1. Personality Disorders

2. Personality Traits
• Enduring patterns of perceiving, relating to
and thinking about the environment, oneself
or others
• They become a disorder when they are
inflexible and maladaptive, and cause
functional impairment or subjective distress
• Severe personality traits that do not meet
criteria for PD may be listed on Axis II

3. Personality Disorder
• Enduring pattern of inner experience and
behavior that deviates markedly from the
expectations of the individual’s culture

4. Personality Disorder
• The pattern is manifested in two or more
of the following areas:
• Cognition
• Affectivity
• Interpersonal Functioning
• Impulse control

5. Enduring Pattern
• Inflexible
• Pervasive
• Across broad range of personal and social
situations

6. Enduring Pattern
• leads to clinically significant distress or
impairment in social, occupational or other
important areas of functioning

7. Enduring Pattern
• Stable and of long duration
• Onset traced back to adolescence or early
adulthood

8. Enduring Pattern
• Not better accounted for as a
manifestation or consequence of another
mental disorder
• Not due to direct physiological effects of a
substance or general medical condition

9. Culture, Age, Gender
• Take into account persons ethnic, cultural
and social background
• May be applied to children who have traits
that appear to be pervasive, persistent,
unlikely to be limited to particular stage or
Axis I diagnosis
• Traits of PD that present in childhood may
not last

10. Culture, Age, Gender
• To diagnose in childhood traits must be
present for at least one year
• PD must be diagnosed no later than early
adulthood, but people may not come to
attention
• Must rule out PD due to general medical
condition

11. Axis I
• A PD should not be diagnosed during an
episode of mood disorder or anxiety
disorder
• PD should not be diagnosed if it occurs
exclusively during an episode of an Axis I
disorder
• Consider PTSD rather than PD after
extreme stress

12. Cluster A
• Schizotypal
• Schizoid
• Paranoid

13. Cluster B
• Narcissistic
• Borderline
• Antisocial
• Histrionic

14. Cluster C
• Obsessive Compulsive
• Dependent
• Avoidant

15. Etiology
• Genetic Factors
• Biological Factors

16. • Childhood and adolescent disorder
correlate strongly with adult personality
disorders
• Conduct disorder>>>Antisocial PD adult
• Schizoid PD childhood>>>Schizoid PD
Adult
• Oppositional disorder

17. • Earlier concepts suggested PDs were
egosyntonic
• Current thought is that they cause
significant distress and there are high rates
of depression and anxiety

18. • Patients with personality disorders are at
higher risk for Axis I disorders
• Flare ups are often during times of
occupational or personal stresses, or at
developmental milestones

19. How can you tell if it is
a personality disorder?
Neruosis? Psychosis?

20. Neurotic or Personality
Disordered
• Neurotic patients have autoplastic
defenses: What’s wrong with me?
• Persoality Disordered patients have
alloplastic defenses: What’s wrong with the
world?

21. Neurotic or Personality
Disordered?
• Neurotic patients perceive personal
shortcomings as egodystonic; unacceptable,
objectionable
• Personality Disordered patients disavow
responsibility for hurting others

22. Psychotic or
Personality Disordered
• Persistent psychotic features are not
present
• Exception is patients with borderline
personality disorder: psychotic symptoms
are short lived, are directly related to a
given situation, do not require
hospitalization or medications.

23. Organic Mental
Disorder or Personality
• Patients with personality disorders have
clear sensorium, are oriented to time and
place, and show normal intellectual function

24. Psychodynamic
Diagnostic Manual

25. • Dimension I: Personality Patterns and
Disorders----P Axis
• Dimension II: Mental Functioning----M Axis
• Dimension III: Manifest Symptoms and
Concerns---S Axis

26. Dimension I:
Personality Patterns
and Disorders

27. • Personality: Relatively stable ways of
thinking, feeling, behaving, and relating to
others.
• Thinking: belief systems, ways of making
sense of self and others, moral values and
ideals.
• Ways in which we habitually try to
accommodate to the exigencies of life, to
reduce anxiety, grief, threats to self esteem

28. • People differ in how they adapt to
circumstance and defend against threat and
in their abilities to integrate these special
efforts seamlessly into the conduct of every
day behavior so that the special efforts do
not show as xuch.

29. • Depending cultural surround and myriad of
other factors, some patterns are more
adaptive than others.
• When our particular ways of thinking,
feeling, acting and being with others
contribute to our living satisfying lives,
enjoying mutually satisfying relationships,
and pursuing socially useful goals, OK.

