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Personality disorders
This document discusses personality disorders. It begins by defining personality and personality traits, then defines personality disorders as inflexible and maladaptive personality traits that interfere with functioning. It describes three clusters of personality disorders - Cluster A which includes odd or eccentric behavior; Cluster B which includes dramatic, emotional or erratic behavior; and Cluster C which includes anxious or fearful behavior. The document then provides more details on specific personality disorders like paranoid, schizoid, schizotypal, antisocial, borderline, histrionic and narcissistic personality disorders. It discusses symptoms, causes, treatment options for each.
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Personality disorders
- 2.
- 3. PERSONALITY The totality ofemotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time PERSONALITY TRAITS…« enduring patterns of perceiving, relating and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. » (APA, 2000)
- 4. PERSONALITY DISORDERS Personality disordersare diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress.
- 5. Cluster A :People whose behavior appears odd or eccentric ◦ Paranoid personality disorder. ◦ Schizoid personality disorder. ◦ Schizotypal personality disorder. Cluster B :People who appear dramatic, emotional, or erratic ◦ Antisocial personality disorder. ◦ Borderline personality disorder. ◦ Histrionic personality disorder. ◦ Narcissistic personality disorder. Cluster C : People who appear anxious or fearful ◦ Avoidant personality disorder. ◦ Dependent personality disorder. ◦ Obsessive-compulsive personality disorder.
- 8. A pervasive distrustand suspiciousness of others such that their motives are interpreted as malevolent beginning by early adulthood and present in variety of contexts
- 9. More commonin men than in women
- 10. Hereditary Parentalantagonism & harassment They learn to perceive the world as harsh and unkind
- 11. Constantly onguard, hypervigilent and ready for any real or imagined threat. Appear tense and irritable Insensitive to the felings of others Avoid interactions with others Always feel that others are taking advantage of them Extremely oversensitive Do not accept responsibility for their own behavior
- 12. A. A pervasivedistrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of conterxts as indicated by 4 or more of thr following Suspects without sufficient basis that others are exploiting harming or deceiving him or her Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
- 13. Is reluctantto confide in others bacause of unwarranted fear that the information will be used maliciously against him or her Reads hidden demeaning or threatening meanings into bedign remarks or events Persistently bears grudges Preceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack Has recurrent suspicions without justification regarding fidelity of spouse or sexual partner
- 14. B. Does notoccur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder and is not due to the direct physiological effects of a general medical condition.
- 15. Psychotherapy –Interpersonal psychotherapy Psychoanalytical psychotherapy Group therapy Behavioral therapy Psychopharmacology • Antipsychotics for psychotic symptoms
- 17. Characterized by primarilyby a profound defect in the ability to form personal relationships or to respond to others in any meaningful, emotional PREVALENCE 3 – 7.5% Gender ratio:-Not known but diagnosed frequently in men.
- 18. Hereditary:- Unclear, thefeature of introversion appear to be a highly inheritable characteristic. Psychosocially:- The development of schizoid personality is influenced by early interactional patterns that the person found to be cold & unsatisfying The childhood of these individuals have often been characterized as bleak, cold, unempathic & notably lacking in nurturing
- 19. Schizoid personalitydisorder occurs in adults who experienced cold, neglectful & ungratifying relationships in early childhood
- 20. Appear cold,aloof & indifferent to others They prefer to work in isolation & are unsociable with little need or desire for emotional ties. In the presence of others they appear shy, anxious or uneasy. They are inappropriately serious about everything and have difficulty acting in a lighthearted manner. They are unable to experience pleasure and their affect is commonly bland and constricted
- 21. A pervasivepattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following: Neither desires nor enjoys close relationships including being part of a family. Almost always chooses solitary activities. Has little, if any, interest in having sexual experiences with another person
- 22. Takes pleasurein few, if any activities Lacks close friends, or confidants other than first- degree relatives. Appears indifferent to the praise or criticism of others Shows emotional coldness, detachment or flattened affectivity Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder and is not due to the direct physiological effects of a general medical condition.
