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Axis II Disorders
DSM-IV-TR Axis II Disorders
| Term | Definition |
|---|---|
| Schizoid Personality Disorder | Neither desires nor enjoys close relationships Little interest in sexual experiences Emotional coldness, detached, flat affect Appears indifferent to praise criticism |
| Schizotypal Personality Disorder | Ideas of Reference Odd Beliefs or magical thinking Unusual perceptual experiences Odd thinking & Speech Suspiciousness/Paranoid Ideation Behavior is odd, eccentric, peculiar Lacks Friends Social Anxiety |
| Paranoid Personality Disorder | Suspects others are harming, exploiting, deceiving Preoccupied w/ unjustified doubts Reluctant to confide in others Reads hidden demeaning Persistently bears grudges Sees attacks to a character unseen by others Recurrent suspicious w/o justification |
| Narcissistic Personality Disorder | Grandiose sense of self-importance Preoccupation w/ fantasies of success Belief that they are "Special" "unique" Requires excessive admiration Sense of entitlement Interpersonally exploitative Envious of others/Believes others envy them Arrogant |
| Histrionic Personality Disorder | Uncomfortable if not center of attention Inappropriate sexual, seductive bx Shifting emotion Physical appearance to draw attention to self Speech impressionistic & lacking detail Self dramatization & exaggerated expressed emotion Easily Influenced |
| Antisocial Personality Disorder | Failure to conform to social norms (criminal activity) Deceitfulness Impulsive Irritability & Aggressive Reckless Irresponsibility Lack Remorse |
| Borderline Personality Disorder | Efforts to avoid abandonment Unstable interpersonal relationships, self image & affect Impulsivity Recurrent suicidal behavior Feelings of emptiness Anger/diff controlling anger |
| Dependent Personality Disorder | Difficulty making everyday decisions Need for others assume responsibility/nurturance Diff expressing disagreement Diff initiating |
| Avoidant Personality Disorder | Avoids significant interpersonal contact Unwilling to get involved with others Restraint w/ intimate relationships Preoccupied w/ rejection Inhibits new interpersonal relationships View self as socially inept Reluctant to take personal risks |
| Obsessive-Compulsive Personality Disorder | Preoccupied w/ details Perfectionism Excessively devoted to work Inflexibility to morality Unable to discord of worthless items Reluctant to delegate tasks Rigid & Stubbornness |
| Difficulty with treating Personality Disorders? | Reluctant to seek treatment and don't seek treatment unless they are under increased stress or pressure in their life Do not think anything is wrong with them |
| Personality Clusters | Cluster A - Odd & Eccentric (Schizotypal, Schizoid, Paranoid) Cluster B - Dramatic Emotional (Antisocial, Borderline, Histrionic, Narcissistic) Cluster B - Fearful & Dismissing (Dependent, OCPD, Avoidant) |
| Treatment for Borderline Personality Disorder | Dialectic Behavior Therapy (EVT). Distress tolerance and mindfulness skills. Decrease suicidal behavior/self-harm/violence toward others. Emotion regulation - teach emotion regulation skills for emotional control. Interpersonal effectiveness skills. |
| OCPD Treatment | Cognitive behavioral techniques should be used to address irrationality of excessive behaviors. Teach Relaxation Techniques. Distraction Techniques. Supportive-Expressive Therapy - provide support & listen, understand, reflect |
| Antisocial Treatment | Cognitive Behavioral Techniques. Focus on rational & useful arguments against repeating past mistakes. (More Confrontational Techniques) |
| Histrionic Treatment | Counter their global and diffuse thinking by attending to structure and detail. Social Training skills. Moderate Emotional Expression. (More Confrontational Techniques) |
| Dependent Treatment | No EVT for DPD Cognitive behavioral techniques can address the inadequacy and helplessness. Interpersonal therapy to address relationships with other people and the outside world. Provide assertiveness training and problem solving techniques. Reassure |
| Avoidant Treatment | Behavior Therapy w/ focus on interpersonal problems. Interpersonal therapy to address relationships with other people and the outside world. Social Skills training. |
| Individual with Schizoid Personality may present with. . . | Uncommon in the clinical setting. Maybe referred by a family member. Prefer being a loner, flat affect. |
| Individual with Schizotypal Personality may present with. . . | Symptoms of anxiety, depression, or other dysphoric affects rather than for the personality disorder. May come in for Major Depressive Disorder. Present as Odd |
