Personality Disorders

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Personality Disorders
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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

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Classification of P.D

• 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.

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General characteristics of P.D

• Inflexible, maladaptive patterns of personality
• Begins early in adulthood
• Results in social, occupational problems or
  distress

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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

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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..

• 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 PDs

• 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

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General Diagnostic Criteria for PDs

• 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

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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)

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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

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Cluster C Personality Disorders

• Avoidant, obsessive-compulsive, dependent
  disorders
• People are often anxious, fearful, and depressed

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Cluster A Personality Disorders
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Paranoid Personality Disorder

• Lack of trust in others
• Fear that friends may be disloyal, unfaithful
• Being hypersensitive, overly suspicious,
  perceived as hostile

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DSM-IV Criteria for Paranoid PD

• Pervasive distrust, suspicion of others, and four
  or more of the following
• 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

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Facts About Paranoid Personality Disorder

• Affects 0.52.5 percent of population
• Sometimes several individuals band together into
  groups that share paranoid beliefs
• More common in males

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Schizoid Personality Disorder

• Enduring pattern of thinking and behavior
  characterized by
• pervasive indifference to others
• diminished range of emotional experiences,
  expressions
• Socially isolated, lacking in social
  relationships

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DSM-IV Criteria for Schizoid PD

• Detachment from social relationships, restricted
  emotions, as indicated by four or more of the
  following
• 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

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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

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DSM-IV Criteria for Schizotypal PD

• Acute discomfort with social relationships,
  eccentric behavior, and five or more of the
  following
• 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

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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

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Antisocial Personality Disorder

• Pervasive, persistent disregard for or violation
  of rights of other people

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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
• 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

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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 2.53.5 percent of population
• More common in men
• Highest prevalence among men 2544 yr old
• 40 percent of affected men and 24 percent of
  affected women were diagnosed with conduct
  disorder as children

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Causes of Antisocial PD

• Genetics
• Birth trauma
• Sensation-seeking
• Family dynamics
• Modeling and media

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Borderline Personality Disorder

• Enduring pattern of thinking, behavior that
  involves
• instability of mood, self-image, interpersonal
  relationships
• efforts to avoid real or imagined abandonment
• unrealistically positive or negative opinions
  about others (intense relationships or
  nonexistance)

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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

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DSM-IV Criteria for Borderline PD

• Instability in relationships, self-image, marked
  impulsivity, and five or more of the following
• efforts to avoid real or imagined abandonment
• pattern of unstable, intense relationships
• identity disturbance
• impulsivity in two or more areas that are
  self-damaging

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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
  attention-seeking behavior
• Person is typically self-centered, demanding
• Appears in 23 percent of the population
• Mainly diagnosed in women
• Person dresses eccentrically, seductively

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DSM-IV Criteria for Histrionic PD

• Excessive emotionality, attention-seeking, and
  five or more of the following
• 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

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Narcissistic Personality Disorder

• Enduring pattern of thinking, behavior
  characterized by grandiosity, preoccupation with
  own achievements and abilities

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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

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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

Shy and socially uncomfortable but desire social
contact Avoid it because of fear of embarrassment
or criticism
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Obsessive-Compulsive Personality Disorder

• Enduring pattern of thinking, behavior
  characterized by perfectionism, inflexibility
• Preoccupied with rules, excessively moralistic,
  judgmental

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Dependent Personality Disorder

• Enduring pattern of submissive, dependent
  behavior
• Exceedingly dependent on others for advice,
  reassurance
• Feelings of anxiety and helplessness when alone

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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

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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

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Pharmacotherapy

• - symptomatic, follows symptoms
• target permanent symptoms (long-term) or actual
  state (acute anxiety, disquiet, suicidal beh.,
  agitation, emotional crises...)

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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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