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Personality Disorders

Personality Disorders. Rebecca Sposato, MS, RN. Overview of Personality Disorders. Personality: an enduring pattern of inner experiences, emotional responses, attitudes and behaviors in an individual Takes years to change Personality Disorders occupy Axis-II in the DSM-IV

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Personality Disorders

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  1. Personality Disorders Rebecca Sposato, MS, RN

  2. Overview of Personality Disorders • Personality: an enduring pattern of inner experiences, emotional responses, attitudes and behaviors in an individual • Takes years to change • Personality Disorders occupy Axis-II in the DSM-IV • conduct follows an inflexible, pervasive pattern that significantly deviates from cultural expectations and leads to distress and impairment • Emerge during adolescence or young adulthood

  3. Dimensional Models of Personality • Personality is seen as place of intersection of 5 major traits: openness, conscientiousness, extraversion, agreeableness, neuroticism • For persons with disorders the intersection is not in the middle • The DSM-IV has 3 categories of personality disorders, based on their location on grid

  4. Cluster A: Eccentric • Paranoid: hold others in distrust, interpret the actions of peoples or entities as malevolent without evidence. • Conspiracy theories, accuse others of plotting and hold grudges for minor infractions • vigilant for expected personal attacks • Poor social relationships and interactions • 1% of general population, 20% of inpt. Psych pop.

  5. Cluster A: Eccentric • Schizoid: Social detachment and bland emotional range • Strongly introverted and indifferent to other’s opinions, approvals or criticisms • Few to none quality relationships/interactions • Drifting life goals, passive to change or adverse events • Considered too uncommon in clinical settings for statistical comparisons

  6. Cluster A: Eccentric • Schizotypal: Distorted interpretation of things, events and actions by others • Magical, paranormal and superstitious explanations • Anxious social interactions and reduced capacity for social relationships, ‘feel like an outsider’ • 50% qualify for depression disorder • 3% of general population

  7. Cluster B - Dramatic • Antisocial Personality: Inconsiderate, disregard or violation of the rights, wishes and feelings of others • Often engage in high risk and illegal behaviors • Resort to lying, intimidation, extortion and aggression in achievement of goals • Emotional chameleons in usury relationships with a warped sense of victim and villain • General population: 1-3% of general population (more male than female) >25% of prison population

  8. Cluster B: Dramatic • Borderline: unstable self-image, relationships, emotional affect, values and interests • Highly charged emotions, attention seeking • Labile Interpersonal patterns: • Mentally splitting person into ‘good’ and ‘bad’ versions • Range clingy to pushing away • Risky, Reckless and impulsive actions • Suicide threats /attempts (10% complete suicide), self-mutilating and damaging • 2% of general population, 20% of inpt psych

  9. Cluster B: Dramatic • Narcissistic: View self as superior and special, seek attention and approval with consistent devalue and lack empathy for others • Cover for low self-esteem and will react strongly when criticized, very sensitive to disproval • Usury and unilateral relationships • Overestimate their accomplishments, and underestimate the accomplishments of others

  10. Cluster B: Dramatic • Histrionic: excessive emotional expression and attention seeking behaviors • Gage self-esteem by external measures of attention and impressing others • Engage in embelishing, provocative and seductive behaviors when routine interventions do not yield enough attention

  11. Cluster C: Anxious • Avoidant: social inhibition, feeling inadequate and hypersensitive to negative evaluation and rejection • Assume others are primarily critical and disapproving • Do not take risks, try new things or expand comfort zone • Although they desire affection and friendship the end result is self-isolating, limited social circle • 1% of general population

  12. Cluster C: Anxious • Dependent: excessive need to be taken care of leading to submissive and clingy behaviors • Cannot tolerate independence • Will no take the initiative because they lack self confidence they can do an adequate job • Seek advice and reassurance for minor or inconsequential decisions • Will comply with wishes of others even when contrasting their own

  13. Cluster C: Anxious • Obsessive Compulsive Personality: preoccupation with orderliness, perfection and control at the expense of time, flexibility and efficiency • Repeat tasks and work in pursuit of inconsequential details • Limit and delay or try to control leisure time and recreational pursuits • Reluctant to delegate tasks or tolerate preferences of others

  14. Treatment • Identify and change behaviors limiting quality of life • Traditional management of depression, hostility, anxiety, addiction and self harming behaviors • Psychoanalysis, CBT, REBT, DBT, milieu, coping skills

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