Transcript Document

Personality Disorders
Types of Personality Disorders
Paranoid personality
Schizoid personality
Cluster A
Schizotypal personality
Antisocial personality
Borderline personality
Histrionic personality
Cluster B
Narcissistic personality
Avoidant personality
Dependent personality
Cluster C
Obsessive-compulsive personality
Classification of P.D
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ICD-10:
F 60 -Specific personality disorders:
Paranoid P.D.
Schizoid P.D.
Dissocial P.D.
Emotionally unstable P.D.
Histrionic P.D.
Anankastic P.D.
Anxious (avoidant) P.D.
Dependent P.D
F 61 –Mixed and Other P.D.
General characteristics of P.D
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Inflexible, maladaptive patterns of
personality
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Begins early in adulthood
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Results in social, occupational problems or
distress
Facts About Personality Disorders
Onset usually late childhood, early adolescence
Causes others distress
Affects behavior in many situations
Poor insight
Little behavior change
Coded on Axis II
Etiology
Hereditary factor : chromosomal
abnormality or genetic predisposition
 Relation of personality disorder to mental
disorder
 P.D and upbringing
eg. Disturbed parent-child relationship
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Cont…………..
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Other causes
maternal deprivation in antisocial P.D
 Physical & sexual abuse in childhood (borderline
P.D)
 Excessive use of repression (histrionic P.D)
 Fixation in the oral stage of development
(dependent P.D)
 Lack of parental affection & persistent rejection
(paranoid P.D)
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General Diagnostic Criteria for PD’s
Enduring pattern of inner experience or
behavior that deviates from expectations of
culture, manifested in two or more of the
following:
- cognition (perception of self, others)
 affectivity (intensity, range of emotions)
 interpersonal functioning
 impulse control
Enduring pattern is inflexible, pervasive in many
situations
General Diagnostic Criteria for PD’s
Enduring pattern leads to distress, impairment
in important areas of functioning
Pattern is stable and of long duration, can be
traced back to childhood
Pattern not better explained by another disorder
Pattern not due to substance abuse or medical
condition
Cluster A Personality Disorders
Paranoid, schizoid, and schizotypal
personality disorders
Marked by eccentricity, odd behavior,
not psychosis
Share a superficial similarity with
schizophrenia (a milder version)
Cluster B Personality Disorders
Antisocial, borderline, histrionic, and
narcissistic personality disorders
Being self-absorbed, prone to
exaggerate importance of
events
Having difficulty maintaining close
relationships
Cluster C Personality Disorders
Avoidant, obsessive-compulsive, dependent
disorders
People are often anxious, fearful, and
depressed
Cluster A Personality Disorders
Paranoid Personality Disorder
Lack of trust in others
Fear that friends may be disloyal, unfaithful
Being hypersensitive, overly suspicious,
perceived as hostile
DSM-IV Criteria for Paranoid PD
Pervasive distrust, suspicion of others,
and four or more of the following:
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suspects, without basis, that others are
exploiting, harming, deceiving
is preoccupied with unjustified doubts of
loyalty or trustworthiness of people
is reluctant to confide in others
persistently bears grudges
perceives attacks on reputation
has unjustified suspicions about fidelity of
others
Facts About Paranoid
Personality Disorder
Affects 0.5–2.5 percent of population
Sometimes several individuals band
together into groups that share paranoid
beliefs
More common in males
Schizoid Personality Disorder
Enduring pattern of thinking and behavior
characterized by
pervasive indifference to others
 diminished range of emotional experiences,
expressions
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Socially isolated, lacking in social
relationships
DSM-IV Criteria for Schizoid PD
Detachment from social relationships,
restricted emotions, as indicated by
four or more of the following:
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neither desires nor enjoys social relationships
prefers solitary activities
has little interest in sexual experiences
gets pleasure from few activities
lacks close friends
appears indifferent to praise or criticism
shows emotional coldness, detachment, flat
affect
Schizotypal Personality Disorder
Enduring pattern of discomfort with others
and odd, peculiar thinking and behavior
Shares symptoms with both paranoid and
schizoid personality disorders
Most closely linked to schizophrenia
DSM-IV Criteria for Schizotypal PD
Acute discomfort with social relationships,
eccentric behavior, and five or more of the
following:
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ideas of reference
odd beliefs
unusual perceptual experiences
odd speech
suspiciousness
inappropriate or constricted affect
odd or eccentric appearance and behavior
lack of close friends
excessive social anxiety
Cluster B Personality Disorders
Antisocial, borderline, histrionic, and
narcissistic personality disorders
Being self-absorbed, prone to exaggerate
importance of events
Having difficulty maintaining close
relationships
Antisocial Personality Disorder
Pervasive, persistent disregard for or
violation of rights of other people
