Personality Disorders: Personality Disorders Marc A. Schuckit, M.D. University of California, San Diego VA San Diego Healthcare System


GREEK TEMPERAMENTS: GREEK TEMPERAMENTS Sanguine Melancholic Choleric Phlegmatic


FREUD: FREUD Oral Anal Phallic Genital


DEFINITIONS: DEFINITIONS Personality - Usual Emotional + Behavioral Characteristics Personality Traits - Components of Personality Temperament - Affective Tone, Intensity, Reactivity Character - Moral + Personality Traits


PERSONALITY DISORDERS: PERSONALITY DISORDERS Totality of Emotional + Behavioral Traits Onset Teens Enduring, Inflexible, Consistent, Maladaptive Causes Significant Impairment and/or Distress


DSM IV PD: DSM IV PD Axis II 10 Diagnoses + NOS + Appendix Polythetic Clusters


DSM IV PERSONALITY DISORDERS: DSM IV PERSONALITY DISORDERS Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive


CLUSTERS: CLUSTERS A. Odd or Eccentric Paranoid Schizotypal Schizoid B. Dramatic or Erratic Antisocial Histrionic Borderline Narcissistic C. Anxious Avoidant Obsessive - Compulsive Dependent


CHARACTERISTICS OF PD: CHARACTERISTICS OF PD Relation to Axis I 10% - 20% of General Population Gender : ASPD, Schizoid Avoidant, Dependent Etiological Theories Dynamic Biological / Genetic


PERSONALITY DISORDERS: PERSONALITY DISORDERS Totality of emotional + behavioral traits Onset teens Enduring, inflexible, consistent, maladaptive Causes significant impairment and/or distress


PARANOID PD: PARANOID PD Pervasive Distrust + Suspiciousness, Interpret Motives as Evil 4 + of : Suspicious Feels Attacked Preoccupation with Distrust Jealous Won’t Confide Grudges Misinterprets Motives


SCHIZOID PD: SCHIZOID PD Detached + Few Emotions 4 + of : Eschew Closeness No Close Friends Solitary Indifferent No Sex Interest Cold Not Enjoy Activities


SCHIZOTYPAL PD: SCHIZOTYPAL PD Discomfort with Relationships, Cognitive Distortions + Eccentric 5 + of : Ideas of Reference Odd Magical Beliefs Perceptual Disturbances Odd Thoughts/Speech Paranoia Inappropriate Affect Odd Behavior/Appearance Loner Anxious Socially


ANTISOCIAL PD (ASPD): ANTISOCIAL PD (ASPD) Disregard Rights of Others (and meet Conduct Disorder) 3 + of : Unlawful Reckless Deceitful Irresponsible Impulsive Lack Remorse Aggressive


BORDERLINE PD: BORDERLINE PD Unstable Relationships, Affect, Self-Image Plus Impulsiveness 5 + of : Fears Abandonment Mood Shifts Unstable Relationships Feels Empty Changing Self-Image Anger Impulsive Sex, Spending, Temporary Etc Paranoia Suicidal Behavior


HISTRIONIC PD: HISTRIONIC PD Excessive Emotionality, Attention Seeking 5 + of : Needs Attention Preens Seductive Dramatic Mood Shifts Suggestible Impressionistic, Exaggerates Vague Speech Relationships


NARCISSISTIC PD: NARCISSISTIC PD Grandiose, Needs Admiration, Without Empathy 5 + of : Self Important Exploitative Fantasies of Success Lacks Empathy Feels Special Envious Needs Admiration Arrogant Entitled


AVOIDANT PD: AVOIDANT PD Inhibited, Inadequate, Sensitive 4 + of : Avoids Social Activity Reluctant Relationships Fears Intimacy Fears Criticism Avoids New Activities Sees Self Inferior Fears Embarrassment


DEPENDENT PD: DEPENDENT PD Needs to be Taken Care of, Fears Separation 5 + of : Indecisive Seeks Nurturance Avoids Responsibility Fears Solitude Avoids Frantic for Disagreements Relationships Lacks Initiative Fears Abandonment


OBSESSIVE-COMPULSIVE PD: OBSESSIVE-COMPULSIVE PD Orderliness, Perfectionist, Inflexible 4 + of : Detail Oriented Unable to Discard Perfectionism Can’t Delegate Work Oriented Miserly Over Conscientious Rigid


PASSIVE-AGGRESSIVE PD: PASSIVE-AGGRESSIVE PD Negative Attitudes with Passive Resistance to Demands 4 + of : Passive Envious, Resentful Misunderstood, Exaggerated Unappreciated Complaints Sullen, Argumentative Defiant then Contrite Scorns Authority


Slide22: PERSONALITY DISORDERS Totality of Emotional + Behavioral Traits Onset Teens Enduring, Inflexible, Consistent, Maladaptive Causes Significant Impairment and/or Distress


SUMMARY PART I: SUMMARY PART I Paranoid Suspicious, Jealous, But Not Psychotic or Unlawful Schizoid Unemotional, Cold, Indifferent Schizotypal Odd + Magical Beliefs, Behaviors, Not Paranoid ASPD Aggressive, Unlawful, Impulsive Borderline Unstable, Chaotic, Impulsive Not Aggressive or Unlawful Histrionic Dramatic, Seductive But Not Chaotic


SUMMARY PART II: SUMMARY PART II Narcissistic Self-Centered, Entitled, Lacks Empathy But Not Unlawful or Chaotic Avoidant Needs People But Fears Relationships Dependent Needs Relationships, Indecisive, Fears Abandonment Obsessive- Rigid, Perfectionist + Inefficient Compulsive Passive- Negative Attitudes with Passive Aggressive Resistance to Demands


INSTRUMENTS FOR PD: INSTRUMENTS FOR PD Mostly Current Status Some Focus on Temperament or Personality Components Few Consider Full Diagnostic Syndrome