CHAPTER 6 PERSONALITY DISORDER
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Transcript of CHAPTER 6 PERSONALITY DISORDER
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CHAPTER 6 PERSONALITY DISORDER
-Traits of personality that are not flexible & not adjusted so result is social or vocational failure or self-suffering.
-Easier to observe sx at adolescence & continue for most of adulthood & less clear at middle age & elderly.
-Dx should not be confirmed unless characteristics are applied for long period & not for specific period.
-Usually pt. is unsatisfied because of effect of his behavior on others or unable to perform his work effectively.
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Causes of personality disorders1-Biological factorsa- Hereditary genes: Great similarity in personality among identical twins > un-identical twins.-Increasing in group (A) among relatives of persons with schizophrenia.b- Biochemical studies: Hyperactive persons have high average of testosterone that increase of aggression & sexual behavior.c- Nervous factors: Slight brain defect in childhood is connected with antisocial P.D. later.
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2-Psychoanalytic theory-Personality characteristics result from fixation on one stage of G & D stages. They are divided as:Oral personality: negative, dependent, eating food excessively.Anal personality: crucial, ungenerous, accurate & hard-headed.Obsessive personality: stiff & superego is dominating.Narcissistic personality: aggressive & self-centered.
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3-Social & cultural factors -Rxn b/w mood of child & father or mother during rearing is very important.Example: anxious child who is cared by anxious mother is susceptible more for P.D. than child with calm mother.*Cultures that increase & encourage aggression, is preparing for paranoid or antisocial P.D.
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Classification of personality disordersThere are 3 clusters:Cluster A: Paranoid, schizoid & schizotypal (odd and /or eccentric). -May be present on the same individual with psychotic disorders.
Cluster B: Antisocial, borderline, histrionic & narcissistic (dramatic & emotional).-Often co-morbid with affective disorders.
Cluster C: Avoidant, dependent, & obsessive-compulsive (anxious & fearful cluster).
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Cluster (A) P. D. (odd/ eccentric)
1)Paranoid Personality Disorder:Epidemiology-Increased in families having 1 or > members dxed with paranoid personality disorder.-Males > females.-Substance abuse is common.
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Sx-Distrust, suspicion-Difficulty adjusting to change-Sensitivity, argument-Feeling of irreversible injury by others-often without evidence-Anxiety, difficulty relaxing-Short temper-Lack of tender feelings toward others-Unwillingness to forgive even minor events-Jealousy of spouse or significant other-often without evidences
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Prognosis-Starts at adulthood & may continue for end of pt.'s life.-In some cases disorder severity decrease by age.-Rarely that pt. is seeking for Rx & many problems appear in his relation with authority or people around him.
Rx-Psychotherapy is Rx of choice & therapist should recognize that areas of trust, love, tolerance: disturbed.-Group psychotherapy is not appropriate.-Drugs may be used esp. in case of anxiety or agitation.
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2)Schizoid Personality Disorder:Epidemiology-Males > females.-Increased prevalence in families with members who have schizophrenia or schizotypal P.D.
Sx-Lack of desires to socialize; enjoys solitude-Lacks strong emotions-Detached, self-absorbed affect-Lacks trust in others-Brief psychotic episodes in response to stressful events-Difficulty expressing anger-Passive rxns to crisis
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Prognosis-Starts in childhood & stays long period; not necessarily for life.-There is unknown percentage converted to schizophrenia.-Limitation in social r/s & vocational performance.-May be able to increase vocational performance in situations that need scientific achievement in socially separated conditions.
Rx-Similar to Rx of paranoid P.D. but pt. with paranoid PD agrees with expectations of therapist through seeing self from inside but exaggerates in fantasy.-Group psychotherapy: useful; allows to communicate others.
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3)Schizotypal Personality DisorderEpidemiology-30%-50% also have major depression.-Pts. seek Rx for anxiety &/or depression, not for P.D. features.-First-degree relatives of pts. with schizophrenia are at increased risk.-Males > females.-Pt. has deep & strange thinking style, appearance, behavior, limitation in r/s with others, but not enough to dx schizophrenia.
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Sx-Incorrect interpretation of external events/ belief that all events refer to self.-Superstition, preoccupation with paranormal phenomena.-Belief in possession of magical control over others.-Constricted or inappropriate affect.-Anxiety in social situation.
Prognosis-10% have suicide & some convert to schizophrenia.-Many can marry & work despite of their strange nature.
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Cluster “B” P. D. (Dramatic & Emotional)
4) Antisocial Personality Disorder: Epidemiology-Usually dxed by year 18.-Have Hx of conduct disorders before age 15.-Males > females.-High percentage of dxed pts. are in substance abuse Rx settings, & prisons.-> in lower socioeconomic classes.-Substance abuse is common.-Impulsive behavior is common.
