Psychopathology Test

PERSONALITY DISORDERS

PERSONALITY DISORDERS Personality Defined • All emotional and behavioral traits that characterize the person in day-to-day living under ordinary circumstances • Enduring patterns of perceiving and relating to/thinking about the environment and oneself, exhibited in wide range of social and personal contexts - DSM IV • Requires evaluation of long-term patterns of functioning, distinct from responses to situational stressors/transient mental states –DSM IV • Enduring pattern of inner experience and behavior, deviating markedly from expectations of a person’s culture - DSM IV • Deviation manifested in at least two areas: cognition, affect, interpersonal functioning, impulse control • Pattern inflexible and pervasive across a broad range of personal and social situations Disorder Definition • Pattern brings significant distress or impairment in social, occupational or other important functional area DSM IV • Pattern stable, of long duration, with onset traced back to adolescence or early adulthood • Not due to, or manifestation of, another mental disorder, substance disorder, or general medical condition Classification • Cluster A - odd and eccentric ○ paranoid ○ schizoid ○ schizotypal • Cluster B - dramatic, emotional, erratic ○ borderline ○ histrionic ○ antisocial ○ narcissistic • Cluster C - anxious, fearful ○ Dependent ○ Obsessive-Compulsive ○ Avoidant ○ Not Otherwise Specified (NOS) Diagnosis • Must distinguish trait (enduring subthresholdpersonality characteristic) from a temporary state and role • Understand the concept of pathological threshold (significant impairment in major functional area) • Assessment: clinical interview; self-report inventory (e.g. MMPI); semistructured interviews (e.g. SCID); third party info • Multiple diagnoses may be made, since a large number of patients meet criteria for 2 or more Axis II syndromes • Important to list every disorder on Axis II • If symptoms/signs not severe enough to warrant a disorder diagnosis, personality characteristics my be noted on Axis II using the term “trait” rather than disorder Etiology • Genetic ○ Twin studies support genetic causation ○ Cluster A increased in schizophrenia families ○ Cluster B  antisocial assoc w/ alcohol dependence  histrionic assoc w/ somatization disorder • More physical problem without an organic reason • Temperament - “POOR PARENTAL FIT” • Biologic Factors ○ Antisocial assoc with organic (abnormal EEG, MBD) ○ Low serotonin assoc with depression, impulsivity, aggression, ruminative thoughts (SSRIs for this) Personality Psychology • Defenses ○ Each individual’s unique personality profile is determined by defenses ○ Each Axis II disorder is a cluster of defenses ○ Effective defenses bring control of mood & function • Object Relations

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e. looking for relationship partners who will collaborate (usually unconsciously) spontaneously or by induction (through projection. Cluster A “I PASSED” .g.Psychopathology Test • • PERSONALITY DISORDERS Interpersonal styles/patterns displayed by key figures or groups/culture early in life are adopted/ internalized. Santini clip) Schizoid. too nice to be normal • Histrionic Facts ○ More frequent in women ○ Association with somatization disorder  (multiple physical complaints w/o organic cause) ○ Association with alcohol use disorders ○ Tendency to repress (forget) affect ○ Female anorgasmia and male impotence increased Borderline “AMID A RISE”. pananxiety. this is called identification An individual’s psychology is drawn to repeat these patterns. Cluster B “I CRAVE SIN” .*4/7 • *Hidden meanings seen in others’ remarks ○ “Idea of reference” • *Unjustified doubts about others • *Grudges held • *Suspects others of exploitation • *Fidelity of partner doubted • *Attacks on character suspected • *Reluctance to confide in others Histrionic.*5/8 • *Inappropriate behavior: seductive/provocative • *Center of attention • *Relationships seen as close when they’re not • *Appearance is important for attention • *Vulnerable to suggestions/influence of others • *Emotional expression is exaggerated/theatric • *Shifting emotions rapidly and shallow • *Impressionistic manner of speaking.*5/9 • *Abandonment frantically avoided • *Mood instability • *Identity disturbance (unsure of who they are and ○ their goals in life) • *Dissociative symptoms & paranoid thoughts • *Anger poorly controlled and chronic • *Relationships unstable with splitting • *Impulsivity that damages • *Suicidal behavior recurrent • *Emptiness that’s chronic • Borderline Facts ○ Short-lived psychoses when stressed  (Brief Psychotic Disorder) ○ Dependence mixed with hostility ○ Self-destructive acts to avoid loneliness ○ Self-mutilation (cutting forearms/thighs) to relieve anxiety/help with identity issues ○ Projective identification and splitting in relationships ○ Panphobia. no friends/confidants • *Sexual experiences of no interest • *Solitary lifestyle by preference • *Emotionally detached • *Desire for close relationships lacking Paranoid “HUGS FAR” . chaotic sexuality Antisocial 2| Page . no details • *Nice.4/7 • *Indifference to praise or criticism • *Pleasure from hobbies/activities absent • *Activities solitary.

brilliance.*4/7 • *Avoids occupational activities w/ others • *Certainty of being liked needed before involved • *Inhibited when meeting people • *Restrained within relationships • *Criticism or rejection is a preoccupation • *Unusually reluctant to take risks • *Self-deprecating Dependent “NEEDS PUSH” . work etc) • *Unstable. can’t delegate • *Task completion blocked by perfectionism • *Inflexible.*4/8 • *Preoccupied with rules.o. plans • *Expression of affect is restricted • *Reluctant to delegate tasks—do everything themselves • *Frugal • *Excessively devoted to work • *Controls others. can’t plan ahead • *Support lacking for children or spouse • *Makes no provisions for safety of self/others • *Aggressive/irritable/assaultive • *Not occuring during schizophrenia or mania • Antisocial Facts ○ Common in urban areas ○ Up to 75% of prison populations ○ 5 times more cases in 1st degree relatives of males with this disorder ○ Frequent abnormal EEG’s and neuro signs ○ Lack of appropriate anxiety and depression ○ Abuse in behavior toward families.*5/8 • *Needs others to take responsibility for life • *Expressed disagreement w/ others is limited • *Excessive lengths to get nurtured and supported • *Decision-making is difficult • *Starting projects independently is difficult • *Preoccupied with fears of being abandoned • *Urgently seeks another when relationship ends • *Self-confidence lacking • *Helpless when alone Obsessive-Compulsive “PERFECTION” . morals.Psychopathology Test PERSONALITY DISORDERS “CALLOUS MAN” . with diagnosis in late childhood 3| Page . hoards objects • Obsessive-Compulsive Facts • Increased in men. • *Antisocial acts that are grounds for arrest • *Lies frequently • *Lacks remorse • *Obligations not honored (financial. details.*5/9 • *Fantasizes about huge success. beauty • *Empathy lacking for others • *Exploitative • *Demands to be treated as special • *Special people are needed to understand him/her • *Admiration needed in large amounts • *Grandiose sense of self • *Arrogant • *Manipulates others to get compliance • *Envious of others Avoidant.*3/7 • *Conduct disorder <15 y. rigid stubborn • *Overconscientious about ethics. values • *Not able to discard belongings. Cluster C “A CIRCUS” . currently >17 y. promiscuous ○ Many have somatization disorder (multiple physical complaints w/o organic cause) Narcissistic “FEEDS A GAME” .. and in use of alcohol.o.

need submission 4| Page .Psychopathology Test • • • PERSONALITY DISORDERS • Increased in first degree biologic relatives Excessive discipline as children Constricted (isolated/walled-off) affect. affect can emerge suddenly (volcanic) need control. need detailed answers to questions Unable to compromise. under stress.

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