Personality Disorder

1. Personality Disorder 华东师范大学 屠筱青 Email: misulaso@yahoo.cn

2. Persona Personality Personality trait Personality disorder

3. Poet of Fairy Tale —— Cheng Gu` 黑夜给了我黑色的眼睛 我却用它寻找光明 ——《黑眼睛》 你 一会看我 一会看云 我觉得 你看我时很远 你看云时很近 —— 《远和近》

4. Personality Disorder Definition Enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. From DSM-IV™

5. About Personality Disorder Characteristics 3P — Persistent PervasiveProblematic Diagnostic Features • cognition • affect • interpersonal functioning • impulse control Diagnose Coded on Axis II3 Clusters 10 PD

6. Paranoid • Schizoid • Schizotypal Cluster A odd, eccentric • Antisocial • Borderline • Histrionic • Narcissistic Cluster B dramatic, emotional, erratic • Avoidant • Dependent • Obsessive-Compulsive Cluster C anxious, fearful

7. About Personality Disorder Prevalence General People 0.5%~2.5% Inpatient 10%~30% Outpatient 2%~10% Gender differences Male: Antisocial / Narcissistic PD Female: Borderline / Histrionic PD : From APA,2000

8. About Personality Disorder Adolf Hitler Comorbidity With Axis I: Anxiety Disorder , Mood Disorder , Substance-related Disorder … Within Categories: Paranoid, Avoidant, & Borderline with other PDs Half with Avoidant meet criteria for Schizotypal ……

9. Cluster A Odd or Eccentric Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder

10. Paranoid Personality Disorder Definition PPD is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

11. Beck. Cognitive Effects and Typical Beliefs in Personality DisordersFrom Cognitive Therapy of Personality Disorders Typical Beliefs People are potential adversaries. I cannot trust other people. Other people have hidden motives. I have to be on guard at all times. It isn't safe to confide in other people. People will take advantage of me if I give them the chance. Other people will deliberately try to demean me. I will be in serious trouble if I let other people think they can get away with mistreating me. If other people find out things about me, they will use them against me.

12. Diagnostic Criteria( DSM-IV™ made easy) SUSPECT (4+) S : Spouse fidelity suspected U : Unforgiving (bears grudges) S : Suspicious of others P : Perceives attacks (and reacts quickly) E : “Enemy or friend” (suspects associates, friends) C : Confiding in others feared T : Threats perceived in benign events

13. XingHua Qiu Characteristics Pervasive unjustified distrust Interpersonal relationship problems Narrow-minded and paranoid Egocentric and denying any criticism

14. Paranoid PD vs Paranoid Schizophrenia PPD focuses on the perceived motives and intentions of others grounded in reality PS psychotic symptoms such as auditory and visual hallucinations paranoia & delusions bizarre

15. Schizoid Personality Disorder Definition Schizoid PD is primarily characterized by a very limited range of emotion, both in expression of and experiencing. Persons with this disorder are indifferent to social relationships and display flattened affect.

16. Typical Beliefs I need plenty of space Relationships are problematic. Life is less complicated without other people. I am empty inside. It is better for me to keep my distance and maintain a low profile. I am a social misfit. Life is bland and unfulfilling. They “consider themselves to be observers rather than participants in the world around them.”

17. Diagnostic Criteria DISTANT (4＋) D : Detached (or flattened affect) I : Indifferent to criticism or praise S : Sexual experiences of little interest T : Tasks (activities) done solitarily A : Absence of close friends N : Neither desires nor enjoys close relations T : Takes pleasure in a few activities

18. Characteristics Autism, aloof, cold, indifferent to other people Schizoid, narcissistic & avoidant PDs are relatively rare, occurring in less than 1% of the general population.

19. Schizotypal Personality Disorder Definition Schizotypal PD is primarily characterized by a need for social isolation, odd behaviour and thinking, and often unconventional beliefs such as being convinced of having extra sensory abilities.

20. Typical Beliefs I need to consider only my own views; I must not be influenced by anyone. I feel like an alien in a frightening environment. Since the world is dangerous, you have to watch out for yourself at all times. There are reasons for everything. Things don't happen by chance. Sometimes my inner feelings are an indication of what is going to happen. Relationships are threatening. I am defective.

21. Diagnostic Criteria ME PECULIAR (5＋) M : Magical thinking or odd beliefs E : Experiences unusual perceptions P : Paranoid ideation E : Eccentric appearance or behavior C : Constricted (or inappropriate) affect U : Unusual (odd) thinking and speech L : Lacks close friends I : Ideas of reference A : Anxiety in social situations R : Rule out psychotic disorders & pervasive development disorder

22. F. Nietzsche Characteristics have paranoid thoughts, express little emotion, and may dress or behave in unusual ways telepathy, ghosts, astrology, sixth sense... Only a small proportion of individuals with schizotypal PDs go on to develop schizophrenia.

23. SchizophreniavsDepersonalizationvsDissociative Identity Axis I Multiple Personality Dissociative Identity

24. Cluster B Dramatic, Emotional or Erratic Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder

25. Antisocial Personality Disorder Definition ASPD is characterized by a lack of regard for the moral or legal standards in the local culture. There is a marked inability to get along with others or abide by societal rules.

