood.
Specific personality disorders have gender differences in prevalence but their is no such difference across all personality disorders.
Cluster B Personality Disorders
Personality disorders characterized by emotional, dramatic, or erratic behaviors that involve problems with emotional regulations.
Affect - Aggressive feelings towards other lack of empathy
Behavior - Generally poor impulse control
Cognition - Believes he or she is entitled to break rules
Social Functioning - Dominant in relationships
-Conduct Disorder - A psychological disorder that typically arises in childhood and is characterized by the violation of the basic rights of others or of societal norms that are appropriate to the person's age.
Affect - Emotionally expressive, with inappropriately string and rapid reactions
Behavior - Poor impulse control
Cognition - Dramatic shifts between over valuing and undervaluing others. May develop paranoid thinking under stress.
Social Functioning - Alternately dominantly and submissive in relationships.
Affect - Rapidly shifting but shallow emotions
Behavior - Relatively poor impulse control strives to be center of attention
Cognition - Wants to be the center of attention
Social Functioning - Dominant in relationships
Affect - No empathy, haughty (ASS-HOLE) towards other
Behavior - Manipulates others
Cognition - Grandiosity
Social Functioning - Dominant in relationships
Genes - Genes are the most influential neurological factor associated with personality disorders. Genes have clearly been shown to influence temperament. Differences in temperament are the foundation on which different personality traits are built, and at their extremes, temperaments can give rise to inflexible personality traits that are associated with personality disorders.
Dysfunctional Belief - Based on what they have learned, people can develop maladaptive and faulty beliefs, which in turn reinforces their views of self and others. The consequence of behavior can thereby lead to pervasive dysfunctional beliefs, which can form the foundation for some types of personality disorders.
Attachment Style - The child's emotional bond and way of interacting with his/her caretaker. The attachment style established during childhood often continues into adulthood, affecting how the person related to others. People with personality disorders are more likely to have an insecure attachment style. People can develop an insecure attachment style for a variety of reasons, such as child abuse (sexual, physical, verbal), neglect, or inconsistent discipline.
(NF)Treatment -Personality Disorders
Antipsychotics, antidepressants, mood stabilizers, other medication. Generally more useful in treating other comorbidities associated with personality disorders such as anxiety, are not very helpful for symptoms of personality disorders per se. Nevertheless some of these medications may reduce temporarily some symptoms,
(PF)Treatment- Personality Disorders
CBT, and psychodynamic therapy have been used to treat personality disorders. Both therapies focus on core issues that are theorized to give rise to the disorders.
-Psychodynamic Therapy - Addresses unconscious drives and motivations
-CBT - Addresses maladaptive views of self and others and negative beliefs that give rise to the problematic feelings, thoughts, and behaviors of the personality disorder.
CBT I is intended to increase the patients sense of self - efficacy and mastery and to modify the negative unrealistic beliefs that lead to maladaptive behaviors.
TREATMENT THAT TARGETS PSYCHOLOGICAL FACTORS HAS BEEN STUDIED IN DEPTH ONLY FOR BORDERINE PERSONALITY DISORDER
(SF)Treatment - Personality Disorders
Family education, family therapy (systems therapy), couples therapy, interpersonal therapy, can provide a forum for family members to learn about the patients personality disorders and to receive practical advice about how to help the patient - for ex. how to respond when the patient gets agitated or upset.
Cluster A Personality Disorders - The odd and Eccentric
(General info associated to its personality disorders)
Patients with Cluster A Personality Disorder are also likely to develop another psychological disorder that involves psychosis such as schizophrenia or delusional disorder. The 3 disorders associated in this cluster are paranoid, schizoid, and schizotypal, they are on the less severe spectrum of schizophrenia related disorders, of these 3 only schizotypal personality disorder is considered to be on the schizophrenia spectrum.
Paranoid Personality Disorder
A personality disorder characterized by persistent and pervasive mistrust and suspiciousness, accompanied by a bias to interpret other peoples motives as hostile.
(There perceived threats come more from more actual individuals rather from (radio waves) which is a characteristic of paranoid schizophrenia)
Diagnostic Criteria for Paranoid Personality Disorder
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of context as indicated by four (or more) of the following
1- suspects without sufficient basis, that others are exploiting, harming or deceiving him or her.
