CHAPTER 7 CHAPTER 7 Personality and Personality and

personality disorderpersonality disorder

Zhong-Lin Tan Ph.D. M.M.Zhong-Lin Tan Ph.D. M.M.Hangzhou Mental Health CenterHangzhou Mental Health Center

Department of psychiatry, School of MedDepartment of psychiatry, School of Medicine Hangzhou Normal Universityicine Hangzhou Normal University

zlintan@yahoo.com.cn zlintan@yahoo.com.cn

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AimAim• Grasp the definitions of personality traits and

disorders features to all personality disorders

• Be familiar with the psychotherapeutic and pharmacologic treatment strategies for patients with personality disorder

• Reference book: Gelder M, Harrison P, Cowen P. Shorter oxford textbook of psychiatry. Fifth Edition. Oxford: Oxford University Press, 2006

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PersonalityPersonality

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PersonalityPersonality

• What is personality?What is personality?• Personality refers to Personality refers to enduring qualitieenduring qualitie

ss of an individual that are shown in his of an individual that are shown in his ways ofways of behavingbehaving in a in a widewide variety of c variety of circumstances.ircumstances.

• Mental disorder: differ from Mental disorder: differ from previousprevious behaviour.behaviour.

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The importance of The importance of personalitypersonality

• Personality as Personality as predispostionpredispostion

• Personality as Personality as pathoplasticpathoplastic factor factor

• Personality in relation to Personality in relation to treatmenttreatment

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Personality typesPersonality types• Sociable and outgoing type vs. solitary and self-conSociable and outgoing type vs. solitary and self-con

scious typescious type

• Extraversion-introversion and neuroticism (EysencExtraversion-introversion and neuroticism (Eysenck)k)

• Fives factors: Openness to experience; ConscientioFives factors: Openness to experience; Conscientiousness, Extraversion-introversion, Agreeableness, Nusness, Extraversion-introversion, Agreeableness, Neuroticism(OCEAN)euroticism(OCEAN)

• Clinicians: Clinicians: positive attributespositive attributes vs. vs. negative attributesnegative attributes

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The origins of personalityThe origins of personality

• Genetic influencesGenetic influences

• Childhood temperamentChildhood temperament– Young infants differ in patterns of sleeping and Young infants differ in patterns of sleeping and

waking, approach or withdrawal from new situawaking, approach or withdrawal from new situations,intensity of emotional responses, and span tions,intensity of emotional responses, and span of attention.of attention.

• Childhood experienceChildhood experience

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The assessment of The assessment of personalitypersonality

• Personality tests are more reliable in hePersonality tests are more reliable in healthy people.althy people.

• Useful in research, seldom used in clinicUseful in research, seldom used in clinical practice.al practice.

• The current behaviour of an ill person reThe current behaviour of an ill person reflects the effects of the flects the effects of the illness illness as well as as well as the personality.the personality.

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Personality Personality disorderdisorder

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1 The concept of abnormal 1 The concept of abnormal personalitypersonality

• Statistical criterion: such as intelligenceStatistical criterion: such as intelligence

• Social criterion: cause individual Social criterion: cause individual suffersuffer or or cause cause sufferingsuffering to others to others

• Personality changePersonality change– Due to organic disease of the brainDue to organic disease of the brain– After psychiatric disorderAfter psychiatric disorder– After a catastrophic experienceAfter a catastrophic experience

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2 How ideas bout abnormal 2 How ideas bout abnormal personality developed?personality developed?

• Koch(1891) used the term Koch(1891) used the term psychopathic psychopathic inferiorityinferiority to denote this group of peopl to denote this group of people who have marked abnormalities of bee who have marked abnormalities of behaviour in the absence of mental illness haviour in the absence of mental illness or intellectual impairment.or intellectual impairment.

• Later the word Later the word inferiorityinferiority was replaced b was replaced by y pesonalitypesonality to avoid judgemental overt to avoid judgemental overtones.ones.

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3 The classification of 3 The classification of abnormal personalitiesabnormal personalities

• Continuous vs. categoriesContinuous vs. categories

• Cut-off points– distress to the persons or othersCut-off points– distress to the persons or others—arbitrary and inprecise—arbitrary and inprecise

• Comorbidity: more than one peraonality diagnoComorbidity: more than one peraonality diagnosis can be made in a single patientsis can be made in a single patient

• ClassificationClassification

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4 Descriptions and diagnostic 4 Descriptions and diagnostic criteriacriteria

• Cluster A personality disordersCluster A personality disorders

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• Cluster B personality disorderCluster B personality disorder

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• Cluster C personality disorderCluster C personality disorder

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5 Epidemilolgy5 Epidemilolgy

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6 Aetiology6 Aetiology

• Genetic causesGenetic causes

• Early life experiencesEarly life experiences

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7 The prognosis of personality 7 The prognosis of personality disorderdisorder

• Personality disorders are defined as Personality disorders are defined as lifelong conditions, so little change lifelong conditions, so little change would be expected with time. There would be expected with time. There is little reliable evidence about their is little reliable evidence about their outcome.outcome.

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8 Treatment(1) important 8 Treatment(1) important pointspoints

• ComorbidityComorbidity• Treatment and follow-upTreatment and follow-up• Collaboration and drop outCollaboration and drop out• Outcome measuresOutcome measures

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Treatment(2)Treatment(2)

• Drug treatmentsDrug treatments

• Psychological treatmentsPsychological treatments

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9 The 9 The management management of of personality disorderspersonality disorders

• AssessmentAssessment

• General aims: conflicts less with their General aims: conflicts less with their charactercharacter

• Overall planOverall plan

• Choice of psychotherapyChoice of psychotherapy

• Choice of medicationChoice of medication

• Organization of servicesOrganization of services

• progressprogress

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The The managementmanagement of of specific personality specific personality disordersdisorders

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• Small-group therapySmall-group therapy

• Therapeutic communitiesTherapeutic communities

• Other group regimensOther group regimens

Antisocial personality disorderAntisocial personality disorder

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• Dynamic psychotherapyDynamic psychotherapy• Group psychotherapyGroup psychotherapy• Dialectical behaviour therapyDialectical behaviour therapy• Psychoanalytically oriented day treatmePsychoanalytically oriented day treatme

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Borderline personality disordeBorderline personality disorderr