Personality Disorder Paranoid Personality

Description Tendency to attribute malevolent motives to others Suspicious, mistrustful Hostile, irritable, angry Often bigots, injustice collectors, Pathologically jealous spouses, litigious crank Reluctant to confide See hidden meanings, tend to bear grudges, quick to counteract Formal manner, humorless, serious Scan environment Projection, prejudiced Ideas of reference Quite restricted and lacked warmth Disdain the weak, sickly, and impaired

Biological Basis Chess and Thomas: temperaments of these individuals irregular, nonadaptable, highly intense reactions, negative mood and tendency to be hyperactive. First degree relatives with Schizophrenia (part of the schizophrenic spectrum) Associated with developmental handicaps

Psychodynamics Was not able to go beyond the paranoidschizoid position have very low self-esteem, constantly warding off humiliation Defenses: projection, denial, rationalization Shame Superego projected onto authority Unresolved separation and autonomy issues ( child splits the love object as good or bad, projecting the bad things to the mother and has the fear that the mother will destroy him because of that. The child will then have to realize that the mother is also good and try to introject the good things in his ego. The

Management Psychotherapy Anxiolytics Anti-Psychotics

 Business-like, generates fear and conflict in others Extremist

process continues until the child is able to integrate in himself that the mother has both good and bad aspects otherwise, the child will continue to project to other objects (people) the badness in him so his ego wont feel distress) Related to schizophrenia, schizotypal and avoidant PD Some theorize that it is due to deficits in the reticular formation and limbic system (all are noneconclusive) Some have increased urine cathecolamines BALINT: inadequate mothering/caregi ving that the person received as infants FAIRBAIRN: a withdrawal from the world when the infant views the caregiver as rejecting. (but the need becomes insatiable so the infant soon strives for her again and then fears that he will devour his mother, thus he Psychotherapy Antipsychotics Antidepressants Psychostimulants

Schizoid Personality

isolated with no longing for relationships Hold solitary jobs Ill at ease with others, poor eye contact Constricted affect, aloof Inappropriately serious Humor is off the mark Avoid spontaneous speech Fascinated with inanimate objects or metaphysical constructs

 Interested in mathematics, astronomy, philosophical Uninvolved, passive and noncompetitive Fantasized sexuality only Often remain single (men) Has inability to express anger History of pervasive social inhibition Social needs are repressed to ward off aggression Schizotypal Personality Odd and eccentric behavior and thought, affect, speech, appearance Strange Magical thinking is prominent Peculiar ideas, ideas of reference, illusions, derealization Distinctive speech, idiosyncratic or peculiar Strong genetic link to schizophrenia There is an abnormality in the smooth pursuit eye movement Elevated levels of homovanillic acid in the CSF Enlarged ventricles diminished MAO impaired smooth-pursuit eye tracking

will again withdraw) They live under the constant threat of abandonment.

Social causation theory lower income group Double bind conflicting messages within a family cause a patient to withdraw into a regressed state to avoid unsolvable problems Schisms and skews abnormal interaction within families,

Psychotherapy Antipsychotics

 May not know their feelings and are insensitive to others negative feelings Superstitious Isolated and may have transient psychosis Involved in cults, strange religious practices, or the occult Have few close friends Some has social anxiety Antisocial Personality Psychopathic features Manipulative and appear trustworthy With criminal or dishonest activities (lying truancy, running away from home) Promiscuous, commits child or spouse abuse Lack remorse Impulse dyscontrol, fails to plan Lack of

diminished brain mass, especially in the temporal lobe

abnormally dominant caretaker Parents who are too indulgent, neglectful or authoritarian Substance use, abuse or dependence Threatened or actual break up of relationships Intrusion into a secretive and isolated lifestyle Leaving home and academic hardships Psychotherapy Psychostimulants Anti-epileptic drugs

perinatal brain injury, head trauma, and encephalitis Chess and Thomas: patients as children are innately aggressive and with high level or activity and irritability, lowered level of consoleability Lower than average reactivity of ANS Lower cortical

Impulse ridden, with ego deficits in planning and judgment Superego lacunae, primitive conscience Difficulties in object relations; fails to empathize, love and develop basic trust Aggressive Sadomasochism, narcissism, depression Frequent moves,

sensitivity to others Irritable and aggressive Deceitful and irresponsible Disregards others safety and oneself

arousal and reduced level of inhibitory anxiety Lowered levels of 5-HIAA ( serotonin metabolite) Alcoholism ADHD hx of parental abandonment or abuse Frontal lobe injury or dysfunction Lesions of the amygdale or temporal lobe With Abnormal EEG findings With soft neurological signs

losses, family break-ups, large families Poverty, urban setting, poorly regulated schooling Little emphasis on communication Eneuresis, firesetting, cruelty to animals Neglectful, harsh, physically abusive, substance dependent parents Mother: weak, depressive, masochistic, somatizing Father: explosive, inconsistent, sadistic, alcoholic, criminal history Psychotherapy Antipsychotics Antidepressants Anticonvulsants

Borderline Personality

Always in crisis Micropsychosis Self-destructive behavior Tumultuous relationships Separationindividuation

Familial Temperamentall y aggressive, with intense emotional attachment needs Dysregulated

