1. PERSONALITY DISORDERS

3. Classifying Personality Disorders Personality disorders are grouped into three clusters based on descriptive similarities. Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders These persons appear odd or eccentric. Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic These persons appear dramatic, emotional, or erratic. Cluster C: Avoidant, Dependent, and Obsessive-Compulsive These persons appear anxious or fearful.

4. Etiology of Personality Disorders Genetics Monozygotic twins reared apart have nearly same personalities Cluster A: more common in the biological relatives of patients with schizophrenia than among control groups. Cluster B: Antisocial personality disorder is associated with alcohol use disorders; depression is common in family backgrounds of patients with borderline personality disorder; a strong correlation between histrionic and somatization disorders

5. Etiology of Personality Disorders Cluster C: Patients with avoidant personality often have high anxiety levels; obsessive-compulsive traits are more common in monozygotic twins than in dizygotic twins - they also show some signs of depression. Neurotransmitters also seem to play a role. 5-HIAA, a metabolite of serotonin is low in people who are impulsive and aggressive.

6. Etiology of Personality Disorders Environmental Factors Children with minimal brain damage are at risk for antisocial personality disorder. Link between fearful children raised by fearful mothers and avoidant personality disorder. Cultures that encourage aggression may contribute to paranoid and antisocial personality disorders.

7. Cluster A Personality Disorders Paranoid Personality Disorder Marked by a pervasive distrust and suspiciousness of others. Often misinterpret the motives and actions of others as malevolent. Differentiated from delusional disorder by the absence of of fixed delusions. Unlike schizophrenics, they have no hallucinations or formal thought disorder. Differ from borderlines because they are mostly incapable of overly involved, tumultuous relationships with others. No long history of antisocial activity. Schizoids are withdrawn and aloof and do not have paranoid ideation.

8. Cluster A Personality Disorders Schizoid Personality Disorder A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. Do not have schizophrenic relatives May have successful, but isolated work histories No thought disorder or delusional thinking Unlike avoidant personalities, who are also isolated, schizoid personalities do not wish to participate in activities

9. Cluster A Personality Disorders Schizotypal Personality Disorder Pronounced interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. Will have family history of schizophrenia No psychosis, or brief, fragmented psychosis Some involved in cults, strange religious practices, and the occult May meet criteria for both schizotypal and borderline May have suspiciousness, but also have odd behavior

10. Cluster B Personality Disorders Antisocial Personality Disorder A disregard for and violation of the rights of others occurring since age 15. Also marked by an inability to conform to the social norms that ordinarily govern many aspects of people’s adolescent and adult behavior. May have a neurological or mental disorder that has gone undiagnosed Can be the byproduct of long-term substance abuse, but the primary (substance abuse) should be diagnosed rather than antisocial personality When antisocial behavior is the only manifestation, patients are diagnosed in the category “additional conditions that may be the focus of clinical attention,”(adult antisocial behavior)

11. Cluster B Personality Disorders Borderline Personality Disorder Pervasive pattern of unstable interpersonal relationships, self-image, and affects, and marked impulsivity by early adulthood. Unlike schizophrenics they have no prolonged psychotic episodes, thought disorder, or other classic schizophrenic symptoms Generally have chronic feelings of emptiness and short-lived psychotic episodes Act impulsively and demand extraordinary relationships May mutilate themselves and perform manipulative suicide attempts

12. Cluster B Personality Disorders Histrionic Personality Disorder Pattern of excessive emotionality and attention seeking, beginning by early adulthood. Difficult to distinguish from borderline, but borderline will have suicide attempts, identity diffusion, and brief psychotic episodes. Patient can have both Somatization disorder may also occur Patients with brief psychotic disorder and dissociative disorder may warrant a coexisting diagnosis of histrionic personality disorder

13. Cluster B Personality Disorders Narcissistic Personality Disorder A pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood. Borderline, histrionic, and antisocial personality disorders often accompany narcissistic personality disorder, making a differential diagnosis difficult They have less anxiety than borderlines Lives are less chaotic Less likely to attempt suicide Lack history of impulsive behavior that get them into legal trouble Do show features of exhibitionism and interpersonal manipulativeness similar to those of histrionics

14. Cluster C Personality Disorders Avoidant Personality Disorder Show an extreme sensitivity to rejection and may lead socially withdrawn lives. Appear shy and need unusually strong guarantees of uncritical acceptance. Often described as having an inferiority complex. Schizoids want to be alone, avoidant personalities don’t Not as demanding, unpredictable, and irritable as borderlines or histrionics Similar to dependent personality disorder except that dependent personalities have a stronger fear of being abandoned or unloved, but it may be difficult to sort this out

15. Cluster C Personality Disorders Dependent Personality Disorder A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. Traits of dependence are found in many disorders such as borderline and histrionic or agoraphobia Dependent personalities tend to have long-term relationships with one person Not overly manipulative

16. Cluster C Personality Disorders Obsessive-Compulsive Personality Disorder Characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness. The essential feature is a pervasive pattern of perfectionism and inflexibility. When recurrent obsession or compulsions are present, obsessive-compulsive disorder should be noted on Axis I In some cases, delusional disorder coexists