9 personality disorders 102 111111111

Personality Disorders Characterized by personality patterns that are pervasive (persistent), inflexible, and maladaptive.Obsessivecompulsive personality disorder: Individuals are preoccupied with orderliness, perfectionism, and control. They are often consumed by the details of everything and lose their sense of overall goals. They are strict and perfectionists, over conscientious, and inflexible. They may be obsessed with work and productivity and are hesitant to delegate tasks to others. This personality disorder should not be confused with obsessive compulsive disorder, a separate disorder. Associated features include indecisiveness, dysphoria, anger, social inhibition, and difficult interpersonal relationships.

PERSONALITY DISORDERS

 Personality trait––an enduring pattern of

perceiving, relating to, and thinking about the

environment and oneself that is exhibited in a

wide range of important social and personal

contexts

 Personality disorder— when these patterns

become inflexible and maladaptive, causing

impairment in social or occupational functioning

or subjective distress

Personality Disorders

Characterized by personality patterns that are

pervasive (persistent), inflexible, and maladaptive

General characteristics

 a Inflexible, inability to adapt

 b One way of responding

 c Lifelong

 d All areas of life

 e Maladaptive response to stress; response to social context

 f Can thrive if situation is right

 g Interactive, interpersonal disorders

i Patients really annoy others

There are 3 clusters

 Cluster A: Peculiar thought processes,

Risk Factors / Etiology

 Personality disorders are the product of the

interaction of inborn temperament and

subsequent developmental environment

 Risk factors include-

-Innate temperamental difficulties, such as

irritability;

-Adverse environmental events, such as child

neglect or abuse; and

 Prevalence: All are relatively common Overall, 10% to 15% prevalence

-more males have antisocial and narcissistic

personality disorders,

-more females have borderline and histrionic

personality disorders

 Onset: Usually not diagnosed until late

adolescence or early adulthood

 Course: Usually very chronic over decades

 Key Symptoms: Long pattern of difficult

interpersonal relationships, problems adapting to stress, failure to achieve goals, chronic

unhappiness, low self-esteem

 Associated Diagnosis- Mood disorders

 Treatment: Psychotherapy is the mainstay of treatment

-Intensive and long-term psychodynamic and

cognitive therapy are treatments of choice for

most personality disorders

-Use of mood stabilizers and antidepressants is

sometimes useful for Cluster B personality

disorders

Differential Diagnosis: Major rule-outs are-

1.Mood disorders,

2.Personality change due to a general medical

condition, and

3.Adjustment disorders

SPECIFIC PERSONALITY DISORDERS :

Cluster A: Odd or eccentric, cannot develop

meaningful social relationship ,“Weird”

-Higher prevalence in biological relatives of

schizophrenics;

-Higher prevalence in males

1.Paranoid personality disorder

2.Schizoid personality disorder

3.Schizotypal personality disorder

Paranoid personality disorder:

suspicious of the motivations and actions of others and are often secretive and isolated

psychosis with persecutory delusions.

 A 47-year-old man living in a complex constantly accuses his neighbours of plotting to avoid payment of their share of maintenance He writes angry letters to other owners and has initiated several lawsuits He lives alone and does not socialize

CASE EXAMPLE

Schizoid personality disorder :

 Detachment and restricted emotionality

Individuals are emotionally distant

 They are disinterested in others and indifferent to praise or criticism

 Associated features include social drifting and

dysphoria

 A 24-year-old man lives alone and works nights as a security guard

He ignores invitations from co-workers to socialize and has no

outside interests

CASE EXAMPLE

Schizotypal personality disorder :

 Discomfort with social relationships; thought

distortion; eccentricity Individuals are socially

isolated and uncomfortable with others

 Unlike schizoid personality disorder, they have

peculiar patterns of thinking, including ideas of reference and persecution, odd preoccupations, and odd speech and affect

 A 30-year-old man is completely preoccupied with the study and the brewing of herbal teas He

associates many peculiar powers with such

infusions and says that plants sometimes whisper

to him He spends all of his time alone, often taking solitary walks in the wilderness for days at a time, collecting plants for teas He has no history of

disorganized behaviour

CASE EXAMPLE

Cluster B: dramatic and emotional, “Wild”

-often associated with alcoholism and somatization disorder

Include- 1.Histrionic personality disorder

 2.Borderline personality disorder

 3.Antisocial personality disorder

 4.Narcissistic personality disorder

Histrionic personality disorder:

 Usually characterized by colourful, exaggerated behaviour and excitable, shallow expression of emotions;

 Uses physical appearance to draw attention to

self;

 Sexually seductive; and

 Is uncomfortable in situations where she or he is not the centre of attention

 A 30-year-old woman presents to the doctor's office dressed

in a sexually seductive manner and insists the doctor to

comment on her appearance When the doctor refuses to do

so, she becomes upset

CASE EXAMPLE

A 47-year-old woman, who was believed to be suffering from

histrionic personality disorder with regression and conversion,

was finally diagnosed with a frontal meningioma Patients with meningiomas can present with a variety of psychiatric symptoms, sometimes even before neurological symptoms occur The

diagnosis is often delayed because the symptoms are misleading and it is difficult to modify a psychiatric diagnosis once this has been made Discussion focuses on the characteristic signs of a meningioma, the reasons for delays in diagnosis and the

indications for brain-imaging on psychiatric patients.

