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  Personality Disorders (Supplement)

Posted: August 01, 2007 21:24
Concord Dependency Seminar 31 July 2007.

Dr Glenys Dore, Senior Staff Specialist Psychiatrist, NSCCAHS

Summary Supplement

Paranoid personality disorder: SUSPECT (four criteria)

S (1) Suspicious of others

U (5) Unforgiving (bears grudges)

S (7) Spouse fidelity suspected

P (6) Perceives attacks (and reacts quickly)

E (2) "Enemy or friend" (suspects associates &friends)

C (3) Confiding in others feared

T (4) Threats perceived in benign events

Mrs F complained that people at work disliked her and she contemplated seeking legal advice as she thought they wanted her to leave. She had prolonged disagreements with the pay office about salary and conditions. When she requested a change of appointment with her doctor she "knew" it would be rejected despite it being offered, and complained bitterly about inflexible health professionals" Harari &Meares 2001

Schizoid personality disorder: DISTANT (four criteria)

D (7) Detached or (flattened) affect

I (6) Indifferent to criticism and praise

S (3) Sexual experiences of little interest

T (2) Tasks (activities) done solitary

A (5) Absence of close friends

N (1) Neither desires nor enjoys close relations

T (4) Takes pleasure in few activities

Schizoid personality disorder

Marjorie, a nurse, worked in the night shift in a small hospital. She lived alone with her 6 cats and saw her family only on Christmas Day, an event which she found most anxiety-provoking. Born of elderly parents, she had always been quiet and remote, a compliant child who seemed to need no company. In adult life she found it difficult to understand other people's need for friends and believed that an emotional life was 'unnecessary'. Harari &Meares 2001

Schizotypal personality disorder: ME PECULIAR (five criteria)

M (2) Magical thinking or odd beliefs

E (3) Experiences unusual perceptions

P (5) Paranoid ideation

E (7) Eccentric behaviour or appearance

C (6) Constricted (or inappropriate) affect

U (4) Unusual (odd) thinking and speech

L (8) Lacks close friends

I (1) Ideas of reference

A (9) Anxiety in social situations

R (10) Rule out psychotic disorders and pervasive developmental disorder

Avoidant personality disorder: CRINGES (four criteria)

C (2) Certainty (of being liked required before willing to get involved with others)

R (4) Rejection (or criticism) preoccupies one's thoughts in social situations

I (3) Intimate r'ships (restraint in intimate relationships for fear of being shamed)

N (5) New interpersonal relationships (is inhibited in)

G (1) Gets around occupational activity (involving significant interpersonal contact)

E (7) Embarrassment (potential) prevents new activity or taking personal risks

S (6) Self viewed (as unappealing, inept or inferior)

Dependent personality disorder: RELIANCE (five criteria)

R (1) Reassurance (required for decisions)

E (3) Expressing disagreement difficult (due to fear of loss of support or approval)

L (2) Life responsibilities (needs to have these assumed by others)

I (4) Initiating projects difficult (due to lack pf self confidence)

A (6) Alone (feels helpless and discomfort when alone)

N (5) Nurturance (goes to excessive lengths to obtain nurturance and support)

C (7) Companionship (another relationship is sought urgently when close relationship ends)

E (8) Exaggerated fears of being left to care for self

Obsessive-compulsive personality disorder: LAW FIRMS (four criteria)

L (1) Loses point of activity (due to preoccupation with detail)

A (2) Ability to complete tasks (compromised by perfectionism)

W (5) Worthless objects (unable to discard)

F (3) Friendships (and leisure activities) excluded (due to a preoccupation with work)

I (4) Inflexible, scrupulous, overconscientious (on ethics, values, or morality, not accounted for by religion or culture)

R (6) Reluctant to delegate (unless others submit to exact guidelines)

M (7) Miserly towards self and others

S (8) Stubbornness (and rigidity)

Histrionic personality disorder: PRAISE ME (five criteria)

P (2) Provocative (or sexually seductive) behaviour

R (8) Relationships (considered more intimate than they are)

A (1) Attention (uncomfortable when not the centre of attention)

I (7) Influenced easily

S (5) Style of speech (impressionistic, lacks detail)

E (3) Emotions (rapidly shifting and shallow)

M (4) Made up (physical appearance used to draw attention to self)

E (6) Emotions exaggerated (theatrical)

Narcissistic personality disorder: SPEEECIAL (five criteria)

