NUR 448

Personality Disorders

Definition

Extreme exaggerations of personality traits or styles.

Essential features are: chronicity pervasiveness maladaption

Three clusters

Cluster A (Odd, eccentric) Paranoid, Schizoid, Schizotypal

Cluster B (Dramatic, erratic) Antisocial, Borderline, Histrionic, Narcissistic

Cluster C (Anxious, fearful) Avoidant, Dependent, Obsessive-compulsive

Cluster A - Paranoid

Distrustful, suspiciousBears grudgesJealous, envious, hypersensitiveHypervigilent, ideas of referenceRestricted affect, controllingDefense mechanism—projectionOften racist

Paranoid Personality

Cluster A - Schizoid

LonerOdd thoughts, perceptions & speechAloof, no social involvementIndifferent to praise or criticismBouts of mini psychosisCognitive impairment

Schizoid Personality

Cluster A - Schizotypal

Odd, peculiar speechBizarre fantasies and behaviorMagical thinkingIdeas of referenceUnusual beliefs, clairvoyantFortune tellers, street people

Schizotypal Personality

Cluster B - Antisocial

Disregard for the rights of othersInstant gratificationNo remorseLying, stealing, revengefulTruant as children, cruelty to animalsFiresetting, substance abuseRx. Restrictive settings (jail, prison)Qualitative difference to soci0pathic personality

Antisocial Personality

Cluster B - Borderline

Theory-problems with separation-individuationBad mother-good motherUnstable and impulsive on eating, spending,

and sexualityUnstable personal relationshipsClinging, demanding, controlling

Borderline Personality

Borderline

Difficulty being alone, mood swingsExplosive anger, self-mutilationMini-psychoses, eating disordersSplitting (pitting one person against another)Projection, suicide gesturesCutting, carving or other self abuse actions

(never the face)Rx: Small doses of antipsychotic medication

Cluster B - Histrionic

Needs to be center of attentionSeductive, provocative behaviorShallow emotional expressionDramatic, theatricalSuggestibleFocused on physical appearanceOften show “la belle indifference”- disconcern

for personal problems

Histrionic Personality

Cluster B- Narcissistic

Grandiose self importanceUnlimited fantasies of power, wealth, brilliance, beautyFeels special or unique-associates with people of

high statusDemands admiration, entitlement, special

treatmentAble to break laws-severe cases act as anti-social

personalitiesNarcissistic Personality

Narcissistic

ExploitiveLacks empathyEnviousHaughty, arrogant

Cluster C - Avoidant

Social inhibitionFear of close relationshipsAnxious, lonely, fearful of criticism or rejectionViews self as socially inept, reluctant to take risks

Avoidant Personality

Cluster C - Dependent

Difficulty with decision makingSeeks excessive advice and reassurance Difficulty expressing disagreementFear of having to take care of selfExcessive lengths to obtain nurturanceFeels uncomfortable when alone

Dependent Personality

Cluster C - Obsessive-compulsive

Preoccupied with details, rules, lists and orderPerfectionism that interferes with task completionOver-conscientious and inflexibleReluctant to delegateMiserly spendingRigid and stubborn

Obsessive Compulsive Personality

Obsessive Compulsive Personality

Obsessive Compulsive Personality

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

FastidiousNeatness and

orderlinessDemanding of othersAble to lead normal

lifeBehaviors: labeling,

measuring, things are the same

HoardingCompulsive actionsSeclusiveDisabling and anxiety

producingBehaviors: checking

the door, hand washing, counting, picking at face

Some Differences Between

Treatment

Symptom specificSome improve with time (borderline and

antisocial)Group therapy helpful for some

Questions

Which personality disorders are more disruptive?

What is the difference between schizoid and avoidant personalities?

What are the differences among obsessive- compulsive behavior, obsessive-compulsive personality, and obsessive-compulsive disorder?

Which axis of the DSMIV includes personality disorders?

What are the culture issues of personality disorders?

What are the gender issues of personality disorders?