Personality disorders 2008
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Personality disorders 2008
- 2. Learning Objectives Be able to recognize each of the 10 Personality Disorders when presented with a case history Be able to predict how these patients might commonly react to medical illnesses Be able to name a specific technique that may be employed by a physician to successfully interact with a patient with each of the 10 Personality Disorders
- 3. The totality of emotional and behavioral traits that characterize the person in day-to-day living under ordinary conditions. Relatively stable and predictable
- 5. Deeply ingrained, inflexible, and maladaptive patterns of relating to and perceiving both the environment and themselves. Influence cognition, affect, behavior and interpersonal style. Cause subjective distress or significant functional impairment. Symptoms are alloplastic and egosyntonic. 5-10% of the population. 60% of inpatient psychiatry patients. 12-100% of psychiatric outpatients with mood disorder
- 6. Axis II pathology affects the predisposition, presentation, course, and prognosis of Axis I pathology
- 8. Pattern not better accounted for as a manifestation of another disorder Not due to substance or GMC (e.g., head trauma) Person must meet the general criteria before a specific PD is diagnosed Coded on Axis II
- 9. Lack insight into PD (seek treatment for Axis I problem or relationship problems) PD symptoms are egosyntonic = feels like a normal part of oneself Most have interpersonal problems Can be difficult to diagnose in initial session Intractable, difficult to treat; can affect treatment of other disorders
Notas del editor
- Psychological Medicine Block Year 3, 24/2/2008
- The totality of emotional and behavioral traits that characterize the person in day-to-day living under ordinary conditions. Relatively stable and predictable
- Normal Personality actively organizes, integrates, and regulates experiences and behaviour to enable individuals to reach their goal cognitive and behavioural transformation of experience of the self and the environment striving to attain long term strategic goals (goal directed behaviour)- adaptation coordinate life experiences and provide direction for people’s lives problem is that traits and personality processes can only be inferred from behaviour Traits: Normal personality is believed to be governed by traits Traits are relatively stable and enduring aspects of the person that are assumed to be continuously distributed
- Definition of Personality A person’s general style of interacting with the world (or a consistent style of behavior) People differ from one another in ways that are relatively consistent over time and place
- B. DSM-IV General criteria for personality disorder Can children be dx with a PD? Yes -- Adolescents (under 18) and children may receive PD dx except for Antisocial PD pervasive - spreading or spread throughout Inflexible - Incapable of being changed; unalterable
- - Phinneus Gage
- PDs classified within clusters defined by common features
- Paranoid Personality Disorders DSM-IV (p. 637): A. A pervasive pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent as indicated by 4 OR MORE of the following: Suspects without sufficient basis, that others are exploiting, harming, or deceiving him or her Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her Reads hidden demeaning or threatening meanings into benign remarks or events Persistently bears grudges, i.e., is unforgiving or insults, injuries, or slights Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. B. Does not occur exclusively during the course of Schizophrenia, Mood Disorder with Psychotic Features, or another Psychotic Disorder
- Schizoid Personality Disorder DSM-IV (p. 641): 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 4 or more of: Neither desires nor enjoys close relationships, including being part of a family Almost always chooses solitary activities Has little, if any, interest in having sexual experiences with another person Takes pleasure in few, if any, activities Lacks close friends or confidants other than first-degree relatives Appears indifferent to the praise or criticism of others Shows emotional coldness, detachment, or flattened affectivity B. Does not occur exclusively during the course of Schizophrenia, Mood Disorder with Psychotic Features, or another Psychotic Disorder, or a Pervasive Developmental Disorder, Diagnostic Features:Schizoid Personality Disorder is a condition characterized by excessive detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This disorder should not be diagnosed if the distrust and suspiciousness occurs exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder or if it is due to the direct physiological effects of a neurological (e.g., temporal lobe epilepsy) or other general medical condition. Complications:Individuals with this disorder may have particular difficulty expressing anger, which contributes to the impression that they lack emotion. Their lives sometimes seem directionless, and they appear to ?drift? in their goals. These individuals often react passively to adversity and have difficulty responding appropriately to important life events. Because of their lack of social skills and lack of desire for sexual experiences, individuals with this disorder have few friendships and often do not marry. Occupational functioning may be impaired, particularly if interpersonal involvement is required, but individuals with this disorder may do well when they work under conditions of social isolation. Comorbidity:In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder. Other Personality Disorders (especially Schizotypal, Paranoid, and Avoidant) often co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:Schizoid Personality Disorder is uncommon in clinical settings. This disorder occurs slightly more commonly in males. Course:This disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, underachievement in school, which may attract teasing from their peers. The course of this disorder is chronic. Familial Pattern:This disorder is more common among first-degree biological relatives of those with Schizophrenia or Schizotypal Personality Disorder.