S (3) Special (believes he or she is special and unique)

P (2) Preoccupied with fantasies (of unlimited success, power, brilliance, beauty or ideal love)

E (8) Envious (of others, or believes others are envious of him/her)

E (5) Entitlement

E (4) Excess admiration required

C (2) Conceited (grandiose sense of self importance)

I (6) Interpersonal exploitation

A (9) Arrogant (haughty)

L (7) Lacks empathy

Antisocial personality disorder: CORRUPT (Three criteria)

C (1) Conformity to law lacking

O (6) Obligations ignored

R (5) Reckless disregard for safety of self or others

R (7) Remorse lacking

U (2) Underhanded (deceitful, lies, cons others)

P (3) Planning insufficient (impulsive)

T (4) Temper (irritable and aggressive)

A Quick Guide to the Personality Disorders (adapted from "DSM Made Easy", an excellent reference tool for the busy clinician!)

"DSM-IV lists 10 personality disorders.... divided into three clusters, A, B, and C........ Five of the 10 have been studied reasonably well and therefore have greater validity than the rest: antisocial, borderline, obsessive-compulsive, schizoid, schizotypal."

Cluster A: "withdrawn, cold, suspicious, or irrational."

Paranoid Personality Disorder:....."distrustful and suspicious of others, whose motives are seen as malevolent."

Schizoid Personality Disorder:..... "isolated from social relationships and shows a restricted emotional range in interpersonal settings."

Schizotypal Personality Disorder:....... "isolation and discomfort with social relationships, as well as perceptual or cognitive distortions and peculiar behaviour."

Cluster B: "dramatic, emotional, and attention-seeking.....moods are labile and often shallow.......often have intense interpersonal conflicts."

Antisocial Personality Disorder:..... "Before age 15, for 12 months or more the patient [satisfied criteria for Conduct Disorder]...repeatedly violated rules, age appropriate societal norms, or the rights of others.... Since age 15, the patient has shown disregard for the rights of others in a variety of situations."

Borderline Personality Disorder: ......"unstable impulse control, interpersonal relationships, moods, and self-image."

Histrionic Personality Disorder: ...... "emotional excess and attention-seeking behaviors are present in a variety of situations"

Cluster C: "anxious and tense, ......... often overcontrolled."

Narcissistic Personality Disorder:...... "grandiosity (fantasized or actual), lack of empathy, and need for admiration"

Avoidant Personality Disorder:........."social inhibition, hypersensitivity to criticism, and feelings of inadequacy are present in a variety of situations"

Dependent Personality Disorder:..... "a need to be taken care of leads to clinging, submissive behaviour and fears of separation that are present in a variety of situations"

Obsessive-Compulsive Personality Disorder:....... "a preoccupation with control, orderliness, and perfection overshadow qualities of efficiency, flexibility, and candour."

Generic Criteria for Personality Disorders

1. A lasting pattern of behaviour and inner experience that markedly deviates from norms of the patient's culture..... evident in at least two of these areas:

. Affect

. Cognition

. Impulse control

. Interpersonal functioning

2. This pattern is fixed and affects many personal and social situations ....[and] causes clinically important distress or impairs work, social, or personal functioning.

3. This pattern has lasted a long time.......with roots in adolescence or young adulthood.

4. It isn't better explained by another mental disorder ......[and] isn't directly caused by a general medical condition or by the use of substances, including medications.

Full Diagnostic Criteria for Borderline Personality Disorder

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 the following:

. Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behaviour covered in criterion 5).

. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and evaluation.

. Identify disturbance: persistent and markedly disturbed, distorted, or unstable self-image or sense of self (eg. feeling like one does not exist or embodies evil).

. Impulsiveness in at least two areas that are potentially self damaging (eg. Spending, sex, substance abuse, shoplifting, reckless driving, binge eating - do not include suicide or self -mutilating behaviour covered in criterion 5).

. Recurrent suicidal threats, gestures, or behaviour, or self-mutilating behaviour.

. Affective instability: marked reactivity of mood (eg. 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 lack of control of anger (eg. Frequent displays of temper, constant anger, recurrent physical fights).

. Transient, stress-related severe dissociative symptoms or paranoid ideation.

Full Diagnostic criteria for 301.7 Antisocial Personality Disorder

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

. failure to conform to social norms with respect to lawful behaviours 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 behaviour or honour financial obligations

. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behaviour is not exclusively during the course of Schizophrenia or a Manic Episode.


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