Top Banner
CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering. -Easier to observe sx at adolescence & continue for most of adulthood & less clear at middle age & elderly. -Dx should not be confirmed unless characteristics are applied for long period & not for specific period. -Usually pt. is unsatisfied because of effect of his behavior on others or unable to perform his work effectively. 1
30

CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

Dec 23, 2015

Download

Documents

Jeffry Logan
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

1

CHAPTER 6 PERSONALITY DISORDER

-Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

-Easier to  observe sx at  adolescence & continue for most of adulthood & less clear at middle age & elderly.

-Dx  should  not  be  confirmed  unless characteristics are applied for long period & not for specific period.

-Usually pt. is unsatisfied because of effect of his behavior on others or unable to perform his work effectively.

Page 2: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

2

Causes of personality disorders1-Biological factorsa- Hereditary genes: Great similarity in personality among identical twins > un-identical twins.-Increasing in group (A) among relatives of persons with schizophrenia.b- Biochemical studies: Hyperactive persons have high average of testosterone that increase of aggression & sexual behavior.c- Nervous factors: Slight brain defect in childhood is connected with antisocial P.D. later.

Page 3: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

3

2-Psychoanalytic theory-Personality characteristics result from fixation on one stage of G & D stages. They are divided as:Oral personality: negative, dependent, eating food excessively.Anal personality: crucial, ungenerous, accurate & hard-headed.Obsessive personality: stiff & superego is dominating.Narcissistic personality: aggressive & self-centered. 

Page 4: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

4

3-Social & cultural factors -Rxn b/w mood of child & father or mother during rearing is very important.Example: anxious child who is cared by anxious mother is susceptible more for P.D. than child with calm mother.*Cultures  that  increase &  encourage aggression,  is preparing for paranoid or antisocial P.D.

Page 5: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

5

Classification of personality disordersThere are 3 clusters:Cluster A: Paranoid, schizoid & schizotypal (odd and /or eccentric). -May be present on the same individual with psychotic disorders.

Cluster B: Antisocial, borderline, histrionic & narcissistic (dramatic & emotional).-Often co-morbid with affective disorders.

Cluster C: Avoidant, dependent, & obsessive-compulsive (anxious & fearful cluster).

Page 6: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

6

Cluster (A) P. D. (odd/ eccentric)

 1)Paranoid Personality Disorder:Epidemiology-Increased in families having 1 or > members dxed with paranoid personality disorder.-Males > females.-Substance abuse is common.

Page 7: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

7

Sx-Distrust, suspicion-Difficulty adjusting to change-Sensitivity, argument-Feeling of irreversible injury by others-often without evidence-Anxiety, difficulty relaxing-Short temper-Lack of tender feelings toward others-Unwillingness to forgive even minor events-Jealousy of spouse or significant other-often without evidences

Page 8: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

8

Prognosis-Starts at adulthood & may continue for end of pt.'s life.-In some cases disorder severity decrease by age.-Rarely that pt. is seeking for Rx & many problems appear in his relation with authority or people around him.

Rx-Psychotherapy is Rx of choice & therapist should recognize that areas of trust, love, tolerance: disturbed.-Group psychotherapy is not appropriate.-Drugs may be used esp. in case of anxiety or agitation.

Page 9: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

9

2)Schizoid Personality Disorder:Epidemiology-Males > females.-Increased prevalence in families with members who have schizophrenia or schizotypal P.D.

Sx-Lack of desires to socialize; enjoys solitude-Lacks strong emotions-Detached, self-absorbed affect-Lacks trust in others-Brief psychotic episodes in response to stressful events-Difficulty expressing anger-Passive rxns to crisis

Page 10: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

10

Prognosis-Starts in childhood & stays long period; not necessarily for life.-There is unknown percentage converted to schizophrenia.-Limitation in social r/s & vocational performance.-May be able to increase vocational performance in situations that need scientific achievement in socially separated conditions.

Rx-Similar  to  Rx  of  paranoid  P.D.  but  pt.  with paranoid  PD  agrees  with  expectations  of  therapist  through seeing self from inside but exaggerates in fantasy.-Group psychotherapy: useful; allows to communicate others.

Page 11: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

11

3)Schizotypal Personality DisorderEpidemiology-30%-50% also have major depression.-Pts. seek Rx for anxiety &/or depression, not for P.D. features.-First-degree relatives of pts. with schizophrenia are at increased risk.-Males > females.-Pt. has deep & strange thinking style, appearance, behavior, limitation in r/s with others, but not enough to dx schizophrenia.

Page 12: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

12

Sx-Incorrect interpretation of external events/ belief that all events refer to self.-Superstition, preoccupation with paranormal phenomena.-Belief in possession of magical control over others.-Constricted or inappropriate affect.-Anxiety in social situation.

Prognosis-10% have suicide & some convert to schizophrenia.-Many can marry & work despite of their strange nature.

Page 13: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

13

Cluster “B” P. D. (Dramatic & Emotional)

4) Antisocial Personality Disorder: Epidemiology-Usually dxed by year 18.-Have Hx of conduct disorders before age 15.-Males > females.-High percentage of dxed pts. are in substance abuse Rx settings, & prisons.-> in lower socioeconomic classes.-Substance abuse is common.-Impulsive behavior is common.

