הפרעות אישיות

1. הפרעות אישיות דר' אבלין שטיינר מנהלת מרפאת ע"ש דודיזון- רעננה

2. הפרעות אישיות • נוירוזה • פסיכוזה • הפרעות אישיות

3. אישיות • מכלול יציב יחסית, של מאפיינים התנהגותיים ורגשיים של הפרט. • הדרך שבה האדם רואה את, מתייחס אל,וחושב על עצמו וסביבתו, הזולת/ העולם/ החיים • התגובות והתנהגות האופייניות לאדם צפויות במידה רבה מראש • מתפתחת במהלך הילדות ומגיעה לקביעות בסוף גיל ההתבגרות • האופי הוא החלק באישיות הנראה/ בולט כלפי חוץ בהתנהגות וניתן לצפייה.

4. הפרעת אישיות • תכונות אופי, חשיבה והתנהגות הנמשכות לאורך זמן וגורמות לליקוי במישור אישי, בינאישי ותפקודי • הלקוי מתבטא במישור קוגניטיבי, רגשי, התנהגותי, ביכולת של ריסון הדחפים, בדמוי העצמי ובהתייחסות לזולת • תבנית ההתנהגות סוטה סטייה ניכרת ורבת משמעות מהתנהגות ה"נורמלית"ולא אדפטיבית לתנאים • מאופיין חוסר גמישות ואגו- סינטוניות • לא קיים קונפליקט ולכן פניה לטיפול בדרך כלל בגלל משבר. • מאובחן ב Axis II of the DSM-IV

5. Development of Personality Disorder- theories • Genetic - under reactive autonomic nervous system. • Environment – primarily parental interaction patterns – Bowlby (1973) • Learning theory

6. Learning Theory • Child learns to avoid punishment by being charming – learns that it is not the deed that counts but being charming and repentant (Antisocial personality disorder) • An over-indulged child does not learn to tolerate frustration. • A child who is always protected from frustration may not learn to empathise with other’s distress.

7. ארגון האישיות • מידת התפתחותו וגיבושו של ה"אני" : דרכי התמודדות,יכולת לשאת מתח, תסכול, חרדה, כשלון. • מבחר מנגנוני ההגנה שהוא נוקט • טיבם של יחסי האובייקט במהלך החיים, עומקם ומשכם. • תפקוד מקצועי וחברתי ורמת התפתחות ה"אני העליון" של הפרט.

8. DSM-IV Personality Disorder Clusters • Cluster A – Odd or eccentric cluster (e.g., paranoid, schizoid, schizotypal) • Cluster B – Dramatic, emotional, erratic cluster (e.g., antisocial, borderline, narcistic) • Cluster C – Fearful or anxious cluster (e.g., avoidant, obsessive-compulsive)

9. Personality Disorders: Facts and Statistics • Prevalence of Personality Disorders Affect about 0.5% to 2.5% of the general population • Rates are higher in inpatient and outpatient settings • Origins and Course of Personality Disorders thought to begin in childhood ,tend to run a chronic course if untreated • Co-Morbidity Rates are High

10. Cluster A: Paranoid Personality Disorder • Feel as though one needs to be constantly on their guard • Tendency to view the world as a threatening place • Expect trickery and doubt the loyalty of others • Being hyper alert for signs of threat • Vigilance for any slight against them • Show a tendency to be defensive and antagonistic Inability to accept blame and mild criticism • Tendency to be highly critical of others. Often argumentative and uncompromising • Appear cold and aloof socially • Often avoid intimacy with other people

11. Paranoid Personality Disorder • The Causes Biological and psychological contributions are unclear • May result from early learning that people and the world is a dangerous place • Defense of “split” and “projection” • Need to control • Treatment Options • Few seek professional help on their own • Treatment focuses on development of trust • therapy to counter negativistic and depressive thinking

12. Violence prevention with paranoid patient • Help the patient to save the face • Avoid arousing suspicion • Help the patient maintain a sense of control • Encourage the patient to verbalize not to make “acting out” • Give the patient “breathing room” • Be attuned to your own countertransferance

13. Schizoid Personality Disorder • No desire for social relationships • Lack of ability to form close social relationships • Often single and unmarried, with little interest in sex or intimacy • Preference for solitary activities • Limited range of emotions, particularly in social settings (e.g., coldness, detachment, or flatness) • Often appear indifferent to compliments and criticisms • Find little or no joy in activities or in life

14. Cluster A: Schizoid Personality Disorder • Overview and Clinical Features • Pervasive pattern of detachment from social relationships • Very limited range of emotions in interpersonal situations • Etiology is unclear • Preference for social isolation in schizoid personality resembles autism • Treatment Options • Few seek professional help on their own • Focus on the value of interpersonal relationships, empathy, and social skills

15. Schizotypal Personality Disorder • Clinical Features • Behavior and dress is odd and unusual • Most are socially isolated and may be highly suspicious of others • Magical thinking, ideas of reference, and illusions are common • Risk for developing schizophrenia is high in this group • The Causes Schizotypal personality • A phenotype of a schizophrenia genotype? Left hemisphere and more generalized brain deficits • Treatment Options • Main focus is on developing social skills • Treatment also addresses co- morbid depression • Medical treatment is similar to that used for schizophrenia

16. DSM-IV Personality Disorder Clusters • Cluster A – Odd or eccentric cluster (e.g., paranoid, schizoid, schizotypal) • Cluster B – Dramatic, emotional, erratic cluster (e.g., antisocial, borderline, narcistic) • Cluster C – Fearful or anxious cluster (e.g., avoidant, obsessive-compulsive)