2- Is preoccupied with unjustified doubts about the loyalty or trust worthiness of friends or associates
3- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
4- Reads hidden demeaning or threatening meanings into benign remarks or events
5- Persistently bears grudges (is unforgiving of insults, injuries, or slights)
6- Perceives attacks on hos or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
7- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder wit psychotic features, or another psychotic disorder and I not attributable to the physiological effects of another medical condition.
Paranoid Personality Disorder Facts
-Prevalence - Between 2.3% and 4.5% of the general population is estimated to have paranoid personality disorder
-Comorbidity - People with paranoid personality disorder may also have another personality disorder, usually another cluster A (odd/eccentric) personality disorder (schizoid or schizotypal) or narcissistic, avoidant, or borderline personality disorder.
-Onset - Symptoms can fist appear in childhood or adolescence, when the person appears hypersensitive, has difficulties with peers, and has odd thoughts or fantasies or uses language unconventionally.
-Course - The symptoms of paranoid personality disorder are relatively stable over time
-Gender Differences - Based on surveys in he general population, there is no clear gender differences in the prevalence of paranoid personality disorder. However, among people with this disorder, men are more likely than women to come to the attention of mental health professionals.
Schizoid Personality Disorder
A personality disorder characterized by a restricted range of emotions in social interactions and few if any close relationships.
(People with schizoid personality disorder often lack social skills and may not pick up on or understand the normal social cues required for smooth social interactions, for instance, they may return some one's smile with a stare. People with this personality disorder generally are not interested in developing personal relationships.)
Diagnostic Criteria for Schizoid Personality Disorder
A. A Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following
1- Neither desires nor enjoys relationships, including being part of a family
2- Almost always chooses solitary activities
3- Has little id any interest in having sexual experiences with another person.
4- Takes pleasure in few if any activities
5-Lacks close friends of confidants other than first degree relatives
6- Appears indifferent t the praise or criticism of others
7- Shows emotional coldness, detachment, or flattened affectivity
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features or another psychotic disorder and is not attributable to the physiological effects of another medical condition.
Schizoid Personality Disorder Facts
-Prevalence - Approx. 3% of the general population is estimated to have schizoid personality disorder.
-Comorbidity - Common comorbid personality disorders are the other cluster A (odd/eccentric) personality disorders and avoidant personality disorder. Half of the people diagnosed with schizoid personality disorder will also be diagnosed with schizotypal personality disorder
-Onset - Those who develop schizoid personality disorder were often socially isolated underachievers who were teased by their classmates as children and adolescents.
-Course - Schizoid personality disorder is relatively stable over time
-Gender Differences - This personality disorder tends to be diagnosed more often in men than in women. Men with this personality disorder are often more impaired than their female counterparts.
Schizotypal Personality Disorder
A personality disorder characterized by eccentric thoughts, perceptions, and behaviors, in addition to having very few close relationships.
(Schizotypal has nine symptoms. These symptoms have been categorized into 3 distinct groups: Cognitive, Interpersonal Disorganized)
Schizotypal is the most researched personality disorder researched in Cluster A
Diagnostic Criteria for Schizotypal Personality Disorder
A. 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 and eccentricities of behavior beginning by early adulthood ad present in a variety of contexts as indicated by five (or more) of the following.
-Ideas of reference - In which the person interprets ordinary events to have particular meaning for him or her (milder form of referential delusions)
-Odd beliefs or magical thinking, in which the person believes that he or she has control over external events, as occurs with superstitious beliefs.
-Unusual perceptual experiences, such as feeling "dislocated" from parts of ones body or hearing a voice on the radio murmuring ones name
-Inappropriate or constricted affect, such as showing only a narrow range of emotions
-Lack of close friends because of a preference for being alone
-Excessive social anxiety that arises because of a general suspiciousness about other people.
-Odd thinking and speech, such as being overly vague or elaborate or using words idiosyncratically (ex. "My coworker isn't talkable")
-Behavior or appearance that is odd or eccentric, such as wearing mismatched or unkempt clothing, avoiding eye contact, or being unable to make conversation.
Schizotypal Personality Disorder Facts
-Prevalence - Approx. 0.6-4.6% of the general population has schizotypal personality disorder
-Comorbidity - Common comorbid personality disorders include other Cluster A personality disorders, as well as borderline avoidant and obsessive-compulsive personality disorders. Common comorbid psychological disorders are major depressive disorder, social phobia, and panic disorder.