- Schizotypal Personality Disorder DSM-IV (p. 645): 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 5 or more of: Ideas of reference (excluding delusions of reference) Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms Unusual perceptual experiences, including bodily illusions Odd thinking and speech (e.g. vague, circumstantial, metaphorical, overelaborate, or stereotyped Suspiciousness or paranoid ideation Inappropriate or constricted affect Behavior or appearance that is odd, eccentric, or peculiar Lack of close friends or confidants other than first-degree relatives Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. Does not occur exclusively during the course of Schizophrenia, a Mood disorder with Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.
- Tortures are probably related to depression and low self-esteem Rituals are not prominent or incapacitating to warrant and OCD diagnosis, but may be considered “magical thinking”. No psychotic periods therefore a diagnosis of schizotypal is warranted.
- Diagnostic Features:Paranoid Personality Disorder is a condition characterized by excessive distrust and suspiciousness of others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This disorder should not be diagnosed if the distrust and suspiciousness occurs exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder or if it is due to the direct physiological effects of a neurological (e.g., temporal lobe epilepsy) or other general medical condition. Complications:Individuals with this disorder are generally difficult to get along with and often have problems with close relationships because of their excessive suspiciousness and hostility. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations. Individuals with this disorder have a need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves. They often become involved in legal disputes. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. More severely affected individuals with this disorder may be perceived by others as fanatics and form tightly knit cults or groups with others who share their paranoid beliefs. Comorbidity:In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Alcohol and Substance-Related Disorders. Other Personality Disorders (especially Schizoid, Schizotypal, Narcissistic, Avoidant, and Borderline) often co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Paranoid Personality Disorder is about 0.5%-2.5% of the general population. It is seen in 2%-10% of psychiatric outpatients. This disorder occurs more commonly in males. Course:This 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 idiosyncratic fantasies. These children may appear to be ?odd? or ?eccentric? and attract teasing. The course of this disorder is chronic. Familial Pattern:This disorder is more common among first-degree biological relatives of those with Schizophrenia and Delusional Disorder, Persecutory Type.
- Diagnostic Features:Schizotypal Personality Disorder is a condition characterized by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This disorder should not be diagnosed if the distrust and suspiciousness occurs exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder or if it is due to the direct physiological effects of a neurological (e.g., temporal lobe epilepsy) or other general medical condition. Complications:Individuals with this disorder often seek treatment for the associated symptoms of anxiety, depression, or other negative emotions rather than for the personality disorder features per se. Comorbidity:In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Brief Psychotic Disorder, Schizophreniform Disorder, Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder. Other Personality Disorders (especially Schizoid, Paranoid, Avoidant, and Borderline) often co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:Schizoid Personality Disorder occurs in 3% of the general population. This disorder occurs slightly more commonly in males. Course:This disorder may first appear in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and bizarre fantasies. These children may appear ?odd? or ?eccentric? and attract teasing. The course of this disorder is chronic. Only a small proportion of individuals with this disorder go on to develop Schizophrenia or another Psychotic Disorder. Familial Pattern:This disorder is more common among first-degree biological relatives of those with Schizophrenia. There is a modest increase in Schizophrenia and other Psychotic Disorders in the relatives of individuals with Schizotypal Personality Disorder.
