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Personality Disorders

What are personality disorders?


o Enduring subjective experiences and behavior that deviate from cultural
standards, manifested in at least 2 of following areas:
Cognition
Affectivity
Interpersonal functioning
Impulse control
o Inflexible and pervasive pattern across personal and social situations
o Result in unhappiness and impairment
o Onset can be traced to adolescence or early adulthood
Usualmente se dx a los 18 an os
o Not better accounted by another mental disorder
o Not due to effects from substances or GMC
*Any similarities between you and what is discussed in this conference are purely
coincidental
How do personality disorders originate?
o Genetic Factors As shown from twin studies and psychiatric disorder
epidemiology in relatives
o Biologic Factors
Hormones such as testosterone, 17- estradiol and estrone are
implicated
Niveles altos de estas hormonas se puede ver asociado a
mayor agresividad
Low Platelet Monoamine Oxidase
Se ha asociado a personas que no socializan mucho y que se
aislan
Saccadic smooth pursuit eye movements
NeurotransmittersLow levels of 5- hydroxyindolacetic acid (5-
HIAA); high levels of endorphins may be implicated
ElectrophysiologySlow wave activityon EEGs in some antisocial
and borderline patients
No son estudios completamente conclusivos
IMP: Trastorno antisocial es lo mas que se ha estudiado (mas
informacion que tenemos), por lo tanto lo mas que deben saber!
o Psychological Factors Each personality disorder has characteristic
mechanisms of defense that protect them from internal impulses and from
interpersonal anxiety
Personality disorders are divided in clusters:
o Cluster A Weird Odd or eccentric: Paranoid, Schizoid, Schizotypal
o Cluster B Wild Dramatic, emotional or erratic: Antisocial, Borderline,
Histrionic, Narcissistic
o Cluster C Worried Anxious or fearful: Avoidant, Dependent, Obsessive-
Compulsive



Paranoid Personality Disorder
DSM IV Criteria (4 or more)
o Suspicious, afraid of being deceived or exploited
o Unjustified doubts about others loyalty or trustworthiness
o Reluctant to confide in others because it will be used against them
o Reads hidden malicious meanings in benign remarks or events
Ej: le dicen que bien te ves hoy! y piensan que la otra persona esta
siendo sarcastica
o Bears grudges, is unforgiving
o Perceives attacks on character or reputation that are not apparent to others;
quick to react angrily
o Recurrent suspicions on fidelity of spouse
Epidemiology
o Prevalence: .5 - 2.5% general population
o More common in men
o Rarely seek treatment
Caracteristico!
Son egosintonicos, ellos verdaderamente piensa que el mundo es
como ellos piensan y no tienen ningun sentido de introversion
o Higher incidence in relatives of patients with schizophrenia and Delusional
Disorder, Persecutory Type
o Mechanism of Defense used: Projection
Los impulsos negativos que tengo yo incoscientes los proyecto hacia
otros y pienso que aquel me esta engan ando

Schizoid Personality Disorder
DSM IV Criteria
o Neither desire nor enjoy close relationships
o Prefer solitary activities
o Little interest in sex
o Take pleasure, if any, in few activities
Jama s te van a decir que algo les encanta
o Lack confidants, other than first degree relatives
o Indifferent to praise or criticism
o Emotional coldness, detachment or flat affect
Epidemiology
o Prevalence: ???
o Unknown sex ratio, probably more common in men

Schizotypal Personality Disorder
DSM IV Criteria
o Ideas of reference
o Odd beliefs or magical thinking
o Unusual perceptual experiences
o Odd thinking and speech
o Suspiciousness
o Inappropriate or constricted affect
o Odd or peculiar behavior or appearance
o Lack of confidants other than first degree relatives
o Excessive social anxiety associated to paranoid fears
A diferencia del schizoid que no le importa
Prevalence: about 3% gen. pop.
Unknown sex ratio
o Se sospecha que es mas en hombres
Higher incidence among relatives of patients with schizophrenia
o Se dice que puede ser un preambulo (una personalidad que viene antes de la
schizophrenia)
Higher incidence among monozygotic twins
In one study, 10% committed suicide (bien importante!)
o Son casos serios y hay que prestarles atencion
Thought of as premorbid personality for schizophrenia

Antisocial Personality Disorder
DSM IV Criteria
o Failure to conform to social norms leading to possible arrest
Rompe las reglas sin ningun tipo de remordimiento
o Deceitfulness
o Impulsivity, failure to plan ahead
Dejan el trabajo rapido y cuando pierden el trabajo se lo culpan a
otro
o Irritability and aggressiveness
Se puede confundir con un episodio ma nico
o Reckless disregard for safety of self or others
o Consistent irresponsibility
o Lack of remorse
o Must be at least 18 y/o
o Evidence of conduct disorder before age 15
Adolescente que se escapa de la casa, roba, hace dan o a los animals,
pega fuego.
Es un adolescente antisocial pero todavia no se le da el dx de
antisocial hasta los 18
Epidemiology
o Prevalence: 3% men; 1% women
o Most common in poor urban areas
o May be present in 75% of prison populations
PERO NO NECESARIAMENTE EL QUE ES CRIMINAL ES ANTISOCIAL!!
Pero tambien se ha asociado con personas que
o 5 times more common among 1st degree relatives
Course and prognosis
o Height of antisocial behavior in late adolescence; in many cases sx may
ameliorate with time
o Associated with Somatization Disorder and Substance Use Disorders

