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 conduct follows an inflexible, pervasive pattern

that significantly deviates from cultural expectations and leads to distress and impairment

Emerge during adolescence or young adulthood

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

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.

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

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

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

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

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

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

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

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

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

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