CHAPTER 7 Personality and personality disorder

1. CHAPTER 7 Personality and personality disorder Zhong-Lin Tan Ph.D. M.M. Hangzhou Mental Health Center Department of psychiatry, School of Medicine Hangzhou Normal University zlintan@yahoo.com.cn

2. Aim • Grasp the definitions of personality traits and disorders features to all personality disorders • Be familiar with the psychotherapeutic and pharmacologic treatment strategies for patients with personality disorder • Reference book: Gelder M, Harrison P, Cowen P. Shorter oxford textbook of psychiatry. Fifth Edition. Oxford: Oxford University Press, 2006

3. Personality

4. Personality • What is personality? • Personality refers to enduring qualities of an individual that are shown in his ways ofbehaving in a wide variety of circumstances. • Mental disorder: differ from previous behaviour.

5. The importance of personality • Personality as predispostion • Personality as pathoplastic factor • Personality in relation to treatment

6. Personality types • Sociable and outgoing type vs. solitary and self-conscious type • Extraversion-introversion and neuroticism (Eysenck) • Fives factors: Openness to experience; Conscientiousness, Extraversion-introversion, Agreeableness, Neuroticism(OCEAN) • Clinicians: positive attributes vs. negative attributes

7. The origins of personality • Genetic influences • Childhood temperament • Young infants differ in patterns of sleeping and waking, approach or withdrawal from new situations,intensity of emotional responses, and span of attention. • Childhood experience

8. The assessment of personality • Personality tests are more reliable in healthy people. • Useful in research, seldom used in clinical practice. • The current behaviour of an ill person reflects the effects of the illness as well as the personality.

9. Personality disorder

10. 1 The concept of abnormal personality • Statistical criterion: such as intelligence • Social criterion: cause individual suffer or cause suffering to others • Personality change • Due to organic disease of the brain • After psychiatric disorder • After a catastrophic experience

11. 2 How ideas bout abnormal personality developed? • Koch(1891) used the term psychopathic inferiority to denote this group of people who have marked abnormalities of behaviour in the absence of mental illness or intellectual impairment. • Later the word inferiority was replaced by pesonality to avoid judgemental overtones.

12. 3 The classification of abnormal personalities • Continuous vs. categories • Cut-off points– distress to the persons or others—arbitrary and inprecise • Comorbidity: more than one peraonality diagnosis can be made in a single patient • Classification

14. 4 Descriptions and diagnostic criteria • Cluster A personality disorders

15. Cluster B personality disorder

17. Cluster C personality disorder

19. 5 Epidemilolgy

20. 6 Aetiology • Genetic causes • Early life experiences

21. 7 The prognosis of personality disorder • Personality disorders are defined as lifelong conditions, so little change would be expected with time. There is little reliable evidence about their outcome.

22. 8 Treatment(1) important points • Comorbidity • Treatment and follow-up • Collaboration and drop out • Outcome measures

23. Treatment(2) • Drug treatments • Psychological treatments

24. 9 The management of personality disorders • Assessment • General aims: conflicts less with their character • Overall plan • Choice of psychotherapy • Choice of medication • Organization of services • progress

25. The management of specific personality disorders

26. Antisocial personality disorder • Small-group therapy • Therapeutic communities • Other group regimens

27. Borderline personality disorder • Dynamic psychotherapy • Group psychotherapy • Dialectical behaviour therapy • Psychoanalytically oriented day treatment