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Personality Disorders

Definition:. Chronic , pervasive , fixed , inappropriate patterns of relating to others that cause social

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Personality Disorders

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    1. Personality Disorders DR.NAYEL ALADWAN

    2. Definition: Chronic , pervasive , fixed , inappropriate patterns of relating to others that cause social & occupational impairment. Patients with personality disorders lack insight about their problem and they dont seek psychological help unless forced by others. Their symptoms are ego-syntonic(i.e. compatible with their wishes and acceptable to their egos). Personality disorders are axis II diagnosis.

    3. Diagnosis & DSM-IV Criteria: Pattern of behavior/inner experience that deviates from the persons culture & is manifested in two or more of the following ways (CARPI): Cognition Affect Personal Relations Impulse control The pattern: Pervasive & inflexible Stable & its onset not later than adolescence or early adulthood. Affects functioning. Not related to another mental/medical illness or substance

    4. Cluster A: MAD Paranoid Schizoid Schizotypal Cluster B: BAD Borderline Antisocial Narcissistic Histrionic Cluster C: SAD Avoidant Dependent Obsessive-compulsive Personality disorders not otherwise specified(NOS)include disorders that dont fit in the above clusters including (passive-aggressive personality disorder. Personality disorders are divided into three clusters:

    5. Etiology & Treatment: Etiology: biological, genetic & psychosocial factors contribute to the development of PD. each PD affects approximately 1% of the population. Treatment: Very difficult to treat. Psychotherapy & group therapy are usually the most helpful while pharmacological treatment has limited usefulness.

    6. Cluster A Odd & eccentric

    7. Diagnostic Criteria: display pervasive distrust and suspiciousness . At least 4 of the following must also present: Suspicion without evidence , that others are exploiting, harming, or deceiving him/ her. preoccupation with doubts of loyalty or trustworthiness of friends or associates. reluctance to confide in others because of unwarranted fear that the information will be used maliciously against him / her.

    8. interpretation of benign remarks or events as threatening or demeaning. Persistence of grudges i.e. unforgiveness of insults, injuries, or slight. Perception of attacks on his/her character that are not apparent to others, quick to counterattack. recurrent suspicions, regarding fidelity of spouse or lover.

    9. Its prevalence is 0.5 to 25%. Men are more likely to be affected. Higher incidence in family members of schizophrenics. May have psychosis under stressful conditions. Life long marital & job-related problems. DDx: paranoid schizophrenia but with no fixed delusions or frank psychosis. Psychotherapy is the best, but we may use anxiolytics or short course antipsychotics for transient psychosis.

    10. Diagnostic Criteria: Voluntary social withdrawal & restricted range of emotional expression. at least 4 of the following must also present: Neither desires nor enjoys close relationships Chooses solitary activities Little interest in sexual experiences Takes pleasure in few activities No close friends except first-degree relatives Indifferent to praise or criticism shows emotional coldness, detachment, or flattened affectivity.

    11. Its prevalence is 7%. Men are 2 times ore affected. No increased incidence of schizoid personality in families with history of schizophrenia. Chronic but not life long. DDx: Paranoid schizophrenia Schizotypal personality disorder : but with no eccentric behavior or magical thinking. Treatment same as paranoid , group therapy is useful also.

    12. Diagnostic Criteria: At least 5 of the following must be present: ideas of reference (excluding delusions of reference). odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, telepathy, or "sixth sense) unusual perceptual experiences, including bodily illusions odd thinking and speech (e.g., involvement in cults ,vague, metaphorical speech)

    13. suspiciousness or paranoid ideation. inappropriate or constricted affect. behavior or appearance that is odd, eccentric, or peculiar; lack of close friends or confidants other than first-degree relatives; excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

    14. Its prevalence is 3%. More in monozygotic than dizygotic twins. Chronic ,Patients may eventually develop schizophrenia. DDx: Paranoid schizophrenia Schizoid personality disorder Treatment as the others.

    15. Cluster B Dramatic & emotional

    16. Diagnostic Criteria: Repeated unlawful activity. Deceitfulness. Impulsivity. Irritability & aggressiveness. Lack of remorse. Reckless disregard for safety of self and others. Irresponsible.

    17. Its prevalence is 3% in men & 1% in women. Higher incidence in poor urban areas and in prisons. 5 times more risk in 1st degree relatives. Chronic but may improve with age. Many patients have multiple somatic complaints and co-existence of substance abuse and/or major depression is common. DDx: Drug abuse Treatment : psychotherapy is the best , but we may use antidepressants or anxiolytics with caution due to their high addictive potential.

    18. Diagnostic Criteria: Desperate efforts to avoid real or imagined abandonment. Unstable , intense relationships. Unstable sense of self. Impulsivity in at least 2 potentially harmful ways. Unstable mood/affect. general feelings of emptiness. Difficulty controlling anger. Transient , stress-related paranoid ideation or dissociative symptoms. Recurrent suicidal threats or attempts or self mutilation.

    19. Its prevalence is 1-2 %. Women are 2 times more affected 10% suicide rate. Chronic , stable course. High incidence of coexisting major depression and/or substance abuse. DDx: Schizophrenia Treatment : psychotherapy is the best , behavioral & cognitive therapy are also helpful. we can use antidepressants and antipsychotics when necessary .

