Personality Disorders

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Introduction

Personality disorders are pervasive and largely inflexible patterns of inner thoughts and behaviours markedly different from others of the individuals's culture and leading to significant impairment in social, occupational, or other settings.Two or more of the following are affected:

For more information, please see assessing personality disorders.

Cluster A

 

Paranoid personality disorder

Schiziod personality disorder

Schizotypal personality disorder

 

Cluster B

 

Antisocial personality disorder

Borderline personality disorder

Histrionic personality disorder

Narcissistic personality disorder

Cluster C

 

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-compulsive personality disorder

 

 

Impact of Personality Disorders

Quality of life: complete physical, mental, and social well-being, not just the absence of disease and infirmity.

Cluster A, avoidant, dependent and borderline folks may have lower quality of life.

 

 

Helping People with Personality Disorders

By definition these folks can be difficult to work with; counter-transference is common. Often co-morbid with Axis I disorders, or Axis I conditions may be mimic a PD.

For the most part, they do not tend to repsond well to medication, but can often respond to certain types of psychotherapy.

 

 

Cannot be diagnosed before the age of 18 or due to an underlying medical condition. And cannot be diagnosed because a patient is difficult or we don't like them.

 

Problems with PD Diagnoses

PD Diagnoses can be different because the categories may not be as useful as a 'dimensional' model in which certain personality traits (ie sociability) are considered separately. Patients often fit more than one category, and patients with an untreated Axis I disorder can lead to personality symptoms.

PD diagnoses can also be used in a negative, stigmatizing way.

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  • paranoid
  • schizoid
  • schizotypal
  • antisoc.
  • borderline
  • histrionic
  • narcissistic
  • avoid.
  • dependent
  • obs/comp

Paranoid Personality Disorder

 

Core Features and Examples

 

distrust and suspiciousness

  • others are deceiving them
  • preoccupied with doubts about others
  • reluctant to confide in others

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Schizoid Personality Disorder

 

Core Features and Examples

detachment from relationships and restricted range of emotion expression

  • does not want relationships
  • chooses solitary activities
  • has little interest in sex
  • enjoys few actitivies
  • lacks friends
  • appears detached and indifferent
  • don't often present to psychiatrists

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Schizotypal Personality Disorder

 

Core Features and Examples

reduced capacity for close relationships and eccentricity

  • ideas of reference
  • odd beliefs or magical thinking
  • unusual perceptual experiences
  • suspiciousness
  • inappropriate affect
  • eccentric behaviour
  • lack of friends

don't often present to psychiatrists

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Antisocial Personality Disorder

 

Core Features and Examples

disregard for and violation of the rights of others

  • illegal activiites
  • deceitfulness, conning others
  • impulsiviitiy
  • irritability and aggressiveness
  • recklessness
  • irresponsibility
  • lack of remorse

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Borderline Personality Disorder

Borderline personaliity disorder (BPD) is one of the most studied and most challenging personality disorders.

 

Core Features and Examples

Diagnosis requires 4 of the following:

  • instability in sense of self, sense of others, relationships, and others
  • frantic efforts to avoid abandonment (often a problem at the end of an interview or discharge)
  • alternating idealization and devaluation in relationships
  • identity disturbance, including in sexuality
  • impulsivity in at least two areas: spending, promiscuity, reckless driving
  • recurrent suicidal or self-harm behaviour (often the reason for psychiatric consults)
  • affective instability, cycling within minutes
  • chronic emptiness
  • intense anger, suspiciousness and dissociation

 

Defense mechanisms

  • splitting
  • acting out
  • regression
  • externalizing blame

 

 

Possible Causes and Risk Factors

May be related to reactive attachment disorder in children.

There seems to be a preponderance of childhood sexual assault.

 

 

Treatments, Support, and Coping

Health care providers should set clear boundaries with patients regarding visits. Ensure the patient's concerns are explored quickly at the introduction of the interview; don't allow them to spend too much time asking personal questions.

People with borderline personality disorder are often greatly stigmatized by health.

Suicide assessment is critical.

Admissions should be approached with great caution, especially with long-term stays. Short-stay visits may be necessary for suicidality, crisis-management.

Dialectical behaviour therapy (DBT) can be useful, especially to help people decide on goals. Group therapy can also be useful

Interpersonal therapy can also be good to help people

 

Complications

There is a very high rate of concurrent substance abuse, depression, chronic pain (Sansone and Sansone, 2012), and other conditions.

Histrionic Personality Disorder

 

Core Features and Examples

 

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Narcissistic Personality Disorder

 

Core Features and Examples

grandiosity and lack of empathy

  • grandiose selse of self-inportance
  • requires admiration, fantasies of unlimited success
  • beleives he/she should only associate with other special people
  • sense of entitilement
  • explites others, lacks empathy
  • haughty

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Avoidant Personality Disorder

 

Core Features and Examples

Avoiding people and places

unwilling to be in contact with people unless they are certain they will be liked

generally not strong communicators

view themselves

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Dependent Personality Disorder

 

Core Features and Examples

ensure this is not depression.

Need to be cared for, submissiveness

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

Obsessive-Compulsive Personality Disorder

 

Core Features and Examples

preoccupation with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency

  • peoccupied with details, lists, and order
  • perfectionistic
  • devoted to work to the explusion of a personal life
  • miserly spending
  • obsessions with morality

No obsessions

 

 

Possible Causes and Risk Factors

 

 

 

Treatments, Support, and Coping

 

 

Complications

 

 

 

Resources and References

Sansone RA, Sansone LA. 2012. Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 9(1):10-4.

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