Chapter 9 Personality Disorders 07 05 2014 What is Personality Personality is the ways we act think and feel that make each of us unique Personality trait is a complex pattern of behavior thought and feeling considered stable across time stable develops in childhood adolescence One of the leading theories of personality is the five factor model which posits that everyone s personality is organized along five broad dimensions or factors of personality o The Big 5 negative emotionality extraversion openness to experience agreeableness and conscientiousness o Personality traits in the five factor model appear to be strongly influenced by genetics Personality Disorders A long standing pattern of maladaptive behaviors thoughts and feelings Highly comorbid substance abuse and depression Getting info about a person s life in order to diagnose is very difficult Differential Diagnosis Most people experience way of seeing as normal When would an individual with a personality disorder present for treatment Diagnostic Summary o Major Depression o Generalized Anxiety Disorder o Paranoid Personality Disorder Personality Disorder Clusters Cluster A odd eccentricbehavior thinking o Paranoid personality disorder Cluster B dramatic emotional behavior and interpersonal relationships o Schizoid personality disorder o Schizotypal personality disorder o Antisocial personality disorder o Histrionic personality disorder o Borderline personality disorder o Narcissistic personality disorder Cluster C anxious fearful emotions and chronic self doubt o Dependent personality disorder o Avoidant personality disorder o Obsessive compulsive personality disorder Cluster A The Odd Eccentric The behavior of people with odd eccentric personality disorder is similar to that of people with schizophrenia but these people retain their grasp on reality to a greater degree than do people who are psychotic o May be paranoid speak in odd and eccentric ways that make them difficult to understand have difficulty relating to other people and have unusual beliefs or perceptual experience that fall short of delusions and hallucinations o No delusions hallucinations other severe symptoms Some researchers consider this group of personality disorders to be part of the schizophrenia spectrum these disorders may be precursors to schizophrenia in some people or may even be milder versions of schizophrenia Often occur in people with first degree relatives who have schizophrenia Difficult to treat personality disorders because one of the hallmarks of paranoid is being mistrustful even paranoid about the therapist s attempt to be helpful Cluster A Disorders Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Paranoid Personality Disorder Pervasive distrust and suspiciousness of others They are hypervigilant for evidence confirming their suspicions Often penetrate observers of situations noting details most other people miss Sensitive to criticism Motives interpreted as malevolent because they misinterpret situations in line with their suspicions Resistant to rational arguments against their suspicions and may consider the fact that another person is arguing with them as evidence that the person is part of a conspiracy against them Onset by early adulthood Present in a variety of contexts Some withdraw to protect themselves while others become aggressive and arrogant Differential Diagnosis o Distinct from similar disorders characterized by a period of persistent psychotic symptoms e g delusions and hallucinations Schizophrenia paranoid type Mood disorder with psychotic features Prevalence and Course o 0 5 5 6 of general population o In treatment 3x more men than women o Chronic course o Paranoid PD inevitably contributes to other disorders Family History Studies o Somewhat more common in families of people with schizophrenia o Twin and adoption studies have not been done Cognitive Theory o Paranoid PD result from Underlying belief that people are malevolent and deceptive Lack of self confidence about being able to defend oneself Difficult to treat because therapy therapists are interpreted in line with Schizoid Personality Disorder paranoid beliefs their interactions with others and humorless Lack the desire to form interpersonal relationships and are emotionally cold in Other people describe them as aloof reclusive and detached or as dull uninteresting People diagnosed with this disorder show little emotion in interpersonal interactions They view relationships with others as unrewarding messy and intrusive Pervasive detachment from social relationships and restricted range of expression in interpersonal settings Onset by early adulthood Present in a variety of contexts Prevalence o Very rare 0 4 1 7 lifetime prevalence o 3x more men than women Biology o Indirect evidence of relationship to Schizophrenia o Twin studies indicate personality traits associated with schizoid personality o Psychosocial treatments focus on increasing social skills social contacts and are heritable Treatment affective awareness Schizotypal Personality Disorder Tend to be socially isolated to have a restricted range of emotions and to be uncomfortable in interpersonal interactions As children people who develop schizotypal personality disorder are passive socially unengaged and hypersensitive to criticism Pervasive social and interpersonal deficits Acute discomfort and reduced capacity for close relationships Cognitive or perceptual distortions and eccentricities Onset in early adulthood Present in a variety of contexts The distinguishing characteristics of schizotypal personality disorder are the oddities in cognition which generally fall into four categories o Paranoia or suspiciousness ideas of reference random events related to them odd beliefs and magical thinking illusions that are short of hallucinations People diagnosed with schizotypal personality disorder tend to have speech that is tangential circumstantial vague or overelaborate May have inappropriate emotional responses and behaviors are odd Neuropsychological tests show deficits in working memory learning and recall similar to those shown by people with schizophrenia Retain basic contact with reality Prevalence o 0 6 5 2 lifetime prevalence o 2x more women than men Biology o Studies suggests genetic relationship between schizotypal PD and schizophrenia o Much more common in first degree relatives of people with schizophrenia o Schizotypal PD may be a milder
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