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9-Personality Disorders

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9-Personality Disorders

Uploaded by

isellee4
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Personality Disorder

Anas Sarhan

Assistant professor
Faculty of medicine, Um Alqura University

French Board of Psychiatry


University of Strasbourg, France
2015
Outline of PD Module

⦿ Personality Development

⦿ Personality Disorders
1: Personality Development
Personality
⦿ ‘Enduring patterns of perceiving, relating to,
and thinking about the environment and oneself
that are exhibited in a wide range of social and
personal contexts’

Diagnostic and Statistical Manual 5th Edition (DSM-V)


Freud’s parts of personality
1 - ID

2- Ego

3- Superego

5
6
7
Psychoanalytic Stages of Development:

⦿ Oral Phase: 0-1 ½ yrs


⦿ Anal Phase: 1 ½ -3 yrs
⦿ Phallic Phase: 3-4 yrs
⦿ Oedipal Phase: 4-6 yrs
⦿ Latency: 6- puberty
⦿ Genital Phase: Adult sexuality from
puberty
……..oral stage
….anal stage
….latency
Personality consists of:
⦿COGNITION:
⦿ identity, sense of self, gender, sexuality, beliefs, fantasy life
⦿ ways of thinking about self + others

⦿AFFECT:
⦿ range, intensity and appropriateness of emotional responses
⦿BEHAVIOUR:
⦿ interpersonal functioning,
⦿ social functioning
⦿ Occupational functioning
⦿ Impulse control

12
2. Personality Disorders
Personality Disorder
⦿ Severe disturbance in the characterological constitution
and behavioural tendencies of the individual
⦿ Usually involving several areas of the personality
⦿ Nearly always associated with considerable personal and
social disruption
⦿ Appears in late childhood / adolescence continues into
adulthood
⦿ Cannot make diagnosis before 18 (ICD-10)
Types of Personality Disorder (PD)
CLUSTER A (odd/eccentric)
⦿ Schizoid
⦿ Schizotypal
⦿ Paranoid

CLUSTER B (flamboyant / dramatic)


⦿ Antisocial / Dissocial
⦿ Borderline / Emotionally Unstable
⦿ Histrionic
⦿ Narcissistic

CLUSTER C (anxious / fearful)


⦿ Anxious/ Avoidant
⦿ Dependent
⦿ Anankastic/ Obsessive-compulsive
Diagnostic Criteria for all PD
⦿ Marked disruption of several areas of functioning
⦿ Enduring and long-standing and not limited to periods of
mental illness
⦿ Pervasive over broad range of situations (not context
specific)
⦿ Onset during childhood and continues throughout
adulthood
⦿ Causes significant problems to self + others
A Schizoid PD
⦿ Few if any activities provide pleasure
⦿ Emotionally cold and detached
⦿ Limited capacity to express warmth / tender feelings or anger to
others
⦿ Indifference to praise / criticism
⦿ Excessive preoccupation with fantasy / introspection
⦿ Lack of interest in friends / relationships
⦿ Insensitive to social norms
A Schizotypal PD
⦿ Classified along with Schizophrenia-like
disorders in ICD-10 but in PD in DSM-IV
⦿ Interpersonal discomfort
⦿ Odd ideas, perceptions, appearance and
behaviour
⦿ Increasingly eccentric social misfits
⦿ Not frankly psychotic
⦿ 50% go on to develop diagnosis of
schizophrenia
Paranoid PD
A Paranoid PD
⦿ Excessively sensitive to criticism
⦿ Tendency to bear grudges
⦿ Suspicious
⦿ Tendency to misunderstand actions of others as hostile
⦿ Recurrent suspicions of spousal sexual infidelity
⦿ Persistent self-referential attitude
⦿ Pre-occupation with conspiratorial explanations
Antisocial PD (ASPD)
B Antisocial PD (ASPD)
⦿ Callous unconcern for feelings of others
⦿ Irresponsible attitude and disregard for rules and social norms
⦿ Incapacity to maintain enduring relationships although no
difficulty in establishing them
⦿ Very low tolerance to frustration + low threshold to discharge
aggression including violence
⦿ Proneness to blame others
⦿ Usually preceded by conduct disorder of childhood
Emotionally Unstable / Borderline PD
B Emotionally Unstable/Borderline PD

⦿ Emotional instability
⦿ Lack of impulse control
⦿ Unclear or disturbed self-image, aims, preferences (incl sexual)
⦿ Chronic feelings of emptiness
⦿ Intense + unstable relationships
⦿ Excessive efforts to avoid abandonment
⦿ Para suicidal activity, self harm, self-mutilation
⦿ Lack of self-control
Histrionic behaviour….
B Histrionic PD
⦿ Self-dramatization , theatricality, exaggerated emotions
⦿ Suggestible and easily influenced
⦿ Shallow + labile affect
⦿ Continual excitement seeking
⦿ Inappropriately seductive appearance / behaviour
⦿ Over concern with physical attractiveness
Narcissist?
B Narcissistic PD
⦿ Grandiose sense of self-importance
⦿ Preoccupied by fantasies of success, power, brilliance or ideal love
⦿ Requires excessive admiration
⦿ Sense of entitlement
⦿ Takes advantage of others to suit own needs
⦿ Rarely acknowledges mistakes
⦿ Lack of Empathy, unable to identify with feelings / needs of others
⦿ Need for admiration
⦿ Arrogant
Anxious / Avoidant PD
C Anxious / Avoidant PD
⦿ Believes they are socially incompetent , personally
inferior to others
⦿ Excessively preoccupied with being criticised or socially
rejected
⦿ Need for physical security restricts lifestyle
⦿ Avoiding social / occupational activities involving
interpersonal contact for fear of criticism / rejection.
Dependent PD
C Dependent PD
⦿ Encourages others to make important decisions for them
⦿ Unwilling to make even reasonable demands on the people one
depends on
⦿ Feeling uncomfortable / helpless when alone
⦿ Fear of inability to care for oneself
⦿ Preoccupied with fears of abandonment by person whom one
dependent on
⦿ Limited capacity to make everyday decisions
⦿ Seeks excessive reassurance
Anankastic / Obsessive Compulsive PD
Anankastic / Obsessive Compulsive PD
C Anankastic / Obsessive-Compulsive
⦿ Feelings of excess doubt and caution
⦿ Preoccupation with details, rules, lists, order, organization or schedule
⦿ Perfectionism interfering with task completion
⦿ Excessive concern with productivity to the exclusion of pleasure and
interpersonal relationships
⦿ Rigidity
⦿ Unreasonable insistence that others submit to their way of doing things
⦿ May worsen with age. High rates of depression
Epidemiology of PD
⦿ Prevalence rates
⦿ General Community 10% all PD
⦿ (approx 1% for each specific PD)
⦿ Primary Care 20%
⦿ Psychiatric Outpatients 30-40%
⦿ Psychiatric Inpatients 40-50%
⦿ Prisons 25-75% usually ASPD
Management of PD
⦿ Psychiatric, Psychological and Social
⦿ Specialist Assessment
⦿ Specialist clinical treatment
⦿ Management of co-morbid mental illness
⦿ Management of crises: self harm/Para suicide
⦿ Access to services, housing, employment
⦿ Stigma and Exclusion
⦿ Offending in ASPD
Co-morbidity of PD with Mental Illness
⦿ People with PD are more likely to suffer from a
co-morbid mental illness

⦿ People with a PD are more likely to commit


suicide (10% Borderline PD commit suicide)

⦿ Increased homicide risk if ASPD + Substance


Misuse + Mental Illness
Treatments for PD
⦿ Mainstay of treatments for PD = Psychotherapy
⦿ Type of psychotherapy depends on type of PD
⦿ Short term psychological intervention not appropriate
⦿ Medication alone = unhelpful for PD
⦿ Medication may be used as adjunct or for co-morbid mental illness
⦿ Antipsychotics for psychotic/paranoid symptoms
⦿ Antidepressants + mood stabilizers for affective component
Treatment for PD contd

⦿ PD Previously thought to be untreatable but


increasingly now able to be treated with
advances in specialist psychological treatments
Individual therapy
Group therapy
Therapeutic Community
Prognosis
⦿ Higher rates of other mental disorders
⦿ Outcome of physical and mental illnesses are worse
for people with PD

⦿ High rates of accidents, suicide and violent deaths


especially if cluster B type PD
⦿ Disorder is lifelong but symptoms may lessen with
age
Prognosis: ASPD
⦿ Antisocial PD (ASPD) extremely difficult to treat
⦿ No evidence as yet that any treatment effective
⦿ Other disorders result in suffering to individual

hospital
⦿ ASPD results in suffering for society

prison
Good luck with your careers!

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