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:
- perception and interpretation of self, others, events
- affect regulation
- interpersonal functioning
- impulse control
For more information, please see assessing personality disorders.
Cluster A
Paranoid personality disorder Schiziod personality disorder Schizotypal personality disorder
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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
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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.
- 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
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
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,
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
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