CASE REPORT

Borderline personality disorder

marked impulsivity, unstable relationships, recurrent suicidal behaviours, chronic feelings of emptiness or boredom,

identity disturbance, and inappropriate anger

 A 22-year-old nurse was recently admitted after

reporting auditory hallucinations, which have

occurred during the last few days She reports

marital difficulties and believes her husband is to

blame for the problem She has several scars on her fore arms and has a history of substance abuse

CASE EXAMPLE

Antisocial personality disorder :

 Usually characterized by continuous antisocial or criminal acts, inability to confine to social rules, impulsivity, disregard for the rights of others,

aggressiveness, lack of regret, and deceitfulness

 These have occurred since the age of 15, and the individual is at least 18 years of age

 A 22-year-old man was recently arrested after he set his mother's house on fire He has had numerous

problems with the law, which started at an early age when he was sent to a juvenile detention centre for his behaviour at both home and school He lacks

remorse for setting the fire and expresses a desire that his mother would have died in the fire

CASE EXAMPLE

Narcissistic personality disorder

grandiosity, and preoccupation with fantasies of success

admiration, reacts with rage when criticized, lacks empathy,

is envious of others, and is interpersonally exploitative

 A famous actor is outraged when a director questions his acting abilities during rehearsal for a play The actor

responds by walking off the stage and not returning to

the stage unless the director apologizes publicly for her

behaviour

CASE EXAMPLE

Cluster C: anxious and fearful, “Worried”

-behaviours associated with fear and anxiety

Include- 1.Avoidant personality disorder

 2.Dependent personality disorder

 3.Obsessive-compulsive personality disorder

Avoidant personality disorder

 Individuals have social inhibition, feelings of

inadequacy, and hypersensitivity to criticism

 They shy away from work or social relationships because of fears of rejection that are based on

feelings of inadequacy

 They feel lonely and substandard and are

preoccupied with rejection

 A 43-year-old man dreads an upcoming company holiday party because he believes that he is

incapable of engaging in social conversation or

dancing He believes that he will become an object

of pity or ridicule if he attempts such things He

anticipates yet another lonely holiday

CASE EXAMPLE

Dependent personality disorder:

taken care of

disagreements with others They worry unrealistically

about abandonment

spouse and desperately seek a substitute if this person

becomes unavailable

poor independent functioning, mood disorders, anxiety

disorders, adjustment disorder, and other personality

disorders

Obsessive-compulsive personality disorder: Individuals are preoccupied with orderliness,

perfectionism, and control

 They are often consumed by the details of

everything and lose their sense of overall goals

 They are strict and perfectionists, over

conscientious, and inflexible

 They may be obsessed with work and productivity and are hesitant to delegate tasks to others

 This personality disorder should not be confused with obsessive compulsive disorder, a separate

disorder

 Associated features include indecisiveness,

dysphoria, anger, social inhibition, and difficult

interpersonal relationships

 A 31-year-old woman seeks psychotherapy as a result of an impending divorce She demands that the house be kept

spotless, that extremely detailed and fixed work and

recreational schedules be maintained, and that rigid dietary habits be observed have driven her spouse away

CASE EXAMPLE

P D

 A 30-year-old man has always been extremely

neat and conscientious, skills he makes good use

of as the executive secretary to the president of a large corporation Something of a perfectionist,

he often stays long after normal working hours to check on the punctuation and spelling of letters that he prepared during the day Although his

work is impeccable, he has few close

relationships with others His boss referred him

for counseling after repeatedly getting into fights with his co workers "They just don't take the job

to heart;' he says disapprovingly about them "All they seem to want to do is joke around all day”

CASE

The most likely preliminary diagnosis for this

patient is ?

 (A) Obsessive-compulsive personality disorder

 (B) Paranoid personality disorder

 (C) Schizoid personality disorder

 (D) Histrionic personality disorder

 (E) Antisocial personality disorder

 (F) Narcissistic personality disorder

 (G) Borderline personality disorder

 (H) Dependent personality disorder

 Answer: A Focusing on details, loving routine, having a

sense that there is only one right way to do things, lack of humor, and few close relationships suggests an obsessive compulsive personality disorder.

 A 24-year-old male patient refuses to provide answers to

standard questions during an initial history and physical exam, including address and telephone number When asked the

reason for the refusal, he doesn't understand why the physician needs such irrelevant information and eyes the physician

suspiciously When pressed further, he asks angrily ,"Look, are you going to treat me or do I have to get my lawyer?"

CASE

This behavior is most consistent with a diagnosis of ?

 (A) obsessive-compulsive personality disorder

 (B) paranoid personality disorder

 (C) schizoid personality disorder

 (D) histrionic personality disorder

 (E) antisocial personality disorder

 (F) narcissistic personality disorder

 (G) borderline personality disorder

 (H) dependent personality disorder

 Answer: B General suspiciousness and mistrust suggests a paranoid personality disorder.

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