-Onset - Symptoms emerge by early adulthood. In childhood and adolescence, symptoms may include social isolation and social anxiety, academic underachievement, hypersensitivity, odd fantasies and thoughts and idiosyncratic use of language.
-Course - Although schizotypal personality disorder I stable over time, symptoms may improve for some people. In fact, for almost one quarter of patients, symptoms improve to the point where they no longer meet all the diagnostic criteria. Among other patients with this disorder, the opposite is true. A small percentage go on to develop schizophrenia or another psychotic disorder
-Gender Differences - Schizotypal personality disorder is slightly more common in among men than women.
(NF)Schizotypal Personality Disorder
-Genes - The rate of schizotypal personality disorder are higher among family members of people with schizophrenia than among the general population.
-Maternal illness, malnourishment of the fetus, birth complications.
-Abnormalities in brain structure and in mental function (activity of dopamine, serotonin, and glutamate). These abnormalities are generally less severe in people with schizotypal personality disorder as in people with schizophrenia.
(PF)Schizotypal Personality Disorder
-Attention Deficit - (distinguishing relevant from irrelevant stimuli)
-Executive Functions - (used in problem solving, planning, and judgment)
-Primary distortions are mental processes
-Impaired theory of mind - Difficulty recognizing emotions in others, and in taking another's point of view or recognizing another's mental state.
-Have cognitive deficits but generally have better cognitive skills than do people with schizophrenia.
-People with this disorder have unusual ways which make other people more likely to mistreat them, intentionally or not. Such mistreatment confirms there beliefs about them selves and others, thus reinforce their isolation from and avoidance of other people.
(SF)Schizotypal Personality Disorder
-Insecure attachment style
-Children who develop schizotypal personality disorder are more likely to have experienced trauma, abuse and neglect than are those who develop most other personality disorders. These negative childhood experiences influence patients' views of other people as untrustworthiness and having malevolent motives
Treating Odd/Eccentric Personality Disorders
Very little research has been conducted to evaluate treatments for odd/eccentric personality disorders. People with any of these sorts of personality disorders tend not to be interested in treatment and if urged to coerced into it, are often reluctant participants at best. Treatment may also cause Anxiety for the patient
When such patients do participate in CBT, they can develop more adaptive strategies such as improved social skills (which makes them less likely to be conspicuous and in turn leads them to feel safer with other). CBT may also employ relaxation techniques, exposure to avoided social situations, and cognitive restructuring of distorted views of self and others and of dysfunctional beliefs.
Most medications that effectively treat symptoms of schizophrenia can also treat symptoms of schizotypal personality disorder, although the medications are often taken at lower doses.
Custer B Personality Disorders - The Dramatic and Erratic
(General info associated with in personality disorder)
People with cluster B personality disorder display the disorders typical reactions which are: impulsive, dramatic, and erratic behaviors. These disorders arise because of difficulty regulating emotions. People may tend to have symptoms that are not unique to a single personality disorder making it difficult to determine which specific Cluster B personality disorder a patient may have.
People with a dramatic/erratic personality disorder also tend to have a certain additional psychological disorders: substance-abuse disorders, mood disorders, anxiety disorders, or eating disorders.
Antisocial Personality Disorder
A personality disorder diagnosed in adulthood characterized by a persistent disregard for the rights of others.
(The diagnostic criteria for antisocial personality disorder are the most behaviorally specific of the criteria for personality disorders and even include overt criminal behaviors. Because of this specificity, antisocial personality disorder is the most reliably diagnosed personality disorder)
Diagnostic Criteria for Antisocial Personality Disorder
A. A pervasive pattern of disregard for the violation of the rights of others, occurring since age 15 years, as indicated by 3 (or more) of the following.
1- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3- Impulsivity or failure to plan ahead
4- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
5- Reckless disregard for safety of self or others
6- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7-Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
B. The individual is at least age 18 years
C. There is evidence of conduct disorder with onset before age 15 years
-Conduct Disorder - A psychological disorder that typically arises in childhood and is characterized by the violation of the basic rights of others or of societal norms that are appropriate to the person's age.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.
