What 4 qualities determine personality
•Temperament - “nature”
•Development – effect of “nurture” on biology
•Character – “nurture”
•Psyche – self awareness (the ability to learn, adapt, change)
Apparent before traditional learning occurs
50% of personality is related to temperment
Negative events in early childhood (typically repeated, chronic abuse or neglect) can physiologically alter the limbic system and cause permanent effects on emotional arousal, etc.
unconscious mental processes that the ego uses to resolve conflicts...” between instinct (id), reality, important persons, conscience (superego)
What is the paradigm of defense mechanism
Instincts and drive (Id)
Conscience, reality, important persons (Super Ego)
feed into Defense mechanism =Ego
Info on defense mechanisms
In other words, they help you cope with difficult situations when your instinct is to do one thing (punch someone) and your mind/heart/conscience wants to do another (play nice).
When defense mechanisms work vs not so much
Defense mechanisms are universal, in everyone. They work!
When they remain rigid, despite changing situations, they don’t work!
When they are effective, they help resolve anxiety and depression. So changing it increases anxiety.
A major reason not to change!!!
____– ignoring reality (can be adaptive dealing with serious illness or can get in the way of treatment)
•____– Mentally separating part of one’s consciousness from real life events
•____– intentionally (consciously) pushing down to deal with now
When is Personality a Disorder?
a relatively stable and enduring set of characteristic behavioral and emotional traits.” *
•Normally, it is flexible and adaptable
•“When disordered, it is ...maladaptive, deeply ingrained , and often distressing for both the patient and significant others.”
Personailty is disordered when:
Personality is “disordered” when
It’s ingrained and inflexible
It gets in the way (of relationships, functioning)
It’s relatively stable
It distresses people around them
What's the difference between Ego-syntonic vs. Ego-dystonic
Personality Disorders are often ego- syntonic rather than ego-dystonic.
Ego-syntonic means “acceptable to the ego” i.e. it doesn’t bother them, it bothers others, as opposed to
ego-dystonic – uncomfortable
OCPD – , perfection is expectation, not bothersome =
OCD – , “I know it doesn’t make sense, but...” =
Epidemiology of personality disorders
10-18% prevalence in the general population – i.e. your office
30-50% prevalence in psychiatric outpatient populations
Over 50% on inpatient psychiatric unit
Of patients with (Axis I) disorders, 34% have co-morbid personality disorder
Personality Disorders, in general, are _____ in men and women
Some personality d/o tend to be diagnosed more in one gender (borderline, histrionic for females, narcissistic, antisocial for males) - ?some validity, some stereotype
Describe Cluster A personality disorder
more detached, eccentric
Emotionally detached, loners Don’t want relationships
schizoid P.D; Cluster A
Prevelance of Schizoid PD
Prevalence – anywhere from “uncommon” to 7.5% of general population
Males diagnosed twice as much as females
Higher incidence of psychosis in relatives
How is Schizoid PD different from schizophrenia?
Differentiated from schizophrenia by absence of psychotic symptoms (hallucinations, delusions, thought disorder)
cognitive, perceptual and behavioral eccentricities. ...frequently embrace beliefs, such as telepathy, clairvoyance, and magical thinking, to a degree that exceeds cultural and subcultural norms
Schizotypal Personality Disorder
Epidemiology of Schizotypal PD
•3% of population
•Highly genetic (33% concordance in monozygotic twins vs. 4% in dizygotic)
•Increased risk in biological relatives of schizophrenics
Long-standing suspiciousness and mistrust
of people (with no basis for this mistrust) Read threats into non-threatening
Pathologically jealous if in a relationship
Paranoid Personality Disorder (cluster A)
Epidemiology of Paranoid PD
0.5-2.5% of population
Rarely seek treatment themselves
Males diagnosed more than females
How do we differentiate Paranoid PD from schizophrenia?