- Antisocial Personality Disorder: DSM-IV (p.649): A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 OR MORE of Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure Impulsivity or failure to plan ahead Irritability and aggressiveness, as indicated by repeated physical fights or assaults Reckless disregard for safety of self or others Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Lack of remorse, as indicated by begin indifferent to or rationalizing having hurt, mistreated, or stolen from another B. The individual is at least age 18 C. There is evidence of Conduct Disorder with onset before age 15 D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode
- Borderline Personality Disorder DSM-IV (p. 654): A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 OR MORE of: Frantic efforts to avoid real or imagined abandonment (does not include suicidal or self-mutilating behavior from Criterion 5) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation Identity disturbance: markedly and persistently unstable self-image or sense of self Impulsivity in at lease two areas that are potentially self-damaging (e.g. spending, sex , substance abuse, reckless driving, binge eating) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress-related paranoid ideation or severe dissociative symptoms
- Histrionic Personality Disorder DSM-IV (p. 657) A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of: Is uncomfortable in situations in which he or she is not the center of attention Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior Displays rapidly shifting and shallow expression of emotions Consistently uses physical appearance to draw attention to self Has a style of speech that is excessively impressionistic and lacking in detail Show self-dramatization, theatricality, and exaggerated expression of emotion Is suggestible, i.e., easily influenced by others or circumstances Considers relationships to be more intimate than they actually are
- Diagnostic Features:Histrionic Personality Disorder is a condition characterized by excessive emotionality and attention-seeking. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. Complications:Individuals with this disorder may have difficulty achieving emotional intimacy in romantic relationships. Without being aware of it, they often act out a role (e.g., "victim" or "princess"). They may seek to control their partner through emotional manipulation or seductiveness on one level, whereas displaying a marked dependency on them at another level. Individuals with this disorder often have impaired relationships with same-sex friends because of their sexually provocative behavior or their demands for constant attention. They crave novelty, stimulation, and excitement and have a tendency to become bored with their usual routine. Although they often initiate a job or project with great enthusiasm, their interest may lag quickly. The actual risk of suicide is not known, but individuals with this disorder are at increased risk for suicidal gestures and threats to get attention and coerce better care giving. Comorbidity:Somatization Disorder, Conversion Disorder, Major Depressive Disorder and other Personality Disorders (especially Borderline, Narcissistic, Antisocial, and Dependent) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The frequency of this disorder is equal in males and females, and this disorder is present in about 2%-3% of the general population (and 10%-15% of psychiatric outpatients). Course:It usually begins in early adulthood, and has a chronic course.
