Copyright Alcohol Medical Scholars Program1 Personality Disorders Marc A. Schuckit, M.D. University of California, San Diego VA San Diego Healthcare System

Copyright Alcohol Medical Scholars Program2 GREEK TEMPERAMENTS Sanguine Melancholic Choleric Phlegmatic

Copyright Alcohol Medical Scholars Program3 FREUD Oral Anal Phallic Genital

Copyright Alcohol Medical Scholars Program4 DEFINITIONS n Personality - Usual Emotional + Behavioral Characteristics n Personality Traits - Components of Personality n Temperament - Affective Tone, Intensity, Reactivity n Character - Moral + Personality Traits

Copyright Alcohol Medical Scholars Program5 PERSONALITY DISORDERS n Totality of Emotional + Behavioral Traits n Onset Teens n Enduring, Inflexible, Consistent, Maladaptive n Causes Significant Impairment and/or Distress

Copyright Alcohol Medical Scholars Program6 DSM IV PD n Axis II n 10 Diagnoses + NOS + Appendix n Polythetic n Clusters

Copyright Alcohol Medical Scholars Program7 DSM IV PERSONALITY DISORDERS n Paranoid n Schizoid n Schizotypal n Antisocial n Borderline n Histrionic n Narcissistic n Avoidant n Dependent n Obsessive- Compulsive

Copyright Alcohol Medical Scholars Program8 CLUSTERS A. Odd or Eccentric Paranoid Schizotypal Schizoid B. Dramatic or Erratic AntisocialHistrionic BorderlineNarcissistic C. Anxious AvoidantObsessive - Compulsive Dependent

Copyright Alcohol Medical Scholars Program9 CHARACTERISTICS OF PD n Relation to Axis I n 10% - 20% of General Population n Gender : ASPD, Schizoid Avoidant, Dependent n Etiological Theories ä Dynamic ä Biological / Genetic

Copyright Alcohol Medical Scholars Program10 PERSONALITY DISORDERS n Totality of emotional + behavioral traits n Onset teens n Enduring, inflexible, consistent, maladaptive n Causes significant impairment and/or distress

Copyright Alcohol Medical Scholars Program11 PARANOID PD Pervasive Distrust + Suspiciousness, Interpret Motives as Evil 4 + of : SuspiciousFeels Attacked Preoccupation with Distrust Jealous Won’t Confide Grudges Misinterprets Motives

Copyright Alcohol Medical Scholars Program12 SCHIZOID PD Detached + Few Emotions 4 + of : Eschew Closeness No Close Friends Solitary Indifferent No Sex Interest Cold Not Enjoy Activities

Copyright Alcohol Medical Scholars Program13 SCHIZOTYPAL PD Discomfort with Relationships, Cognitive Distortions + Eccentric 5 + of : Ideas of Reference Odd Magical Beliefs Perceptual Disturbances Odd Thoughts/Speech Paranoia Inappropriate Affect Odd Behavior/Appearance Loner Anxious Socially

Copyright Alcohol Medical Scholars Program14 ANTISOCIAL PD (ASPD) Disregard Rights of Others (and meet Conduct Disorder) 3 + of : UnlawfulReckless DeceitfulIrresponsible ImpulsiveLack Remorse Aggressive

Copyright Alcohol Medical Scholars Program15 BORDERLINE PD Unstable Relationships, Affect, Self- Image Plus Impulsiveness 5 + of : Fears AbandonmentMood Shifts Unstable RelationshipsFeels Empty Changing Self-ImageAnger Impulsive Sex, Spending,Temporary Etc Paranoia Suicidal Behavior

Copyright Alcohol Medical Scholars Program16 HISTRIONIC PD Excessive Emotionality, Attention Seeking 5 + of : Needs AttentionPreens SeductiveDramatic Mood ShiftsSuggestible Impressionistic,Exaggerates Vague Speech Relationships

Copyright Alcohol Medical Scholars Program17 NARCISSISTIC PD Grandiose, Needs Admiration, Without Empathy 5 + of : Self Important Exploitative Fantasies of Success Lacks Empathy Feels Special Envious Needs Admiration Arrogant Entitled

Copyright Alcohol Medical Scholars Program18 AVOIDANT PD Inhibited, Inadequate, Sensitive 4 + of :Avoids Social Activity Reluctant Relationships Fears Intimacy Fears Criticism Avoids New Activities Sees Self Inferior Fears Embarrassment

Copyright Alcohol Medical Scholars Program19 DEPENDENT PD Needs to be Taken Care of, Fears Separation 5 + of : IndecisiveSeeks Nurturance Avoids ResponsibilityFears Solitude Avoids Frantic for Disagreements Relationships Lacks InitiativeFears Abandonment

Copyright Alcohol Medical Scholars Program20 OBSESSIVE-COMPULSIVE PD Orderliness, Perfectionist, Inflexible 4 + of : Detail OrientedUnable to Discard PerfectionismCan’t Delegate Work OrientedMiserly Over ConscientiousRigid

Copyright Alcohol Medical Scholars Program21 PASSIVE-AGGRESSIVE PD Negative Attitudes with Passive Resistance to Demands 4 + of : PassiveEnvious, Resentful Misunderstood,Exaggerated Unappreciated Complaints Sullen, ArgumentativeDefiant then Contrite Scorns Authority

Copyright Alcohol Medical Scholars Program22 PERSONALITY DISORDERS n Totality of Emotional + Behavioral Traits n Onset Teens n Enduring, Inflexible, Consistent, Maladaptive n Causes Significant Impairment and/or Distress

Copyright Alcohol Medical Scholars Program23 SUMMARY PART I Paranoid Suspicious, Jealous, But Not Psychotic or Unlawful Schizoid Unemotional, Cold, Indifferent Schizotypal Odd + Magical Beliefs, Behaviors, Not Paranoid ASPD Aggressive, Unlawful, Impulsive Borderline Unstable, Chaotic, Impulsive Not Aggressive or Unlawful Histrionic Dramatic, Seductive But Not Chaotic

Copyright Alcohol Medical Scholars Program24 SUMMARY PART II Narcissistic Self-Centered, Entitled, Lacks Empathy But Not Unlawful or Chaotic Avoidant Needs People But Fears Relationships Dependent Needs Relationships, Indecisive, Fears Abandonment Obsessive- Rigid, Perfectionist + Inefficient Compulsive Passive- Negative Attitudes with Passive AggressiveResistance to Demands

Copyright Alcohol Medical Scholars Program25 INSTRUMENTS FOR PD 4 Mostly Current Status 4 Some Focus on Temperament or Personality Components 4 Few Consider Full Diagnostic Syndrome