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 populationsTheories- Biologicalo Certain inherited traits present at birtho Genetic alterations may result in an extreme variationo Unfavorable environmental conditions may affect development of disorder- Potentially inherited personality traitso Novelty seekingo Harm avoidanceo Reward dependence o Persistenceo Neuroticism (negative affect) versus emotional stabilityo Introversion versus extraversiono Conscientiousness versus undependabilityo Antagonism versus agreeablenesso Closeness versus openness to experiences- Psychosocial factorso Learning theoryo Cognitive theoryo 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 willo EnvironmentalCategories- Cluster A- odd eccentric- Cluster B- dramatic, emotional, erratic (MOST COMMON*)- Cluster C- anxious, fearfulParanoid personality disorder-A• Suspicious• Distrusting• Hypervigilant• Argumentative• HumorlessSchizoid personality Disorder-A• Prefers solitude• Socially Distant• Unmotivated by feedback• Lacks spontaneity• Does not make small talkSchizotypal PD-A• Uncomfortable around people• Poor social skills • Eccentric• Odd BehaviorsHistrionic PD-B• Self-centered• Attention seeking• Seductive • Exaggerates and dramatizesNarcissistic PD-B• Demands admiration, recognition, attention• Insensitive to anyone except self• Overestimation of abilities and importance• VERY self centered- ME ME MEAntisocial 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 rulesBorderline 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 BehaviorsAvoidant PB- C• Poor self-image• Highly sensitive to criticism• High anxiety about being OK, so limits contact with peopleDependent 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• Gets lost in details• Needs to feel in control• Perfectionist• Comfortable with rules, order, and conformityVocab• Catastrophizing- blowing out of proportion• Dichotomizing- very black and white• Self-attribution Errors- assume everything is their own fault• Dialectical behavioral therapy (DBT)- recreates a parent child relationship. Therapist makes themselves available 24/7 for the patient while setting boundaries and limits. 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 managementof anger, anxiety, shame, and