Personality Disorder Notes

Prevalance 10-20% of population… 50% of all patients with axis I also have axis II, personality disorders are all ego syntonic…

Paranoid personality;

  • Pervasive, distrust, suspicious of others
    • Suspects exploitation or deceit
    • Questions loyalty and fidelity
    • Reluctant to confide
    • Reads hidden demeaning messages
    • Unforgiving – grudge holder
    • Perceives attacks on character/reputation
  • Has to be without Schizophreia or other psychosis
  • Prevalance 0.5-2.5% of gen population
  • Increased risk in families who have schizophrenia
  • M>F
  • No direct family inheritence
  • Higher incidence in minorities, immigrants and deaf population
  • Affectively restricted, pride in being rational
  • Lack warmth and are impressed by power and rank
  • Psychotherapy is treatment of choice, requiring honest and straigtforward approaches, may need to use small doses of antipsychotics…

Schizoid personality

  •  Schizoids avoid
  • A pervasive pattern of detachment from social relatonships
  • A restricted range of emotional expression
  • Doesn’t desire or enjoy closeness with others
  • Chooses solitary activities, limited interests
  • Little interest in sex or friendships
  • Indifferent to opinions of others
  • Seems cold, detached, affect flattned
  • Rule out psychotic illness before diagnosing
  • May affect 7.5% of the general population
  • 2:1 M:F ratio
  • Choose solitary jobs with little to no contact with others
  • Not psycotic, and have good reality testing
  • Onset usually in early childhood
  • Psychotherapy treatment – single or group
  • Small doses of antipsychotics, antidepressants, stimulants

Schizotypal personality.

  • Atypical behaviour
  • Pervasive pattern of social and interpersonal deficits
  • Cognitive, perceptual distortions and eccentric behaviour
  • Ideas of reference, magical thinking, bodily illusions
  • Suspicious, odd, affect constricted
  • Lack of close friends, social anxiety that does not ease with familiarity, paranoid fears
  • Not explained by psychotic disorder
  • 3% of population… sex ratio unknown…
  • Increased in relatives of those with schizoprenia
  • ??? % commit ??? to tx ??? antipsychotics…

Antisocial personality

  • Pervasive pattern for and violation o basic rights of others since age 15
  • Failure to conform to social norms, unlawful behaviour
  • Deceitful, comfortable lying, conning others
  • Impulsive, does not plan ahead
  • Irritable, agressive, reckless disregard for safety
  • Irresponsible behaviour towards work or finances
  • Lack of remorse for actions
  • The person must be at least 18 years old for diagnosis
  • There must be evidence of conduct disorder onset prior to 15 years old
  • This behavour is not better explained by mania or schizophrenia
  • Many have a neurological or mental disorder that has been overlooked or undiagnosed
  • The height of antisocial behaviour is in late adolescence, improves as they age…
  • Many have somatisation disorder and multipe physical complaints
  • Co-morbidity common wit substance abuse and depression
  • When in hospital or prison, they become more open to change… when amongst peers, motification decreases.
  • Therapy – set firm limits, medications – mood stabilisers, beta blockers to reduce aggression
  • Prevalance 3% in men, 1% in women, 75% of prisoners
  • Family inheritance, 5 more in male’s 1st relatives.

Borderline personality

  • pervasive patterns of instability of interpersonal relationships, self-image and affects
  • Frantic efforts to avoid real or imagined abandomnent
  • Alternate between extremes of idealisaiton and devaluing others
  • Markedly disturbed self image or sense of self…
  • Impulsive in damaging ways – spending, sex, substance abuse, reckless driving, binge eating.
  • Recurrent suicidal behaviour, gestures, threats, self-mutilation
  • Affect unstable, marked reactivity of mood in hours
  • Chronic feelings of emptiness
  • inappropriate intense anger, difficulty controlling anger
  • Transient stress related paranoia or dissociation
  • “borderline” i.e. border of neurosis and psychosis…
  • 1-2% of population affected
  • M:F ratio – 1:2-3
  • Comorbidity with depression and substance abuse which is also found in first degree relatives
  • Dialectical behaviour therapy is treatment of choice
  • Medication; antidepressants, mood stabilisers and antipsycotics
  • Responds the best of all personality disorders to medication…

Histrionic personality

  •  Pervasive pattern of excessive emotionally and attention seeking, beginning by early adulthood
  • Uncomfortable when not center of attention
  • Sexually seductive, provocative interactions
  • Rapidly shifting and shallow emotions
  • Uses physical appearance to draw attention to oneself
  • Impressionistic speech – lacking in in details
  • Dramatic, theatrical, exaggerated emotions
  • Easily influenced by others, trusting, gullible
  • Considers relationships to be more intimate than they are
  • Prevalanece 2-3% in the population, 10-15% in mental health clinics and inpatient settings
  • F>M
  • Association with somatisation disorder and alcohol use…
  • Psychotherapy to connect them with their own feeling, psychoanalytic therapy is best…
  • Medication: antidepressants, antianxiety and antipsychotics…

Narcissistic Personality

  • Pervasive pattern of grandiosity, need for admiration and lack of empathy
  • Great sense of self importance, exaggerating achievements
  • Fantasies of success and adoration by others
  • Special and should only associate with high-ups.
  • Requires excessive admiration, arrogant attitude
  • Entitled and exploitative, envious of others
  • handles criticism poorly, relationshps are fragile
  • More vulnerable to midlife crisis
  • Group therapy is best.
  • medication; lithium and antidepressants…

Avoidant personality

  • Pervasive pattern of social inhibition
  • Avoids social contact fearing rejection
  • Needs assurance of being liked before risking interaction
  • Fear of shame or ridicule
  • Keeps connections superficial
  • Reluctant to try new things
  • Fears embarrassment
  • Views self as inept, or inadequate
  • Wanting companionship but having an inferiority complex…
  • Anxious upon interview – wanting approval
  • Function in a protective environment
  • Therapy; acceptance and trust are key… group therapy and assertiveness behavioral therapy are useful.
  • Medication; beta blockers, tx for anxiety and depression

Dependent Personality

  • Pervasive, excessive need to be taken care of with submissive, clinging behaviour
  • Trouble making decisions without advice and support
  • Difficulty disagreeing, doing things on their own.
  • Go to excessive lengths to obtain approval… e.g. doing unpleasant tasks
  • Unable to be alone, fears being unable to care for oneself…
  • Jumps from one relationship to another…
  • Fears of being left a big preoccupation
  • 2.5% of all personality disorders
  • Impaired occupational functioning
  • Therapy; insight oriented, group therapy
  • Medication for anxiety and depression, imipramine for panic attacks

Obsessive Compulsive personality (med students…)

  • Pervasive pattern of preoccupation with orderliness, perfectionism, control
  • Has rules, lists schedules which interfere with task completion
  • Excessive devotion to productivity at the expense of leisure
  • Over-moral, inflexible
  • Miserly, saves useless objects
  • Doesn’t delegate
  • Stubborn
  • Has few friends
  • Tx, group therapy and behavioural therapy
  • Unkown prevalance or family ineritence
  • Backgrounds of harsh discuplin
  • Medications; Clomipramine, Clonazepam, Fluoxetine…










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