30. Healthy Personality
• Engaged in satisfying relationships
• Experience a full range of age expected
feelings and thoughts
• Function flexibly when stressed by external
forces or internal conflict
• Clear sense of personal identity
• Well adapted to life circumstances

31. Healthy Personality
• Neither experience significant distress nor
impose it on others.

32. Unhealthy Personality
• Rigid/Inflexible
• Deficits in Identity
• Deficits in Relations with Others
• Difficulty with reality testing, adaptation to
stress
• Deficits Moral Functioning or Affective
Range (recognition, expression, regulation)

33. Differential Diagnosis of
Personality Disorders
• When someone’s personality is so rigid or
so marked by deficit that he/she has
persistent problems in living = personality
disorder.
• Human functioning falls on a continuum
• Well functioning people with stable
personalities may have many features of
pathological personality types

34. Differential Diagnosis of
Personality Disorder
• Caused significant distress to self or others
• Is of longstanding duration
• Is so much a part of the patient’s consistent
experience that he/she cannot remember,
or easily imagine being different

35. Differential Diagnosis of
Personality Disorders
• Symptom syndromes
• Effects of injury to the brain
• Psychosis

36. Differential Diagnosis of
Personality Disorders
• Ritualized behavior could represent single
obsessive-compulsive problem
• Constitute a pervasive obsessive-
compulsive personality problem
• Be the result of brain injury
• Express a psychotic delusion

37. Level of Personality
Organization

38. Neurosis
• Minor or major psychopathology
• Capacity to assess reality is not
compromised

39. Psychosis
• Serious impairments in reality-testing

40. New Category
• Too disturbed to be labeled neurotic
• Too anchored in reality to be considered
psychotic
• Borderline: Between psychoses and
neuroses

41. Cluster A

42. Paranoid Personality
Disorder

43. • A pervasive distrust and suspiciousness of
others such that their motives are
interpreted as malevolent, beginning by
early adulthood and present in a variety of
contexts, as indicated by four or more of
the following:

44. • Suspects w/o sufficient basis that others are
exploiting, harming or deceiving him/her
• Is preoccupied with unjustified doubts
about the loyalty or trustworthiness of
friends or associates
• Is reluctant to confide in other because of
unwarranted fear that th einformation will
be used maliciously against him/her

45. • Reads hidden demeaning or threatening
meanings into benign remarks or events
• Persistently bears grudges, i.e., is unforgiving
of insults, injuries or slights
• Perceives attacks on his or her character
or reputation that are not apparent to
others and is quick to react angrily or to
counterattack

46. • Has recurrent suspicions, without
justification, regarding fidelity of spouse or
sexual partner
• Does not occur exclusively during the
course of schizophrenia, a mood disorder
with psychotic disorder and is not due to
the direct physiological effects of a general
medical condition.

47. • May first become apparent in childhood
and adolescence with solitariness, poor
peer relationships, social anxiety,
underachievement, hypersensitivity, peculiar
thoughts and language, idiosyncratic
fantasies.

48. Prevalence
• 0.5%-2.5% general population
• 10%-30% inpatient population
• 2%-10% outpatient population

49. Familial Patterns
• Increased prevalence of PPD in relatives of
probands with chronic Schizophrenia
• Familial realtionship with delusional
Disorder, Persecutory Type

50. Course
• Often lifelong problems living with and
working with others
• May be harbinger of schizophrenia
• Paranoid traits may give way to reaction
formation and appropriate concern with
morality altruistic concerns.

51. Differential Diagnosis
• Delusional Disorder
• Borderline Personality Disorder
• Antisocial Personality Disorder
• Schizoid Personality Disorder

52. Course and Prognosis
• No adequate systematic long-term studies
• Some may be lifelong
• Some may be precursor to schizophrenia.
• In general lifelong problems orking and
living with others.