Differentiated from schizophrenia by absence of hallucinations or thought disorder, higher functioning and non-bizarre paranoia
CLUSTER B –
MORE DRAMATIC, IMPULSIVE
Frantic efforts to avoid real or imagined abandonment (interpersonal)
Getting distraught if a spouse is 5 minutes late getting home from work
Placing dozens of phone calls to one’s therapist before the therapist goes on vacation
Borderline Personality Disorder (cluster B)
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and
devaluation (interpersonal, affective)
you are the best doctor ever after you prescribe Vicodin for minor knee pain. When you appropriately refuse to refill the prescription one month later you become the worst physician ever
Borderline Personality Disorder (cluster B)
Affective instability due to marked reactivity of mood, “mood swings”, (can be argumentative one moment, depressed the next, and later complain of having no feelings) (affect)
Chronic feelings of emptiness
Recurrent suicidal behavior, threats or self mutilating behavior (impulse control)
seen in Borderline P.D. (cluster B)
Epidemiology of Borderline Personality Disorder
1-2% of population
Females diagnosed more commonly than males
High genetic load. More MDD and substance abuse in relatives.
Multiple suicide attempts, up to 10% complete suicide
repetative unlawful acts and socially irresponsible behaviors that began prior to age 15.
...so unconcerned with the feelings and rights of others that they are morally bankrupt and lack a sense of remorse.
Antisocial Personality Disorder (cluster B)
What characteristics do we see in Antisocial PD
• Deceitful, impulsive
• Irritability and aggressiveness
• Reckless disregard for safety of self or others
• Consistent irresponsibility (doesn’t honor financial obligations)
• Lack of remorse
What is the difference between asocial and antisocial?
What's the epidemiology of Antisocial PD?
Often confused in lay terms, taken to mean “asocial”.
Antisocial = sociopath
3% of male population, 1% of female population
High genetic load, 5x more common in relatives with the disorder
pervasive overconcern with appearance and attention, exaggerated emotional response, poor frustration tolerance that ends in outbursts, and impressionistic speech that lacks detail. ”
“View physical attractiveness as the core of their existence
Histrionic Personality Disorder (cluster B)
Epidemiology of histrionic PD
Believed to occur in 2-3% of population
Females diagnosed more than males
Characterized by a heightened sense of self-importance, grandiose feelings and lack of empathy
Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
Arrogant, entitled, and often envious
Require excessive admiration. Take advantage of others to achieve their own ends
Narcissistic Personality Disorder (cluster B)
What are my 3 Cluster C personality disorders?
(more anxious )
Become so preoccupied with details and rules that the major point of an activity is lost
Display perfectionism that interferes with task completion (taking hours to do notes because it has to be perfect)
Have inflexible values and are overly conscientious
Epidemiology of OCPD
More common among first degree relatives with OCPD
Tend to be oldest children
What is the difference from OCD vs OCPD?
Defenses of person with OCPD– rationalizing, intellectualizing, reaction formation, undoing, controlling
NOT the same as OCD – ego dystonic, however, under stress, OCPD can develop OCD symptoms
Show extreme sensitivity to rejection which may lead to a socially withdrawn life
Although shy, they have a great desire for relationships (which differentiates them from schizoid p.d.)
Avoidant Personality Disorder (cluster C)
Subordinate their own needs to those of others
Lack self-confidence and can’t make decisions without excessive advice and reassurance
Doesn’t speak up b/c may lose support or approval
Uncomfortable being alone. Urgently seeks another relationship when a close one ends.
Dependent Personality Disorder(cluster C)
Epidemiology of Dependent PD
• Females diagnosed more than males
• Tend to be youngest children
What are the tx options for personality disorders?
Psychodynamic psychotherapy – to change the defenses
Supportive if too unstable or minimal insight
Behavioral (DBT) if self destructive behavior
Psychopharm – to target symptoms. Serotonin for impulse control, rejection sensitivity, mood stabilizer for lability, affect dysregulation
is an interplay between genetic factors (temperament), environmental factors (character) and biological factors (development) and psyche
are adaptive and universal. When they become rigid or inappropriate for reality, they may become symptoms
____tends to be more detached and eccentric
_____ tends to be more dramatic & self-focused
_____ tends to be more anxious