- Narcissistic Personality Disorders DSM-IV (p. 661): A. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by 5 OR MORE of: Has a grandiose sense of self-importance (e.g. exaggerates achievements and talent, expects to be recognized a superior without commensurate achievements) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty , or ideal love Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) * will devalue their credentials if they are questioned or disappointed Requires excessive admiration Has a sense of entitlement, i.e., unreasonable expectations of specially favorable treatment or automatic compliance with his or her expectations Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends Lacks empathy: is unwilling to recognized or identify with the feelings and needs of others Is often envious of others or4 believes that others are envious of him or her Show arrogant haughty behaviors or attitudes
- Diagnostic Features:Narcissistic personality disorder is a condition characterized by an inflated sense of self-importance, need for admiration, extreme self-involvement, and lack of empathy for others. Individuals with this disorder are usually arrogantly self-assured and confident. They expect to be noticed as superior. Many highly successful individuals might be considered narcissistic. However, this disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. Complications:Vulnerability in self-esteem makes individuals with this disorder very sensitive to criticism or defeat. Although they may not show it outwardly, criticism may haunt these individuals these individuals and may leave them feeling humiliated, degraded, hollow, and empty. They may react with disdain, rage, or defiant counterattack. Their social life is often impaired due to problems derived from entitlement, the need for admiration, and the relative disregard for the sensitivities of others. Though their excessive ambition and confidence may lead to high achievement; performance may be disrupted due to intolerance of criticism or defeat. Sometimes vocational functioning can be very low, reflecting an unwillingness to take a risk in competitive or other situations in which defeat is possible. Individuals with this disorder have special difficulties adjusting to growing old and losing their former ?superiority?. Comorbidity:In this disorder, sustained feelings of shame or humiliation and the attendant self-criticism may be associated with social withdrawal, depressed mood, and Dysthymic or Major Depressive Disorder. In contrast, sustained periods of grandiosity may be associated with a hypomanic mood. Anorexia Nervosa, Substance-Related Disorders (especially related to cocaine), and other Personality Disorders (especially Histrionic, Borderline, Antisocial, and Paranoid) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Narcissistic Personality Disorder is less than 1% of the general population. It is seen in 2% to 16% of psychiatric outpatients. This disorder is more frequent in males (50% to 75%) than females. Course:Narcissistic traits are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this narcissistic behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.
- On testing, Gary had a verbal IQ of 140, demonstrating a remarkably good fund of knowledge considering his poor schooling. His performance IQ was 120 and his full-scale IQ was 129. Criminal acts may be understood as an expression of subcultural norms (e.g. group delinquent behavior), or isolated responses of an individual to a desperate situation (e.g. stealing a snowsuit for a child when she has no money) or as a symptom of a psychological disorder (e.g. writing a bad check in a manic phase, violence during a psychotic episode). In this case, there is a pervasive and life-long pattern of antisocial behavior lack of sympathy of guilt- perhaps the most salient features which became emphasized in DSM-III-R Diagnostic Features: Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder. For this diagnosis to be given, the individual must be at least 18, and must have had some symptoms of Conduct Disorder (i.e., delinquency) before age 15. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. Complications:Individuals with this disorder have an increased risk of dying prematurely by violent means (e.g., suicide, accidents, and homicide). Prolonged unemployment, interrupted education, broken marriages, irresponsible parenting, homelessness, and frequent incarceration are common with this disorder. Comorbidity:Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling (and other impulse control disorders), and other Personality Disorders (especially Borderline, Histrionic, and Narcissistic) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Antisocial Personality Disorder in the general population is about 3% in males and 1% in females. It is seen in 3% to 30% of psychiatric outpatients. Course:The course of this disorder is chronic. This disorder is usually worse in young adulthood and often improves in middle age. Familial Pattern:This disorder is more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders and Somatization Disorder.
- Diagnostic Features:Narcissistic personality disorder is a condition characterized by an inflated sense of self-importance, need for admiration, extreme self-involvement, and lack of empathy for others. Individuals with this disorder are usually arrogantly self-assured and confident. They expect to be noticed as superior. Many highly successful individuals might be considered narcissistic. However, this disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. Complications:Vulnerability in self-esteem makes individuals with this disorder very sensitive to criticism or defeat. Although they may not show it outwardly, criticism may haunt these individuals these individuals and may leave them feeling humiliated, degraded, hollow, and empty. They may react with disdain, rage, or defiant counterattack. Their social life is often impaired due to problems derived from entitlement, the need for admiration, and the relative disregard for the sensitivities of others. Though their excessive ambition and confidence may lead to high achievement; performance may be disrupted due to intolerance of criticism or defeat. Sometimes vocational functioning can be very low, reflecting an unwillingness to take a risk in competitive or other situations in which defeat is possible. Individuals with this disorder have special difficulties adjusting to growing old and losing their former ?superiority?. Comorbidity:In this disorder, sustained feelings of shame or humiliation and the attendant self-criticism may be associated with social withdrawal, depressed mood, and Dysthymic or Major Depressive Disorder. In contrast, sustained periods of grandiosity may be associated with a hypomanic mood. Anorexia Nervosa, Substance-Related Disorders (especially related to cocaine), and other Personality Disorders (especially Histrionic, Borderline, Antisocial, and Paranoid) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Narcissistic Personality Disorder is less than 1% of the general population. It is seen in 2% to 16% of psychiatric outpatients. This disorder is more frequent in males (50% to 75%) than females. Course:Narcissistic traits are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this narcissistic behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.