53. Treatment
• Psychotherapy
• Therapist should be straightforward in all
dealings
• If accused of inconsistency: honesty/
apology
• Professional and not overly warm style
• Over-interpretation generates mistrust

54. Pharmacotherapy
• Anxiolytics
• Antipsychotics
• Antidepressents

55. Schizoid Personality
Disorder

56. • A pervasive pattern of detachment from
social relationships and a restricted range
of expression of emotions in interpersonal
settings, beginning by early adulthood and
present ina variety of contexts, as indicated
by four or more of the following

57. • Neither desires nor enjoys close
relationships, including being part of a family
• Almost always chooses solitary activities
• Has little, if any, interest in having sexual
experiences with another person
• Takes pleasure in few, if any, activities

58. • Lacks close friends or confidants other
than first degree relatives
• Appears indifferent to the praise or
criticism of others
• Shows emotional coldness, detachment or
flattened affectivity

59. • Does not occur during the course of
schizophrenia, a mood disorder with
psychotic features, another psychotic
disorder, or a pervasive developmental
disorder, and is not due to the direct
physical effects of a general medical
condition.

60. Prevalence
• Uncommon in clinical settings

61. Familial Pattern
• May have increased prevalence in relatives
of individuals with Schizophrenia or
Schizotypal PD

62. Differential Diagnosis
• Schizophrenia, delusional disorder, affective
disorder with psychotic features
• Paranoid Personality Disorder
• Obsessive Compulsive Personality d/o
• Shizotypal Personality Disorder
• Avoidant Personality Disorder

63. Course and Prognosis
• Usually begins in childhood
• Long lasting, but not necessarily life long.
• Proportion who incur schizophrenia not
known

64. Treatment
• Psychotherapy

65. Pharmacotherapy
• Antipsychotics
• Antidepressants
• Psychostimulants
• Serotonergic agents less sensitive to reject
• Benzodiazepines for anxiety

66. Schizotypal Personality
Disorder
• Social and interpersonal deficits marked by
acute discomfort with and reduced capacity
for close relationships, as well as by
cognitive or perceptual distortions and
eccentricities of behavior, beginning by early
adulthood in a variety of contexts marked
by five or more

67. • Unusual ideas of reference (not delusions
of ref)
• Odd beliefs or magical thinking that
influences behavior, and is not consistent
with sub-cultural norms
• Unusual perceptual experiences
• Odd thinking and speech

68. • Suspiciousness or paranoid ideation
• inappropriate or constricted affect
• Behavior or appearance that is odd,
eccentric or peculiar
• Lack of close friends or relatives
• Excessive social anxiety

69. Prevalence
• 3% of general population
• Relatively stable course, small proportion
go on to develop Schizophrenia or other
psychotic disorder

70. Familial Pattern
• Aggregates in families
• More common in relatives of individuals
with Schizophrenia
• May be modest increase in Schizophrenia
and other psychotic disorders in relatives
of probands with Schizotypal PD

71. Differential Diagnosis
• Differentiate from schizoid or avoidant
personality by presence of oddities, or by
family history of schizophrenia
• Differentiate from schizophrenia by
absence of psychosis
• Paranoid have suspiciousness but not
oddities

72. Treatment
• Psychotherapy (respectful of peculiarities
such as cults, the occult, strange religious
practices)
• Pharmacotherapy: Antipsychotics and
antidepressants

73. Cluster B

74. 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 five or more:

75. • Frantic efforts to avoid real or imagined
abandonment
• Pattern intense and unstable interpersonal
relationships, characterized by alternating
between extremes of idealization and
devaluation
• Identity disturbance: markedly and
persistently unstable self image or sense of
self

76. • Chronic feelings of emptiness
• Inappropriate intense anger or difficulty
controlling anger (frequent displays of
temper, constant anger, recurrent physical
fights)
• Transient, stress related paranoid ideation
or severe dissociative symptoms

77. • Impulsivity in at least two areas that are
potentially self damaging (sex, spending,
substance abuse, reckless driving, binge
eating)
• Recurrent suicidal behavior, gestures, or
threats, or self mutilating behavior
• Affective instability due to a marked
reactivity of mood (intense episodic
dysphoria, irritability, or anxiety)

78. Prevalence
• 2% general population
• 10% outpatient mental health
• 20% inpatient mental health
• 30%-60% among clinical populations with
personality disorders

79. Familial Pattern
• 5 times as common in first degree relatives
• Increased familial risk for Substance Related
Disorders, Antisocial PD, and Mood
Disorders

80. Course
• Most commonly chronic instability in early
adulthood, serious affective and impulse
control and high use of MH resources
• Impairment and risk of suicide highest in
young adult, wane advancing age
• During 30s and 40s majority develop
greater stability relationships/work

81. Differential Diagnosis
• Differs from schizophrenia as borderline
patient lacks prolonged psychotic episodes
• Schizotypal patients have marked
peculiarities thought, behavior
• Paranoid personality show extreme
suspiciousness
• BPD self mutilate and manipulative SA