- 23. Psychotherapy –Interpersonal psychotherapy Psychoanalytical psychotherapy Group therapy Behavioral therapy Psychopharmacology • Antipsychotics for psychotic symptoms
- 25. Described aslatent schizophrenics Behavior is odd and eccentric, but does not decompensate to the level of schizophrenia PREVALENCE Less than 3%
- 26. Hereditary:-More commonamong first degree relatives of people with schizophrenia Anatomical deficits or neurochemical dysfunctions resulting in diminished activation, diminished pleasure-pain sensibilities and impaired cognitive functions. Family dynamics:- characterized by indifference, impassivity or formality, leading to a pattern of discomfort with personal affection and closeness
- 27. Aloof &isolated & behave in a bland and apathetic manner Magical thinking Ideas of reference Illusions Depersonalization Bizzare speech pattern They cannot orient their thoughts logically and become lost in personal irrelevancies
- 28. Under stressthey may decompensate and demonstrate psychotic symptoms Affect is bland or inappropriate
- 29. A pervasivepattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more of the following Ideas of reference Odd beliefs or magical thinking that influences behavior and is inconsistent with sub cultural norms
- 30. Unusual perceptualexperiences including bodily illusions Odd thinking and speech (eg:- vague, circumstantial, metaphorical, over elaborate and stereotyped) Suspiciousness or paranoid ideation Inappropriate or constricted affect Behavior or appearance that is odd, eccentric or peculiar Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
- 31. Does notoccur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder.
- 32. Psychotherapy –Interpersonal psychotherapy Psychoanalytical psychotherapy Group therapy Behavioral therapy Psychopharmacology • Antipsychotics for psychotic symptoms
- 35. Antisocial personality disorderis a pattern of socially irresponsible, exploitative and guiltless behavior that reflects a disregard for the rights of others -Phillips,Yen & Gunderson,2003
- 36. Usually diagnosedby age 18 yrs H/o conduct disorder Common among males Common in substance abuse treatment setting and prisons (50%) Common in lower socioeconomic classes Impulsive behavior is common
- 37. Child abuse Deprived environment Neglect Antisocial environment in home Antisocial parents Alcoholic parents ADHD Reading disorder
- 38. Biological influences: Commonamong first degree biological relatives Children of antisocial personality- even when they are separated from biological parents Temperament in newborn Serotonergic dysregulation in septohippocampal system
- 39. Family dynamics Chaotichome environment Separation due to parental delinquency Physical abused in childhood Absence of parental discipline Extreme poverty Removal from the home Growing up without parental figures of both sexes Erratic and inconsistent methods of discipline Being rescued each time they are in trouble Maternal deprivation
- 40. Idiopathic Heredity Environmental influence Difficulty in developing emotional bonds Few healthy role models for behavior No rewards for socially acceptable behavior
- 41. Indifferent tothe needs of others Manipulation Fails to pay debts Usually loners Aggressive, violent involves in fights Frequent encounters with the law Persistent lying or stealing Inability in keeping jobs
- 42. Tendency toviolate the rights of others A persistent agitated or depressed feeling Inability to tolerate boredom Disregard for hurting others Impulsiveness Inability to make or keep friends No acceptable behavior Provoking arguments
- 43. Violation ofthe rights of others Lack of remorse for behavior Shallow emotions Lying Rationalization of own behavior Poor judgment
- 44. Impulsivity Irritabilityand aggressiveness Lack of insight Thrill-seeking behaviors Exploitation of people in relationships Poor work history Consistent irresponsibility
