Terms

• Personality- enduring pattern of perceiving, relating to , & thinking about environment & self.  Exhibited in social and personal function.   Reflects personality traits.
• Character- person’s distinctive nature
• Temperament- biologically (genetically) based, simple, nonmotivated characteristics.  Become stable after first few years of life.  (ex. Quiet, shy, active)
• Personality disorder- chronic maladaptive pattern of behavior.  Unpredictable & egocyntonic (don’t care or can’t understand what their actions may cause) Usu. associated w/ social & occupational dysfunction.

Diagnostic criteria

A.     Marked deviation from cultural expectations.  At least 2 of the following:

1. Cognition- way of perceiving & interpreting self, others,  & events.
2. Affectivity- range, intensity, lability, & appropriateness of emotions.
3. Interpersonal functioning for impulse control.

B.     The pattern leads to chronic, significant distress/impairment in social, occupational, or other important areas of function.

C.    Pattern is stable & enduring.  Can be tracked back to adolescence or early adulthood.

D.    Pattern not better explained by a different disorder.

E.     Pattern not due to a substance (ex. drugs) or a general medical condition (ex. head trauma)

Significance

A.     Costly to society.  The following figures represent the % of the named population that have PD’s.

• Criminals- 70-85% (incl. murderers: infanticide, matricide (kill parents), filicide (kill offspring))
• Alcoholics- 60-70%
• Substance abusers- 70-90%

B.     Personality along with other psychiatric disorder (ex. Depression, panic, OCD) usually doesn’t respond well to meds.

Classification

Cluster A (odd, eccentric)

1)   Paranoid

1. characteristics- suspiciousness
2. epidemiology- 0.5-2.5% of pop.  More in men.
3. Etiology- genetic…common if related to schizophrenic or someone w/ delusional DO. -psychodynamics…Erikson’s trust v. mistrust.  Defense mech. …projection.
4. Dx- suspicious, preoccupied w/ doubts, reluctant to confide, finds hidden motives, unforgiving, critical, sensitive to criticism, pathological jealousy.
5. Diff.- Paranoid schizophrenia, delusional DO, psychotic DO, schizotypal personality DO, borderline personality DO.
6. Px- early adulthood onset, chronic, poor Px w/out therapy.
7. Tx- psychotherapy, antipsychotics, anxiolytics.

2)   Schizotypal

1. characteristics- social & interpersonal deficit, cognitive/perceptual distortions, eccentric behavior.
2. Epidemiology- 3-5% of pop.  More in men.
3. Etiology-       genetic…common if 1^st deg. relative of schizophrenic.  More in monozygotes than dizygotes.

-        psychodynamic…DMs… fantasy, regression, projection

-        biologic… abnl. biogenic amines & structural abnormalities like schizophrenia

1. Dx- odd beliefs, magical thinking, ideas of reference, perceptual disturbances (ex. Illusions, odd speech, paranoid ideation), inappropriate/constricted affect,  weird behavior/appearance, lack of friends.
2. Diff.- schizophrenia, psychotic DO, delusional DO, major depression w/ some psychosis thrown in, schizoid personality DO, paranoid personality DO.
3. Px- early adult onset, chronic, severe social impairment, poor Px.  10-20% of Pts develop full schizophrenia.
4. Tx- antipsychotics, antidepressants, anxiolytics, psychotherapy.

3)     Schizoid

1. characteristics- detachment, restricted emotions, loner, cold person.
2. Epidemiology- 0.5-7% of pop.  More in men.
3. Etiology-   genetic…common if relatives have (-) symptoms of schizophrenia

-        psychodynamic…traumatic early experience.   DMs…fantasy, repression, regression.

1. Dx- loner.  No desire for relationships, sex, pleasure, praise.  Cold, flat affect.
2. Diff.- schizophrenia, major depression, anxiety DO, schizotypal, avoidant, OCD.
3. Px- early adult onset, chronic.
4. Tx- psychotherapy, antipsychotics, antidepressants, anxiolytics.

Cluster B (dramatic, erratic)

1)     Borderline

1. characteristics- instability of relationships, self-image, affect, & impulses.
2. Epidemiology- 2-3% of pop.  More in women.
3. Etiology-   genetic… common if a 1^st deg. relative has mood DO (ex. Major depression)

-        Psychodynamic… fixated in Mahler’s separation individuation phase.  Poor object constancy.  DMs… splitting, projection, idealization, devaluation.

1. Dx- fear of abandonment, unstable emotions, relationships, identity,  and impulses (anger).  Suicidal, self-mutilative, chronic feelings of emptiness,  stress-related paranoia or dissociative symptoms.
2. Diff.- Schizophrenia, depression, bipolar DO, cyclothymia, dissociative DO, histrionic personality DO, antisocial PDO, paranoid PDO.
3. Px- adolescent onset, variable course, usually subsides in 30′s & 40′s.  Complicated by suicide and substance abuse.  8-10% of Pts die from suicide.
4. Tx- psychotherapy, antipsychotics, antidepressants, antimanics, anxiolytics.