- Mood disturbance is not sufficiently sustained or associated with other symptoms to warrant a diagnosis of an affective disorder. Difficulty with impulse control (more examples of storming out), manipulation of other people, and unstable interpersonal relationships. Some narcissistic traits also. Diagnostic Features: Emotionally Unstable (Borderline) Personality Disorder is a condition characterized by impulsive actions, rapidly shifting moods, and chaotic relationships. The individual usually goes from one emotional crisis to another. Often there is dependency, separation anxiety, unstable self-image, chronic feelings of emptiness, and threats of self-harm (suicide or self-mutilation). This disorder is only diagnosed when these behaviors become persistent and very disabling/distressing. Complications:Completed suicide occurs in 8%-10% of individuals with this disorder, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent job losses, interrupted education, and broken marriages are common. Comorbidity:Very stressful or chaotic childhoods are commonly reported (e.g., physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation). Mood disorders, Substance-Related Disorders, Eating Disorders (usually Bulimia), Posttraumatic Stress Disorder, Attention-Deficit/Hyperactivity Disorder, and other Personality Disorders frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Emotionally Unstable (Borderline) Personality Disorder is about 2% of the general population. It is seen in 10% of psychiatric outpatients, and 20% of psychiatric inpatients. This disorder is more frequent in females (about 75%) than males. Emotional instability and impulsivity are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this emotional instability and impulsivity persists and intensifies into adulthood; thus they become diagnosed with this disorder. Course:The course of this disorder is quite variable. The most common pattern is one of chronic instability in early adulthood. This disorder is usually worse in the young-adult years and it gradually decreases with age. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and vocational functioning. After about 10 years, about half of individuals with this disorder no longer meet the full criteria for Borderline Personality Disorder. Familial Pattern:This disorder is about 5 times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders, Antisocial Personality Disorder, and Mood Disorders.
- A. A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by FOUR OR MORE of the following: Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection Is unwilling to get involved with people unless certain of being liked Shows restraint within intimate relationships because of the fear of being shamed or ridiculed Is preoccupied with being criticized or rejected in social situations Is inhibited in new interpersonal situations because of feelings of inadequacy Views self as socially inept, personally unappealing, or inferior to others Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. Diagnostic Features: Anxious (Avoidant) Personality Disorder is a condition characterized by extreme shyness, feelings of inadequacy, and sensitivity to rejection. These individuals feel inferior to others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This diagnosis should be used with great caution in children and adolescents for whom shy and avoidant behavior may be appropriate (e.g., new immigrants). Complications:Loss and rejection may be so painful that the individual with this disorder will choose loneliness rather than risk trying to connect with others. The individual with this disorder has few close friends, but often is very dependent on them. Individuals with this disorder are described by others as being "shy", "timid," "lonely," and "isolated". Their occupational functioning may also suffer because they avoid the social situations that are important for job advancement. Comorbidity:Mood and Anxiety Disorders (especially Social Phobia), and other Personality Disorders (especially Dependent, Borderline, Paranoid, Schizoid and Schizotypal) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Anxious (Avoidant) Personality Disorder is about 0.5% to 1% of the general population. It is seen in 10% of psychiatric outpatients. Course:The course of this disorder is chronic. This disorder is usually worse earlier in life and often improves in middle age. This avoidant behavior often starts in infancy or childhood with shyness, isolation, and fear of strangers and new situations. Unfortunately, for some, this avoidant behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder. This disorder is equally frequent in males and females.