26. Typical Beliefs People are there to be taken. Force or cunning is the best way to get things done. We live in a jungle and the strong person is the one who survives. People will get at me if I don't get them first. It is not important to keep promises or honor debts. Lying and cheating are OK as long as you don't get caught. I have been unfairly treated and am entitled to get my fair share by whatever means I can. If people can't take care of themselves, that's their problem.

27. Hannibal Mike Tyson

28. Diagnostic Criteria • CORRUPT （3+） • C : Conformity to law lacking • O : Obligations ignored • R : Reckless disregard for safety of self and others • R : Remorse lacking • U : Underhanded (deceitful, lies, cons others) • P : Planning insufficient (impulsive) • T : Temper (irritable and aggressive ) • The individual is at least 18 years old ( under 15 see Conduct Disorder ).

29. Conduct Disorder <15, 3 +, 1-6months aggression to people and animals destruction of property deceitfulness or theft serious violations of rules

30. ASPD vs Psychopath vs Criminality Development Mania without delirium, Moral insanity Egopathy, Sociopathy, Psychopathy Psychopath Cleckley & Hare PCL - R

31. Not all people with ASPD are criminals (or in jails) • Not all people in jail or considered criminal have ASPD • Not all people with ASPD are psychopaths

32. Borderline Personality Disorder Definition BPD is characterized by a lack of ones own identity, with rapid changes in mood, intense unstable interpersonal relationships, marked impulsively, instability in affect, and instability in self image.

33. Diagnostic Criteria AM SUICIDE (5＋) A : Abandonment M : Mood instability S : Suicidal or self mutilating behavior U : Unstable and intense relationships I : Impulsivity C : Control of anger I : Identity disturbance D : Dissociative (or paranoid) symptoms that are transient & stress –related E : Emptiness (chronic feelings of)

34. Characteristics About 75% of BPD patients are women Heightened risk for completed suicide8.5% to 10.0% among BPD patients Comorbidity Mood disorder: depression Eating disorder: bulimia Substance-related disorder: drug use

35. Girl, Interrupted Satisfy a Craving Fatal Attraction

36. Typical Beliefs Other people must satisfy my needs. No one would love me or want to be close to me if they really got to know me. I can't cope on my own. I need someone to rely on. I must subjugate my wants to the desires of others or they'll abandon me or attack me. People will hurt me, attack me, take advantage of me. I must protect myself. It isn't possible for me to control myself or discipline myself. I must control my emotions or something terrible will happen. No one is ever there to meet my needs, to be strong for me, to care for me.

37. Histrionic Personality Disorder Definition A pervasive pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood.

38. Sister Hibiscus Yang Er

39. Typical Beliefs I need to impress. In order to be happy I need other people to pay attention to me. Unless I entertain or impress people, I am nothing. If I don't keep others engaged with me, they won't like me. The way to get what I want is to dazzle or amuse people. It is awful for people to ignore me. I should be the center of attention. If I entertain people, they will not notice my weaknesses. People will pay attention only if I act in extreme ways.

40. Diagnostic Criteria PRAISE ME (5+) P : Provocative (or sexually seductive) behavior R : Relationships (considered more intimate) A : Attention I : Influenced easily S : Style of speech (impressionistic, lacks detail) E : Emotions (rapidly shifting and hollow) M: Made up E : Emotions exaggerated

41. Characteristics Vain, extravagant & seductive Always onstage Comorbidity 2/3 of people with HPD also met criteria for ASPD

42. NarcissisticPersonality Disorder Definition NPD is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts

43. Narcissus

44. Typical Beliefs • I am special. • Since I am so superior, I am entitled to special treatment • and privileges. I don't have to be bound by the rules that apply to other • people. If others don't respect my status, they should be punished. Other people should satisfy my needs. Other people should recognize how special I am. Since I am so talented, people should go out of their way • to promote my career. No one's needs should interfere with my own.

45. Diagnostic Criteria SPECIAL (5＋) S : Special P : Preoccupied with fantasies E : Entitlement Envious C : Conceited I : Interpersonal exploitation A : Arrogant (haughty) Admiration L : Lacks empathy

46. Cluster C Anxious or Fearful Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder

47. Avoidant Personality Disorder Definition Avoidant PD is characterized by a lifelong pattern of extreme shyness, feelings of inadequacy and sensitivity to rejection.

48. Typical Beliefs I may get hurt. I am socially inept and socially undesirable in work or social situations. Other people are potentially critical, indifferent, demeaning, or rejecting. If people get close to me, they will discover the "real" me and reject me. Being exposed as inferior or inadequate will be intolerable. I should avoid unpleasant situations at all costs. Unpleasant feelings will escalate and get out of control. If I ignore a problem, it will go away.

49. Diagnostic Criteria CRINGES (4+) C : Certainty R : Rejection (or criticism) preoccupies one’s thoughts in social occasions I : Intimate relationships N : New interpersonal relationships (is inhibited in) G : Gets around occupational activity E : Embarrassment (potential) prevents new activity or taking personal risks S : Self-viewed as unappealing, inept or inferior

50. Avoidant PDvsSchizoid PD Avoidant PD Low self-esteem Interpersonally anxious & fearful of rejection Schizoid PD Apathetic, affectively flat, relatively uninterested in interpersonal relationships