Page 14: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

14

Sx:-Irresponsibility-Failure to honor financial obligations, plan ahead, provide children with basic needs-Involvement in illegal activities-Lack of quilt-Difficulty learning from mistakes-Initial charm dissolves to coldness, manipulation, blaming others-Lacks empathy-Irritability-Abuse of substances

Page 15: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

15

Prognosis-Beginning in childhood: disturbance in behavior; among boys: childhood,  among girls: adolescence.-Bad behavior of pts. may decrease after 30.-Failure in academic achievement, getting injury or die as a result of his/her disturbed behavior.-If did not appear in childhood, he/she can succeed academically, politically or economically.-Using work for his benefit & no consideration for values ethics & without blaming self or taking into consideration benefit of community.

Page 16: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

16

Rx-Before starting Rx, therapist should find method to stop self-destructive behavior of pt. & his  fear  of  intimacy & friendship  with  others  &  convincing  him  to  communicate  with  others without fear of pain result from this communication or rxn.-Most useful method is group composed for their help & empathy with them & providing emotions they lost.-Meds. for anxiety or depression if found.

Page 17: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

17

5)Borderline Personality Disorder: Epidemiology-75% are female.-Have Hx of physical & sexual abuse, neglect, hostile, conflict & early parental losses or separation.

Page 18: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

18

Sx-Intense, stormy relationships-Sees people as “all good” or “all bad” -Impulsivity-Self mutilation-Difficulty identifying self-Negative & angry affect-Feelings of emptiness & boredom-Difficulty being alone, feeling of abandonment-Has impulsive acts (binging, spending money)-Suicidal ideation

Page 19: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

19

Prognosis-Starts early in adulthood & characterized by instability.-Doesn’t convert to schizophrenia but to major depression & sometimes to brief psychotic disorder.-Most dangerous complication is suicide.

Rx-Psychotherapy is Rx of choice in addition to drugs.-Psychotherapy is considered difficult subject for therapist & pt. since pt. tends to practice regression & fluctuating feelings toward therapist.-Drugs include anti-psychotic, anti-depression, anti-anxiety, & sometimes anti-convulsion.

Page 20: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

20

6) Histrionic personality disorder:Epidemiology-Females > males.

Sx-Fluctuation in emotions-Attention-seeking, self-centered attitude-Sexual seduction-Attentiveness to own physical appearance-Dramatic, impressionistic speech style-Vague logic-lack of conviction in arguments, often switching sides-Shallow emotional expression-Craving for immediate satisfaction-Complaints of physical illness, somatization-Use of suicidal gestures and threats to get attention

Page 21: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

21

Prognosis- Appears in early adulthood & sx decrease by age. -Often relation of pt. with others are affected & disturbed.-Brief psychotic disorder, hysterical conversion, somatization may occur.

Rx-Often pt. doesn’t recognize his real feeling so clarifying them to pt. is important step in Rx.-Drugs maybe used if sever anxiety or depression.  

Page 22: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

22

7) Narcissistic personality disorder:Epidemiology-Males > females.

Sx-Grandiose view of self.-Lacks empathy toward others.-Needs for admiration.-Preoccupation with fantasies of success, brilliance, beauty, ideal love.

Page 23: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

23

Prognosis-Starts in early adulthood mainly chronic.-Disturbance in their social r/s, difficulties with others, & unrealistic goals.

 Rx-Difficult to be treated & need long-term psychoanalysis to establish change.

Page 24: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

24

Cluster “C” P. D.(Anxious & Fearful)

8)Avoidant Personality Disorder:Epidemiology -Males equals females. Sx-Fearful of criticism, disapproval, or rejection-Avoid social interactions-Withhold thoughts or feelings-Negative sense of self, low self-esteem

Page 25: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

25

Prognosis-Starts in early adulthood & can work in socially comfortable situation.-Some may have depression, anxiety, anger or social phobia.  Rx-Depends on acceptance of therapist to fears of pt. & stability of therapeutic r/s & encouraging him to communicate with outside world but carefully in order not to have any failure that may support original opinion of pt.

-Group psychotherapy may help these pts.

-Training on self-confidence is behavioral method to teach pt. how to express feeling & needs & improve self-esteem. 

Page 26: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

26

9) Dependent Personality Disorder Epidemiology-Females > males.-Sx are demonstrated early in life.-Children or adolescents with chronic physical illness or separation anxiety disorder may be predisposed. Sx -Submissive, clinging -Unable to make decisions by themselves-Can’t express negative feelings (emotions) -Difficulty following through on tasks

 

Page 27: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

27

Prognosis -Appears in early adulthood & weakness in field of work achievement because of passivity.-Some pts. become addict or depressed or other psychiatric disorders.-Little will live without psychiatric disorders. Rx-Supportive psychotherapy is useful & taking into consideration internal passive aggression of pt.-Giving anti-depression if needed.

Page 28: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

28

10) Obsessive-Compulsive Personality DisorderEpidemiology -Males are twice > females. Sx-Preoccupation with perfection, organization, structure, control-Procrastination-Abandonment of projects due to dissatisfaction-Difficulty relaxing-Rule-conscious behavior

Page 29: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

29

-Self-criticism with inability to forgive own errors-Reluctance to delegate-Inability to discard anything-Insistence on other’s conforming to own methods-Rejection to praise-Reluctance to spend money-Background of stiff & formal r/s-Preoccupation with logic & intellect

Page 30: CHAPTER 6 PERSONALITY DISORDER -Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.

30

Prognosis-Starts in early adulthood.-May have obsessive-compulsives disorder, schizophrenia or depression or hypochondriasis.-May become adjusted with his condition. Rx-Pt. has insight & seeking for Rx to relief their suffering.-Long-term psychoanalytic is useful. -Behavior & group psychotherapy is less useful.-Some drugs maybe added symptomatically.