- 45. Psychotherapy Pharmacotherapy • ADHD- psychostimulants such as methylphenidate (Rilantin) • Impulsive behavior- antiepileptic (carbamazepine, valporate) • Aggression- adrenergic receptor antagonist Symptom wise- antidepressant, antipsychotics
- 46. Occupational therapy Art therapy Music therapy Recreational therapy Individual therapy
- 48. Border betweenneurosis and psychosis Characterized by extraordinarily unstable affect, mood, behavior, object relations and self image
- 49. Also calledambulatory schizophrenia (Helene Deutsch) Pseudoneurotic schizophrenia (Paul Hoch 7 Philip Politan) ICD 10…emotionally unstable personality disorder
- 50. 1-2% ofthe population Twice as common in women as in men Increased prevalence of major depressive disorder Alcohol use disoders & substance abuse in first degree relatives of patients
- 51. Biological influences Biochemical :- Defect in serotonergic activity ( Decreased serotonin ) Genetic :- Relatives with mood disorder Psychosocial influences Childhood trauma Neglect Separation Exposure to physical or sexual abuse Serious parental psychopathology such as substance abuse and antisocial personality disorder
- 52. Developmental factors(Mahler’s Theoryof Object Relations) • Phase 1 Autistic phase • Phase 2 Symbiotic phase • Phase 3 Differentiation phase • Phase 4 Practicing phase • Phase 5 Rapprochement phase • Phase 6 On the way to object Constance phase
- 53. Always ina state of crisis Mood swings Short lived psychotic episodes (macro psychotic episodes) almost always Fleeting or doubtful Highly unpredictable behavior Self destructive acts
- 54. They showdeviant processes on projective tests such as Rorschach test Consider persons- all good or all bad As nurturing or hateful (splitting)
- 55. Clinging andDistancing Splitting Manipulation Self destructive behavior Impulsivity
- 56. A pervasive patternof instability of ins, interpersonal relationships, self image and effects and marked impulsivity beginning by early childhood and present in a variety of contexts as indicated by 5 or more of the following Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- 57. Identity disturbance:markedly and persistently unstable self image or sense of self Impulsivity in at least two areas that are potentially self damaging Recurrent suicidal behavior, gestures or threats or self mutilating behavior Affective instability due to marked reactivity of mood Chronic feeling of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress related paranoid ideation or severe dissociative symptoms.
- 58.
- 60. Persons withhistrionic personality disorder are excitable and emotional and behave in a colourful, dramatic, extroverted fashion. Characterized by a pervasive pattern of excessive emotionality and attention-seeking.
- 61. 2 to3 percent of general population. 10 to 15 % of clinical population. More in women than in men. Studies have found an association with somatization disorder and alcohol use disorders.
- 62. Fluctuation inemotions Attention seeking, self-centered attitude Attentiveness to own physical appearance Dramatic, impressionistic speech style Vague logic – lack of conviction in arguments
- 63. Shallow emotionalexpressions Craving for immediate satisfaction Complaints of physical illness, somatization Use of suicidal gestures and threats to get attention
- 64. Psychotherapy Pharmacotherapy Symptomatic ◦Antidepressants for depression and somatic complaints ◦ Antianxiety agents for anxiety ◦ Antipsychotics for psychotic symptoms.
- 66. Enduring patternsof inner experience and behavior that are sufficiently rigid and deep seated to bring a person into repeated conflicts with his/ her social and occupational environment A pattern of grandiosity in the patient’s private fantasies or outward behavior, a need for constant admiration from others and lack of empathy for others.
