* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Personality Disorders - lakshya education hub
Bipolar disorder wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Autism spectrum wikipedia , lookup
Anxiety disorder wikipedia , lookup
Borderline personality disorder wikipedia , lookup
Excoriation disorder wikipedia , lookup
Panic disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Mental disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Hidden personality wikipedia , lookup
Conversion disorder wikipedia , lookup
Abnormal psychology wikipedia , lookup
Child psychopathology wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Conduct disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Schizoid personality disorder wikipedia , lookup
Personality disorder wikipedia , lookup
Personality Disorders Personality Personality – specific character traitstemperament, emotional reactivity, fairness, interpersonal relations establishment, needs, expectations, stinginess, generosity, arrogance, independence and others...typical for concrete person formed by early adulthood, persist throughout life. Personality disorders Personality disorder- when personality traits are rigid and self-defeating, they may interfere with functioning and even lead to psychiatric symptoms cause more or less suffering of patient or other persons or both and lead to social maladaptation (relations, family, work...) such personality seems to be disbalanced, whithout harmonical coordination of behaviour Main Features of PDs Extreme patterns of thinking, feeling, and behaving that deviate from a person’s culture Listed on Axis II of the DSM-IV-TR Begin early in life and remain stable - not contextual or transient Inflexible and maladaptive Cause significant functional impairment and subjective distress - ego-syntonic vs. ego-dystonic Historical Aspects The concept of PD has been described for thousand of years. In the 4th century B.C., Hippocrates concluded that all disease stemmed from an excess of or imbalance among four bodily humors: yellow bile, black bile, blood and phlegm. Historical Aspects Hippocrates identified four fundamental personality styles: Irritable and hostile, choleric (yellow bile) Pessimistic, melancholic (black bile) Overly optimistic and extraverted, sanguine (blood) Apathetic, phlegmatic (phlegm) PD first recognized apart from psychosis in 1801. In 19th century psychiatrist embraced the term “Moral Insanity” Incidence Prevalence of PD in the general population is 5 to 10 %. Occurrence of mixed PD is common than a single PD in an individual Incidence Paranoid 0,5-2,5% Schizoid ?% Schizotypal 3% Antisocial 3% (disocial in ICD-10) Borderline 2% Histrionic 2-3% Narcissistic less than 1% Avoidant 0,5-1% Dependent 2,5-25% DSM-IV-TR Personality Disorders Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Cluster A Cluster B Cluster C ICD-10 Classification F 60-69 Disorders of adult personality and behavior F 60 F60.0 F60.1 F60.2 F60.3 F60.4 F60.5 F60.6 F60.7 Specific personality Disorders Paranoid PD Schizoid PD Dissocial PD Emotionally Unstable PD Histrionic PD Anankastic PD Anxious PD Dependent PD ICD-10 Classification F61 F62 Mixed and other PD Enduring personality changes, not attributable to brain damage and disease Note :- the 3rd edition of DSM included passive-aggressive PD in Cluster C in DSM-IV this included in the section of criteria provided for further study Etiology Exact cause is unknown Genetic factors Biological factors:- poor regulation of brain circuits that control emotion Psychodynamic theories:- deficiencies in ego and superego development and may relate to mother-child relationship (over protectiveness, early separation, unresponsiveness) Etiology Maternal deprivation, especially in antisocial personality Borderline personalities are more likely to report physical and sexual abuse in childhood. Dependent personality may be due to fixation in the oral stage of development Etiology Paranoid personality is due to absence of trust, which results from lack of parental affection in childhood and persistent rejection by parents leading to low self esteem. Histrionic personality is said to occur as a result of failure to resolve oedipal complex and excessive use of repression as a mechanism of defense. Cluster A: Odd or Eccentric Paranoid PD – is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent Schizoid PD – is a pattern of detachment from social relationships and restricted range of emotional expression Schizotypal PD – is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour Paranoid Personality Disorder suspicious of other’s motives interprets actions of others as deliberately demeaning/threatening expectation of being exploited see hidden messages in benign comments easily insulted/ bears grudges appear cold and serious More commonly diagnosed in men than women. Schizoid Personality Disorder indifferent to relationships limited social range (some are hermits) aloof, detached, called loners no apparent need of friends, sex solitary activities seem to be missing the “human part” Appear indifference to the praise or criticism Schizotypal Personality Disorder peculiar patterns of thinking and behaviour perceptual and cognitive disturbances magical thinking(superstitiousness, belief in clairvoyance) Idea of reference Odd thinking and speech Excessive social anxiety Cluster B: Dramatic, Emotional, or Erratic Antisocial PD – is a pattern of disregard for, and violation of, the rights of others Borderline PD – is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity Histrionic PD – is a pattern of excessive emotionality and attention