82. Differential Diagnosis
• Histrionic PD attention seeking,
manipulative, rapidly shifting emotions:
BPD self-destructiveness, angry disruptions
close relationships, emptiness, loneliness
• Paranoid and Narcissistic can have angry
reaction to minor stimuli: stability of self
image, lack of self-destructive,
impulsiveness, abandonment fears

83. Differential Diagnosis
• Antisocial PD manipulative to gain profit,
power, or some other material
gratification, BPD gaining concern of
caregivers
• Dependent and BPD both fear of
abandonment, BPD emotional emptiness,
rage, demands, Dependent increased
appeasement, submissiveness, other parnter

84. Treatment
• DBT
• Long term psychodynamic therapy with
therapist specifically trained for BPD

85. Pharmacotherapy
• Antipsychotics for anger, hostility, brief
psychotic episodes
• Antidepressants for depressed mood
• MAOIs for impulse control???

86. Antisocial Personality
Disorder

87. • Criteria A:
• Pervasive pattern of disregard for and
violation of the rights of others occurring
since age 15 years, as indicated by three or
more:

88. • Failure to conform to social norms with
respect to lawful behaviors indicated by
repeated acts that are grounds for arrest
• Deceitfulness, indicated by lying, aliases,
conning other for personal profit/pleasure
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness, indicated by
repeated fights or assaults

89. • Reckless disregard for safety of self or
others
• Consistent irresponsibility, as indicated y
repeated failure to sustain consistent work
behavior or honor financial obligations
• Lack of remorse, indicated by indifference
to or rationalizing having hurt, mistreated
or stolen from others

90. • Criteria B: Individual is 18 year or older
• Criteria C Evidence of Conduct Disorder
with onset before 15 years
• Criteria D: Antisocial behavior is not
exclusively during course of Schizophrenia
or Manic Episode

91. Prevalence
• 3% males, 1% females general populaiton
• 3%-30% depending on setting, or higher in
substance abuse population or prison

92. Course
• Chronic course
• May be less evident by 4th decade of life
• Remission may be most prominent in
decrease crime, but likely also to be a
decrease in full spectrum

93. Familial Pattern
• More common in first degree relatives
• Biological risk higher for females with
disorder
• Association with substance abuse d/o and
somatization d/o (males/females)
• Bio or adapted children of adults with
ASPD are both at higher risk of each d/o

95. Differential Diagnosis
• If antisocial behavior in context of
substance abuse, do not dx with ASPD
unless signs of ASPD were there before
adulthood and carried into adulthood
• If both substance abuse and ASPD sx there
from childhood through adulthood, make
both diagnoses, even if some antisocial
behavior is due to substance use

96. Differential Diagnosis
• Narcissistic PD and ASPD both tough-
minded, glib, superficial, exploitative and un-
empathic, but Narcissistic PD does not
include impulsivity, aggression, deceit
• Histrionic share impulsive, superficial,
excitement seeking, reckless, seductive but
not antisocial behaviors.
• BPD manipulate for nurture not power

97. Treatment
• Psychotherapy/Group therapy
• Therapist has to frustrate the patient’s
need to run from “honest human
encounter”

98. Pharmacotherapy
• Substance abuse makes more difficult
• If ADHD, stimulants may be helpful
• Antiepileptic drugs or beta blockers for
impulsivity/aggression

99. Histrionic Personality
Disorder

100. • A pervasive pattern of excessive
emotionality and attention seeking
beginning by early adulthood and present in
a variety of contexts, indicated by five or
more:

101. • Uncomfortable in situations in which he or
she is not the center of attention
• Interaction with others is often
characterized by inappropriate sexually
seductive or provocative behavior
• Displays rapidly shifting and shallow
expression of emotion

102. • Consistently uses physical appearance to
draw attention to self
• Style of speech that is excessively
impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and
exaggerated expression of emotio

103. • Is suggestible, easily influenced by others or
circumstances
• Considers relationships to be more
intimate than they actually are

104. Prevalence
• 2%-3% general population
• Similar in men and women
• 10%-15% in mental health settings

105. Differential Diagnosis
• As before
• Narcissistic PD also want praise, but for
superiority, whereas Histrionic PD willing
to be viewed as fragile or dependent if htis
is instrumental in getting attention
• Dependent PD want praise, guidance but
w/o flamboyant, exaggerated emotional
features

106. Treatment
• Patients are not aware of their own feelings
• Psychodynamic therapy best choice
• Antidepressants for depression, antianxiety
for anxiety, antipsychotics for derealization
and illusions????

