Tiêu đề 12 AbPsy - Personality Disorders.pdf ✅

12 – Personality Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Overview of Personality Disorders 2. Paranoid Personality Disorder 3. Schizoid Personality Disorder 4. Schizotypal Personality Disorder 5. Antisocial Personality Disorder 6. Borderline Personality Disorder 7. Histrionic Personality Disorder 8. Narcissistic Personality Disorder 9. Avoidant Personality Disorder 10. Dependent Personality Disorder 11. Obsessive-Compulsive Personality Disorder OVERVIEW OF PERSONALITY DISORDERS ASPECTS OF PERSONALITY DISORDERS Personality Disorder – enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture ● Personality disorders are described as chronic because unlike many disorders, they originate in childhood and continue throughout adulthood ● Behavior results in enduring emotional distress for the person affected and/or for others ● May cause difficulties with work and relationships ● Individuals with personality disorders may not feel any subjective distress ○ Others may acutely feel distress because of the actions of the person with the disorder ○ Particularly common with antisocial personality disorder ● Many people who have personality disorders in addition to other psychological problems tend to do poorly in treatment ● In the DSM-IV-TR, personality disorders were included in Axis II ○ As a group they were seen as distinct ○ It was thought that the characteristic traits were more ingrained and inflexible in people who have personality disorders DIAGNOSTIC CRITERIA FOR GENERAL PERSONALITY DISORDER A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events). 2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response). 3. Interpersonal functioning. 4. Impulse control. B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration, and Its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better explained as a manifestation or consequence of another mental disorder. F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma). CATEGORICAL AND DIMENSIONAL MODELS ● Problems of people with personality disorders may just be extreme versions of day-to-day and temporary problems ● Dimensions: extreme versions of otherwise typical personality variations ○ Individuals would not only be given categorical diagnoses but also would be rated on a series of personality dimensions ○ Focuses on a continuum of disturbances of “self ” and interpersonal functioning ○ Advantages ■ Retains more information about each individual ■ More flexible because it would permit both categorical and dimensional differentiations among individuals ■ Avoids the often arbitrary decisions involved in assigning a person to a diagnostic category ● Categories: ways of relating that are different from psychologically healthy behavior ○ Mere act of using categories leads clinicians to reify them PERSONALITY DISORDER CLUSTERS Cluster A Odd or eccentric cluster Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Cluster B Dramatic, emotional, or erratic cluster Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder 1 | @studywithky
Cluster D Anxious or fearful cluster Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder STATISTICS AND DEVELOPMENT Statistics ● As many as 1 in 10 adults in the United States may have a diagnosable personality disorder ● Worldwide, about 6% of adults may have at least one personality disorder ● More women were diagnosed with borderline personality disorder and more men identified with antisocial personality disorder Development ● Personality disorders were thought to originate in childhood and continue into the adult years ● Sophisticated analyses suggest that personality disorders can remit over time ● A person could receive a diagnosis of one personality disorder at one point in time and then years later no longer meet the criteria for his original problem but now have characteristics of a second (or third) personality disorder GENDER DIFFERENCE ● Although gender differences are evident in the research of personality disorders, some differences in the findings may be the result of bias ○ Criterion Gender Bias: criteria for the disorder may themselves be biased ○ Assessment Gender Bias: assessment measures and the way they are used may be biased ● Men tend to display traits characterized as more aggressive, structured, self-assertive, and detached ● Women tend to present with characteristics that are more submissive, emotional, and insecure ● Antisocial personality disorder is present more often in males and dependent personality disorder more often in females ● Equal numbers of males and females may have histrionic and borderline personality disorders COMORBIDITY PERSONALITY DISORDERS UNDER STUDY ● Sadistic Personality Disorder: includes people who receive pleasure by inflicting pain on others ● Passive-Aggressive Personality Disorder: includes people who are defiant and refuse to cooperate with requests ○ attempting to undermine authority figures PARANOID PERSONALITY DISORDER DEFINING PARANOID PERSONALITY DISORDER Paranoid Personality Disorder – pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent ● They are excessively mistrustful and suspicious of others, without any justification ● They assume other people are out to harm or trick them; therefore, they tend not to confide in others ● Most other people would agree their suspicions are unfounded ● Mistrust often extends to people close to them and makes meaningful relationships difficult ● Individuals are sensitive to criticism and have an excessive need for autonomy ● May be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and idiosyncratic fantasies DIAGNOSTIC CRITERIA G. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 2 | @studywithky