Borderline Personality Disorder
DSM IV Criteria
o Frantic efforts to avoid abandonment
o Unstable , intense interpersonal relationships
Siempre hay un issue con las relaciones: hoy eres mi principe, mi
razon de vivir y man ana eres un perro muerto y no quiero saber de ti
o Unstable sense of self
Pueden tratar de imitar otras personas (usar ropa que usan otros
normalmente)
o Potentially self-damaging impulsivity
Imp tomar un buen hx para diferenciar de episodio manico
o Recurrent suicidal behavior or self mutilation
o Affective instability
o Chronic feelings of emptiness
Toda mi vida me he sentido vacia RED FLAG!!
o Difficulty controlling anger
o Transient paranoid ideation or severe dissociation
Defense mechanism used:
o Splitting
Solo ven negro y blanco
o Projective identification
Impulsos o emociones negativas que tengo yo incoscientes las
proyecto hacia otra persona y hago que esa persona acte en esos
impulsos que yo tengo
Epidemiology
o 1 2% general population
o Twice as common in women than men
o Increased prevalence of Major Depression, alcohol and substance use
disorders in 1st degree relatives
o Patients have high incidence of Major Depression

Histrionic Personality Disorder
Tu idola Addy Miley Cyrus llama mucho la atencion, no se sienten bien si no
son el centro de atencion
DSM IV Criteria
o Uncomfortable if not the center of attention
o Interactions characterized by inappropriate seductive behavior
o Rapidly shifting and shallowness of emotion
o Use physical appearance to draw attention to self
o Excessively impressionistic speech, lacking in detail
o Dramatic, theatrical
o Suggestible
o Considers relationships to be more intimate than they really are
Epidemiology
o Possibly 2-3% prevalence general population
o More common in women than men

Narcissistic Personality Disorder
Face it. I am God, and you are not. Soy una persona que la admiran mas que a ti y
se creen mucho mas superiores que las personas alrededor de ella.
DSM IV Criteria
o Excessive sense of entitlement
o Fantasies of power, success, beauty
o Grandiose sense of self importance
o Believes should associate only with people as special as him/her
o Requires excessive admiration
o Interpersonally exploitative
o Lacks empathy
o Envious of others
o Arrogant attitudes or behaviors
o Solamente se realcionan con personas que piensan que estan a su nivel, pero
no manipulan con intecion de hacer dan o como en el caso de los antisociales.
Pero si pueden usar a otras personas por estar ma s alante que ellos.
o No buscan ayuda pero en el curso de su trastorno puede bajar las
caracteristicas y al ser mas adultos y ver que sus facultades fisicas y
mentales han disminuido y entran en depression.
Epidemiology
o Less than 1% general population

Avoidant Personality Disorder
DSM IV Criteria
o Avoids occupational activities due to fears of rejection or criticism
o Unwilling to get involved with people unless certain of being liked
o Restrained within intimate relationships due to fear of being ridiculed
o Preoccupied with being criticized in social situations
o Inhibited in new interpersonal situations due to feelings of inadequacy
o Views self as inept or inferior
o Reluctant to take risks or engage in new activities due to possible
embarrassment
Epidemiology
o 1-10% general population, common
o May develop social phobia

Dependent Personality Disorder
Mujeres que se quedan con esposos que las maltratan porque piensan que no van a
conseguir mas nada o que no pueden estar solas
DSM IV Criteria
o Difficulty making everyday decisions without excessive reassurance from
others
o Needs others to assume responsibility for major areas of life
o Difficulty expressing disagreement due to fears of loss of support
o Difficulty to do things alone due to lack of self confidence
o Go to excessive lengths to obtain support to the point of doing things that
are unpleasant
o Feels uncomfortable when alone due to fears of not being able to care for
self
o Urgently seeks another relationship as a source of care when a close one
ends
o Unrealistically preoccupied with fears of being left to care for self
Epidemiology
o More common in women
o Persons with chronic childhood illnesses may be more prone
Aprenden que no pueden estar solas y necesitan de otras personas
para funcionar

Obsessive Compulsive Personality Disorder
BIEN IMPORTANTE SABER DIFERENCIARLO DE OCD!!!
DSM IV Criteria
o Preoccupied with details, rules, organization, etc. to extent that major
point of activity is lost
o La personalidad es algo egocintonico eso esta bien con ellos y
piensan que las cosas se tienen que hacer como ellos dicen
mientras que OCD es un trastorno de ansiedad y se siente controlado
por esos impulsos y desarolla obsesiones y compulsions para
mejorar la ansiedad.
o Perfectionism that interferes with task completion
o Excessively devoted to work/productivity to the exclusion of leisure
workaholics
o Scrupulous and inflexible on matters of morality, ethics, values
o Unable to discard worthless or old objects with no sentimental value
o Reluctant to delegate tasks unless sure it will be done according to his/her
rules
o Miserly spending style
o Rigid and stubborn

Epidemiology
o Prevalence unknown
o More common in men
o Occurs more frequently in 1st degree relatives

Personality Change due to Another Medical Condition
Phineas Cage le traspaso un tubo por la cabeza, paso de ser una persona bien
amable a una persona que decia todo sin filtro sin importarle las consecuencias
(personalidad disinhibida)
o Trauma a la parte frontal
DSM IV Criteria
o Change from previous personality pattern
o There is evidence change is direct consequence of GMC
o Not better accounted by another mental disorder
o Does not occur during delirium
Causes significant distress or impairment
Types: labile, disinhibited, aggressive, apathetic, paranoid
Examples of GMC: epilepsy, traumatic brain injury, stroke, frontal lobe personality