1. Personality Disorders
Adesola Ogunsakin

2. Personality Disorders?
Inflexible, maladaptive and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
Person is usually not aware of problem
Presents by early adulthood

3. General characteristics:
Inflexible, inability to adapt
One way of responding
Lifelong
All areas of life are affected
Maladaptive patterns of behavior
Ego-syntonic- when a person’s behavior is acceptable to the aims of the ego and the related psychological needs of the individual

4. Cluster A- Odd or Eccentric
Paranoid
Schizoid
Schizotypal
Cluster B- Dramatic and Emotional
Histrionic
Narcissistic
Borderline
Antisocial
Cluster C- Anxious and Fearful
Avoidant
Obsessive-compulsive
Dependent

5. Cluster A Higher prevalence in biologic relative of schizophrenics
Higher prevalence in males
PARANOID
SCHIZOID
SCHIZOTYPAL

6. Cluster A- PARANOID Long-standing suspiciousness or mistrust of others
Reluctant to confide in others
Preoccupied with issues of trust
Reads hidden meaning into comments or events
Carries grudges
Differentiate from:
Paranoid schizophrenic has hallucinations and formal thought disorders; PPD does not
Delusional disorder, paranoid type has fixed, focal delusions; PPD does not
Attributes involvement motives to others, suspicious
M>W
Increased incidence in families with schizophrenia
Defense mechanism- projection

7. Cluster A- SCHIZOID
Lifelong pattern of social withdrawal, and they like it that way
Seen by others as eccentric, isolated, withdrawn
Restricted emotional expression
Isolated lifestyle, has no longing for others, ‘loner’
M>W
Increased incidence in families with schizophrenia

8. Cluster A- SCHIZOTYPAL
Very odd, strange, weird
Magical thinking, ideas of reference, illusions
Social anxiety
Suspiciousness
Lack of close friends
Incongruous affect
Odd speech, social isolation
May have short-lived psychotic episodes
Weird, eccentric behavior, thought, speech
Prevalence is 3%
M>W

9. Cluster B Dramatic and Emotional
Genetic association with mood disorders & substance abuse
HISTRIONIC
NARCISSISTIC
BORDERLINE
ANTISOCIAL

10. Cluster B- HISTRIONIC Colorful, dramatic, extroverted
Inability to maintain long-lasting relationships
Attention-seeking
Seductive behavior
Excessive emotion and attention seeking
W>M
Underdiagnosed in men

11. Cluster B- NARCISSISTIC
Grandiose sense of self-importance
Preoccupation with fantasies of unlimited wealth, power, love
Demands constant attention
Fragile self-esteem, prone to depression
Criticism met with indifference or rage
Genuine surprise and anger when others don’t do as they want
Can be charismatic
Grandiose, over-concerned with issues of self-esteem
common

12. Cluster B- BORDERLINE Females 2x more than males
Very unstable affect, behavior, self-image
In constant state of crisis, chaos
Self-detrimental impulsivity: promiscuity, gambling, overeating, substance abuse
Unstable but intense interpersonal relationships: very dependent and hostile, love/hate
Great problems with being alone
Self-injurious behavior
History of sexual abuse
Common defenses: splitting, passive-aggressive
Particularly incapable of tolerating anxiety
Often coupled with mood disorder
50% commit suicide

13. Cluster B- BORDERLINE
Instability of mood, self-image and relationships
W>M
Increased mood disorders in families
Associated defense mechanism- splitting

14. Cluster B- ANTISOCIAL 3% males, 1% females Continual criminal acts
Inability to conform to social norm: truancy, delinquency, theft, running away
Cant hold job, no enduring attachments, reckless, aggressive
Onset before age 15; if younger than 19, diagnose as conduct disorder
Does not recognize the rights of others
Associates defense mechanism: superego lacunae

15. Cluster C
Anxious and Fearful
AVOIDANT
OBSESSIVE-COMPULSIVE
DEPENDENT

16. Cluster C- AVOIDANT Extreme sensitivity to rejection
Sees self as socially inept
Excessive shyness, high anxiety levels
Social isolation, but an intense, internal desire for affection and acceptance
Wants the world to change, to be nicer, more accepting
Tends to stay in same job, same life situation, same relationships
Shy, timid, fears rejection
Common
Possible deforming illness

17. Cluster C- OBSESSIVE-COMPULSIVE
Orderliness, inflexible, perfectionist
More common in males, firstborn, harsh discipline upbringing
Loves lists, rules, order
Unable to discard worn-out objects
Doesn’t want change
Excessively stubborn
Lack sense of humor
Wants to keep routine
Differentiate from:
Obsessive-compulsive anxiety disorder the anxiety disorder has obsessions and compulsions that are focal and acquired. Personality disorders are lifelong and pervasive
Perfectionistic and inflexible, orderly, rigid
M>W
Increased concordance in identical twins
Associated defense mechanism: undoing and reaction formation

18. Cluster C- DEPENDENT Gets others to assume responsibility
Subordinates own needs to others
Cant express diasgreement
Great fear of having to care for self
May be linked to abusive spouse
Dependent, submissive
Common
W>M

19. Sources
Kaplan
First Aid- USMLE STEP