PERSONALITY DISORDERS Rebecca Sposato, MS, RN

Overview of Personality Disorders  Personality: an enduring pattern of inner experiences, emotional responses, attitudes and behaviors in an individual  Takes years to change  Personality Disorders occupy Axis-II in the DSM-IV  conduct follows an inflexible, pervasive pattern that significantly deviates from cultural expectations and leads to distress and impairment  Emerge during adolescence or young adulthood

Dimensional Models of Personality  Personality is seen as place of intersection of 5 major traits: openness, conscientiousness, extraversion, agreeableness, neuroticism  For persons with disorders the intersection is not in the middle  The DSM-IV has 3 categories of personality disorders, based on their location on grid

Cluster A: Eccentric  Paranoid: hold others in distrust, interpret the actions of peoples or entities as malevolent without evidence.  Conspiracy theories, accuse others of plotting and hold grudges for minor infractions  vigilant for expected personal attacks  Poor social relationships and interactions  1% of general population, 20% of inpt. Psych pop.

Cluster A: Eccentric  Schizoid: Social detachment and bland emotional range  Strongly introverted and indifferent to other’s opinions, approvals or criticisms  Few to none quality relationships/interactions  Drifting life goals, passive to change or adverse events  Considered too uncommon in clinical settings for statistical comparisons

Cluster A: Eccentric  Schizotypal: Distorted interpretation of things, events and actions by others  Magical, paranormal and superstitious explanations  Anxious social interactions and reduced capacity for social relationships, ‘feel like an outsider’  50% qualify for depression disorder  3% of general population

Cluster B - Dramatic  Antisocial Personality: Inconsiderate, disregard or violation of the rights, wishes and feelings of others  Often engage in high risk and illegal behaviors  Resort to lying, intimidation, extortion and aggression in achievement of goals  Emotional chameleons in usury relationships with a warped sense of victim and villain  General population: 1-3% of general population (more male than female) >25% of prison population

Cluster B: Dramatic  Borderline: unstable self-image, relationships, emotional affect, values and interests  Highly charged emotions, attention seeking  Labile Interpersonal patterns: Mentally splitting person into ‘good’ and ‘bad’ versions Range clingy to pushing away  Risky, Reckless and impulsive actions Suicide threats /attempts (10% complete suicide), self- mutilating and damaging  2% of general population, 20% of inpt psych

Cluster B: Dramatic  Narcissistic: View self as superior and special, seek attention and approval with consistent devalue and lack empathy for others  Cover for low self-esteem and will react strongly when criticized, very sensitive to disproval  Usury and unilateral relationships  Overestimate their accomplishments, and underestimate the accomplishments of others

Cluster B: Dramatic  Histrionic: excessive emotional expression and attention seeking behaviors  Gage self-esteem by external measures of attention and impressing others  Engage in embelishing, provocative and seductive behaviors when routine interventions do not yield enough attention

Cluster C: Anxious  Avoidant: social inhibition, feeling inadequate and hypersensitive to negative evaluation and rejection  Assume others are primarily critical and disapproving  Do not take risks, try new things or expand comfort zone  Although they desire affection and friendship the end result is self-isolating, limited social circle  1% of general population

Cluster C: Anxious  Dependent: excessive need to be taken care of leading to submissive and clingy behaviors  Cannot tolerate independence  Will no take the initiative because they lack self confidence they can do an adequate job  Seek advice and reassurance for minor or inconsequential decisions  Will comply with wishes of others even when contrasting their own

Cluster C: Anxious  Obsessive Compulsive Personality: preoccupation with orderliness, perfection and control at the expense of time, flexibility and efficiency  Repeat tasks and work in pursuit of inconsequential details  Limit and delay or try to control leisure time and recreational pursuits  Reluctant to delegate tasks or tolerate preferences of others

Treatment  Identify and change behaviors limiting quality of life  Traditional management of depression, hostility, anxiety, addiction and self harming behaviors  Psychoanalysis, CBT, REBT, DBT, milieu, coping skills