107. Narcissistic Personlity
Disorder

108. • A pervasive pattern of grandiosity (in
fantasy or behavior), need for admiration,
and lack of empathy beginning by early
adulthood and present in a variety of
contexts as indicated by five or more:

109. • Grandiose sense of self-importance
• Preoccupied with fantasies of unlimited
success , power, brilliance, beauty, ideal love
• Believes he or she is special, and unique,and
can only be understood by, or should
associate with other special or high-status
people or institutions

110. • Requires excessive admiration
• Sense of entitlement
• Interpersonally exploitative, takes advantage
of others to achieve ow ends
• Lacks empathy

111. • Envious of other or believes that others are
envious of him or her
• Shows arrogant, haughty behaviors or
attitudes

112. Prevalence
• Less than 1% in general population
• 2%-16% in clinical population
• 50%-75% male

113. Differential Diagnosis
• Histrionic, Antisocial, Borderline
• Coquettish, callous, needy
• GRANDIOSITY
• relative lack of self-destructiveness,
impulsivity, abandonment concerns (BPD)

114. Differential Diagnosis
• Excessive pride in achievements, relative
lack of emotional display, disdain for others’
sensitivities (Histrionic)
• Obsessive Compulsive PD usually self
critical, in addition to commitment to
perfectionism and belief others can not do
things as well

116. Treatment
• Psychotherapy: Kernberg and Kohut
advocate psychoanalytic approach

117. Pharmacotherapy
• Lithium??? (mood swings)
• Antidepressants (susceptible to depression
due to poor tolerance of rejection)

118. Cluster C

119. Avoidant Personality
Disorder

120. • A pervasive pattern of social inhibition,
feelings of inadequacy, and hypersensitivity
to negative evaluation, beginning by early
adulthood and present in a variety of
contexts, as indicated by 4 or more:

121. • Avoids occupational activities that involve
significant interpersonal contact, b/c of
fears of criticism, disapproval, rejection
• Unwilling to get involved with people
unless certain of being liked
• Shows restraint within intimate
relationships b/c of fear of being shamed or
ridiculed

122. • Preoccupied with being criticized or
rejected in social situations
• Inhibited in new interpersonal situations
because of feelings of inadequacy
• Views self as socially inept, personally
unappealing, or inferior to others
• Unusually reluctant to take personal risk
for fear of embarrassment

123. Prevalence
• 0.5%-1% general population
• 10% outpatient population

124. Course
• Avoidant behaior often starts in infancy or
childhood with shyness, isolation, and fear
of strangers and new situations
• Most individuals dissipates and does not
become a PD
• Avoidant PD individuals become more shy
and avoidant in adolescence, early
adulthood, may remit with age

125. Differential Diagnosis
• Social Phobia (high overlap ? same)
• Panic d/o with Agoraphobia (often co-
ocurence)
• Avoidant and Dependent both have feelings
of inadequacy, hypersensitivity to criticism,
need for reassurance: Avoid humiliation/
rejection vs focus on being taken care of

126. Differential Diagnosis
• Avoidant Personality d/o and Dependent
Personality d/o may be co-occurring
• Schizoid or Schizotypal PD also tend to
isolation, but Avoidant PD want to have
relationships, and feel loneliness deeply, vs
perhaps preferred isolation

127. Differential Diagnosis
• Paranoid PD and Avoidant PD: Both
reluctant to confide in others, but in
Avoidant PD due to fear of being
embarrassed or being found inadequate vs
others’ malicious intent.

128. Course
• Many may function in protected
environment
• Phobic avoidance is common
• May develop social phobia

129. Treatment
• Psychotherapy: Solidify alliance
• Accepting attitude toward fears, especially
fear of rejection
• Eventual encouragement to take “great
risk”
• Care with “assignment” due to worsened
low self esteem with “failure”

130. Psychopharmacology
• Treat anxiety and depression
• Consider beta blocker for autonomic
nervous system hyperactivity which is
common
• SSRIs for rejection sensitivity
• Dopamine agonists for “novelty seeking
behavior” if psychologically prepared

131. Dependent Personality
Disorder

132. • A pervasive and excessive need to be taken
care of that leads to submissive and clinging
behavior and fears of separation, beginning
in early adulthood and present in a variety
of contexts as indicated by five or more:

133. • Difficulty making everyday decisions w/o an
excessive amount of advice and
reassurance
• Needs others to assume responsibility for
most major areas of his or her life
• Difficulty expressing disagreement with
others b/c of fear of loss of support/
approval (do not include fears of realistic
retribution)

134. • Difficulty initiating projects or doing things
on his/her own (lack self confidence)
• Goes to excessive lengths to obtain
nurturance and support from others, to
point of volunteer to do unpleasant things
• Feels uncomfortable or helpless when
alone b/c of exaggerated fears of being
unable to care for slef

135. • Urgently seeks another relationship as a
source of care and support when close
relationship ends
• Unrealistically preoccupied with fears of
being left to take care of self

136. Prevalence
• Among the most frequently encountered in
mental health field
• More common in women than men
• One study stated 2.5% of all Pd
• Children chronically ill susceptible

137. Differential Diagnosis
• Distinguish from dependence secondary to
Axis I or general medical condition’
• BPD react with emotional emptiness, rage,
whereas Dependent react with increasing
appeasement and submissivenes
• Histrionic: both need reassurance/approval
but Dependent self-effacing/docile, vs
gregarious flirtation/flamboyance

138. Differential Diagnosis
• Avoidant Personality Disorder also feelings
of inadequacy, hypersensitivity to criticism,
need reassurance (like Dependent) but so
fearful of humiliation and rejection they
withdraw until certain of acceptance vs
Dependent seek relationships

139. Course
• May have impaired functioning as don’t act
independently
• Risk for physical or mental abuse as can not
assert themselves
• Risk of depression when loss of person on
whom they depend

140. Treatment
• Psychotherapy: Often successful
• Insight oriented, CBT, Group have all been
successful
• Therapy is risked with pressure to leave a
pathological relationship, patients feel torn
• Must show great respect for feelings of
attachment no matter how pathological

141. Pharmacotherapy
• Antidepressants for Anxiety and
Depression
• Imipramine for panic or separation anxiety

142. Obsessive Compulsive
Personality Disorder

143. • Pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency, beginning
by early adulthood and present in a variety
of contexts as indicated by 4 or more:

144. • Preoccupied with details, rules, lists, order,
organization or schedules to extent that
point of activity is lost
• Shows perfectionism that interferes with
task completion (unable to complete
project b/c own overly strict standards not
met)

145. • Excessively devoted to work and
productivity to exclusion of leisure
activities and friendships
• Overconscientious, scrupulous, and
inflexible about matters of morality, ethics
or values
• Unable to discard worn-out or worthless
objects even when have no sentimental
value

146. • Reluctant to delegate tasks or work w/
others unless they submit to exactly his or
her way of doing things
• Adopts a miserly spending style toward
both self and others; money is to be
hoarded for future catastrophes
• Shows rigidity and stubornness

147. Prevalence
• 1% general population
• 3%-10% in mental health setting

148. Course
• Highly variable
• May flourish in positions demanding
methodical, demanding, deductive work,
vulnerable to unexpected changes
• Personal life may be barren
• High risk depression

149. Treatment
• Often aware of suffering, seek treatment
• Psychotherapy treatment long and
complex, countertransference problems
common
• CBT and group therapy offer interrupting
maladaptive behaviors

150. Pharmacotherapy
• Consider clomipramine or fluoxetine or
benzodiazepine clonazepam for severe
obsessive compulsive symptoms

151. • Criteria Sets and Axes provided for further
study
• The DSM IV Task Force determined that
there was insufficient information to
warrant inclusion of these proposals as
official categories or axes in DSM IV

152. • Pervasive pattern of depressive cognitions
and behaviors beginning by early
adulthood.....5 or more

153. • Usual mood dominated by defection,
gloominess, cheerlessness, joylessness,
unhappiness
• Self-concept centers around beliefs of
inadequacy, worthlessness, and low self
esteem
• Critical, blaming, derogatory toward self
• Brooding and given to worry

154. • Negativistic, critical, and judgmental toward
others
• Pessimistic
• Prone to feeling guilty or remorseful
• Does not occur exclusively during Major
Depressive Disorders and is not better
accounted for by Dysthymic Disorder

155. Passive Aggressive PD
• Passively resists fulfilling routine social and
occ tasks
•

156. Treatment