| Individual with Antisocial Personality may present with. . . | Likely mandated to therapy by a court or significant other |
| Individual with Narcissistic Personality may present with. . . | Issues related to others (interpersonal). Symptoms related to crises and relatively external Axis I diagnoses, rather than in an effort to address the personality disorder itself |
| Individual with Obsessive-Compulsive Personality may present with. . . | issues related to anxiety or problems within relationships. Feel loosing control. |
| Schizoid Treatment | Goal: increase ability to function consistently (effectively). Should include Behavioral Techniques, coping-oriented, and supportive therapy. Supportive - encourage to become more active |
| Schizotypal Treatment | Should include Behavioral Techniques, coping-oriented, and supportive therapy |
| Test to assess for Personality Disorders | MMPI-2, MCMI-II, Rorschach, and the TAT can be useful in determining personality traits |
| Individual with Avoidant personality may present with. . . | Difficulty concentrating or poor social skills |
| Individual with Dependent Personality may present with. . . | symptoms related to anxiety/panic attacks or agoraphobia, hypochondriasis |
| Individual with Histrionic Personality may present with. . . | Difficulty with intimate relationships or significant other. Recent suicidal attempt (to get attention). |
| Narcissistic Treatment | Client Centered Either short or long term treatment. Short - alleviates crisis symptoms of anxiety/depression, or somatic complaints. Long - restructuring personality, increasing empathy, decrease cognitive distortions. |
| Paranoid Treatment | Increase perception of reality and trusting behavior. Cognitive Behavioral - cognitive restructuring and progressive muscle relaxation. Social skills training |
| Individual with Paranoid Personality may present with. . . | Usually do not come for therapy unless, court ordered. Difficulty getting along with others |
| Therapeutic orientation for Antisocial | CBT - behavior is guided by self-serving dysfunctional cognitions. Self is autonomous and strong. |
| Therapeutic orientation for Avoidant | Interpersonal Theory - Likely have experienced mockery for social failures causing embarrassment and humiliation which is associated with exclusion/rejection. |
| Therapeutic orientation for Borderline | CBT Schemas - schemas develop during childhood of abandonment "I'll always be alone" and emotional deprivation "no one there for me." Resulting in dysfunction of emotional regulation |
| Therapeutic orientation for Dependent | CBT - Have views of self and world, view self as helpless and inadequate and the world as too dangerous to be alone. |
| Therapeutic orientation for Histrionic | Biosocial - As an infant they received a lot of attention which lowered pleasure/excitement limbic threshold. As a child they learned to employ cuteness & charm for parental reinforcement. |
| Therapeutic orientation for Narcissistic | CBT - Create schemas about self, world, and future. Schemas develop from parents, siblings, and significant others & mold belief about being unique and important. May be shaped by flattery and favoritism. Behavior then becomes self-indulgent. |
| Therapeutic orientation for Obsessive-Compulsive | Interpersonal Theory - Raised in an atmosphere of unreasonable rules and developed unbalanced view of having to be perfect. Parents may have held high expectations |
| Therapeutic orientation for Paranoid | CBT - pattern of assumptions, automatic thoughts, and cognitive distortions. View self as righteous & mistreated. Driven by hypervigilance & guardedness |
| Therapeutic orientation for Schizoid | Cognitive Theory - View self as self-sufficient and world as intrusive |
| Therapeutic orientation for Schizotypal | Cognitive Theory - presentation is due to autonomic thoughts: Suspicious or paranoid, ideas of reference, magical thinking, and illusions. |
| Criteria for Personality Disorders | -Deviates from culture -Inflexible & Pervasive -Leads to significant distress -Stable & long lasting -Not better accounted by another mental disorder -Not directly due to Substance or medical condition |
| In order to Diagnosis Axis II... | -Disorder must have been present prior to 18, but is diagnosis at 18 yrs old -Not associated w/ developmental stage or axis I -Pervasive, Persistent, long lasting -Stable & chronic |
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PsychStudent
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