17. Antisocial Personality Disorder • Problems with the legal system • Habitually lying or being manipulative • Frequent physical aggression and conflict with other people • Show little empathy for others. Lack remorse for persons they have hurt. Blaming others or offering rationalizations for antisocial behavior • Having had serious behavioral problems in childhood and teenage years from age 15 • Being impulsive. May be accompanied with unusually early age of drug and/or alcohol abuse

18. Antisocial Personality Disorder • Overview and Clinical Features • Failure to comply with social norms and violation of the rights of others Irresponsible, impulsive, and deceitful • Lack a conscience, empathy, and remorse Relation • Relation Between ASPD, Conduct Disorder, and Early Behavior Problems • Many have early histories of behavioral problems, including conduct disorder • Many come from families with inconsistent parental discipline and support • Families often have histories of criminal and violent behavior

19. אתיולוגיה - גורמים ביולוגיים גורמים ביולוגיים: מתייחסים יותר לאלימות בכלל ופחות לASPD תחומי המחקר העיקריים: אנדוקריניים: טסטוסטרון נשאים: סרוטונין, דופמין מטבוליזם: כולסטרול, מינרלים סביבתיים: תזונה, חשיפה לניקוטין, אלכוהול, חומרי הדברה גורמים גנטיים נאורולוגיים ונואורופסיכיאטרים: שינויים מבניים - פונקציונאלייםEvoked Potentials ,

20. Neurobiological features- Antisocial Personality • Under arousal hypothesis • During childhood: ADHD and conduct disorder • – Cortical arousal is too low • – Cerebral cortex is not fully developed – Psychopaths fail to respond with fear to danger cues

21. Treatment of Antisocial Personality • Treatment • Few seek treatment on their own • Antisocial behavior is predictive of poor prognosis, even in children • Emphasis is placed on prevention and rehabilitation • Often incarceration is the only viable alternative

22. Cluster B: Borderline Personality Disorder • Overview and Clinical Features • Patterns of unstable moods and relationships Impulsivity, fear of abandonment, coupled with a very poor self-image • Self-mutilation and suicidal gestures are common • Most common personality disorder in psychiatric settings • Co- morbidity rates are high

23. Borderline Personality Disorder • Impulsive action without consideration of the consequences. • Affective instability. • Inappropriate and intense anger outbursts. • Chronic feelings of emptiness. • Recurrent suicidal and / or self-harming behaviour. • Pattern of intense and unstable relationships. • Frantic efforts to avoid abandonment. • Unstable self-image and sense of self.

24. Borderline Personality Disorder • The Causes Borderline personality disorder • runs in families • Early trauma and abuse seem to play some etiologic role • Treatment Options • Few good treatment outcome studies • Antidepressant medications provide some short-term relief • Dialectical behavior therapy is the most promising psychosocial approach

25. Cluster B: Histrionic Personality Disorder • Overview and Clinical Features • Patterns of behavior that are overly dramatic, sensational, and sexually provocative • Often impulsive and need to be the center of attention • Thinking and emotions are perceived as shallow • Common diagnosis in females

26. Histrionic Personality Disorder • The Causes • Etiology is largely unknown Is histrionic personality a sex-typed variant of antisocial personality? • Treatment Options • Few good treatment outcome studies • Treatment focuses on attention seeking and long-term negative consequences • Targets may also include problematic interpersonal behaviors

27. Cluster B: Narcissistic Personality Disorder • Overview and Clinical Features • Exaggerated and unreasonable sense of self-importance • Preoccupation with receiving attention • Lack sensitivity and compassion for other people • Highly sensitive to criticism • Tend to be envious and arrogant

28. Narcissistic Personality Disorder • The Causes • Link with early failure to learn empathy as a child • Sociological view – Narcissism as a product of the “me” generation • Treatment Options • Extremely limited treatment research • Treatment focuses on grandiosity, lack of empathy, unrealistic thinking • Treatment may also address co-occurring depression

29. Cluster C: Avoidant Personality Disorder • Clinical Features • Extreme sensitivity to the opinions of others • Highly avoidant of most interpersonal relationships • Are interpersonally anxious and fearful of rejection

30. Avoidant Personality Disorder • The Causes Numerous factors have been proposed • Early development : A difficult temperament produces early rejection • Treatment Options • Several well-controlled treatment outcome studies exist • Treatment is similar to that used for social phobia Treatment targets include social skills and anxiety

31. Cluster C: Dependent Personality Disorder • Clinical Features • Excessive reliance on others to make major and minor life decisions • Unreasonable fear of abandonment • Tendency to be clingy and submissive in interpersonal relationships

32. Dependent Personality Disorder • Causes • Still largely unclear • Linked to early disruptions in learning independence • Treatment Options • Research on treatment efficacy is lacking • Therapy typically progresses gradually • Treatment targets include skills that foster independence

33. Cluster C: Obsessive-Compulsive Personality Disorder • Overview and Clinical Features • Excessive and rigid fixation on doing things the right way • Tend to be highly perfectionistic, orderly, and emotionally shallow • Obsessions and compulsions, as in OCD, are rare

34. Obsessive-Compulsive Personality Disorder • The Causes • Are largely unknown • Treatment Options • Data supporting treatment are limited • Treatment may address fears related to the need for orderliness • Other targets include rumination, procrastination, and feelings of inadequacy

35. הפרעת אישיות אורגנית • חבלת ראש • מחלה צרברווסקולרית • הרעלת מתכות כבדות • גידולים מוחיים • אפילפסיה • טרשת נפוצה • זיהומים מוחיים