Schizoid treatment: typically do not seek treatment, may do so in crisis.

Group treatment, focusing on increasing person’s social

skills (role plays, behavioral experiments) and awareness of self feelings
Schizotypal PD: 1. socially isolated, (2) as children: passive, socially unengaged, sensitive to criticism. (3) Vague/over-
elaborate/wandering speech. (4) few emotional responses/not situation appropriate, (5) maintain contact with reality
Cognitions: paranoia, ideas of reference (ordinary events/objects/people have special meanings), magical thinking (one's thoughts
directly influence the world, esp w ocd), illusions
- Weak information processive (e.g. working memory, recall, attention)
Genetics: psychotic-like traits are highly heritable based on MZ DZ twins. (2) more common in first degree relatives of people w
schizophrenia (10x more likely), shared genes and chromosomal regions
“Mild form of schizophrenia”: deficits in memory, learning, recall - similar to schizophrenia
- Similar dysregulation of dopamine as schizophrenia
Prevalence: 3-5%, more common in men 2:1, depression is a comorbid diagnosis
- trauma/racial discrimination explained 8-23% of each dimension of each disorder
Schizotypal treatment: no specific medication, antidepressants/antipsychotics to reduce symptoms. (2) psychotherapy –
establish good therapeutic relationship, help client increase social contact, identifying objective evidence for thoughts (e.g. if u
see someone acting this way, what do u think will happen), behavioral experiments
Cluster B: dramatic, erratic, and emotional behavior + interpersonal relationships
BPD, ASPD + Narcissistic (grandiose self-image, need for attention), Histrionic (excessive emotionality and attention
seeking)
Borderline Personality disorder (5+)
- Frantic efforts to avoid real or imagined abandonment – rejection or neglect is expected and cues are misinterpreted
- Unstable and intense interpersonal relationship, extremes between idealization and devaluation – ‘i hate u, don't leave
me’
- Identity disturbance, unstable self-image
- Self-damaging impulsivity – i.e. spending, gambling, sexually promiscuous, substance abuse
- Recurrent suicidal behavior, gestures of threats, self-mutilating behavior – suicidal ideation
- Affective instability due to reactivity of mood (intense episodes of low mood and irritability
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress related paranoid ideation or severe dissociative symptoms
Disorder of dysregulation (BPD theory): emotions: unpredictable mood shifts, anger problems. Interpersonal: chaotic, fear of
abandonment. Self: emptiness, identity disturbance. Behavior: self-hard and impulse control. Cognition: paranoid ideation,
dissociative
Biosocial model of BPD (slide 28): emotional vulnerability+invalidating environment=emotion dysregulation
Biological factors: greater activity in amygdala: regulating emotions and memory, prefrontal cortex: language, emotional
expression, planning, mediating social interactions. (2) low levels of serotonin: fueling impulsivity (3) Childhood trauma
+wearing down the HPA axis (allostatic load: physiological dysregulation due to chronic stress) (4) BDNF Val66Met genetic
polymorphism, risk for AN, not BPD, plays role in neuroplasticity
BPD prevalence: 1-2% across cultures, 75% females, comorbidity of EDs, +risk factor for suicide
BPD treatment: DBT (first targetting life self-injury/suicidal ideation), patients are taught to deal with regulating emotions,
distressing situations, and improving relationships
- Individual therapy, skills training (mindfulness, emotions, stress), 24-hour consultation
- DBT reduces nonsuicidal self-injury, attempts, depression, hopelessness, anger, impulsivity, substance abuse, and
INCREASES self-esteem and social adjustment
Antisocial personality disorder (ASPD)
- Pervasive pattern of disregard for and violation of the rights of others
1. Failure to conform to social normal with respect to lawful behavior - repeated illegal behavior
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for self-pleasure/profit
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness - repeated physical violence
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility - repeated failure to sustain consistent work behavior or honor financial
obligations
7. Lack of remorse
 - Must be 18+ and have had a conduct disorder (repetitive violating behavior) before 15 years old.
Psychopathy vs ASPD: psycho: 1%, ASPD: 3%, psychopaths make up 15-20% of prisoners, majority also meet criteria for
ASPD, only 25% with ASPD possess psychopathic traits
ASPD diagnosis: identified by Phillipe Pinel, DSM5 moved toward ‘trait’ based (impulsivity, deceitfulness). The problem w trait
based is that it has lower reliability
- 44% of Ontario’s correctional facilities have ASPD, lower education than individuals with other PDs, 60% more likely
for substance, most have poor outcomes
Biological theories of ASPD: reduced volume in the amygdala and orbital ventrolateral frontal cortex; resulting in deficits in
emotion regulation, fear responses, higher levels of reasoning/learning
- Reduced cardiac response in anticipation or response to a threat, lower resting heart rate
- Hypo-arousal in response to murder scenes/unpleasant images (arousal helps with decision-making and taking in cues,
guiding uncertainty)
- Fearlessness vs under-stimulation, more easily bored/low arousal = distress, seeking reward
ASPD risk factors: GxE: twins share 38-69% traits, physical, sexual abuse in childhood +neglect, coercive family proccesses
(reinforcing negative) = development of conduct disorder
- Poor executive functioning: sustain attention, abstract thinking, self-awareness, difference in temporal and frontal lobes
ASPD treatment: do not seek out treatment, increase control over anger/impulsive behavior, identifying triggers, and developing
alternative coping strategies, increase empathy, lithium and atypical antipsych
Cluster C: anxious-fearful PDs
- Cognitive theories: distorted beliefs about being worthless, treatments focus on skills training, behavioral
experiments, and challenging negative automatic thoughts
1. Avoidant personality disorder: Pervasive anxiety, sense of inadequacy, fear of being criticized = leading to the
avoidance of social interactions/nervousness
a. Avoids occupational activities that involve significant social interaction
b. Unwilling to get involved with people unless certainty of being liked
c. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
d. Is preoccupied with being criticized or rejected in social situations
e. Is inhibited in new interpersonal situations because of feelings of inadequacy
f. Views self as socially inept, personally unappealing, or inferior to others
g. Unusually reluctant to take personal risks or to engage in any new activities ; Depressed and lonely – at risk
for double depression; Wants relationships but feel unworthy
2. Dependent personality disorder: pervasive selflessness, need to be cared for, fear of rejection = leads to a total
dependence on others and submission to others
a. Anxiety is experienced in relationships due to a deep need to be cared for by others
b. Cannot make decisions for themselves, unless its to act in a way to please others
c. 1.6-6.7% more common in women
i. Frequently seek treatment (CBT + BT): w a goal to increase independence
3. Obsessive-compulsive personality disorder: pervasive rigidity in one’s activities and relationships, including
emotional construction, extreme perfectionism, anxiety about even minor disruptions in routine
a. Similar to OCD, but generalized pattern of navigating the world
b. 1.7-7.7%, more common in men
i. Poor interpersonal relationships, prone to depression
How anxious-fearful PD differs from social phobia: social phobia is more related to performance anxiety, often easily
embarrassed or feel they’re constantly being judged vs AFPD: personality related to feeling worthless, while social phobia is
more directed to external factors with internal cues
- Differs from schizoid: schizoid genuinely don’t want to be around people, vs AFPD want to form relationships but feel
too inferior to do so