Lack insight of connection between their behaviors and interpersonal problems

Argue that their behavior is appropriate because the other person is the problem (externalize difficulties)

• Altered perception of self/other people/events (cognition)

• Altered interpersonal functioning/impulse control (affect) that is inflexible and pervasive

• Causes clinically significant distress/impairment in social or job

• Traced back at least to adolescence/early adulthood 

  • Sx must be present for 1yr to DX if < 18yo ( must be at least 18yo for antisocial DX)

Schizoid

• Voluntary detachment from social relationships with restricted range of emotional expression

Schizotypal

• Acute discomfort in close relationships with cognitive/perceptual distortions and eccentricities of behavior

Paranoid personality disorder

• Distrust/suspiciousness, other people's motives are perceived as malevolent

Antisocial

• Disregard for/violation of rights of others

Borderline

• ♀> ♂  

• Instability in interpersonal relationships and self-image

• Impulsive and moody

• Self-harm/sabotage, superficial wounds, restricted intake, reckless (unsafe sex)

• Benefits from DBT

Histrionic

• Excessive emotionality and attention seeking

Narcissistic

• Grandiosity, need for admiration, and lacks empathy

Avoidant

• Social inhibition (avoidance), feels inadequate, and hypersensitive to negative evaluation

Dependent

• Excessive need to be taken care of ➔ submissive and clingy

Obsessive compulsive personality disorder 

• MC personality disorder 

• Egosyntonic: behavior in agreement with self-image (they are OK being this way)

• Not obsessive compulsive disorder which is egodystonic (they don't like they are this way)

• Preoccupied with orderliness, perfectionism, control 

TX personality disorders

• First line TX is psychotherapy: DBT, CBT, STEPPS

  • Focus on current functioning and relationships

  • Help with emotional regulation to ↓ affective instability

  • Educate pt and family about disorder

• BOLO suicidality

Symptom domain TX

• Cognitive perceptual sx (typically stress-induced)

  • Dissociation, disturbed identity, paranoid, hallucinations

    • Low dose antipsychotic drugs

• Impulsive behavioral dyscontrol

  •  Self-injury, promiscuity, recklessness, gambling, binging, hostility/aggression

    • Mood stabilizers ±  omega-3 fatty acids

• Affective dysregulation

  • Depressed/dysphoria/labile mood, anxiety, anger

    • Mood stabilizers or low-dose antipsychotics

Disruptive mood dysregulation disorder

• Comorbid with CD/ODD, develop major depressive

• Must be older than 6yo for DX

• Severe outbursts of anger (verbal/behavioral) grossly disproportionate (intensity/duration) to situation or expected for age

  • At least 3x/wk for 1yr (without interruption for 3 consecutive months)

Oppositional defiant disorder

• Typically manifests in late preschool-early elementary 

• "Pre-conduct disorder"

• Associated with ADHD, family instability

• At least 6mo of at least 4 of the following when interacting with someone that IS NOT A SIBLING

  • Argues with authority figures

  • Deliberately annoying

  • Blames others for mistakes

  • Frequently loses temper

  • Easily annoyed

  • Resentful/angry

  • Vindictive or spiteful

  • Defies rules/refuses to comply

 Conduct disorder

• "Pre-anti-social"

• DX - Must be <18yo

  • Aggression toward people/animals

    • Bullying, fighting, weapons, cruelty to animals

  • Destroys property

    • Fires

  • Deceitful/theft

    • Steals or lies to get something

  • Serious rule violation 

    • Truancy, stays out late, runs away (all beginning before 13yo)

• TX

  • CBT, parent training

  • Stimulants for comorbid attention deficit

  • Antipsychotics/mood stabilizers if severe