Personality

2. Personality person's characteristic totality of emotional and behavioral traits apparent in ordinary life, a totality that is usually stable and predictable the set of characteristics that defines the behavior, thoughts, and emotions of individuals - characteristics/traits that dictate people’s lifestyles

3. Personality traits: • schemes of perceptions of word around, our own person, and connections between them.

4. temperament • is the aspect of personality concerned with emotional dispositions and reactions and their speed and intensity; the term often is used to refer to the prevailing mood or mood pattern of a person.

6. Personality Temperament Character

7. Theory of liquids/Hipocrates, Galen/ • Hippocrates divided humanity into four temperaments ostensibly based on which "humours" (or bodily fluids) dominated the personality. According to their relative predominance in the individual, they were supposed to produce, respectively, temperaments. • Choleric- yellow bile- quick to react, hot tempered • Phlegmatic- phlegm- slow moving, apathetic • Sanguine- blood- warm, pleasant • Melancholic- black bile- depressed, sad

8. Temperaments typesby Hipocrates/ Galen/ Pawłow High reactivity cholerics Sanquinic Even-tempered Unbalanced melancholic flegmatic Low reactivity

9. ICD 10: • severe disturbances of personality and behavior that are pronounced deviations from normal cultural patterns

11. Characteristics of people with PD • Lack of empathy, abilieties to love, • Disrupted social and familial relationships, • Seek quick gratification of needs, frustrated easily • Self-destruction; carelessness • Lack of consequence to realize valid aims • They can’t recognize existing problems as a result of their characteristics, • Generally good intelligence • Pseudologia fantastica • Lack of deep interests

12. PROBLEMS - why do they need help?

13. PROBLEMS - why do they need help? • often they do not see a need for therapy, and they are referred by their peers, their families, or a social agency • inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, leading to medical and psychiatric problems for their children. • are often very frustrating to physicians--who have to deal with their unrealistic fears, excessive demands, sense of entitlement, unpaid bills, noncompliance, and angry vilification.

14. ETIOLOGY of PDGenetic Factors • PD twins investigation: monozygotic concordance>>dizygotic twins • PD of cluster A - more relatives with schizophrenia • schizophrenia patients – more relatives with schizotypal p. • antisocial p. associated with alcohol abuse • more depression in families of borderline p. patients • histrionic p. - more somatization d. • avoidant p. have high anxiety levels • obsessive-compulsive p. – signs associated with depression —shortened REM latency period, abnormal DST results.

15. ETIOLOGY of PDBiological Factors Neurotransmitters • High endogenous endorphin levels may be associated with people who are phlegmatic • Dopaminergic and serotonergic systems indicate an arousal-activating function • Levels of 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin, low in people who attempt suicide and in impulsive and aggressive patients. • Serotonin/SSRI/ reduces depression, impulsiveness, and rumination, general well-being. • Increased dopamine in the CNS /psychostimulants/ induce euphoria

16. ETIOLOGY of PDBiological Factors • Hormones - impulsive traits = increased levels of testosterone, 17-estradiol, estrone. • Platelet Monoamine Oxidase – • high level connected with sociality; • low - schizotypal p. • Electrophysiology. EEG-changes /slow-waves/ most commonly antisocial and borderline p.

17. ETIOLOGY of PD Temperamental, Familial, and Environmental Factors • antisocial father, alcoholysm in a family, inconsistent and impulsive parenting, severe abuse in childhood /verbal, physical, sexual/ - borderline, antisocial p. • temperamentally fearful children may later develop avoidant PD. • childhood CNS dysfunctions, MBD, soft neurological signs most common in antisocial and borderline PD • Cultural factors - cultures that encourage aggression may contribute to paranoid and antisocial PD

18. Psychoanalytic Factors • Sigmund Freud suggested that personality traits are related to a fixation at one psychosexual stage of development. • an oral character - passive and dependent • an anal character - stubborn, parsimonious, and highly conscientious

19. ICD-10 Diagnostic Criteria for Specific Personality Disorders G1. There is evidence that the individual's characteristic and enduring patterns of inner experience and behavior as a whole deviate markedly from the culturally expected and accepted range (or "norm"). Such deviation must be manifest in more than one of the following areas: • cognition(i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others); • affectivity(range, intensity, and appropriateness of emotional arousal and response); • control over impulses and gratification of needs; • manner of relating to others and of handling interpersonal situations.

20. ICD-10 Diagnostic Criteria for Specific Personality Disorders G2. The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations. G3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior referred to in criterion G2. G4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence. G5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders. G6. Organic brain disease, injury, or dysfunction must be excluded.