Antisocial Personality Disorder Facts
-Prevalence - Between 1% and 4% of Americans are diagnosed with antisocial personality disorder. Approx. 60% of male prisoners in a number of countries have antisocial personality disorder
-Comorbidity - The most common comorbid psychological disorders are anxiety disorder, and mood disorders, substance use disorders, and somatization disorders. In a clinical setting, most patients who meet the criteria for antisocial personality disorder also are diagnosed with at least one other personality disorder, typically another dramatic/erratic personality disorder.
-Onset - As required by the DSM-5 criteria, symptoms of conduct disorder emerge before age 15 and specific symptoms of antisocial behavior occur since age 15. The specific antisocial behaviors then continue into adulthood.
-Course - Antisocial personality disorder has a chronic course, but symptoms may improve as patients age, particularly in their 40s
-Gender Differences - Antisocial personality disorder is diagnosed more often in men than in women.
Psychopath (sociopath in the old DSM)
Has often been used to refer to someone with symptoms of antisocial personality disorder
A set of emotional and interpersonal characteristics marked by a lack of empathy, an unmerited feeling of high self-worth, and a refusal to accept responsibility for ones actions, as well as antisocial behaviors.
Psychopathy is generally considered to be more universal concept than antisocial personality disorder; most cultures recognize a similar cluster of psychopathic characteristics.
(NF)Antisocial Personality Disorder
-Structure - Small Frontal Lobe
-Function - Brain function of the frontal and temporal lobe show less activation than normal during tasks.
-Genes - Dopamine and serotonin may influence temperament and have been linked to being highly motivated by the possibility of reward not being strongly motivated by the threat of punishment and having low frustration tolerance which often leads to impulsive behavior and a tendency to take shortcuts.
(PF)Antisocial Personality Disorder
Antisocial personality disorder and psychopathy appear to develop because of problems with classical and operant conditioning processes. whereas classical conditioning and operant conditioning lead most people to learn to avoid encounters with a painful stimuli, criminal with psychopathic traits do not learn to avoid painful stimuli. Thus, they cannot learn from punishing experiences, and are likely to repeat behavior associated with negative consequences, despite receiving punishment, such as a prison sentence
(SF)Antisocial Personality Disorder
-One factor for conduct disorder and subsequent antisocial personality disorder is a child's relationship with his or he parents or primary caretakers.
-insecure attachment style
These children have a relatively high risk of developing conduct disorder and later antisocial personality disorder
Treatment for Antisocial Personality Disorder
Most research on treatment involves people who are diagnosed with psychopathy not antisocial personality disorder specifically. Psychopathy has a poor prognosis, and treatments developed thus far are not likely to alter behavior or reduce symptoms. Psychopaths who are prisoners are more likely to commit additional crimes after their release.
-Managing the patient may be more realistic and appropriate than treating the patient's personality problems.
-Patients often will attend therapy only when required to do so. Treatment generally focuses on changing overt behaviors.
Borderline Personality Disorder
A Personality disorder characterized by volatile emotions, an unstable self-image, and impulsive behavior in relationships.
Rather than suicidal because the intention is not to commit suicide but rather to gain relief from feeling emotionally numb.
Diagnostic Criteria For Borderline Personality Disorder
A. A Pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity, beginning by early adulthood and present ina variety of contexts, as indicated by five (or more) of the following
1- Frantic efforts to avoid real or imagined abandonment
2- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3- Identity disturbance: markedly and persistently unstable self-image or sense of self.
4- Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating)
5- Recurrent suicidal behavior, gestures, or threats, or self mutilating behavior.
6- Affective instability due to a marked reactivity of mood (intense dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7- Chronic feelings of emptiness
8- Inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights)
9- Transient, stress-related paranoid ideation or severe dissociative symptoms.
Borderline Personality Disorder Facts
-Prevalence - Borderline personality disorder occurs in about 2% of the general population. 10% of outpatients, and 20% of inpatients. Borderline personality disorder is the most common personality disorder: 30-60% of those diagnosed with a personality disorder have borderline personality disorder. Borderline personality disorder is five ties more common among the first-degree relatives of someone with the disorder than in the general population.
-Comorbidity - Common comorbid disorders include mood disorders, substance use disorders, eating disorders (especially bulimia) and anxiety disorders
-Onset - As with all other personality disorders, symptoms for borderline personality disorder emerge in childhood or adolescence.
-Course - People with borderline personality disorder have a high suicide rate, with almost 10% dying by suicide.
