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DSM-IV-TR General Discription of Personality Disorder
Enduring patterns of inner experience and behaviour that deviates markedly from individual’s cultural expectations.
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DSM-TR-IV
How do PD's manifest
In which areas
How many present for diagnoses
- 1.Cognitions: Disorders regarding self & others
- 2. Affective: Unstable, extremes of too much/too little/poor regulation and inappropriate affect.
- 3.Interpersonal functioning: Problems in affiliation and power (and absence of) interpersonal functioning
- 4.Impulse control: Problems controlling impulsive behaviour.
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Cluster A:
- Odd or Eccentric
- 1.Schizoid- Detachment from social relationships and restricted range of expression of emotions
2. Paranoid- Distrust and suspiciousness of others
3. Schizotypal- Discomfort with close relationships, cognitive and perceptual distortions, eccentricities of behaviour.
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Cluster B:
- Dramatic, Erratic, Emotional
- 1.Histrionic: Excessive emotionality and attention seeking
2. Borderline: Instability of interpersonal relationships, self-image, emotions, and control over impulses.
3. Antisocial: Disregard for and frequent violation of the rights of others
4. Narcissistic: Grandiosity, need for admiration, and lack of empathy
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Cluster C:
- Anxious or Fearful
- 1.Avoidant: Social inhibition, feelings of inadequacy, and hypersensitivity or negative evaluations
2.Obsessive –Compulsive: Preoccupation with orderliness and perfectionism at the expense of flexibility.
3. Dependent: Excessive need to be taken care of, leading to submissive and clinging behaviour.
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General info/ Symptoms
- 1. Inflexible and maladaptive, causing significant (clinical) functional impairment & distress in social
- occupational and interpersonal settings.
- 2.Pervade all aspects ofpersons’ life (personal/social dysfunction)
- 3. Ego Dystonic-may affect others more than person=family member more likely to seek treatment
- 4. Comparable dysfunction to Axis I disorders
- 5. Strong stigma attached
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Prevalence
- - Lifetime Prevalence: 10-14%
- -Specific disorders: .2-3%
Higher rates in inpatient setting
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Gender Differences
- More common in males
-Often comorbidity
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Onset/ Course/ Duration
Traced back to at least adolescents/early adulthood.
Chronic
- Some aspects ameliorate after 40yrs (most
- continue)
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DSM-IV-TR Features of Paraoid PD
- 1.Pervasive distrust and suspiciousness of others without justification
- 2.Interprets others motives as malevolent
- 3.Suspects others are exploiting, harming or deceiving them
- 4. Preoccupied with doubts of loyalty or others
- 5. Reluctant to confide
- 6.Sees benign messages as demeaning or threatening
- 7.Bears grudges
- 8. Perceives attacks on character, quick to react with anger
- 9. Recurrent suspicions regarding sexual fidelity of partner.
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· Predominately environmental pathway
- · Sadistic, degrading, humiliating caregivers
- · Experiences of deep mistrust of motives of others from infancy
- · Little research on biological underpinnings
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Treatment of Paranoid PD
& Behavioural Markers
Difficult to establish as do not trust therapist
CBT based to challenge mistaken assumptions
No good evidence of efficacy
- Markers
- Behavioral: Vigilance
- Intrapsychic: Overwhelming fear
- Interpersonal: Hostility
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Schizoid PD
- 1.Pervasive detachment from social relationships
- 2.Restricted emotional expression in interpersonal setting
- 3.Neither wants nor enjoys close relationships, including family
- 4.Strongly prefers solidary activities
- 5.Little interest in sexual relationships
- 6.Little pleasure from activities
- 7.Lacks close friendships
- 8.Indifferent to praise or criticism
- 9.Emotional cold, detached, flat
- 10.Do not experience strong subjective emotions (anger, sadness, happiness)
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