- A. A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5 OR MORE of: Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others Needs others to assume responsibility for most major areas of his or her life Has difficulty expressing disagreement with others because of fear of loss of support or approval Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself Urgently seeks another relationship as a source of care and support when a close relationship ends Is unrealistically preoccupied with fears of being left to take care of himself or herself Diagnostic Features: Dependent Personality Disorder is a condition characterized by an over-reliance on others that leads to submissive and clinging behavior and fears of separation. The dependent and submissive behaviors arise from feeling unable to cope without the help of others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This diagnosis should be used with great caution, if at all, in children and adolescents, for whom dependent behavior may be developmentally appropriate. Complications:Complications of this disorder are increased risk of: depression; alcohol or drug abuse; physical, emotional, or sexual abuse. Occupational functioning is impaired if independent initiative is required. The individual avoids positions of responsibility and becomes anxious when faced with decisions. Social relations tend to be limited to those few people on whom the individual is dependent. Comorbidity:Mood Disorders, Anxiety Disorders, Adjustment Disorder, and other Personality Disorders (especially Borderline, Avoidant, and Histrionic) frequently co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:This disorder is more frequent in females, and is present in about 0.5% of the general population. Course:It usually begins in early adulthood, and has a chronic course. Dependent behavior is very common in childhood, but most adolescents grow out of this behavior. Unfortunately, for some, this dependent behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder. Chronic physical illness or Separation Anxiety Disorder in childhood or adolescence may predispose the individual to develop this disorder
- A. A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4 OR MORE of: Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. Shows perfectionism that interferes with task completion (e.g. is unable to complete a project because his or her own overly strict standards are not met) Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). Is unable to discard worn-out or worthless objects even when they have no sentimental value Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes Show rigidity and stubbornness. OCPD- a pervasive pattern or preoccupation with orderliness, perfectionism, and control which must begin by early adulthood OCAD- obsessions (persistent ideas or thoughts usually around contamination that the individual recognizes as the product of hiss or her own mind) and compulsions (repetitive behaviors to prevent or reduce anxiety or distress)
- Diagnostic Features:Obsessive-Compulsive Personality Disorder is a condition characterized by a chronic preoccupation with rules, orderliness, and control. This disorder is only diagnosed when these behaviors become persistent and disabling. The individual with this disorder often becomes upset when control is lost. The individual then either emotionally withdraws from these situations, or becomes very angry. The individual usually expresses affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. The person often has difficulty expressing tender feelings, and rarely pays compliments. Complications:The individual's chronic preoccupation with rules, orderliness, and control seems to prevent many of the complications (e.g., drug abuse, reckless sex, financial irresponsibility) that are common to some other personality disorders. Occupationally, the individual tends to be a high achiever with an excessive devotion to work. However, inflexibility, perfectionism, preoccupation with detail, and inability to delegate work may seriously interfere with the individual's ability to complete a given task. The individual experiences occupational difficulties when confronted with new situations that demand flexibility and compromise. Comorbidity:Obsessive-Compulsive Disorder should not be confused with Obsessive-Compulsive Personality Disorder. The majority of individuals with Obsessive-Compulsive Disorder do not have Obsessive-Compulsive Personality Disorder. Anxiety Disorders (e.g., Generalized Anxiety Disorder and Obsessive-Compulsive Disorder, Social Phobia, Specific Phobias), Mood Disorders, and Eating Disorders often co-occur with this disorder. Associated Laboratory Findings:No laboratory test has been found to be diagnostic of this disorder. Prevalence:The prevalence of Obsessive-Compulsive Personality Disorder is about 1% of the general population. It is seen in 3%-10% of psychiatric outpatients. It is twice as common in males as females. Course:It usually begins in early adulthood, and has a chronic course.