Personality Disorders

common and chronic disorder prevalence is estimated between 10 and 20 precent in the general population aggravating, demanding, or parasitic also a predisposing factor for other psychiatric disorders symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment) and ego-syntonic (i.e., acceptable to the ego) do not feel anxiety about their maladaptive behaviour Etiology 1. Genetic Factors monozygotic twins:2X than dizygotic 2. Hormones high levels of testosterone, 17-estradiol, and estrone 3. Platelet Monoamine Oxidase Low platelet monoamine oxidase (MAO) levels 4. Smooth Pursuit Eye Movements saccadic (i.e., jumpy) 5. Neurotransmitters Levels of 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin, are low in persons who attempt suicide and in patients who are impulsive and aggressive. Raising serotonin levels with serotonergic agents such as fluoxetine (Prozac) can produce dramatic changes in some character traits of personality 6. Electrophysiology Slow-wave activity on EEGs. 7. Psychoanalytic Factors oral character are passive and dependent Anal characters are stubborn, parsimonious, and highly conscientious because of struggles over toilet training during the anal period.

Classifications:
Cluster A: Odd or Eccentric Higher Prevalence in Biologic Relatives of Schizophrenics; Higher Prevalence in Males Paranoid 1. Long-standing suspiciousness or mistrust of others: a base line of mistrust ii. Preoccupied with issues of trust iii. Reluctant to confide in others iv. Reads hidden meaning into comments or events v. Carries grudges vi. May have history of misdemeanor arrests vii. Differentiate from: o Paranoid schizophrenic has hallucinations and formal thought disorders; paranoid personality disorder does not o Delusional disorder, paranoid type has fixed, -focal delusions; paranoid personality disorder does not Schizoid i. Lifelong pattern of social withdrawal, and they like it that way ii. Seen by others as eccentric, isolated, withdrawn

iii. iv. v.

Restricted emotional expression Prevalence: 7.5% of population Males two times more than females

Schizotypal i. ii. iii. iv. v. vi. vii. vi. vii. viii. ix. Very odd, strange, weird Magical thinking (including ESP and telepathy), ideas of reference, illusions Idiosyncratic meanings Social anxiety (paranoid) Suspiciousness Lack of close friends Incongruous affect Odd speech, social isolation Collections (e.g., ball of barbed wire) Ill-fitting or mismatched clothing

Cluster B: dramatic and emotional

Histrionic i. ii. iii. iv. Colorful, dramatic, extroverted Inability to maintain long-lasting relationships Attention-seeking, constantly wanting the spotlight Seductive behavior

Narcissistic i. Number of reported CISes increasing ii. Grandiose sense of self-importance iii. Preoccupation wlih fantasies of unlimited wealth, power, love iv. Demands constant attention v. Fragile self-esteem, prone to depression vi. Criticism met with indifference or rage vii. Genuine surprise and anger when others don't do as they want viii. Can be charismatic Borderline i. l to 2% of population ii. Females two times more than males iii. Very unstable affect, behavior, self-image iv. In constant state of crisis, chaos v. Self-detrimental impulsivity: promiscuity, gambling, overeating, substance abuse vi. Unstable but intense interpersonal relationships: very dependent and hostile, love/hate vii. Great problems with being alone viii. Self-mutilation ix. History of sexual abuse x. Common defenses: splitting, passive-aggressive xi. Particularly incapable of tolerating anxiety xii. Often coupled with mood disorder xiii. 5% commit suicide

Antisocial 3% males, 1% females i. Continual criminal acts ii. Inability to conform to social norms: truancy, delinquency, theft, running away iii. Can't hold job, no enduring attachments, reckless, aggressive iv. Onset before age 15; if younger than 18, diagnose as conduct disorder v. Three times greater in areas of social disintegration; this matters more than does SES

Cluster C: Anxious and Fearful

Behaviours Associated with Fear and Anxiety Avoidant i. Extreme sensitivity to rejection ii. Sees self as socially inept iii. Excessive shyness, high anxiety levels II. iv. Social isolation, but an intense, internal desire for affection and acceptance v. Wants the world to change, to be nicer, more accepting vi. Tends to stay in same job, same life situation, same relationships Obsessive-compulsive i. Orderliness, inflexible, perfectionist ii. More common in males, firstborn, harsh discipline upbringing iii. Loves lists, rules, order iv. Unable to discard worn-out objects v. Doesn't want change vi. Exce5sively stubborn vii. Lacks sense of humour viii. Wants to keep routine ix. Differentiate from obsessive-compulsive anxiety disorder. The anxiety disorder has obsessions and compulsions that are focal and acquired. Personality disorders are lifelong and pervasive. Dependent i. ii. iii. iv. v. Gets others to assume responsibility Subordinates own needs to others Can't express disagreement Great fear of having to care for self May be linked to abusive spouse DSM-IV-TR General Diagnostic Criteria for a Personality Disorder A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: 1. cognition (i.e., ways of perceiving and interpreting self, other people, and events) 2. affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) 3. interpersonal functioning 4. impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social

situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma). C: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed