Personality Disorders

1. Personality Disorders

2. What is personality disorder?

3. Personality disorders(causes) Personality- is formed and exists in interaction between hereditary factors and large psychosocial contact Hereditary factors seem to be basic to establish the type of personality Various influences in ontogenetical expierience can modify it.

4. Definition of Personality • “Enduring patterns of perceiving, relating to, and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts”

5. Definition of Personality Disorders • Personality disorders are “enduring patterns of perceiving, relating to, and thinking about the environment and oneself” that “are exhibited in a wide range of important social and personal contexts,” and “are inflexible and maladaptive, and cause either significant functional impairment or subjective distress” (DSM-IV, p. 630)

6. 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

7. DSM-IV-TR Personality Disorders Cluster A: Odd or Eccentric • Paranoid Personality Disorder • Schizoid Personality Disorder • Schizotypal Personality Disorder Cluster B: Dramatic, Emotional, or Erratic • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder Cluster C: Anxious or Fearful • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

8. 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

9. 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

10. 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”

11. Schizotypal Personality Disorder • peculiar patterns of thinking and behaviour • perceptual and cognitive disturbances • magical thinking • not psychotic • perhaps a distant “cousin” of schizophrenia

12. 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

13. Antisocial Personality Disorder • pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy) • adulthood: • criminal behaviour • little adherence to societal norms, • little anxiety • conflicts with others • callous/exploitive

14. 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”

15. Glib and superficial Egocentric and grandiose Lack of remorse or guilt Lack of empathy Deceitful and manipulative Shallow emotions Impulsive Poor behavior controls Need for excitement Lack of responsibility Early behavior problems Adult antisocial behavior Psychopathy Checklist-Revised (Hare, 1991) – 2 Factors

16. 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”

17. Borderline and comorbidity • High degree of overlap with both Axis I and Axis II disorders • 24%-74% also diagnosed with major depression; 4% to 20% bipolar • 25% of bulimics also diagnosed with BPD • 67% also diagnosed with substance use disorder

18. Histrionic Personality Disorder • excessive emotional displays/ dramatic behaviour • attention-seeking, victim stance • seek re-assurance, praise • shallow emotions, flamboyant, self-centred • very seductive, “life of the party”

19. Narcissistic Personality Disorder • grandiose, sense of self-importance • lack of empathy • hyper-sensitive to criticism • exaggerate accomplishments/ abilities • special and unique • entitlement • below surface is fragile self-esteem

20. 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

21. 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

22. Dependent Personality Disorder • submissive, clingy behaviour • fear of separation • easily hurt by criticism

23. Obsessive-Compulsive Personality Disorder • excessive control and perfectionism • inflexible • preoccupied with trivial details • judgmental/moralistic • workaholic/ignore family members • often humourless

24. 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...)

25. Treatment Motivation to the therapy, compliance and efficiency is different from case to case. - Psychoterapy - basis - Pharmacotherapy -in some cases, symptomatic - few controled studies of efficiency - difficult but helpful

26. Psychoterapy - the choise of the type of psychoterapy depends on specific type of P.D. and other factors as motivation to therapy, intelectual state, age and another. - basic psychoterapeutic support - psychoanalytic: individual or group - cognitive-behavioral therapy

27. Pharmacotherapy - symptomatic, follows symptoms • target: permanent symptoms (long-term) or actual state (acute anxiety, disquiet, suicidal beh., agitation, emotional crises...)

28. Pharmacotherapy for symptoms depression- SRI, IMAO, atyp.AP acute anxiety and agitation- BZD, AP anxiety- (S)SRI, buspiron, IMAO, low dose AP em. instability- VAL, CBZ, Li, low dose AP em. flateness- atyp.AP, SSRI, IMAO dysforia- SSRI, low dose atyp.AP aggression- Li, antikonv., AP impulsivity- SSRI, anticonv., Li, low dose AP psychotic- AP