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Sx:-Irresponsibility-Failure to honor financial obligations, plan ahead, provide children with basic needs-Involvement in illegal activities-Lack of quilt-Difficulty learning from mistakes-Initial charm dissolves to coldness, manipulation, blaming others-Lacks empathy-Irritability-Abuse of substances
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Prognosis-Beginning in childhood: disturbance in behavior; among boys: childhood, among girls: adolescence.-Bad behavior of pts. may decrease after 30.-Failure in academic achievement, getting injury or die as a result of his/her disturbed behavior.-If did not appear in childhood, he/she can succeed academically, politically or economically.-Using work for his benefit & no consideration for values ethics & without blaming self or taking into consideration benefit of community.
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Rx-Before starting Rx, therapist should find method to stop self-destructive behavior of pt. & his fear of intimacy & friendship with others & convincing him to communicate with others without fear of pain result from this communication or rxn.-Most useful method is group composed for their help & empathy with them & providing emotions they lost.-Meds. for anxiety or depression if found.
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5)Borderline Personality Disorder: Epidemiology-75% are female.-Have Hx of physical & sexual abuse, neglect, hostile, conflict & early parental losses or separation.
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Sx-Intense, stormy relationships-Sees people as “all good” or “all bad” -Impulsivity-Self mutilation-Difficulty identifying self-Negative & angry affect-Feelings of emptiness & boredom-Difficulty being alone, feeling of abandonment-Has impulsive acts (binging, spending money)-Suicidal ideation
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Prognosis-Starts early in adulthood & characterized by instability.-Doesn’t convert to schizophrenia but to major depression & sometimes to brief psychotic disorder.-Most dangerous complication is suicide.
Rx-Psychotherapy is Rx of choice in addition to drugs.-Psychotherapy is considered difficult subject for therapist & pt. since pt. tends to practice regression & fluctuating feelings toward therapist.-Drugs include anti-psychotic, anti-depression, anti-anxiety, & sometimes anti-convulsion.
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6) Histrionic personality disorder:Epidemiology-Females > males.
Sx-Fluctuation in emotions-Attention-seeking, self-centered attitude-Sexual seduction-Attentiveness to own physical appearance-Dramatic, impressionistic speech style-Vague logic-lack of conviction in arguments, often switching sides-Shallow emotional expression-Craving for immediate satisfaction-Complaints of physical illness, somatization-Use of suicidal gestures and threats to get attention
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Prognosis- Appears in early adulthood & sx decrease by age. -Often relation of pt. with others are affected & disturbed.-Brief psychotic disorder, hysterical conversion, somatization may occur.
Rx-Often pt. doesn’t recognize his real feeling so clarifying them to pt. is important step in Rx.-Drugs maybe used if sever anxiety or depression.
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7) Narcissistic personality disorder:Epidemiology-Males > females.
Sx-Grandiose view of self.-Lacks empathy toward others.-Needs for admiration.-Preoccupation with fantasies of success, brilliance, beauty, ideal love.
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Prognosis-Starts in early adulthood mainly chronic.-Disturbance in their social r/s, difficulties with others, & unrealistic goals.
Rx-Difficult to be treated & need long-term psychoanalysis to establish change.
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Cluster “C” P. D.(Anxious & Fearful)
8)Avoidant Personality Disorder:Epidemiology -Males equals females. Sx-Fearful of criticism, disapproval, or rejection-Avoid social interactions-Withhold thoughts or feelings-Negative sense of self, low self-esteem
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Prognosis-Starts in early adulthood & can work in socially comfortable situation.-Some may have depression, anxiety, anger or social phobia. Rx-Depends on acceptance of therapist to fears of pt. & stability of therapeutic r/s & encouraging him to communicate with outside world but carefully in order not to have any failure that may support original opinion of pt.
-Group psychotherapy may help these pts.
-Training on self-confidence is behavioral method to teach pt. how to express feeling & needs & improve self-esteem.
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9) Dependent Personality Disorder Epidemiology-Females > males.-Sx are demonstrated early in life.-Children or adolescents with chronic physical illness or separation anxiety disorder may be predisposed. Sx -Submissive, clinging -Unable to make decisions by themselves-Can’t express negative feelings (emotions) -Difficulty following through on tasks
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Prognosis -Appears in early adulthood & weakness in field of work achievement because of passivity.-Some pts. become addict or depressed or other psychiatric disorders.-Little will live without psychiatric disorders. Rx-Supportive psychotherapy is useful & taking into consideration internal passive aggression of pt.-Giving anti-depression if needed.
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10) Obsessive-Compulsive Personality DisorderEpidemiology -Males are twice > females. Sx-Preoccupation with perfection, organization, structure, control-Procrastination-Abandonment of projects due to dissatisfaction-Difficulty relaxing-Rule-conscious behavior
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-Self-criticism with inability to forgive own errors-Reluctance to delegate-Inability to discard anything-Insistence on other’s conforming to own methods-Rejection to praise-Reluctance to spend money-Background of stiff & formal r/s-Preoccupation with logic & intellect
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Prognosis-Starts in early adulthood.-May have obsessive-compulsives disorder, schizophrenia or depression or hypochondriasis.-May become adjusted with his condition. Rx-Pt. has insight & seeking for Rx to relief their suffering.-Long-term psychoanalytic is useful. -Behavior & group psychotherapy is less useful.-Some drugs maybe added symptomatically.