22. Personality disorders - Clusters A. the odd and eccentric group Projection/fantasy/paranoja  Schizoid, schizotypal, paranoid B. the dramatic, emotional and erratic group Dissociation/denial/splitting/acting out Histrionic, narcisstic, antisocial, borderline C.  the anxious and fearful group Isolation/ passive aggression/ hypochondriasis Avoidant, dependent, obsessive-compulsive

23. PARANOID PERSONALITY DISORDER • long-standing suspiciousness and mistrust of people in general. • refuse responsibility for their own feelings and assign responsibility to others. • often hostile, irritable, and angry • bigots, injustice collectors, pathologically jealous spouses, and litigious cranks. • excessive sensitivity to setbacks and rebuffs • tendency to bear grudges persistently, refusal to forgive insults, injuries, or slights; • persistent self-referential attitude, associated particularly with excessive self-importance; • preoccupation with unsubstantiated "conspiratorial" explanations of events

25. SCHIZOID PERSONALITY DISORDER • display a lifelong pattern of social withdrawal • discomfort with human interaction, introversion • often seen by others as eccentric, isolated, or lonely. • few, if an, activities provide pleasure • limited capacity to express either warm, tender feelings or anger towards others • little interest in having sexual experience with another person (taking into account age) • consistent choice of solitary activities • excessive preoccupation with fantasy and introspection; • no desire for, or possession of, any close friends or confiding relationships (or only one)

26. SCHIZOTYPAL PERSONALITY DISORDER • strikingly odd or strange, even to laypersons • magical thinking, peculiar notions, ideas of reference, illusions, and derealization • their speech may be distinctive or peculiar • inner world may be filled with vivid imaginary relationships and childlike fears and fantasies • they are isolated and have few, if any, friends • may decompensate and have psychotic symptoms, but these are usually of brief duration • greater association of cases among the biological relatives of patients with schizophrenia Course and Prognosis 10 percent committed suicide/ the schizotype is the premorbid p. of schizophrenia

27. ANTISOCIAL PERSONALITY DISORDER ICD-10 = dissocial personality disorder • onset before 15: lying, truancy, running away from home, thefts, fights, substance abuse • gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations • incapacity to maintain enduring relationships, though with no difficulty in establishing them • very low tolerance to frustration and a low threshold for discharge of aggression, including violence • incapacity to experience guilt • is not synonymous with criminality Epidemiology 3 percent in men ; 1 percent in women/ most common in poor urban areas /the prevalence in prison population circa 75 percent

28. BORDERLINE PERSONALITY DISORDER ambulatory schizophrenia, as-if personality, pseudoneurotic schizophrenia, psychotic character ICD-10 emotionally unstable p. disorder • stand on the border between neurosis and psychosis • extraordinarily unstable affect, mood, marked impulsivity, behavior is highly unpredictable • uncertainty about self-image, aims, preferences (including sexual) • intense and unstable relationships • recurrent threats or acts of self-harm • chronic feelings of emptiness • may have short-lived psychotic episodes (so-called micropsychotic) • high incidence of major depressive disorder episodes

29. HISTRIONIC PERSONALITY DISORDER • excitable and emotional • behave in a colorful, dramatic, extroverted fashion. • suggestibility (the individual is easily influenced by others or by circumstances); • shallow and labile affectivity; • continual seeking for excitement and activities in which the individual is the center of attention; • inappropriate seductiveness in appearance or behavior; • overconcern with physical attractiveness. • are sensation seekers and may get into trouble with the law, abuse substances, and act promiscuously • about 2 to 3 percent of GP • more frequently in women than in men • an association with somatization disorder and alcohol use disorders.

31. NARCISSISTIC PERSONALITY DISORDER • characterized by a heightened sense of self-importance and grandiose feelings of uniqueness. • is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love • believes that 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) • requires excessive admiration • has a sense of entitlement ie, unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations • is interpersonally exploitative ie, takes advantage of others to achieve his or her own ends • lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

33. AVOIDANT PERSONALITY DISORDER= anxious pd • an extreme sensitivity to rejection that lead a socially withdrawn life • show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance. described as having an inferiority complex • persistent and pervasive feelings of tension and apprehension • belief that one is socially inept, personally unappealing, or inferior to others • excessive preoccupation with being critized or rejected in social situations; • avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval, or rejection • social phobia is common

34. DEPENDENT PERSONALITY DISORDER =passive-dependent personality • subordinate their own needs to those of others • cannot make decisions without an excessive amount of advice and reassurance from others • do not like to be alone, they seek out others on whom they can depend; their relationships are thus distorted by their need to be attached to another person • pessimism, self-doubt, passivity, and fears of expressing sexual and aggressive feelings • an abusive, unfaithful, or alcoholic spouse may be tolerated for long periods in order not to disturb the sense of attachment • women > men • Influence of a chronic physical illness in childhood

35. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER ICD-10 - anancastic personality disorder • emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness. • a pervasive pattern of perfectionism and inflexibility. • defense mechanisms they use are rationalization, isolation, intellectualization • preoccupied with details, rules, lists, order, organization to the extent that the major point of the activity is lost • undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships • feelings of excessive doubt and caution • men > women /most often in oldest children. • more frequently in first-degree biological relatives

36. PERSONALITY DISORDER NOT OTHERWISE SPECIFIED • Passive-aggressive personality disorder • depressive personality disorder • oppositionalism, sadism, or masochism

37. PERSONALITY CHANGE DUE TO A GENERAL MEDICAL CONDITION • Head trauma • Cerebrovascular diseases • Cerebral tumors • Epilepsy (particularly complex partial epilepsy) • Huntington's disease • Multiple sclerosis • Endocrine disorders • Heavy metal poisoning (manganese, mercury) • Neurosyphilis • Acquired immune deficiency syndrome (AIDS) • have a clear sensorium. • Mild disorders of cognitive function often coexist, but do not amount to intellectual deterioration. • show marked changes in behavior or personality involving emotional liability and impaired impulse control

38. Treatment of Personality Disorders • takes a long time • Treatment is guided by a patient's symptoms and may include psychotherapy: psychodynamic, interpersonal, cognitive, and behavioral • and/or pharmacologic therapy. • Establish safeguards to protect patients from dangerous impulsive behavior (e.g., limit medication supply) • Periods of hospitalization may be needed. Personality traits such as coping mechanisms, beliefs, and behavior patterns take many years to develop, and they change slowly

40. Impulse-control disorders • Pathological gambling • Pathological fire setting (pyromania) • Pathological stealing (kleptomania) • Trichotillomania • Other habit and impulse disorders This category should be used for other kinds of persistently repeated maladaptive behavior that are not secondary to a recognized psychiatric syndrome and in which it appears that there is repeated failure to resist impulses to carry out the behavior. There is a prodromal period of tension with a feeling of release at the time of the act.

41. Impulsive- aggressive disorders ADHD SPECTRUM BD SPECTRUM Personality disorders: cluster B+ borderline TOURETTE/ OCD IMPULSIVENESS AND AGGRESSION DEVELOP.DISORDERS + AUTISM SPECTRUM SEXUAL COMPULSIONS IMPULS CONTROL DISORDERS HARMFUL USING OF SUBSTANCES PTSD

42. SEXUAL AND GENDER IDENTITY DISORDERS • Sexual Dysfunctions • Sexual Desire Disorders Hypoactive sexual desire disorder Sexual aversion disorder • Sexual Arousal Disorders Female sexual arousal disorder Male erectile disorder • Orgasmic Disorders Female orgasmic disorder/Male orgasmic disorder Premature ejaculation • Sexual Pain Disorders Dyspareunia / Vaginismus

43. SEXUAL AND GENDER IDENTITY DISORDERS Paraphilias • Exhibitionism • Fetishism • Frotteurism • Pedophilia • Sexual masochism • Sexual sadism • Transvestic fetishism • Voyeurism Gender Identity Disorders • in children/ in adolescents or adults

45. Eating disorders

46. Behawioral syndromes (F50-F59) • F50 Eating disorders • F51 Sleep disorders • F52 Sexual dysfunctions • F53 Mental disorders associated with puerperium. • F55 Abuse of non-dependence-producing substances

47. What is „normal eating” • Everybody eats and feels hunger. • Normally you have a meal when you’re hungry. • You stop eating in the while you are bellyfully but because „It is wrong to eat so much - I can gain weight”

48. What is „normal eating” • You choose food according to many rules eg. hunger, time, apetite but not according to inflexible rules: eg. „I may eat only below 100 calories meals and always without sugar” • Having main meals 3 times a day, with optional snacks between them. • Prefering to have a meal with a company.

49. What is „normal eating” • You can eat more food if it special tasty and do less if it’s tastelees. • You don’t feel guilty after you have eaten more then planned. • You realize that you don’t put on very much after you eat overmuch once. • Eating isn’t most significant sphere of your life.

50. Anorexia nervosa • beginning before age of 25, • Disturbed attitude to eating, food, body, weight and misshapening of own body. • Preoccupation with slimness and body mass. • Low selfattitude, problems with personal relations, „overperfection”, oversensitivness. • Disturbed relations and attitudes in close family, alkohol abuse, mental illness. • Exluded somatic and other mental illness