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PERSONALITY DISORDERS
Rebecca Sposato, MS, RN
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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