Interrupted development at the rapproachment subphase of separation individuation object constancy

problems sticky Intolerant of being alone and driven by object hunger Frantic efforts to avoid real or imagined abandonment Easily enraged Manipulative Unstable identity and self-image Impulsive regarding sex, money Have affect storm Panaxiety and chaotic sexuality

dopamine and serotonin levels Lowered excitability of the limbic system Brain damage (perinatal brain injury, encephalitis, head injury, etc) Frontal lesions impaired judgment and affective control Temporal lesions Kluver Bucy traits Serotonin deficiency

is not developed and fear that separation will always result to abandonment or disappearance of the caregiver No tolerance for being alone. Hx of physical and sexual abuse, abandonment or overinvolvement Unresolved rapproachment phase (separationindividuation) impaired object constancy (impaired internalization and control) turns against self generalized ego dysfunction identity disturbance Psychotherapy Anxiolytics Antidepressants Antipsychotics

Histrionic Personality

Dramatic, emotional, impressionistic Cooperative and eager to be helped Colorful,

Increased prevalence among first degree relatives Temperamental factors include: intensity,

Neglectful parenting- for females, lack of maternal nurturance, thus seeking paternal gratification

flamboyant, attention seeking, seductive Dependent behavior Emotional and shallow or insincere Suggestible Superficially likeable and gregarious

hypersensitivity, extroversion and reward dependence Right brain dominant

(attention seeking behavior is rewarded by parent of the opposite sex), for males, too much attachment to mothers as he enters the phallic stage, genital inadequacy when comparing with father, always disappointed with women ( nothing compares to mom) A father who is intimidating and seductive Fathers who turn to their daughters for gratification not available in the marriage Fixation in the oral and oedipal stages Fantasy in playing a role Defenses used: repression, regression, identification,

somatization, conversion, dissociation, denial, externalization Faulty identification with the samesex parent and ambivalent and seductive relationship with the opposite-sex parent Narcissistic Personality Grandiose sense of self and overconcern with issues of selfesteem Sense of specialness and entitlement Handles criticism or defeat with rage or depression, fragile selfesteem Exploitative, lacking in empathy Excessive concern about appearance rather than substance, requires excessive Genetic predisposition Failure in maternal empathy, early rejection and loss Defense against primitive aggression Compensation for a sense of inferiority Psychotherapy Lithium Antidepressants

admiration ObsessiveCompulsive Personality Perfectionist, orderly, inflexible Perseverance is common extending to stubbornness Indecisive at times Emotionally constricted Controls themselves and the situation Stiff, formal demeanor, lacking spontaneity Circumstantial and detailbound, routinary and ritualistic life Lack interpersonal skills, humor, warmth, or ability to compromise Authoritarian manner, excessively devoted to work and productivity Hoard objects and are miserly Not genetically linked to other disorders Temperament: high energy, overconscientiou s, increased sensitivity to noverbalized affect, lack of tolerance for anxiety due to aggressive drives Kernberg_ psychic hunger or oral rage due to spiteful parent Kohut lack of validation from the parent during childhood Special treatment of the child Background of harsh discipline Defenses: Isolation of affect, reaction formation, undoing, intellectualizatio n, rationalization Distrusted emotions Issues of defiance and submission Fixated at the anal stage Psychotherapy Anxiolytics Antidepressants

Avoidant Personality

Shy or timid, phobic Easily hurt and sensitive to rejection Socially withdrawn and requires uncritical acceptance Longs for social involvement Has inferiority complex, lacks self-confidence, self-effacing Sees oneself as inept, misinterpret others comments as derogatory

No clear genetic etiology Share the same biological features as that of patients with GADhyperaraousable sympathetic nervous system Abnormally high baseline level of cortisol Abnormal functioning of the hypoccampus and limbic system

Children were belittled, often criticized by parents resulting in decreased self-esteem As they grow these experiences are reinforced by their peers Timidity help cope with raging impulses Developmental handicaps Overt parental deprecation, overprotection, phobic features in the parents Defenses: avoidance, inhibition Fears of rejection covers for underlying aggression either oedipal or pre-oedipal Unresolved separation issues Defense against aggression

Psychotherapy Anxiolytics Antidepressants

Dependent Personality

Dependent and submissive Subordinates needs and responsibilities to those of others and delegates

Chronic physical illness, separation anxiety, parental loss in childhood

Psychotherapy Anxiolytics Antidepressants

decisions to others Tolerate abusive relationships Lacks selfconfidence, requires advice and reassurance Intolerant of being alone and tend to require excessive supervision at work Passive, with difficulty expressing disagreement Insufficient data Conflicts regarding authority, autonomy, dependence Submission, defiance, aggression Psychotherapy Ant6idepressants

Passive-Aggressive Personality

Obstructionism, procrastination, stubbornness, & inefficiency Resists demands for adequate performance Finds excuses for delays and finds faults Lacks assertiveness Pessimistic, anhedonic, dutybound, selfdoubting, chronically unhappy

Depressive Personality

Involve the hypothalamicpituitaryadrenal-thyroid axis, including the

Early loss or poor parenting Low self-esteem Guilt Self-punishing

Psychotherapy Ant6idepressants

 Critical of others, brooding Quiet, introverted, passive Sadistic Personality Relationships are dominated by cruel or demeaning behavior Pxs direct their lives toward bad outcomes Reject help or good outcomes Have a dysphoric response to good outcomes

noradrenergic and serotonergic amine systems Genetic predisposition

Early loss of love object

Related to parental abuse

Self-defeating Personality