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Personality Disorders

Personality Disorders

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Published by Noe Cenal
Psychiatric personality disorders by Kaplan and Saddocks
Psychiatric personality disorders by Kaplan and Saddocks

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Published by: Noe Cenal on Aug 29, 2013
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Personality Disorders
Personality disorder is a common and chronic disorder. Its prevalence is estimated between 10 and 20percent in the general population, and its duration is expressed in decades. Persons with personalitydisorder are frequently labeled as aggravating, demanding, or parasitic and are generally considered tohave poor prognosis. Approximately one half of all psychiatric patients have personality disorder, whichis frequently comorbid with Axis I conditions. Personality disorder is also a predisposing factor for otherpsychiatric disorders (e.g., substance use, suicide, affective disorders, impulse-control disorders, eatingdisorders, and anxiety disorders) in which it interferes with treatment outcomes of Axis I syndromes andincreases personal incapacitation, morbidity, and mortality of these patients.Persons with personality disorders are far more likely to refuse psychiatric help and to deny theirproblems than persons with anxiety disorders, depressive disorders, or obsessive-compulsive disorder.Personality disorder symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment)and ego-syntonic (i.e., acceptable to the ego). Persons with personality disorders do not feel anxietyabout their maladaptive behavior. Because they do not routinely acknowledge pain from what othersperceive as their symptoms, they often seem disinterested in treatment and
DSM-IV-TR General Diagnostic Criteria for a Personality Disorder
A.
 
An enduring pattern of inner experience and behavior that deviates markedly from theexpectations of the individual's culture. This pattern is manifested in two (or more) of thefollowing areas:1.
 
cognition (i.e., ways of perceiving and interpreting self, other people, and events)2.
 
affectivity (i.e., the range, intensity, lability, and appropriateness of emotionalresponse)3.
 
interpersonal functioning4.
 
impulse controlB.
 
The enduring pattern is inflexible and pervasive across a broad range of personal and socialsituations.C.
 
The enduring pattern leads to clinically significant distress or impairment in social, occupational,or other important areas of functioning.D.
 
The pattern is stable and of long duration, and its onset can be traced back at least toadolescence or early adulthood.E.
 
The enduring pattern is not better accounted for as a manifestation or consequence of anothermental disorder.F.
 
The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).
Paranoid Personality Disorder
Persons with paranoid personality disorder are characterized by long-standing suspiciousness andmistrust of persons in general. They refuse responsibility for their own feelings and assign responsibilityto others. They are often hostile, irritable, and angry. Bigots, injustice collectors, pathologically jealousspouses, and litigious cranks often have paranoid personality disorder.
Diagnosis
On psychiatric examination, patients with paranoid personality disorder may be formal in manner andact baffled about having to seek psychiatric help. Muscular tension, an inability to relax, and a need to
 
scan the environment for clues may be evident, and the patient's manner is often humorless andserious. Although some premises of their arguments may be false, their speech is goal directed andlogical. Their thought content shows evidence of projection, prejudice, and occasional ideas of reference. The DSM-IV-TR diagnostic criteria are listed in Table 27-2.
Clinical Features
The hallmarks of paranoid personality disorder are excessive suspiciousness and distrust of othersexpressed as a pervasive tendency to interpret actions of others as deliberately demeaning, malevolent,threatening, exploiting, or deceiving. This tendency begins by early adulthood and appears in a variety of contexts. Almost invariably, those with the disorder expect to be exploited or harmed by others in someway. They frequently dispute, without any justification, friends' or associates' loyalty or trustworthiness.Such persons are often pathologically jealous and, for no reason, question the fidelity of their spouses orsexual partners. Persons with this disorder externalize their own emotions and use the defense of projection; they attribute to others the impulses and thoughts that they cannot accept in themselves.Ideas of reference and logically defended illusions are common.
DSM-IV-TR Diagnostic Criteria for Paranoid Personality Disorder
A.
 
