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Prevalence of personality disorders (PD) (5,1/2,30)
- Affect between 5-10% of population
- 1/2 of those who seek counseling are diagnosed with a PD
- Up to 30% of those who seek mental health services have at least 1 PD
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Those with a PD are at a higher risk for...? (EISL)
- Eating Disorders
- Impaired social and occupational functioning
- Substance abuse
- Legal issues
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Define a Personality Disorder (PD)
- Inflexible, maladaptive patterns of behavior that cause distress to the individual or impairment in functioning
- Culturally defined
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People with PDs typically (behaviors)...
- Responds poorly to change
- Has trouble forming/ maintaining relationships
- Has interpersonal problems in a variety of areas (work, school, home, legal system, etc)
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Cluster A personality Disorders
- Individuals seen as odd and eccentric
- Encompasses paranoid, schoizotypal, and schizoid personality disorders
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Cluster B Personality Disorders
- Individuals appear highly emotional, erratic, or dramatic.
- Anti-social, borderline, histrionic and narcissistic PD
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Cluster C Personality Disorders
- Anxious and fearful
- Avoidant, obsessive compulsive, and dependent personality disorders
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DSM 4 Diagnostic criteria for personality disorders
- Personality traits which deviate from one's general cultural expectations
- Pervasive and inflexible
- On set is in adolescence or young adulthood
- Stable over time, leading to distress and impairment
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DSM Criteria for pattern of personality disorders (must me 2 or more)
- Cognition/perceptions impaired
- Emotional abnormality/ range
- Interpersonal functioning impaired
- Poor impulse control
- Not accounted for by another disorder
- Not due to substance use or another medical condition
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Aspects of personality (TDDST)
- Traits
- Dimensions
- Domains
- States
- Types
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Personality Traits
Long standing characteristics that endure over time a cicrumstance
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Personality States
Time limited conditions that can be associated with with a specific personality type (like anxiety and depression)
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Personality Dimensions
Clusters of traits
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Personality domains
Clusters of dimensions such as being agreeable, good nurtured, etc.
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Paranoid personality disorder
- Pervasive distrust and suspicion.
- Usually referred for treatment by others
- Hostile, irritable, angry, refuse to take responsibility for actions/feelings
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DSM criteria for paranoid personality disorder
- Feels exploited, harmed, deceived by others without justification
- Unjustified doubts about others loyalty
- Reluctant to confide in others due to distrust
- Reads into harmless comments
- Bears grudges
- Perceived attacks on character (unjust)
- Recurring doubts about others fidelity
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Aspects of functioning impacted by PDs
- Cognition- Distorted ways of thinking and perceiving
- Affect- dysfunctional or abnormal in range
- Interpersonal functioning
- Impulse- control poor.
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Schizoid Personality Disorder diagnostic criteria
- Does not desire or enjoy close relationships with others; including family members.
- Almost always chooses solitary activities
- Has little (or no) sexual interests or experiences with others.
- Takes little pleasure from activities
- Lacks close friends, except close relatives
- Indifferent to the praise or criticism of others
- Emotional coldness, detachment, and flat affect
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Schizotypal Personality Disorder
- May have a strong genetic component (linked with schizophrenia)
- Ideas of reference
- Odd beliefs or magical thinking which influences behavior (not subculture norms)
- Odd thinking and speech
- unusual experiences
- Inappropriate or constricted affect
- Peculiar appearance or behavior
- No close friends (other than relatives)
- Excessive social anxiety which is related to paranoia and does not diminish with familiarity
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Anti-social personality disorder
- Failure to conform to laws and norms (repeated arrests)
- Deceitfulness
- Impassivity/ failure to plan ahead.
- Irritability and aggressiveness (repeated fights or assaults)
- Reckless disregard for the safety of others
- Consistent irresponsibility
- Lack of remorse.
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Borderline personality disorder diagnostic criteria
- Frantic efforts to avoid real or imagined abandonment
- Unstable or intense relationships involving idealization and devaluation
- Identity disturbance- unstable self-image or sense of self
- Impassivity in areas which can cause damage
- Recurrent suicidal suicidal behavior/threats or self mutilation.
- Unstable affect due to reactivity of mood
- Chronic feelings of emptiness
- Inappropriate intense or issues controlling anger
- Stress related paranoid ideation or dissociation symptoms.
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Histrionic Personality Disorder diagnostic criteria (5 or more)
- Discomfort when he or she is not the center of attention
- Sexually seductive or provocative behavior
- Rapidly shifting and shallow emotions
- Uses physical appearance to draw attention to ones self.
- Impressionistic style of talking which lacks detail
- Prone to self-dramatization and theatrical expression of emotion
- Suggestible and easily influenced by outside circumstances and others
- Sees relationships to be more intimate than they actually are
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Narcissistic Personality Disorder diagnostic criteria (5 or more)
- Grandiose sense of self-importance, exaggerates achievements and talents, expects to be recognized as superior.
- Preocupied with fantasies of unlimited success, love, power, brilliance, and beauty
- Believes they are special and unique and should only associate with high status people/places
- Requires excessive admiration
- Sense of entitlement
- Takes advantage of others to meet their needs
- Lacks empathy
- Envious of others and believes others are envious of them
- Shows arrogant or haughty behaviors or attitudes
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Avoidant Personality Disorder Diagnostic Criteria (4 or more)
- Avoids occupational activities which involve interpersonal fears of criticism, rejection, etc
- Unwilling to be involved with others unless it is certain they are liked.
- Shows restraint in intimate relationships for fear of being shamed
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new social situations for fear of inadequacy
- Views self as socially inept, unappealing, or inferior
- Unusually reluctant to take personal risks or engage in new activities for fear of embarrassment
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Dependent Personality Disorder (Excessive need to be taken care of) Diagnostic criteria (4 or more)
- Has difficulty making common everyday decisions without reassurance from others.
- Needs others to assume responsibility for most major areas of their life.
- Difficulty expressing disagreement with others due to fear of loss of approval/support
- Difficulty imitating due to lack of self-confidence in judgment or abilities
- Excessive efforts to gain support and nuturance from others to the point of volunteering to do unpleasant things
- Feels uncomfortable and/or helpless when alone
- Has unrealistic fears and preoccupation with being left alone (To care for themselves)
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Obsessive Compulsive Personality Disorder diagnostic criteria (for or more)
- Preoccupied with details, rules, lists, organization or schedules to the point that activity is lost
- Perfectionism which interferes with task completion.
- Excessively devoted to work and excludes leisure time relationships.
- Is overly conscientious and inflexible about rules, morals, values, etc.
- Unable to discard old, worthless objects, even when they have no sentimental value.
- Reluctant to delegate tasks to others unless they do it exactly the same.
- Adopts a miserly spending style
- Rigidity and stubbornness.
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Treatments for Personality Disorder (PD) Levels
- 1) Symptoms
- 2) Modifying personality features related to the environment
- 3) Personality features related to character
- 4) Personality features related to temperment
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Types of PD Treatment
- Individual, family, group, and medication (can all be combined)
- Dialectical Behavioral Therapy (DBT)
- Residential Treatment
- Biological Therapy
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Risks associated with PD
- Interapersonal risks (pg 307)
- Interpersonal Risks (pg 308)
- Community and environmental risks (308)
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