The early adulthood years of people with this disorder are marked by mood episodes and serious impulse control problems, including suicide attempts; the risk of suicide peaks during early adulthood. Those who survive into their 20s and 30s are likely to improve within 10 years
-Gender Differences - Approx. 75% of those diagnosed with borderline personality disorder are female.
-Cultural Differences - The diagnostic criteria for borderline personality, and its conceptual underpinnings, may not apply equally well in all cultures, especially Asian cultures
(NF)Borderline Personality Disorder
Brain Systems - The frontal lobes, hippocampus, and amygdala are usually small in people with borderline personality disorder. The frontal lobes are less strongly activated in these patients than is normal. The amygdala is more strongly activated than normal in these patients when they see faces with negative expressions. Small hippocampus means these patients have impaired visual and verbal memory.
Neural Communication -Relatively low levels of serotonin are related to impulsivity. In addition this dysfunction involving serotonin is apparently greater in women than in men with the disorder, and many more women than men receive this diagnosis
(PF)Borderline Personality Disorder
People with this disorder often engage in other behaviors that are most directly self-destructive, including substance use or abuse, binge eating, and parasuicidal behaviors; they may act in these ways to try to feel better after interpersonal stress. And in fact, such maladaptive behaviors can be (negatively) reinforcing because the do temporarily relieve emotional pain.
(SF)Borderline Personality Disorder
Interpersonal dysregulation, relationships are typically intense, chaotic, and difficult. One explanation for the interpersonal problems suggests that they arose in childhood. Family member and friends were likely to invalidate the patients experience. For instance a parent might tell a child "You're too sensitive" or "You're overreacting." During childhood, such chronic dismissals may have led to fear of rejection and abandonment, if not actual rejection. Such experiences may have sensitized the child, leading him or her subsequently to overreact to the slightest hint of being invalidated.
(NF)Treatment for Borderline Personality Disorder
-SSRI - May diminish symptoms of emotional liability and anxiety and help with anger management.
-Antipsychotics - Can alleviate psychotic symptoms
-Mood Stabilizers - May help some symptoms
(although medications may reduce the intensity of some symptoms, medications have limited effect and should not be the only form of treatment for people with borderline personality disorder).
(PF)Treatment for Borderline Personality Disorder
Dialectical behavior therapy (DBT) - A form of treatment that includes elements of CBT as well as an emphasis on validating the patient's experience, a Zen Buddhist approach, and a dialectics component.
-An emphasis on validating the patient's experience - The patient's thoughts, feelings, and behaviors in a given situation make sense in the context of hos or her life, past experiences, and strengths and weaknesses
-A Zen Buddhist approach - Patients should see, and then without judgment, accept any painful realities of their lives. Patients are encouraged to "let go" of emotional attachments that cause them suffering. Mindfulness, or nonjudgmental awareness, is the goal.
-A dialectics component - Dialectics refers to a synthesis of opposing elements; in this context it refers to the patients coming to accept the situation and aspects of it that he or she does not fee able to change (validating his or her experiences) while at the same time recognizing that in order to feel better, change must occur.
(SF)Treatment for Borderline Personality Disorder
-DBT - Group Therapy component
-Interpersonal Therapy - Focus on current relationships and effects of patients actions.
Histrionic Personality Disorder
A Personality disorder characterized by attentions-seeking behaviors and exaggerated and dramatic displays of emotion.
Diagnostic Criteria for Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood an present in a variety of contexts as indicated by five (or more) of the following.
1- Is uncomfortable in situations in which he or she is not the center of attention.
2- Interactions with others is often characterized by inappropriate sexually seductive or provocative behavior
3- Displays rapidly shifting and shallow expression of emotions.
4- Consistently uses physical appearance to draw attention to self.
5- Has a style of speech that is excessively impressionistic and lacking in detail.
6- Shows self-dramatization, theatrically, and exaggerated expression of emotion.
7- Is suggestible (easily influenced by others or circumstances).
8- Considers relationships to be more intimate than they actually are.
Histrionic Personality Disorder Facts
-Prevalence - Approx. 2% of the general population will have histrionic personality disorder at some point during their lives. Among people seeking treatment in inpatient and outpatient mental health settings, the prevalence of this disorder is 10-15%.
