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Personality Disorders (Classification (PD (An enduring pattern of inner…
Personality Disorders
Classification
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Paranoid PD
Pervasive tendency to be inapproprately suspicious of other people's motives and behaviours: constantly on guard and hyper-vigilant, exaggeration
People who are paranoid are inflexible in the way that they view the motives of other people, making it difficult for them to develop relationships or choose situations in which they can trust other people
Schizoid PD
Pervasive patterns of indifference to other people, coupled with a diminished range of emotional experience and expression: appear cold and aloof, do not experience strong subjective emotions
Schizotypal PD
Centers on peculiar patterns behaviour rather than the emotional restriction and social withdrawal associated with schizoid PD: perceptual and cognitive disturbance, not out of touch with reality
Antisocial PD
Persistent pattern of irresponsible and antisocial behaviour that begins during childhood or adolescence and contibues into the adult years; disregard and violation of the rights of others, conflict, irritability and aggression, little consequences for action
Borderline PD
Pervasive pattern of instability in mood and interpersonal relationship: intolerant of being alone, manipulative (strategy to maintain an attachment they perceive as vital), mood shift rapidly, intense anger, identity disturbance (not integrated image of self)
Narcissistic PD
Pervasive pattern of grandiosity, need for admiration, and a limited capacity to respond with empathy to others; exaggerated sense of own importance; ignore feelings of others and inflated sense of self
Avoidant PD
Pervasive pattern of social discomfort, fear of negative evaluation and timidity; socially isolated, afraid of criticism, extremely shy, hurt by signs of disapproval; few close relationships
Dependent PD
Pervasive pattern of submissive and clinging behaviour: afraid of separating from other people on whom they depend for advice and reassurance; easily hurt by criticism, sensitive to disapproval; problems being alone or separating
Obsessive-compulsive PD
Pervasive pattern of orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficacy; marked need for control and lack of intolerance for uncertainty; devoted to work
PD
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture
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Histrionic PD
Pervasive pattern of excessive emotionality and attention-seeking behaviour; self-centred, vain and demanding, seek approval; inappropriately sexually seductive or provocative; intact sense of own identity
Symptoms
PDs represent a wide spectrum of maladaptive styles of perceiving, relating to, and feeling and thinking about the world; egosynton (no insight)
Distinctions among healthy traits, eccentricity, and personality pathology are contextual and depend on ability to demands of different situations
Stable self-identity that remain intact regardless of changing demands in environment; capacity to handle stress
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Social motivation
Motives (conscious or unconscious) describe the way people would like things to be: affiliation vs. power - PDs maladaptive variations with regard to this
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Defensive organization
Each individual has a unique constellations defences: reaction formation, projection, isolation, denial - four categories: (1) psychotic, (2) immature, (3) neurotic, (4) mature
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Clinical implications
Identify defences and decide how to address those defences; remain aware of how defences are used and be cognisant of how they become manifest
Addressing "schemas", misconceptions is likely to be an important aspect of the therapist's role throughout the course of treatment
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Epidemiology
Prevalance
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Prevalence rates for specific types vary: highest prevalence associated with obsessive-compulsive, antisocial, avoidant may affect 3-4% adults
Gender differences
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Antisocial PD is much more common among men, with prevalence rates of 5% reported for men and 1% for women: paranoid and obsessive-compulsivemore common among men
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PD may affect men and women differentially: borderline males showed higher rates of comorbid substance abuse, while females showed comorbidity with depression, anxiety, PTSD
Age differences
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Paranoid, schizoid, and obsessive-compulsive PDs are more prevalent in older people than in younger people: borderline and antisocial PDs are less prevalent in older people than in younger people
Differences in the extent of social isolation or dependence might reflect variation in life circumstances for younger and older adults rather than ture developmental changes in the prevalence of specific personality
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A diagnosis of PD in children or adolescence should use a systemic framework that examines child's or adolescent's personality within context of family, community and cultural systems, and to view personality as adaptation to relational and cultural forces
Must PDs begin early in a person's life? Some personality dysfunctions may emerge under certain conditions and in certain contexts
Onset of a PD is a difficult to identity; symptoms that emerge gradually and many disorders are preceded by an extended prodromal period that is difficult to identify
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Clinical implications
Critical to assess for PDs during the initial assessment process, while keeping in mind potential gender, age, and ethnicity differences
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Course and outcome
Comorbidity
Major depression, substance use disorders, anxiety disorders
75% who qualify for a PD diagnosis also meet criteria for a another syndrome: borderline slightly more than 30% of all patient treated
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Stability: CLPS (18-45) - symptoms of PDs not as stable as believed: fewer than half of the adolescents who originally qualified for a PD met the same criteria 2 years later
Burnout: patients treated are still significantly impaired several years later, but disorders are not stable - Cluster A has greatest neurobiological vulnerability and is less likely to benefit
Etiology
Genetic factors
Extensive research on schizotypal PD: significant genetic contribution - first-degree relatives are considerably more likely than poplin the general population to exhibit features of schizotypal PD
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Environmental adversity
Antisocial PD: genetic factors interact with environmental events to produce pattens of antisocial and criminal factors
Events: childhood abuse, neglect, physical abuse, sexual abuse, emotional neglect, childhood maltreatment
Children who experienced childhood abuse or neglect were four times more likely than those who had not been mistreated to develop PDs
Physical abuse was most closely associated with subsequent antisocial PD; sexual abuse with borderline; childhood neglect with antisocial, narcissistic and avoidant
Borderline PD: problematic problems with parents - lack of supervision, witnessing domestic violence; inappropriate behaviour by parents and other adults
Clinical implications
Childhood trauma and PDs: evaluation of lifetime trauma exposure, with a particular focus on childhood maltreatment is encouraged when treating PDs
Family history of psychiatric conditions should also be assessed, especially considering genetic factors for antisocial and schizotypal PD
Descriptions of current relationships with family and friends also provide clinicians with idea of what social support is present for the patient and what environmental factors may impede treatment progress
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