- PD Work Group proposed sweeping changes
- new conceptualization, fewer types of PD, trait rating scales
- changes not approved
- retain DSM-IV-TR disorders
- but updated text
- pattern of inner experience and behavior that deviates from the expectations of individual's culture
- pervasive and inflexible
- onset in adolescence early adulthood
- stable over time
- leads to distress or impairment
- impairments in personality functioning amd pathological personality traits
Personality Functioning
a. Self
- identity (self as unique)
- self direction (ability to self reflect productively)
b. Interpersonal Functioning
- empathy
- intimacy
Pathological Personality Traits
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychotism
General Personality Disorder
- manifested in two or more areas; cognition, ways of perceiving self or others, affectivity, appropriateness of emotional response, intepersonal functioning, impulse control
1) Odd/Eccentric Cluster
a. Paranoid Personality Disorder
Four or more of the ff:
- suspects that others are exploiting, harming, or deceiving them
- unjustified doubt about loyalty or trust
- reluctant to confide with others
- bears grudges
- reads hidden demeaning or threatening meanings
- quick to react angrily or to counterattack
- has suspicions on infidelity
Theories
- psychoanalytic model (defense mechanism of projection)
- contemporary cognitive processing models (biases)
- integrative cognitive model (early maladaptive schemas, maladaptive coping mechanisms
Interventions
- Psychotherapy (enhance self-efficacy, social skills and empathy)
- collaborative empiricism
b. Schizoid Personality Disorder
- detachment from social relationships and restricted emotional expression
c. Schizotypal Personality Disorder
- acute discomfort in close relationships
- cognitive or perceptual distortions
- eccentricities of behavior
2) Emotional/Erratic Cluster
a. Antisocial Personality Disorder
- pattern of disregard for and violation of tbe rights of others
- occur since age 15, the individual is at least 18 years or older
- there is evidence of conduct disorder before age 15
Criteria
- failure to conform to social norms with respect to lawful behaviors
- deceitfulness, repeated lying, conning others for personal profit
- impulsive, failure to plan ahead
- irritability, aggressiveness, repeated fights or assaults
- reckless disregard safety of self or others
- irresponsible, failure to sustain work behavior or honor financial obligations
- lack of remorse
Theories
- biological
- psychosocial (family, adoptive home)
Interventions
- CBT
- skills for family members
b. Borderline Personality Disorder
- frantic efforts to avoid real or imagined abandonment
- pattern of unstable and intense interpersonal relationships (alternating between extremes)
- identity disturbances
- impulsitivity
- recurreng suicidal behavior
- emotional instability
- chronic feelings of emptiness
-difficulty controlling anger
- stress related paranoid thoughts or dissociative symptoms
Etiology
- genetics
- environmental factors (childhood abuse, neglect, separation from loved ones)
- brain abnormalities
Theories
- psychodynamic perspective (childhood separation from mother - mahler)
- family perspective
- biological perspective
Interventions
- psychotherapy (coping skills, emotional regulation)
- hospitalization
- medication (antipsychotic, antianxiey, antidepressants)
- self help
c. Histrionic Personality Disorder
- excessive emotionality
- attention seeking
d. Narcissistic Personality Disorder
- pattern of grandiosity
- pathological need for admiration
- lack of empathy
3) Anxious/Fearful Cluster
a. Avoidant Personality Disorder
- pattern of social inhibition
- feelings of inadequacy
- hypersensitive to negative evaluation
b. Dependent Personality Disorder
- submissive and clinging behavior
- excessive need to be taken care of
c. Obssessive-Compulsive Personality Disorder
- preoccupied with details, rules, list, order, schedules to the extent that the major point of the activity is lost
- shows perfectionism that interferes with task completion
- excessively devoted to work
- overconscientious, inflexible about matters of morality, ethics or values
- unable to discard worthless objects even they have no sentimental value
- reluctant to delegate tasks or work to others
- money is viewed as something to be hoarded for future catastrophes
- rigidity or stubbornness
Theories
- cognitive
- biological
Interventions
- CBT (relaxation)
- psychodynamic therapy
- psychopharmacotherapy
Other Conditions that may be the focus of Clinical Attention (ICD-9 V and ICD-10 Z codes)
- relational problems
- abuse and neglect
- educational or occupational problems
- housing and economic problems
- other social environment problems
- crime or legal system
- psychosocial or environmental circumstances
- health service encounters for counseling and medical advice
- other circumstances of personal history