seeking Narcissistic PD – is a pattern of grandiosity, need for admiration, and lack of empathy Antisocial Personality Disorder pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy) Occurring since age 15 yrs. adulthood: criminal behaviour little adherence to societal norms, little anxiety conflicts with others callous/exploitive Psychopathy Egocentric, deceitful, shallow, impulsive individuals who use and manipulate others Callous, lack of empathy Little remorse Thrill-seeking “human predators” (Hare, 1993) No “conscience” At least 18 yrs old. Borderline Personality Disorder marked instability of mood, relationships, self-image intense, unstable relationships uncertainty about sexuality everything is “good” or “bad” chronic feeling of “emptiness” recurrent threats of self-harm/ “slashers” Transient stress related paranoid ideation Histrionic Personality Disorder excessive emotional displays/ dramatic behaviour attention-seeking, victim stance seek re-assurance, praise shallow emotions, flamboyant, selfcentred very seductive, “life of the party” Narcissistic Personality Disorder grandiose sense of self-importance Preoccupied with fantasies of unlimited success lack of empathy hyper-sensitive to criticism exaggerate accomplishments/ abilities Believe that he/she is special and unique Has a sense of entitlement below surface is fragile self-esteem Lack empathy, shows arrogant behavior Cluster C: Anxious or Fearful Avoidant PD – is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Dependent PD – is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of Obsessive-Compulsive PD – is a pattern of preoccupation with orderliness, perfectionism, and control at the expense of flexibility Avoidant Personality Disorder over-riding sense of social discomfort easily hurt by criticism always need emotional support occasionally try to socialize so distressing they retreat into loneliness Views self as socially inept, inferior to others. Dependent Personality Disorder Feel uncomfortable or helpless when alone Submissive, clingy behaviour fear of separation easily hurt by criticism Has difficulty making everyday decisions without an excessive amount of advice from others. Has difficulty initiating projects or doing things Obsessive-Compulsive Personality Disorder Excessive control and perfectionism Inflexible, rigid, and stubborn Preoccupied with trivial details, rule, list, order Judgmental/Moralistic, Workaholic/Ignore family members Is excessively devoted to work to the exclusion of leisure activity & friendship Is reluctant to delegate tasks High standards Passive Aggressive PD Negative attitudes and passive resistance Complains of being misunderstood & unappreciated by others Unreasonably criticizes and scorns authority Voices exaggerated and persistent complaints of personal misfortune Is sullen and argumentative Personality Disorder Not Otherwise Specified Meets general criteria for a PD but no specific criteria for a specific PD. Exhibit at least 10 symptoms of PDs across all subtypes Diagnostic process -Complete psychiatric examination -Objectivisation- obj.anamnesis, observation -Exclusion of secondarity -somatic examination, brain imaging, EEG, laboratory (BCH, toxicology, infections, endokrinology) -Psychological examination -personality tests Complications -secondary mental illnesses (depression, medicament, drug or alcohole abuse or addiction, eating disorders, impulse-control disorders, anxiety disorders, short psychosis) -suicidal behavior -acts of self-harm -violence and crime behaviour -risk behaviour (sexualy transmitted infections, drug application...) Treatment Motivation to the therapy, compliance and efficiency is different from case to case. Psychoterapy – group, occupational, recreational, behaviour, milieu therapy. Pharmacotherapy -in some cases, symptomatic , very limited role or use with associated disorders Psychotherapy Interpersonal Psychotherapy Depending on the therapeutic goal IP may Is brief and time limited or long term exploratory Suggested for the clients with paranoid, schizoid, schizotypal, borderline, dependent, narcissistic, OCPD. Psychoanalytical Treatment of choice for histrionic PD Focuses on the unconscious motivation for seeking total satisfaction from others and for being unable to commit oneself to a stable, meaningful relationship. Psychotherapy Milieu or Group Therapy Especially for antisocial PD, who respond more adaptively to support and feedback from peer May be helpful in overcoming social anxiety and developing interpersonal trust in client with avoidant PD Helpful in dependent PD Psychotherapy Cognitive and Behaviour Therapy May be useful for OCPD, passive-aggressive, antisocial and avoidant PD. Social skills training and assertiveness training alternative ways to deal with frustration. Cognitive strategies help the client recognize and correct inaccurate internal mental schemata. Psychotherapy Others Occupational therapy to increase the level of functioning so that they become more independent. Recreation therapy can assist patients to ventilate feelings and increase socialization skills. 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, MAOI dysforia- SSRI, low dose atyp.AP aggression- Li, antikonv., AP impulsivity- SSRI, anticonv., Li, low dose AP psychotic- AP Psychopharmacotherapy Antipsychotic helpful for psychotic symptoms experience by client with Paranoid, Schizotypal, and Borderline PD SSRI and MAOIs have been successful in decreasing impulsivity and self destructive acts in Borderline PD Lithium carbonate and propanolol may be helpful for the violent episode in Antisocial Anxiolytics for Avoidant PD