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)