Personality Disorders

Adesola Ogunsakin

Personality Disorders?

• Inflexible, maladaptive and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning

• Person is usually not aware of problem

• Presents by early adulthood

General characteristics:

• Inflexible, inability to adapt• One way of responding• Lifelong• All areas of life are affected• Maladaptive patterns of behavior• Ego-syntonic- when a person’s behavior is

acceptable to the aims of the ego and the related psychological needs of the individual

• Cluster A- Odd or EccentricParanoidSchizoidSchizotypal• Cluster B- Dramatic and EmotionalHistrionicNarcissisticBorderlineAntisocial• Cluster C- Anxious and FearfulAvoidantObsessive-compulsiveDependent

Cluster A

• Higher prevalence in biologic relative of schizophrenics

• Higher prevalence in males

PARANOIDSCHIZOIDSCHIZOTYPAL

Cluster A- PARANOID• Long-standing suspiciousness or mistrust of others• Reluctant to confide in others• Preoccupied with issues of trust• Reads hidden meaning into comments or events• Carries grudgesDifferentiate from: Paranoid schizophrenic has hallucinations and formal thought

disorders; PPD does not Delusional disorder, paranoid type has fixed, focal delusions; PPD

does not

Cluster A- SCHIZOID

• Lifelong pattern of social withdrawal, and they like it that way

• Seen by others as eccentric, isolated, withdrawn

• Restricted emotional expression

Cluster A- SCHIZOTYPAL

• Very odd, strange, weird• Magical thinking, ideas of reference, illusions• Social anxiety • Suspiciousness• Lack of close friends• Incongruous affect• Odd speech, social isolation• May have short-lived psychotic episodes

Cluster B

• Dramatic and Emotional• Genetic association with mood disorders &

substance abuse

HISTRIONICNARCISSISTICBORDERLINEANTISOCIAL

Cluster B- HISTRIONIC

• Colorful, dramatic, extroverted

• Inability to maintain long-lasting relationships

• Attention-seeking• Seductive behavior

Cluster B- NARCISSISTIC• Grandiose sense of self-

importance• Preoccupation with fantasies of

unlimited wealth, power, love• Demands constant attention• Fragile self-esteem, prone to

depression• Criticism met with indifference or

rage• Genuine surprise and anger

when others don’t do as they want

• Can be charismatic

Cluster B- BORDERLINE• Females 2x more than males• Very unstable affect, behavior, self-image• In constant state of crisis, chaos• Self-detrimental impulsivity: promiscuity, gambling, overeating, substance

abuse• Unstable but intense interpersonal relationships: very dependent and hostile,

love/hate• Great problems with being alone• Self-injurious behavior• History of sexual abuse• Common defenses: splitting, passive-aggressive• Particularly incapable of tolerating anxiety• Often coupled with mood disorder• 50% commit suicide

Cluster B- BORDERLINE

• Instability of mood, self-image and relationships

• W>M• Increased mood

disorders in families

• Associated defense mechanism- splitting

Cluster B- ANTISOCIAL

• 3% males, 1% females• Continual criminal acts• Inability to conform to social

norm: truancy, delinquency, theft, running away

• Cant hold job, no enduring attachments, reckless, aggressive

• Onset before age 15; if younger than 19, diagnose as conduct disorder

Cluster C

• Anxious and Fearful

AVOIDANTOBSESSIVE-COMPULSIVEDEPENDENT

Cluster C- AVOIDANT• Extreme sensitivity to rejection• Sees self as socially inept• Excessive shyness, high anxiety

levels• Social isolation, but an intense,

internal desire for affection and acceptance

• Wants the world to change, to be nicer, more accepting

• Tends to stay in same job, same life situation, same relationships

Cluster C- OBSESSIVE-COMPULSIVE

• Orderliness, inflexible, perfectionist• More common in males, firstborn, harsh discipline upbringing• Loves lists, rules, order• Unable to discard worn-out objects• Doesn’t want change• Excessively stubborn• Lack sense of humor• Wants to keep routine

Differentiate from: Obsessive-compulsive anxiety disorder the anxiety disorder has

obsessions and compulsions that are focal and acquired. Personality disorders are lifelong and pervasive

Cluster C- DEPENDENT

• Gets others to assume responsibility

• Subordinates own needs to others

• Cant express diasgreement

• Great fear of having to care for self

• May be linked to abusive spouse

Sources

• Kaplan• First Aid- USMLE STEP 1 2014