1. Personality Disorders

2. Definitions Personality trait –a stable, recurring pattern of human behavior Personality type –a constellation of personality traits –recognizable as a frequent and familiar combination

3. Definitions Personality disorder –a constellation of personality traits that are Inflexible Maladaptive lead to difficulties in work or interpersonal relations, subjective distress, and usually both. (Global Criteria)

4. Why Should We Care? …as doctors

5. Presentation In Medical Settings –doctor-patient relationship –Noncompliance –Difficulty coping Hospitalization Disability medical restrictions

6. Presentation In the Family –Marital conflicts –Sexual dysfunction –Child rearing –Domestic violence

7. Presentation Within the individual –Anxiety –Depression –External problems/losses resulting from maladaptive behavior Divorce job loss legal troubles poor outcome from a medical condition When circumstances prevent living according to usual personality style

8. Comorbidity

9. Making a Personality Diagnosis Collateral sources Social and developmental history Personality tests (ex. MMPI) current strengths and weaknesses

10. Speculations on Etiology

11. DSM-IV Personality disorders P Categorical P Arranged by clusters

12. The Clusters P A: Odd P B: Dramatic P C: Anxious

13. A: The Odd Cluster P Paranoid P Schizoid P Schizotypal

14. B: The Dramatic Cluster P Narcissistic P Antisocial P Borderline P Histrionic

15. C: The Anxious Cluster P Avoidant P Obsessive-Compulsive P Dependent

16. The Odd Cluster

17. Paranoid Personality Disorder Paranoid personality mistrustful of everyone but still able to test reality

18. Schizoid personality lacks intimate relationships frightened by closeness incapable of warmth Anxious about any closeness

19. Schizotypal personality odd and eccentric ideas influence daily behavior but not psychotic

20. The Anxious Cluster

21. Avoidant personality Social inhibition Feelings of inadequacy Hypersensitivity to criticism

22. Obsessive-Compulsive Personality preoccupied w/ work/duty not enjoying life Often rigid and inflexible

23. The Dependent Personality clings to stronger person Submissive seeks help/advice anxious when having to make decision

24. 24 The Dramatic Cluster Narcissistic Antisocial Borderline Histrionic

25. Narcissistic personality Exaggerated sense of self-importance, Unrealistic fantasies, Wants recognition for being special Arrogant, Entitled, Requires admiration Exploitative, Unempathic towards others Envious of others Unconcerned about effect on others

26. Antisocial personality the "psychopath“ violates laws/social conventions Dishonest unconcerned about effect on others

27. Borderline personality emotionally intense unstable impulsive behavior self-destructive inner emptiness intolerance of being alone

28. Histrionic personality Dramatic attention-seeking caricature of femininity/masculinity

29. 29 Treatment

30. Treatment: Psychotherapy Acute symptom focused –Ex. Dialectic behavioral therapy Fundamental –Focused on changing personality –Long term psychotherapy

31. Treatment: Pharmacotherapy Symptom Focused Ex. –Depression –Anxiety –Psychosis More fundamental treatment? –Forme frustre approach

32. Treatment In Medical Settings Identify and treat problems acute symptoms –Separate medical diagnosis from behaviors