Personality Disorders

1. Personality Disorders

2. 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

3. 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.DF 61 –Mixed and Other P.D.

4. General characteristics of P.D • Inflexible, maladaptive patterns of personality • Begins early in adulthood • Results in social, occupational problems or distress

5. 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

6. Etiology • Hereditary factor : chromosomal abnormality or genetic predisposition • Relation of personality disorder to mental disorder • P.D and upbringing eg. Disturbed parent-child relationship

7. 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)

8. 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

9. 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

10. 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)

11. 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

12. Cluster C Personality Disorders Avoidant, obsessive-compulsive, dependent disorders People are often anxious, fearful, and depressed

13. Cluster A Personality Disorders

14. Paranoid Personality Disorder Lack of trust in others Fear that friends may be disloyal, unfaithful Being hypersensitive, overly suspicious, perceived as hostile

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Antisocial Personality Disorder Pervasive, persistent disregard for or violation of rights of other people

23. 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

24. DSM-IV Criteria for Antisocial PD • disregard for safety of others • consistent irresponsibility, failure to honor obligations • lack of remorse

25. 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

26. Causes of Antisocial PD Genetics Birth trauma Sensation-seeking Family dynamics Modeling and media

27. 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)

28. 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

29. 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

30. 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

31. Histrionic Personality Disorder Enduring pattern of thinking, behavior characterized by excessive emotionality and attention-seeking behavior Person is typically self-centered, demanding Appears in 2–3 percent of the population Mainly diagnosed in women Person dresses eccentrically, seductively

32. 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

33. Narcissistic Personality Disorder Enduring pattern of thinking, behavior characterized by grandiosity, preoccupation with own achievements and abilities

34. 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

35. 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

36. Cluster C Personality Disorders Avoidant, obsessive-compulsive, dependent disorders People are often anxious, fearful, and depressed

37. 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

38. Obsessive-Compulsive Personality Disorder Enduring pattern of thinking, behavior characterized by perfectionism, inflexibility Preoccupied with rules, excessively moralistic, judgmental

39. Dependent Personality Disorder Enduring pattern of submissive, dependent behavior Exceedingly dependent on others for advice, reassurance Feelings of anxiety and helplessness when alone

40. 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

41. 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

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

43. 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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