Personality Disorders Onset in adolescence or early adulthood Egosyntonic they don t recognize there is a problem OCD egodystonic they recognize there s a problem Often co occur with depression and anxiety Onset usually occurs before onset of other psychiatric disorders Higher in medical and psychiatric populations Theories Biological o Certain inherited traits present at birth o Genetic alterations may result in an extreme variation o Unfavorable environmental conditions may affect development of disorder Potentially inherited personality traits o Novelty seeking o Harm avoidance o Reward dependence o Persistence o Neuroticism negative affect versus emotional stability o Introversion versus extraversion o Conscientiousness versus undependability o Antagonism versus agreeableness o Closeness versus openness to experiences Psychosocial factors o Learning theory o Cognitive theory o Psychoanalytic theory Fraud Psychoanalytic theorists believe that human behavior is deterministic It is governed by irrational forces and the unconscious as well instinctual and biological drives Due to this deterministic nature psychoanalytic theorists do not believe in free will o Environmental Categories Cluster A odd eccentric Cluster B dramatic emotional erratic MOST COMMON Cluster C anxious fearful Paranoid personality disorder A Suspicious Distrusting Hypervigilant Argumentative Humorless Schizoid personality Disorder A Prefers solitude Socially Distant Unmotivated by feedback Does not make small talk Lacks spontaneity Schizotypal PD A Uncomfortable around people Poor social skills Eccentric Odd Behaviors Histrionic PD B Self centered Attention seeking Seductive Exaggerates and dramatizes Narcissistic PD B Insensitive to anyone except self Demands admiration recognition attention Overestimation of abilities and importance VERY self centered ME ME ME Antisocial PD B sociopath Pattern of disregard for rights of others Repeated acts that are grounds for arrest Impulsivity Repeated physical fights or assaults Doesn t follow rules Borderline PD B Frantic attempts to avoid real or imagined abandonment Pattern of unstable relationships Unstable sense of self Impulsivity Clingy and manipulative Recurrent suicidal behaviors attention seeking Chronic feelings of emptiness Inappropriate anger Transient paranoid ideation Self mutilating Behaviors Avoidant PB C Poor self image Highly sensitive to criticism High anxiety about being OK so limits contact with people Dependent PD C Submissive Over compliant regardless of cost Helpless Passive so does not initiate self care Venerable Obsessive compulsive personality disorder C OCD is an anxiety disorder Rigid and unbending Perfectionist Comfortable with rules order and conformity Gets lost in details Needs to feel in control Vocab Dichotomizing very black and white Dialectical behavioral therapy DBT recreates a parent child relationship Therapist makes themselves available 24 7 for the patient while setting boundaries and limits Self attribution Errors assume everything is their own fault Catastrophizing blowing out of proportion Outcome Realistic goal setting is important because change occurs so slowly Small steps are necessary YOU NEED to have the pt identify theres a problem to be succesful Examples include minimizing self destructive or aggressive behavior reducing the effect of manipulative behaviors linking consequences to both functional and dysfunctional behaviors Initiating functional alternatives to prevent a crisis ongoing management of anger anxiety shame and happiness