-Comorbidity - Common comorbid personality disorders are borderline, narcissistic, antisocial, and dependent personality disorders. Common comorbid psychological disorders are somatic symptom disorders and major depressive disorder.
-Onset - As with other personality disorders, symptoms must emerge by young adulthood.
-Course - Symptoms of histrionic personality disorder may improve over time but rarely completely resolve.
-Gender Differences - Some studies find histrionic personality disorder to occur as frequently in men as in women, but others find that it is diagnosed more frequently in women. Men with histrionic personality disorder may appear "macho" and seek attention for their athletic skills, not their appearance.
Distinguishing between Histrionic Personality Disorder and Other Disorder
-Histrionic - Desire frequent attention from other
-Antisocial - Seek power or material gain
-Borderline - Want nurturance
(although both histrionic and borderline personality disorders involve rapidly shifting emotions, only with the latter are the emotions usually related to anger)
Treating Histrionic Disorder
(like other patients with dramatic/erratic personality disorders, those with histrionic personality disorder often do not remain in treatment for long; they become bored or frustrated and continue to see other people as the primary problem).
Narcissistic Personality Disorder
A personality disorder characterized by an inflated sense of self importance, an excessive desire to be admired, and a lack of empathy.
(mixed feelings; on one hand, they are preoccupied with their own concerns and expect other do be as well, and they get angry when other people don't defer to them. They overvalue them selves and undervalue other people. On the other hand, their self-esteem can be fragile, leading them to fish for compliments. They are relatively insensitive to others feelings and points of view).
Diagnostic Criteria for Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following
1- Has a grandiose sense of self-importance (exaggerated achievements and talents, expects to be recognized as superior without commensurate achievements).
2- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3- Believes that he or she is "special" and unique and can only be understood by, or should associate with , other people or high-status people (or institutions)
4- Requires excessive admiration.
5- Has a sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
Narcissistic Personality Disorder Facts
-Prevalence - Up to 1% of the general population will have narcissistic personality disorder at some point in their lifetimes.
-Comorbidity - Common comorbid personality disorders include paranoid personality disorder and the other Cluster B (dramatic/erratic) personality disorders. Common psychological comorbid disorders are substance use disorders and anorexia nervosa.
-Onset - As with other personality disorders, symptoms must emerge by early adulthood.
-Course - People with narcissistic personality disorder may have a hard time adjusting to physical or occupational limitations that arise with advancing age.
-Gender Differences - Between 50% and 75% of those diagnosed with narcissistic personality disorder are male.
Treating Narcissistic Personality Disorder
(however, as for all patients with personality disorders, those with narcissistic personality disorder usually do not remain in treatment for long, and typically continue to see other people as the primary problem rather than their own beliefs or behaviors).
Cluster C Personality disorders - The Fearful and Anxious
Cluster C - avoidant, dependent, and obsessive compulsive personality disorders, share the feature of anxiety or fear. People who have anxiety disorders and a comorbid personality disorder are most likely to have the personality disorder be from Cluster C.
Avoidant Personality Disorder
A personality disorder characterized by extreme shyness that usually stems from feeling inadequate and being overly sensitive to negative evaluation.
(predominant characteristic is social inhibition. Other often characteristics are shyness, self isolation, timid, or lonely.
Diagnostic Criteria for Avoidant Personality Disorder
A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts as indicated by four (or more) of the following
1- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2- Is unwilling to get involved with people unless certain of being liked
3- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4- Is preoccupied with being criticized or rejected in social situations
5- Is inhibited in new interpersonal situations because of feelings of inadequacy
6- Views self as socially inept, personally unappealing, or inferior to others
7- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
Avoidant Personality Disorder Facts
-Prevalence - Approx. 2.5% of the American population has avoidant personality disorder. Up to 10% of those seen in out patient clinics have this disorder
-Comorbidity - Because the diagnostic criteria overlap with those of social phobia comorbidity between the two disorders is very high. In one study 43% of people diagnosed with social phobia were also diagnosed with avoidant personality disorder. Common comorbid personality disorders are dependent personality disorder (because patients are dependent on the few friends they have), borderline personality disorder, and the Cluster A (odd/eccentric) personality disorders. Common comorbid psychological disorders are mood disorders and anxiety disorders.
