Personality Disorders

PERSONALITY

DISORDERS

NARCISSISTICDiagnosis:

1. has a grandiose sense of self-importance

2. preoccupied with fantasies of unlimited

success, power, brilliance, beauty or ideal love

3. believes that he or she is unique and can only

associate with other

special or high-status

people (or institutions).

4. requires excessive

admiration

NARCISSISTICDiagnosis:

5. has a sense of entitlement

6. interpersonally exploitative, i.e., takes advantage of others to achieve his or her

own ends

NARCISSISTICDiagnosis:

7. lacks empathy: unwilling to recognize or identify with the feelings of others

NARCISSISTICDiagnosis:

8. often envious of others or believes that others are envious of him or her

9. shows arrogant, haughty

behaviors or attitudes

NARCISSISTICDiagnosis:

Chronic and

difficult to treat

Aging is handled poorly

NARCISSISTICCourse and Prognosis:

PSYCHOTHERAPY-group therapy so patients can

learn how to share with others and to develop empathic response

PHARMACOTHERAPY-Lithium (Eskalith) for mood swings

and antidepressants—serotonicdrugs—because they’re susceptible

to depression

NARCISSISTICTreatment:

AVOIDANTDiagnosis

1. avoids activities involving interpersonal contact because of fears of criticism, disapproval and rejection

2. unwilling to get involved with people unless certain

of being liked

AVOIDANTDiagnosis

3. restraint within intimate

relationships for fear of being

ashamed or ridiculed

4. preoccupied with being criticized or rejected in social situations

AVOIDANTDiagnosis

5. inhibited in new interpersonal situations because of feelings of inadequacy

6. views self as socially inept, personally

unappealing, or inferior to others

AVOIDANTDiagnosis

7. usually reluctant to take personal risks or engage in any new activities

because they may prove embarrassing

AVOIDANTCourse and Prognosis

Many are able to function in a protected environment.

Should their support system fail, they are subject to

depression, anxiety and anger.

Phobic avoidance in common. Patients may give histories of social phobia.

AVOIDANTTreatment

PSYCHOTHERAPY-solidifying alliance with patients; therapist encourages a patient to move out into the world; assertiveness training- for patient to express needs openly

PHARMACOTHERAPY-serotonic drugs—help rejection sensitivity-dopaminergic drugs—engender novelty-seeking

behavior

DEPENDENTDiagnosis

1. difficulty making decisions without an excessive amount of advice and reassurance from others

2. needs others to assume

responsibility for most major areas of his or her

life

DEPENDENTDiagnosis

3. difficulty expressing disagreement with others because of fear of loss of support or approval

4. difficulty initiating projects or

doing things in his/her own

5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering things that are unpleasant

DEPENDENTDiagnosis

6. feels uncomfortable or helpless when alone because of

exaggerated fears of being unable to care for himself or herself

7. urgently seeks another relationship as a source of care and support when a close relationship ends8. unrealistically preoccupied with fears of being left to take care of oneself

DEPENDENTCourse and Prognosis

Occupational functioning tends to be impaired, because persons with

the disorder can’t act independently and without

close supervision.

DEPENDENTTreatment

PSYCHOTHERAPY -the treatment is often successful

-behavioral therapy, assertiveness training, family therapy,

group therapy

PHARMACOTHERAPY-psychostimulants are used for depression and withdrawalsymptoms

OBSESSIVE-COMPULSIVEDiagnosis

1. preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

2. shows perfectionism that interferes with task completion

3. excessively devoted to work and productivity to the exclusion of activities and friendships

OBSESSIVE-COMPULSIVEDiagnosis

4. overconscientious, scrupulous, inflexible about matters of morality,

ethics or values

5. unable to discard worn-out or

worthless objects even when they have no sentimental value

6. reluctant to delegate tasks or to work with others unless they

submit to exactly his/her way of doing things

OBSESSIVE-COMPULSIVEDiagnosis

7. adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

8. shows rigidity and

stubborness

OBSESSIVE-COMPULSIVECourse and Prognosis

This personality disorder is variable and unpredictable.

Persons may develop obsessions or compulsions in the course of their disorder.

OBSESSIVE-COMPULSIVETreatment

Group therapy and behavior therapy

occassionally offer certain advantages.

PHARMACOTHERAPYClonazepam

ClomipramineNefazodone

Personality Disorders not

Otherwise Specified

PASSIVE-AGGRESSIVEDiagnosis

• characteristically procrastinate

• resist demands for adequate performance

• find excuses for delays

• find fault with those on whom they depend

PASSIVE-AGGRESSIVEDiagnosis

• lack assertiveness

• not direct about their own needs

• fail to ask needed questions

• become anxious when forced to succeed

PASSIVE-AGGRESSIVEDiff erential Diagnosis

Less flamboyant, dramatic,

affective and openly

aggressive than those with

histrionic and borderline personality

DEPRESSIVEDiagnosis

• lonely, solemn, gloomy, submissive, pessimistic, self-deprecatory

• meticulous, perfectionistic, overconscientious, preoccupied with work

• easily discouraged, fearful of disapproval

• tend to suffer in silence, cry easily• tendency to hesitation, indecision

DEPRESSIVEDiff erential Diagnosis

Patients with avoidant personality disorder are introverted and dependent, but they

tend to be more anxious than

depressed, compared with persons with

depressive personality disorder.

SADOMASOCHISTICDiagnosis

SADISM—desire to cause others pain –either sexually abusive or generally physically or psychologically abusive

MASOCHISM—achievement of sexual gratification by inflicting pain on the self

SADISTICDiagnosis

• pervasive pattern of cruel, demeaning, and aggressive behavior that is directed toward others

• humiliate or demean persons in front of others

• treated or disciplined uncommonly harshly people, especially the children

PERSONALITY CHANGE DUE TO A GENERAL MEDICAL CONDITIONDiagnosis• characterized by a marked change in

personality style and traits from a previous level of functioning

• impaired control on the expression of emotions

• emotions are labile and shallow• damage to the frontal lobe: prominent

indifference and apathy• temporal lobe epilepsy: humorlessness,

hyperreligiosity, marked aggressiveness during seizures

• clear sensorium