Understanding PERSONALITY Disorder

1. Understanding PERSONALITYDisorder Dr Ivona Amleh psychiatrist

2. Lat. Persona - mask

3. The First Classification of Personalities Hippocrates (ca.460 – 370 BC) Four temperaments Phlegmatic Choleric SanguineMelancholic

4. Definition of Personality Totality of emotional and behavioural traits that characterize the person in everyday living under ordinary conditions مجمل الميزات العاطفية والسلوكيهوهي التي تميز الشخص تحت الظروف العادية في الحياة اليومية Traits – enduring patterns of perceiving, relating to and thinking about environment and oneself ميزات الشخصية- نماذج منالملاحظة والارتباط والتفكير حول البيئة المحيطة والذات

5. Traits / Classification • C. G. Jung (1921) extroversion / introversion • K. Schneider (1923) “abnormal personalities are those who suffer or make others suffer” – “psychopaths”

6. “The Big Five Factors” Model • Costa & McRea’s (1992) descriptive and comprehensive structure behind all personality traits: OPENNESS (curiosity, liking variety) CONSCIENTIOUSNESS (discipline, achievements) EXTRAVERSION (assertiveness, talkativeness) AGREEABLENESS (helpfulness, cooperation) NEUROTICISM (anxiety, impulsivity)

7. Where is the dividing line between ‘NORMAL’ personality / Personality PROBLEM / Personality DISORDER?

8. Definition of Personality Disorder • Enduring behavioural patterns manifested as inflexible, maladaptive responses in personal and social situations • انماط السلوكية الدائمة التي تتسم الاستجابات غير مرنة وغير متكيفه في مختلف الأوضاع الشخصية والاجتماعية • Significant deviations from the average in a given culture • Associated with subjective distress and problems in social functioning • Recognisable from early adulthood

9. Are PDs Illnesses or Not? • Barely fit to medical concept of disease: - almost impossible to define - may have no actual symptoms - unknown cause - lacking specific treatment • But, impossible to ignore, can cause a lot of damage, elevated morbidity/mortality

10. Etiology heredity / physiology psychological factors interpersonal factors

11. Classification of Personality Disorders Paranoid Schizoid Schizotypal Narcissistic Histrionic Borderline Antisocial Obsessive-Compulsive Avoidant Dependent Passive-Aggressive

12. Paranoid PD • Distrustful • See enemies everywhere • Live lonely, tortured lives • Outbursts of rage • Project their malevolence to others maintaining thereby their self-esteem • May decompensate into delusion or depression

13. Schizoid PD • A quiet loner • Aloof and distant • Loving relationships neither felt nor sought • No fear of rejection, because no desire for acceptance • Like reading (may like religion, science, philosophy…), solitary activities • Well preserved reality testing

14. Schizotypal PD • Seem to lack a core • Vivid fantasy, vague speech • They sense ghostlike presences, magic influences, telepathy • Withdrawn, but have some relatedness • Rejection sensitive • May develop micro-psychotic episodes

15. Narcissistic PD The stable variant: • Feel superior, enjoy themselves • Not seeing the needs of others • Spoiled upbringing, sharing was not common • Difficult to get along with • If rejected in something important to them, may become depressed

16. Narcissistic PD The unstable variant: • The mask of narcissism • Life is a constant threat • Easily wounded and enraged or sad • May have reasonably good impulse control in public or on the job, keeping more primitive qualities in specific relationships

17. Histrionic PD • Demand central stage • Feel little responsibility • The past is a collection of images • Life is exciting for them, a long string of over-reactions, tantrums and lost loves • Behind is a painfully fragile self-esteem • Their tragedy: adults are not made to live as children

18. Borderline PD • Feeling of emptiness • Fear of abandonment • Unstable relationships • Impulsivity and self-harm • Affective instability and aggression • Face a harsh world over which they have no control, vulnerability for addiction • Develop depression and micro-psychosis

19. Antisocial PD • Charming or nasty • No responsibility, no anxiety • Playing games in which others exist as pieces to be manipulated and utilized • At their worst – cruel, sadistic and violent • Their amoral behaviour at least in a part a reflection of defenses to some intense pain

20. Obsessive-Compulsive PD • Hard on themselves • Any failure – the ultimate one • Love and resent their work • Must prove themselves worthy of being loved • Appear serious, cool and distant • Even free-time has to be well spent • Angry if someone is disrespectful for rules • May develop depression

21. Avoidant PD • Extremely low self-esteem • Desperate hope for affection • Do not dare to approach others • Unsure of their identity and self worth, sometimes denigrating and self-ridicule • Frequently appear aloof and cool, living a lonely, painful and introspective existence

22. Dependent PD • Craving for safety • Extremely rejection sensitive • View themselvesas weak and ineffectual, do not want to make any decision • Their unfortunate answer to insecurity is the safety of slavery • May develop depression

23. Passive-Aggressive PD • Negativistic or late • Perplexing ambivalence • Intentionally ineffective • Fearing rejection, they attack by passive means • The result is world lived through the eyes of someone bitterly resigned to sitting on the bench

25. Signal Behaviours Complaints about clinician or the system Antisocial Paranoid Borderline Narcissistic Passive-Aggressive

26. Signal Behaviours Flirtatious behaviour Antisocial Narcissistic Histrionic

27. Signal Behaviours Dramatic behaviour or dress Histrionic Borderline

28. Signal Behaviours Helpless and child-like Dependent Histrionic Borderline

29. Signal Behaviours Manipulative Antisocial Narcissistic Borderline Histrionic Passive-Aggressive