2)     Antisocial

1. characteristics- disregard for and violation of the rights of others.
2. 2-3% of pop.  More in men.  More in low socioeconomic, urban pops.
3. Etiology-    genetic… higher monozygotic concordance.  Common if 1^st deg. relatives have depression, substance abuse, somatization DO.

-        psychodynamic… poor parenting, ADHD, conduct DO, illegitimate or adopted, big family (esp. w/ brothers), divorce, poor school situation.  DMs… regression, repression, aggression, acting out.

1. Dx- don’t follow rules/laws, liar, impulse problems, irritable, aggressive, reckless, irresponsible, remorseless.   At least 18 y.o.a.
2. Diff.- Mood DO (ex. Bipolar, depression), schizophrenia, borderline PDO, narcissistic PDO, histrionic PDO, paranoid PDO.
3. Px- onset before 15 y.o.a.  Often  subsides in 30′s & 40′s.  Complicated by substance abuse, depression, incarceration.
4. Tx- psychotherapy (self-help or group), substance abuse groups, antidepressants, methylphenidate (Ritalin), antimanics.

3)     Histrionic

1. characteristics- excessive emotions and attention-seeking behavior
2. epidemiology- 2-3% of pop.  More in women.
3. Etiology-   genetic… common w/ 1^st deg. relatives w/ same problem.

-        psychoanalytic… Freud’s phallic phase (should be 3-5 y.o.a.).   Dm’s… acting out, fantasy, dissociation, reaction formation.

1. Dx- must be enter of attention, seductive, shifting emotions, shallow, impressionistic speech, lacking in detail, self-dramatization, exaggeration, easy suggestibility.
2. Diff.- borderline PDO, antisocial, narcissistic PDO, mood DO (ex. Bipolar or manic), cyclothymia, somatization DO.
3. Px- early adult onset
4. Tx- psychotherapy, antidepressants, antimanics, anxiolytics.

4)     Narcissistic

1. Characteristics- grandiose, needs admiration, no empathy.
2. Epidemiology- <1% of pop.   More in men.
3. Etiology-   psychodynamic…parental grandiosity.  DMs…projection, repression.
4. Dx- self-important, fantasies of success, power, brilliance, beauty, love.  Wants excessive admiration/entitlement, takes advantage of others, no empathy, envious, and believes others are envious, arrogant.
5. Diff.- histrionic, antisocial, borderline, and paranoid PDOs.   Mood DO (ex. Bipolar), paranoid schizophrenia,  delusional DO.
6. Px- early adult onset.  Complicated by depression (esp. in mid-life), psychosis, suicide.  Occupational and social impairment.
7. Tx- psychotherapy, antipsychotics, antidepressants, anxiolytics, antimanics.

Cluster C  (anxious, timid)

1)     Obsessive-Compulsive

1. characteristics- orderliness, perfectionism, meticulousness, preoccupation w/ details, rules, lists, orders, and schedules.
2. Epidemiology- 1-2% of pop.  Men and women equally.
3. Etiology-    genetic… higher concordance in monozygotes.  Common if 1^st deg. relatives have same problem.

-        psychodynamics…Freud’s anal stage.  Erikson’s autonomy v. shame & doubt.  DMs… intellectualization, rationalization, reaction formation, isolation.

1. Dx- perfectionism, workaholic, overconscientious, inflexible, can’t throw stuff away, can’t delegate, miserly, rigid and stubborn.
2. Diff.- major depression, anxiety DO (generalized or social phobia), narcissistic, paranoid, antisocial, or passive aggressive PDOs.
3. Px- early adult onset
4. Tx- psychotherapy, antidepressants, anxiolytics

2)     Dependent

1. characteristics-  excessive need to be taken care of.  Submissive & clingy.  Fears separation.
2. epidemiology- unknown %.  More in women.
3. Etiology-   genetic… higher concordance in monozygotes.

-        psychoanalytic… Freud’s oral dependent stage.   DMs… regression, repression.

1. Dx- can’t make decisions, needs reassurance, can’t disagree, doesn’t initiate projects, wants nurture and support, fear of being alone, replaces relationships quickly.
2. Diff.- borderline, avoidant, & histrionic PDOs, depression, agoraphobia, social phobia.
3. Px- unknown
4. Tx- psychotherapy, antidepressants, anxiolytics.

3)     Avoidant

1. Characteristics- social discomfort, low self-esteem, hypersensitivity to criticism.
2. Epidemiology- 0.5-1% of pop.  Men and women equally.
3. Etiology-  psychodynamic… childhood/adolescent disfigurement or illness.  DMs… regression, repression, displacement, avoidance.
4. Dx- avoids interpersonal contact, reticent to get involved & resistant in relationships, preoccupies w/ criticism & rejection. Poor self-esteem.  Little risk-taking.
5. Diff.- Schizoid or narcissistic PDOs, anxiety DO, depression.
6. PX- unknown
7. Tx- psychotherapy, antidepressants, anxiolytics

Tags: antisocial, Avoidant, Cluster B, Cluster C, maladaptive pattern of behavior, Narcissistic, Paranoid, Personality disorder, Schizoid, Schizotypal

This entry was posted on Thursday, September 10th, 2009 at 5:00 am and is filed under Behavioral Science and Psychiatry. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.