    20. Diagnostic Criteria: Excessive emotionality and attention seeking, presents by early adulthood, with at least five of the following: Uncomfortable in situations in which he or she is not the center of attention Inappropriate sexually seductive or provocative behavior Uses physical appearance to draw attention to self Has a speech that is impressionistic (???????) and lacking in detail Theatrical and exaggerated expression of emotion Easily influenced by others or situations Considers relationships as more intimate than they actually are

    21. Histrionic patients often use defense mechanism of regression revert into childlike behaviors. Prevalence is 2 3% and is more common in women. Chronic course but may improve with age. DDx: Borderline personality: more likely to be depressed and are less functional. Treatment of choice is psychotherapy, but pharmacotherapy may be used to treat associated depressive or anxious symptoms as necessary.

    22. ???

    23. Diagnostic Criteria: Pattern of grandiosity, need for admiration and lack of empathy beginning by early adulthood, with five or more of: Exaggerated sense of self-importance Preoccupied with fantasies of unlimited money, success, power, brilliance, beauty.. Believes that s/he is special and unique and can only be understood by other high-status people Needs excessive admiration Has a sense of entitlement i.e. unreasonable expectations of favorable treatment or others complying to their expectations Takes advantage of others for self-gain Lacks empathy 5. entitlement (i.e. unreasonable expectations of favorable treatment or others complying to their expectations) 7. empathy: is unwilling to recognize or identify with the feelings and needs of others5. entitlement (i.e. unreasonable expectations of favorable treatment or others complying to their expectations) 7. empathy: is unwilling to recognize or identify with the feelings and needs of others

    24. 8. Envious of others or believes that others are envious of him/her Shows arrogant, haughty (?????)behaviors or attitudes Prevalence is < 1% DDx: Antisocial personality disorder: both exploit others but NPD wants status and recognition while Antisocial wants materialistic gain. The course is usually chronic with high incidence of depression and midlife crises. Psychotherapy is the treatment of choice, but antidepressants or lithium may be needed.

    25. Cluster C Anxious & fearful

    26. Diagnostic Criteria: A pattern of social inhibition, hypersensitivity and feelings of inadequacy since early adulthood, with at least 4 of : Avoids occupational activities that involve significant interpersonal contact, due to a fear of criticism or rejection. Unwilling to interact unless certain of being liked Cautious of intrapersonal relationships Preoccupied with being criticized or rejected in social situations Inhibited in new interpersonal situations because of feelings of inadequacy

    27. 6. Believes s/he is socially inept (??? ???) or inferior to others 7. Reluctant to engage in any new activities for fear of embarrassment. Prevalence is 1-10%, with unknown sex ratio DDx: -Schizoid personality: have no desire for companionship while avoidant wishes them but is fearful. - Social phobias: fear of embarrassment is certain situations, while avoidant has and overall fear of rejection. - Dependent personality Chronic course, associated with anxiety and depressive disorders. Psychotherapy is most effective,B-blockers and SSRIs may be used.

    28. Diagnostic Criteria: Submissive and clinging behavior due to excessive need to be taken care of, features must manifest before early adulthood, with at least five of the following: Difficulty making everyday decisions without reassurance from others. Needs others to assume responsibility for most areas of his or her life Cannot express disagreement with others because of fear of loss of support or approval Has difficulty initiating projects because of lack of self-confidence.

    29. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant Feels helpless when alone because of exaggerated fears of being unable to care for himself or herself. Urgently seeks another relationship as a source of care and support when a close relationship ends Is unrealistically preoccupied with fears of being left to take care of himself or herself Prevalence is 1%, and is more common in women. Many people with debilitating illnesses can develop dependent traits, but DPD must be manifested in early adulthood to be diagnosed.

    30. DDx: -Avoidant personality: both cling to relationships but avoidant are slow to get involved while dependants actively and aggressively seek relationships. -Borderline and histrionic: these 2 are also dependant on others but their relationships dont last long as in dependant. Chronic course usually, but symptoms decrease with age or therapy, patients are more prone to depression, particularly after loss of the care giver. Treat with psychotherapy and pharmacotherapy if necessary.

    31. Diagnostic criteria: Preoccupation with orderliness, control and perfectionism at the expense of efficiency, present by early adulthood, with at least 4 of the following: Preoccupied with details, rules, lists, organization, or schedules to the extent that the major point of the activity is lost Shows perfectionism that interferes with task completion Excessively devoted to work Over conscientious(?? ??????) and inflexible about matters of morality, ethics, or values. Konshiyenshus! Konshiyenshus!

    32. 5. Unable to discard worn-out or worthless objects 6. Is reluctant to delegate (?????)tasks or to work with others unless they submit to exactly his or her way of doing things 7. Adopts a miserly spending style toward both self and others, money is viewed as something to be hoarded for future catastrophes Rigid and stubborn. OCPD is seen in 1% of population, with men being more likely to have it, it often occurs in the oldest child, and incidence is increased in first-degree relatives.

    33. DDx: -OCD: these patients are aware of their problem (ego- dystonic), while OCPD are ego-syntonic and do not have recurrent obsessions or compulsions. - Narcissistic personality: their acheivements are motivated by status while OC persons are motivated by the work itself. Have unpredictable course, some may develop OCD, schizophrenia, or MDD, others improve or stay the same. Psychotherapy is the treatment of choice, and pharmacotherapy may be used for associated symptoms.

    34. Cases!

    37. Thank you!

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