DSM-IV Criteria for Antisocial PD
Pattern of disregard for rights of others
since age 15, as indicated by three or
more of the following:
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failure to conform to social norms, respect
lawful behavior
deceitfulness, lying, conning others for
profit or pleasure
impulsivity, failure to plan ahead
irritability, aggressiveness, repeated fights
DSM-IV Criteria for Antisocial PD
disregard for safety of others
 consistent irresponsibility, failure to honor
obligations
 lack of remorse
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Facts About Antisocial PD
Affects 2.5–3.5 percent of population
More common in men
Highest prevalence among men 25–44 yr old
40 percent of affected men and 24 percent of
affected women were diagnosed with conduct
disorder as children
Causes of Antisocial PD
Genetics
Birth trauma
Sensation-seeking
Family dynamics
Modeling and media
Borderline Personality
Disorder
Enduring pattern of thinking, behavior that
involves
 instability of mood, self-image,
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interpersonal relationships
efforts to avoid real or imagined
abandonment
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unrealistically positive or negative
opinions about others (intense
relationships or nonexistance)
Facts About Borderline
Personality Disorder
Affects 2 percent of population
More common in women
Threats/actions of self-harm are common
Attributed to parental loss or abuse in
childhood
Treatment mostly unsuccessful – often use
behavior therapy
DSM-IV Criteria for Borderline PD
Instability in relationships, self-image,
marked impulsivity, and five or more of
the following:
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efforts to avoid real or imagined
abandonment
pattern of unstable, intense relationships
identity disturbance
impulsivity in two or more areas that are selfdamaging
DSM-IV Criteria for Borderline PD
recurrent suicidal behavior, gestures, threats
 affective instability
 chronic feelings of emptiness
 inappropriate intense anger
 transient, stress-related paranoid ideas
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Histrionic Personality Disorder
Enduring pattern of thinking, behavior
characterized by excessive
emotionality and attentionseeking behavior
Person is typically self-centered,
demanding
Appears in 2–3 percent of the population
Mainly diagnosed in women
Person dresses eccentrically, seductively
DSM-IV Criteria for Histrionic PD
Excessive emotionality, attention-seeking,
and five or more of the following:
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being uncomfortable when not center of attention
rapidly shifting moods
uses physical appearance to draw attention
interactions characterized by provocative
exaggerates in dramatic manner
is suggestible, easily influenced
considers relationships more intimate than they
are
Narcissistic Personality Disorder
Enduring pattern of thinking, behavior
characterized by grandiosity,
preoccupation with own
achievements and abilities
DSM-IV Criteria for Narcissistic PD
Grandiosity in fantasy and behavior, need
for admiration, lack of empathy, and five
or more of the following:
has grandiose sense of self-importance
 is preoccupied with fantasies of power,
success, love
 believes he or she is special or unique
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DSM-IV Criteria for Narcissistic PD
requires excessive admiration
 has sense of entitlement
 takes advantage of others to achieve own
needs
 lacks empathy
 is often envious of others
 is arrogant
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Cluster C Personality Disorders
Avoidant, obsessive-compulsive, dependent
disorders
People are often anxious, fearful, and
depressed
Avoidant Personality Disorder
Enduring pattern of thinking, behavior
characterized by
pervasive social discomfort
 fear of negative evaluation
 social isolation
 being easily hurt
 fear of disapproval
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Shy and socially uncomfortable but desire social contact
Avoid it because of fear of embarrassment or criticism
Obsessive-Compulsive
Personality Disorder
Enduring pattern of thinking, behavior
characterized by perfectionism, inflexibility
Preoccupied with rules, excessively
moralistic, judgmental
Dependent Personality Disorder
Enduring pattern of submissive, dependent
behavior
Exceedingly dependent on others for advice,
reassurance
Feelings of anxiety and helplessness when
alone
Treatment
Motivation to the therapy, compliance and
efficiency is different from case to case.
- Psychoterapy - basis
- Pharmacotherapy -in some cases,
symptomatic
- few controled studies of efficiency
- difficult but helpful
Psychotherapy
- the choice of the type of psychoterapy
depends
on specific type of P.D. and other factors
as motivation to therapy, intelectual state,
age and another.
- basic psychoterapeutic support
- psychoanalytic: individual or group
- cognitive-behavioral therapy
Pharmacotherapy
- symptomatic, follows symptoms
- target: permanent symptoms (long-term)
or actual state (acute anxiety, disquiet,
suicidal beh., agitation, emotional crises...)
Pharmacotherapy for symptoms
depression- SRI, MAOI, atyp.AP
acute anxiety and agitation- BZD, AP
anxiety- (S)SRI, buspiron, MAOI, low dose AP
em. instability- VAL, CBZ, Li, low dose AP
em. flateness- atyp.AP, SSRI, IMAO
aggression- Li, AP
impulsivity- SSRI, anticonv., Li, low dose AP
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