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights. 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner H. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).” CAUSES / RISK FACTORS Genetic and Physiological Risks ● Increased prevalence in relatives of probands with schizophrenia ● A more specific familial relationship with delusional disorder, persecutory type Psychological Contributions ● Retrospective research suggests that early mistreatment or traumatic childhood experiences may play a role in the development ● Maladaptive view of the world ○ “People are malevolent and deceptive” ○ “They’ll attack you if they get the chance” ○ “You can be okay only if you stay on your toes” ● Vigilance causes them to see signs that other people are deceptive and malicious Cultural Factors ● Prisoners, refugees, people with hearing impairments, and older adults, are thought to be particularly susceptible ● Cognitive and cultural factors may interact to produce the suspiciousness DIAGNOSTIC ISSUES Culture ● Members of minority groups, immigrants, political and economic refugees, or individuals of different ethnic backgrounds may display guarded or defensive behaviors because of unfamiliarity ● It should not be confused with paranoid personality disorder ● Some ethnic groups also display culturally related behaviors that can be misinterpreted as paranoid DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Other Personality Disorders ● If an individual has personality features that meet criteria for one or more personality disorders in addition to paranoid personality disorder, all can be diagnosed ● Individuals with behaviors that meet criteria for schizoid personality disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation ● People with avoidant personality disorder may also be reluctant to confide in others, but more from fear of being embarrassed or found inadequate than from fear of others' malicious intent ● Paranoid ● Personality disorder should be diagnosed only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress. TREATMENT ● Unlikely to seek professional help ● Therapists provide an atmosphere conducive to developing a sense of trust ● Cognitive Therapy: counter the person’s mistaken assumptions about others, focusing on changing the person’s beliefs that all people are malevolent and most people cannot be trusted SCHIZOID PERSONALITY DISORDER DEFINING SCHIZOID PERSONALITY DISORDER Schizoid Personality Disorder – pattern of detachment from social relationships and a restricted range of emotional expression ● They seem aloof, cold, and indifferent to other people ● Schizoid: used by Bleuler to describe people who have a tendency to turn inward and away from the outside world ● Seem neither to desire nor to enjoy closeness with others, including romantic or sexual relationships ● Homelessness appears to be prevalent as a result of their lack of close friendships and lack of dissatisfaction about not having a sexual relationship with another person ● They consider themselves to be observers rather than participants in the world around them ● Ideas Of Reference: mistaken beliefs that meaningless events relate just to them ● May be first apparent in childhood and adolescence with solitariness, poor peer relationships, and underachievement in school 3 | @studywithky
DIAGNOSTIC CRITERIA A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, activities. 5. Lacks close friends or confidants other than first-degree relatives. 6. Appears indifferent to the praise or criticism of others. 7. Shows emotional coldness, detachment, or flattened affectivity B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizoid personality disorder (premorbid).” CAUSES / RISK FACTORS Genetic and Physiological Risks ● Increased prevalence in the relatives of individuals with schizophrenia or schizotypal personality disorder ● Very little empirical research has been published on the nature and causes of this disorder ● Research demonstrates significant overlap in the occurrence of autism spectrum disorder and schizoid personality disorder Environmental Risks ● Childhood shyness is reported as a precursor to later adult schizoid personality disorder ● Abuse and neglect in childhood are also reported among individuals with this disorder TREATMENT ● It is rare for a person with the disorder to seek treatment ● Therapists point out the value in social relationships ● May need to be taught the emotions felt by others to learn empathy ● Receive social skills training ● Role-Playing: therapist takes the part of a friend or significant other and help the patient practice establishing and maintaining social relationships SCHIZOTYPAL PERSONALITY DISORDER DEFINING SCHIZOTYPAL PERSONALITY DISORDER Schizotypal Personality Disorder – pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior ● Considered by some to be on a continuum with schizophrenia ● DSM-5 includes this disorder under both the heading of a personality disorder and under the heading of a schizophrenia spectrum disorder ● They have psychotic-like symptoms (such as believing everything relates to them personally), social deficits, and sometimes cognitive impairments or paranoia ● They have ideas of reference ● They also have odd beliefs or engage in magical thinking ● Prospective research on children who later develop schizotypal personality disorder found that they tend to be passive and unengaged and are hypersensitive to criticism ● Often have beliefs around religious or spiritual themes ● Has a relatively stable course, with only a small proportion of individuals going on to develop schizophrenia or another psychotic disorder ● May be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and bizarre fantasies DIAGNOSTIC CRITERIA A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 4 | @studywithky