-Onset - Based on the diagnostic criteria, symptoms such as shyness or a fear of strangers or new situations must emerge by early adulthood
-Course - Two years after diagnosis, approx. 50% of people with avoidant personality disorder improve enough with treatment that their symptoms no longer meet the criteria
-Gender Differences - Men and women do not consistently differ in their prevalence rates for avoidant personality disorder
Distinguishing Between Avoidant Personality disorder and other disorder
-Avoidant personality disorder has much in common with social phobia, and the symptoms of the two disorders overlap. The symptoms include a more pervasive sense of inadequacy or inferiority, and a reluctance to take risks.
Dependent Personality Disorder
A personality disorder characterized by submissive and clingy behaviors, based on fear of separation.
(behaviors are intended to elicit attention, reassurance, and decisive behaviors from other people. These behaviors are not a temporary bid for attention or reassurance, but are part of a chronic pattern of helpless behavior).
Diagnostic Criteria for Personality Disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts,as indicated by five (or more) of the following
1- has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2- needs others to assume responsibility for most major areas of his or her life
3- has difficulty expressing disagreement with others because of fear of loss of support or approval.
4- has difficulty initiating projects or doing things on his or her own (because of a lack of self confidence in judgment or abilities rather than a lack of motivation or energy)
5- goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant
6- feels uncomfortable or helpless when alone because of exaggerated fears of being unable to take care for himself or herself
7- urgently seeks another relationship as a source of care and support when a close relationship ends
8- is unrealistically preoccupied with the fears of being left to take care of himself or herself
Dependent Personality Disorder Facts
-Prevalence - the prevalence of dependent personality disorder in the American population is less than 1%
-Comorbidity - common comorbid personality disorders are avoidant borderline and histrionic personality disorders. Common psychological disorders are mood disorders and anxiety disorders
-Onset - as required by the diagnostic criteria symptoms must emerge by young adulthood
-Course - symptoms may improve over time to the point where the person no longer meets the criteria for the disorder
-Gender Differences - in the general population women tend to be diagnosed with dependent personality disorder more often than men
Obsessive Compulsive Personality Disorder
A personality disorder characterized by preoccupations with perfectionism orderliness and self control as well as low levels of flexibility and efficiency.
( this personality disorder is associated with the least disability and the highest obtained educational level)
Diagnostic criteria for obsessive compulsive personality disorder
A pervasive pattern of preoccupation with orderliness perfectionism and mental and interpersonal control at the expense of flexibility openness and efficiency beginning by early adulthood and present in a variety of context as indicated by four (or more) of the following
1- is preoccupied with details rules list order organization or schedules to the extent that the major point Of the activity is loss
2- shows perfectionism that interferes with task completion is unable to complete a project because his or her own overly strict standards are not met
3- is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
4- is overconscientious scrupulous and inflexible about matters of morality ethics or values (not accounted for by cultural or religious identification)
5- is unable to discard worn out or worthless objects even when they have no sentimental value
6- is reluctant to delegate task or to work with others unless they submit to exactly his or her way of doing things
7- adopts a miserly spending style towards self and others money is viewed as something to be hoarded for future catastrophes
8- shows rigidity and stubbornness
Obsessive compulsive personality disorder facts
-Prevalence - approximately 2 to 8 percent of the general population has obsessive compulsive personality disorder making it the most prevalent personality disorder
-Comorbidity - most people with obsessive compulsive disorder do not also have obsessive compulsive personality disorder
-Onset - the diagnostic criteria specify that symptoms must emerge by early adulthood
-Course - symptoms of up to one-third of patients may improve over time to the point that they no longer meet the diagnostic criteria
-Gender differences - twice as many men as women are diagnosed with obsessive compulsive personality disorder
Distinguishing between obsessive compulsive personality disorder and OCD
Obsessive compulsive personality disorder is distinguished from OCD by the absence of true obsessions and compulsions. rather than those with a festive compulsive personality disorder are preoccupied with details and are inflexible. most people with one of the two disorders do not have the other.
Treating fearful / anxious personality disorders
There is little research on the treatment of fearful / anxious personality disorders, and what research there is has focused primarily on avoidant personality disorder the findings suggest that the best treatment for social phobia can also help people with avoidant personality disorder namely, CBT that uses exposure to avoid a stimulant as well as cognitive restructuring of maladaptive beliefs and strategies treatment may also include family or couples therapy to help family members change their responses to and thus the consequences of the patient's maladaptive behavior
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