A pervasive distrust and suspiciousness of others such that their motives are interpreted asmalevolent, beginning by early adulthood and present in a variety of contexts, as indicated byfour (or more) of the following:1.
 
suspects, without sufficient basis, that others are exploiting, harming, or deceiving himor her2.
 
is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends orassociates3.
 
is reluctant to confide in others because of unwarranted fear that the information willbe used maliciously against him or her4.
 
reads hidden demeaning or threatening meanings into benign remarks or events5.
 
persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights6.
 
perceives attacks on his or her character or reputation that are not apparent to othersand is quick to react angrily or to counterattack7.
 
has recurrent suspicions, without justification, regarding fidelity of spouse or sexualpartnerB.
 
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychoticfeatures, or another psychotic disorder and is not due to the direct physiological effects of ageneral medical condition.
Note
: If criteria are met prior to the onset of schizophrenia, add “premorbid,â€
e.g.,“paranoid personality disorder (premorbid).â€
 Persons with paranoid personality disorder are affectively restricted and appear to be unemotional.They pride themselves on being rational and objective, but such is not the case. They lack warmth andare impressed with, and pay close attention to, power and rank. They express disdain for those they seeas weak, sickly, impaired, or in some way defective. In social situations, persons with paranoidpersonality disorder may appear business-like and efficient, but they often generate fear or conflict inothers.
 
Schizoid Personality Disorder
Schizoid personality disorder is diagnosed in patients who display a lifelong pattern of social withdrawal.Their discomfort with human interaction, their introversion, and their bland, constricted affect arenoteworthy. Persons with schizoid personality disorder are often seen by others as eccentric, isolated,or lonely.
DSM-IV-TR Diagnostic Criteria for Schizoid Personality Disorder
A.
 
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in avariety of contexts, as indicated by four (or more) of the following:1.
 
neither desires nor enjoys close relationships, including being part of a family2.
 
almost always chooses solitary activities3.
 
has little, if any, interest in having sexual experiences with another person4.
 
takes pleasure in few, if any, activities5.
 
lacks close friends or confidants other than first-degree relatives6.
 
appears indifferent to the praise or criticism of others7.
 
shows emotional coldness, detachment, or flattened affectivityB.
 
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychoticfeatures, another psychotic disorder, or a pervasive developmental disorder and is not due tothe direct physiological effects of a general medical condition.
Note
: If criteria are met prior to the onset of schizophrenia, add “premorbid,â€
e.g.,“schizoid personality disorder (premorbid).â
Diagnosis
On an initial psychiatric examination, patients with schizoid personality disorder may appear ill at ease.They rarely tolerate eye contact, and interviewers may surmise that such patients are eager for theinterview to end. Their affect may be constricted, aloof, or inappropriately serious, but underneath thealoofness, sensitive clinicians can recognize fear. These patients find it difficult to be lighthearted: Theirefforts at humor may seem adolescent and off the mark. Their speech is goal-directed, but they arelikely to give short answers to questions and to avoid spontaneous conversation. They may occasionallyuse unusual figures of speech, such as an odd metaphor, and may be fascinated with inanimate objectsor metaphysical constructs. Their mental content may reveal an unwarranted sense of intimacy withpersons they do not know well or whom they have not seen for a long time. Their sensorium is intact,their memory functions well, and their proverb interpretations are abstract. The DSM-IV-TR diagnosticcriteria are listed in Table 27-3.
Clinical Features
Persons with schizoid personality disorder seem to be cold and aloof; they display a remote reserve andshow no involvement with everyday events and the concerns of others. They appear quiet, distant,seclusive, and unsociable. They may pursue their own lives with remarkably little need or longing foremotional ties, and they are the last to be aware of changes in popular fashion.The life histories of such persons reflect solitary interests and success at noncompetitive, lonely jobsthat others find difficult to tolerate. Their sexual lives may exist exclusively in fantasy, and they maypostpone mature sexuality indefinitely. Men may not marry because they are unable to achieveintimacy; women may passively agree to marry an aggressive man who wants the marriage. Persons

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