- 67. Common inlate adolescence and early adulthood It occurs in 1% to 2% of the general population and 2% to 16% of the clinical population 50% to 75% of people with this diagnosis are men
- 68. Arrested psychologicaldevelopment Young child’s defense against psychological pain Problems or unsatisfactory relationship in parent- child relationship or interaction Harsh and punishing super ego
- 69. Child neednot met- sense of emptiness (Mark 2002)-Narcissistic parents Physical or emotional abuse or neglect Environment- parents forcing the child to achieve which they were not able to Not setting limits
- 70. Significant emotionalpain or difficulties in relationship and occupational performance Grandiose sense of self importance Lives in a dream world of exceptional success, power, beauty, genius, perfect love Thinks themselves as ‘ special’ ‘privileged’ only can understand by higher status people
- 71. Demands excessiveamount of praise or admiration from others Exploitative towards other and takes advantage of them Lacks empathy and does not identify with others feeling History of intense but short term relationship with others
- 72. Inability tomake or sustain genuine intimate relationship Tendency to be attracted to leadership or high profile positions or occupations Assessment of others in terms of usefulness Centre of attraction or admiration in a working group or social situation
- 73. Hypersensitivity tocriticism Preoccupation with outward appearance, image or public opinion Painful emotions based on shame impairment
- 74. Antidepressant- torelieve narcissistic grandiosity Psychotherapy Hospitalization- if low functioning
- 76. Extreme sensitivity torejection and may lead a socially withdrawn life Although shy, not asocial Show a great desire for companionship, unsually strong guarantees of uncritical acceptance Described as having inferiority complex ICD 10…anxious personality disorder
- 77. 1-10% ofthe general population No information on sex ratio or familial pattern
- 78. Hypersensitivity torejection Main personality trait is timidity Desires warmth and security of human companionship When talking with someone, they express uncertainty,
- 79. Lack of selfconfidence Afraid to speak up in public Misinterpret others comments Refusal of requests makes them withdraw
- 80. • Vocational sphere…jobson the sidelines • Rarely attain much personal advancement or exercise much authority • Shy & eager to please • Have no close friends or condidants
- 81. Psychotherapy: Grouptherapy Assertiveness therapy Pharmacotherapy…. Used to manage anxiety and depression Serotonergic agents may help rejection sensitivity
- 83. Subordinate theirneeds to those of others Get others to assume responsibility for major areas of their lives Lack self confidence Intense discomfort when alone for longer periods Also called passive dependent personality
- 84. Freud describedpersonality dimension characterized by dependence, pessimism, fear of sexuality, self doubt, passivity suggestibilty and lack of perseverance
- 85. More commonin women 2.5% of personality disorders as falling in this category More common in younger children than older ones Persons with chronic physical illness in childhood may be more susceptible
- 86. Pervasive patternof dependent and submissive behavior Cannot make decisions without and excessive amount of advice & reassurance Avoid positions of responsibility
- 87. Become anxiousif asked to assume a leadership role When on their own, difficult to persevere at tasks Seek out others on whom they can depend Relationships are distorted by their need to be attached to another person
- 88. Pessimism Selfdoubt Passivity and fears of expressing sexual or aggressive feelings An abusive, unfaithful or alcoholic spouse may be tolerated for long periods to avoid disturbing the sense of attachment
- 89. Behavioral therapy Assertiveness training Family therapy Group therapy
- 90. Pharmacotherapy… To dealwith specific symptoms such as anxiety and depression Panic attacks or separation anxiety…imipramine Benzodiazepines and sereotonergic agents psychostimulants
- 92. Obsessive-compulsive personality disorderis characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. ICD -10 : Anancastic personality disorder
- 93. 1 to2 % of general population 3 to 10% in the clinical population Twice in men than in women Most often in oldest children. Occurs more frequently in first-degree biological relatives of persons with the disorder Patients often have backgrounds characterized by harsh discipline.
- 94. Preoccupation withperfection, organization, structure and control. Excessive devotion to work Difficulty relaxing Rule-conscious behavior Self criticism and inability to forgive own errors Reluctance to delegate
- 95. Inability todiscard anything Insistence on others’ conforming to own methods Rejection of praise Reluctance to spend money Background of stiff and formal relationship Preoccupation with logic and intellect
- 96. Psychotherapy Pharmacotherapy ◦Clonazepam ,Clomipramine and serotonergic agents such as fluoxetine ---- useful if obsessive-compulsive signs and symptoms.