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Personality Disorders

Dr. Layali Abbasi Psychiatrist

Yarmouk University

5th year/Faculty of Medicine September, 2017

Definition

• An enduring pattern of behavior and inner experiences that deviates significantly from the individual’s cultural standards.

• Rigidly pervasive. • Has an onset in adolescence or early adulthood. • Stable through time. • Leads to unhappiness and impairment. • Manifests in at least two of the following four

areas: cognition, affectivity, interpersonal function, or impulse control.

Classification

• Cluster A -With odd, aloof features. -Schizotypal, schizoid, and paranoid. • Cluster B -With dramatic, impulsive, and erratic features -Narcissistic, borderline, antisocial, and histrionic. • Cluster C -With anxious and fearful features. -Obsessive-compulsive, dependent, and avoidant.

• Persons with paranoid personality disorder have a pervasive, persistent, and inappropriate mistrust of others.

• They are suspicious of others’ motives and assume that others intend to exploit, harm, or deceive them.

• In response to perceived or actual insults or betrayals, these individuals overreact quickly, becoming excessively angry and responding with counterattacking behavior.

• They are unable to forgive or forget such incidents and instead bear long-term grudges against their supposed betrayers; some persons with paranoid personality disorder are extremely litigious.

• Persons with avoidant personality disorder experience excessive and pervasive anxiety and discomfort in social situations and in intimate relationships. Although strongly desiring relationships, they avoid them because they fear being ridiculed, criticized, rejected, or humiliated.

• They isolate themselves because they believe themselves to be inadequate and unlikable, not because of their overall mistrust of others.

• A common differential diagnosis for paranoid personality disorder is schizoid personality disorder, which also manifests as social isolation, but this is generally born out of overall social detachment and indifference to making connections with others.

• Antisocial personality disorder is marked by a long-standing pattern of socially irresponsible behaviors that reflects a disregard for the rights of others. Persons with this disorder are often superficially charming, aiming to seduce, outwit, or exploit others, and are thus not as likely to be socially isolated.

• Individuals with obsessive-compulsive personality disorder are overly concerned with order and perfection and often struggle interpersonally because of their rigid need to control situations.

• Persons with obsessive-compulsive personality disorder (OCPD) are excessively orderly.

• They are neat, punctual, overly organized, and overly conscientious. • Although these traits might be considered virtues, to qualify as OCPD, the

traits must be so extreme that they cause significant distress or impairment in functioning. For example, attention to detail is so excessive or time-consuming that the point of the activity is lost, conscientiousness is so extreme that it causes rigidity and inflexibility, and perfectionism interferes with task completion.

• Although these individuals tend to work extremely hard, they do so at the expense of leisure activities and relationships. The most characteristic thought of persons with OCPD is “I should”—a phrase that aptly captures their overly high standards, drivenness, conscientiousness, perfectionism, rigidity, and devotion to work and duties

• Schizotypal personality disorder, like schizophrenia, is characterized by positive, psychotic-like symptoms and negative, deficit-like symptoms, experience cognitive or perceptual distortions (positive), behave in an eccentric manner, and are socially withdrawn and anxious (negative).

• Schizotypal personality disorder is considered a schizophrenia spectrum disorder—that is, related to schizophrenia.

• Phenomenological as well as genetic, biological, treatment, and outcome data support this link. For example, family history studies show an increased risk for schizophrenia-related disorders in relatives of schizotypal probands and, conversely, an increased risk for schizotypal personality disorder in relatives of probands with schizophrenia.

• Borderline personality disorder is characterized by fears of abandonment, which may lead to clinging behaviors.

• However, unlike in dependent personality disorder, close relationships in borderline personality disorder are often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

• Also characterized by Instability of interpersonal relationships, self-image, and affects, and marked impulsivity.

• About 10% of patients with BPD commit suicide.

• Overall, the longer-term course of BPD may be more benign than previously thought. Roughly half of patients with BPD have significant remissions of their overt psychopathology within 2 years.

• Social dysfunction, severe childhood trauma, and persistence of substance abuse are predictive of a worse prognosis.

• Persons with histrionic personality disorder are often flamboyant, self-dramatizing, and provocative.

• They also display an effusive, but labile and shallow, range of feelings.

• They are often overly impressionistic and given to hyperbolic description of others.

• More generally, these persons do not attend to detail or facts, and they are reluctant or unable to make reasoned critical analyses of problems or situations.

• Persons with narcissistic personality disorder lack empathy for others.

• In relationships, they are often quite distant and try to sustain an illusion of self-sufficiency, allowing them to unknowingly treat others insensitively while pursuing their self-serving goals.

• Dependent personality disorder is characterized by an excessive need to be cared for by others, which leads to submissive and clinging behavior and excessive fears of separation.

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