1. Personality Disorders
Chapter 16

2. General Features Pervasive style Emotional responses Behaviors
Long-term
Starts in teens
No change in DSM-5
10 problems
3 clusters

3. Clusters Cluster A – schizophrenic feel
Paranoid, schizoid, schizotypal
Cluster B – dramatic feel
Antisocial, borderline, histrionic, narcissistic
Cluster C – anxious feel
Avoidant, dependent, obsessive-compulsive

4. Categorical Approach DSM is categorical
Traits/problems either there or not
Pt either has/does not have a disorder
Personality disorders are contained > no other problems
Hard to dx – validity & reliability issues
There is comorbidity

5. Diagnosing May need to consider degree, dimensions
How this affects pt’s functioning

6. Cluster A Odd, eccentric Have schizophrenic sx Suspicious, withdrawn
Strange ideas
May be comorbid w/ schizophrenia
Some professionals think this is part of schizophrenia spectrum
Causes unknown
Few get tx

7. Cluster A Paranoid personality d/o
Usually lack delusions, but feel everyone out to get them
Spouses cheating, they are victims, government, foreigners…
Judgmental
2% pop
More men

8. Theory behind Paranoid P d/o
Psychodynamic pov – cold demanding parents made child feel inferior > projecting onto others
Cognitive psychologists > maladaptive views
Biological psychologists > look to genetics

9. Treatment Pts generally uncooperative – meds no help
Psychodynamic tx > self-psychology – repair the damaged self
CBT – work on assumptions & healthy behaviors > better relationships

10. Schizoid Personality d/o
Cold, avoidant loners – not paranoid, just unconnected – break from family, disinterested in sex, bad marriages
Ignore praise, criticism
Less than 1%
Men
Theory
Psychodynamic – rejected or abused as children > no trust

11. Theory & Tx
Cognitive theory – no way to read others, miss social cues > slows social & motor development
TX – pts rarely seek it - meds don’t help
CBT most likely – limited relshp w therapist - teach social skills – group is a good place – journaling – focus on what they enjoy

12. Schizotypal Personality d/o
Eccentric thinking that seems like schizophrenia – disturbed relationships – often alone
Appear flat affect – cold – but aspects of depression
Delusions of reference
Sense of self disturbed – out of own bodies
Difficult to focus – backward masking tests – only attn to 1st stimulus
Tangential conversations

13. Schizotypal 3% More males Theories
Mainly similar to schizophrenia – biologically TX
Some help w antipsychotics
CBT – refocus, reconnect

14. Cluster B Drama queens Mean Chaotic Relationships damaged
Antisocial, borderline, histrionic, narcissistic
Cluster B more common than A & C

15. Antisocial Personality d/o
Childhood bad beh > cruelty, bullying, criminality (CD + ADHD)
Only adults get this dx, but show in teens & tweens
Dx most linked to criminal records
Poor employment hx
Debt
Nomadic
fights

16. Antisocial Liars Reckless w/ selves & others
No moral conscience, lack foresight, bad judgment, impulsive 3%
Mostly men
1/3 prison inmates
Higher rates of substance abuse

17. Antisocial
Theories
Psychodynamic – poor childhood – sometimes violence/abuse, unloving parents > child driven to control others by conning, force, violence, manipulation
Behaviorist – modeling – they learned it
Cognitive – put themselves first, do not recognize the needs/rights of others

18. Antisocial Cognitive Don’t see another’s perspective No empathy
Biologically – low serotonin – esp linked to risk-taking/ aggressive beh
Diminished activity in frontal lobes & prefrontal cortex > executive
Low arousal to stimuli

19. Theories & TX Limited feelings of anxiety
Lack anxiety & arousal > limit learning from experience
Tx – limited success – meds have unclear results – CBT used in hospitals & prisons – teaching correct beh

20. Borderline Personality d/o
Chaotic behavior & relationships
Distorted sense of self
Mood swings
Reckless beh
Bipolar flavor – outbursts – self-harm (esp cutting) - suicidality – c/o feeling empty, bored, detached from bodies
75% make a suicidal gesture
10% succeed