Download Personality Disorders: An Overview

‫הפרעות אישיות‬
‫דר' אבלין שטיינר‬
‫מנהלת מרפאת ע"ש דודיזון‪ -‬רעננה‬
‫הפרעות אישיות‬
‫‪ ‬נוירוזה‬
‫‪ ‬פסיכוזה‬
‫‪ ‬הפרעות אישיות‬
‫אישיות‬
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‫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.‬‬
‫הפרעת אישיות‬
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‫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
Development of Personality
theories -Disorder
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Genetic - under reactive autonomic
nervous system.
Environment – primarily parental
interaction patterns – Bowlby (1973)
Learning theory
Learning Theory
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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.
‫ארגון האישיות‬
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‫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.‬‬
DSM-IV Personality
Disorder Clusters
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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)
Personality Disorders: Facts
and Statistics
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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
Cluster A: Paranoid
Personality Disorder
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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
Paranoid Personality
Disorder
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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
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Treatment Options
– Few seek professional help on their own
– Treatment focuses on development of trust
– therapy to counter negativistic and depressive
thinking
Violence prevention with
paranoid patient
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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
Schizoid Personality
Disorder
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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
Cluster A: Schizoid
Personality Disorder
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Overview and Clinical Features
– Pervasive pattern of detachment from social
relationships
– Very limited range of emotions in interpersonal
situations
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Etiology is unclear
– Preference for social isolation in schizoid
personality resembles autism
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Treatment Options
– Few seek professional help on their own
– Focus on the value of interpersonal
relationships, empathy, and social skills
Schizotypal Personality
Disorder
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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
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The Causes Schizotypal personality
– A phenotype of a schizophrenia genotype? Left
hemisphere and more generalized brain deficits
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Treatment Options
– Main focus is on developing social skills
– Treatment also addresses co- morbid depression
– Medical treatment is similar to that used for schizophrenia
DSM-IV Personality
Disorder Clusters
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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)
Antisocial Personality
Disorder
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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
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
‫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 ,‬‬
Neurobiological featuresAntisocial Personality
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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
Treatment of Antisocial Personality
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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
Cluster B: Borderline
Personality Disorder
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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
Borderline Personality Disorder
Impulsive
action without consideration of the
consequences.
Affective
instability.
Inappropriate
Chronic
and intense anger outbursts.
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.
Borderline Personality
Disorder
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The Causes Borderline personality disorder
– runs in families
– Early trauma and abuse seem to play some
etiologic role
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Treatment Options
– Few good treatment outcome studies
– Antidepressant medications provide some shortterm relief
– Dialectical behavior therapy is the most
promising psychosocial approach
Cluster B: Histrionic
Personality Disorder
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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
Histrionic Personality
Disorder
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The Causes
– Etiology is largely unknown Is histrionic
personality a sex-typed variant of antisocial
personality?
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Treatment Options
– Few good treatment outcome studies
– Treatment focuses on attention seeking and
long-term negative consequences
– Targets may also include problematic
interpersonal behaviors
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
Narcissistic Personality
Disorder
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The Causes
– Link with early failure to learn empathy as a
child
– Sociological view – Narcissism as a product of
the “me” generation
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Treatment Options
– Extremely limited treatment research
– Treatment focuses on grandiosity, lack of
empathy, unrealistic thinking
– Treatment may also address co-occurring
depression
Cluster C: Avoidant
Personality Disorder
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Clinical Features
– Extreme sensitivity to the opinions of
others
– Highly avoidant of most interpersonal
relationships
– Are interpersonally anxious and fearful of
rejection
Avoidant Personality Disorder
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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
Cluster C: Dependent Personality
Disorder
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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
Dependent Personality Disorder
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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
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
Obsessive-Compulsive
Personality Disorder
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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
‫הפרעת אישיות אורגנית‬
‫•חבלת ראש‬
‫•מחלה צרברווסקולרית‬
‫•הרעלת מתכות כבדות‬
‫•גידולים מוחיים‬
‫•אפילפסיה‬
‫•טרשת נפוצה‬
‫•זיהומים מוחיים‬