Abdallah Ayyoub, MS Personality disorders - PowerPoint Presentation

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Abdallah Ayyoub, MS

Personality disorders

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What we are

gonna talk about..1. Definition of personality trait.

2.

Definition of personality

disorder.

3. Clusters of personality disorders.

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Personality Trait

• Fixed pattern of behavior • Way of interacting with environment • Positive traits: kind, confident • Negative traits: lazy, rude • Person often aware of own traits

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Personality Disorder

• Fixed pattern of behavior • Fixed way of interacting with environment •

Cause distress or impaired function

• Person often unaware

• Difficult to treat (“enduring”)

• Often strains doctor-patient relationship

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Three clusters:

A, B, C; remember as Weird, Wild

, and

Wacky

,

respectively, based on symptoms

Cluster

A (Weird)

•

Paranoid, schizoid, schizotypal

• Odd and eccentric behavior Cluster B (Wild) • Antisocial, borderline, histrionic, narcissistic • Dramatic, erratic behavior Cluster C (Wacky) • Avoidant, Obsessive-compulsive, dependent • Anxious, fearful behavior

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Paranoid (

Accusatory)

Schizoid (

A

loof)

Schizotypal (

A

wkward)

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Paranoid Personality Disorder (PPD)

• Distrust of others even friends/family • Guarded • Suspicious • Struggles to build close relationships

• Hallmark ego defense: projection

1-Attributing

unacceptable thoughts to others

2-Often

accuses others of being suspicious

•

Prevalence

: 0.5 to 2.5%

• Men are more likely to have PPD than women. • Psychotherapy is the treatment of choice.

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DSM-5 diagnosis of PPD

Diagnosis requires a general distrust of others, beginning by early adulthood and present in a variety of contexts. At least four of the following

must also be present:

1

.

Suspicion (without evidence) that others are exploiting

or

deceiving him

or her

2

. Preoccupation with doubts of loyalty or trustworthiness of acquaintances3. Reluctance to confide in others4. Interpretation of benign remarks as threatening or demeaning5. Persistence of grudges6. Perception of attacks on his or her character that are not apparent to others; quick to counterattack7. Recurrence of suspicions regarding fidelity of spouse or lover

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Schizoid Personality

Disorder• Chooses social isolation: More comfortable alone •

Does not

enjoy

close relationships

• Little/no interest in sexual experiences

• Few/no pleasure activities (hobbies)

• Lacks close friends

• Detachment

• Flat affect

• Prevalence: Approximately 7%• Men are two times as likely to have schizoid personality disorder as women.• Psychotherapy is the treatment of choice.

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A pattern of voluntary social withdrawal and

restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts. Four or more of the following must also be present:1. Neither enjoying nor desiring close relationships (

including family

)

2

. Generally choosing solitary activities

3.

Little (if any) interest in sexual activity with another person

4

. Taking pleasure in few activities (if any)

5. Few close friends or confidants (if any)6. Indifference to praise or criticism7. Emotional coldness, detachment, or flattened affectDSM-5 diagnosis of Schizoid :

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Schizotypal Personality

Disorder • Fear of social interactions and few close friends • Odd beliefs or magical thinking

-

Superstitious

-

Believes in telepathy, sixth sense

• Ideas of reference

-Believe

events and happenings somehow related to them

• Key feature: open to challenges to beliefs - May reconsider superstitions, etc. -Contrast with delusions in schizophrenia - Also no hallucinations, cognitive impairment

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B

1-Antisocial:

B

ad

2-

B

orderline,

3-Histrionic:

flamBoyant,4-Narcissistic:must be the

B

est (corresponding alphabetically).

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Antisocial Personality

Disorder • More common in men • Disregard for rights of others • Often breaks the law

• Impulsive and lacks remorse

• Child (<18) version: conduct disorder

-

25% girls and 40% boys with CD → ASPD

• Must

be at least age 18 years old

• Must

have evidence of conduct disorder before 15

• Prevalence: 3% in men and 1% in women• Higher incidence in poor urban areas and in prisoners• Genetic component: Five times increased risk amongfirst-degree relatives

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Pattern of disregard for others and violation of the rights

of others since age 15. Patients must be at least 18 years old for this diagnosis; history of behavior as a child/adolescent must

be consistent with conduct disorder .

Three or more

of the

following should be present:

1. Failure to conform to social norms by committing unlawful acts

2

. Deceitfulness/repeated lying/manipulating others for personal gain

3

. Impulsivity/failure to plan ahead 4. Irritability and aggressiveness/repeated fights or assaults5. Recklessness and disregard for safety of self or others6. Irresponsibility/failure to sustain work or honor financial obligations7. Lack of remorse for actionsDSM-5 diagnosis of Antisocial :

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Antisocial personality disorder has

frequently been discussed on the show, and the primary character, Gregory House, was diagnosed with the disorder in 

Broken

. House often 

projects 

his disorder onto patients, fellows and colleagues, and is often gratified when they act in an anti-social manner, such as 

lying

 or breaking off their relationships

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Conduct disorder

Repetitive, pervasive behavior violating societal norms or the basic rights of others (eg, aggression to people and animals, destruction of property, theft). After

age 18

, often reclassified as

antisocial personality

disorder. Treatment for both: psychotherapy (

eg

, CBT).

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Borderline Personality

Disorder• Unstable personal relationships - All people are very good or very bad

- Stormy relationships

- “

My boyfriend is the greatest guy in the world!”

- “

My boyfriend is the devil!”

• Fear

of abandonment

-

May accuse others of abandoning them • Prevalence: 1 to 2%• Women are two times as likely to have BPD as men.• 10% suicide rate

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Splitting

• Major defense mechanism in borderline PD • Black and white thinking (always-never) • Cannot hold opposing views • Patent's physician may be great or terrible • All people-things-events wonderful or

horrible

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Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early adulthood and in a variety of contexts

. At least five of the following must be present:1. Desperate efforts to avoid real or imagined abandonment2. Unstable, intense interpersonal relationships3. Unstable self-image4. Impulsivity in at least two potentially harmful ways (spending, sexual activity, substance use, etc.)5. Recurrent suicidal threats or attempts or self-mutilation (you don’t care about me so I will kill my self)

6. Unstable mood/affect

7. General feeling of emptiness

8. Difficulty controlling anger

9. Transient, stress-related paranoid ideation or dissociative symptoms

DSM-5 diagnosis of Borderline personality disorder

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Dialectical Behavior Therapy

• Form of cognitive behavioral treatment • Designed to treat chronical suicidality • Gold standard for borderline personality disorder • Weekly therapy for 1-2 years

-

Mindfulness

-

Distress tolerance

- Emotion regulation

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Borderline personality: (IMPULSIVE

)

I

mpulsive

M

oody

P

aranoid

under stress

U

nstable self imageLabile, intense relationshipsSuicidalInappropriate angerVulnerable to abandonmentEmptines(IMPULSIVE)

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Histrionic Personality Disorder

• Wants to be the center of attention Talks loudly, tells wild stories, uses hand gestures • Inappropriate sexually provocative behavior

-Often

wears provocative

clothing

-Touching others frequently

• Very concerned with physical appearance

-Exotic outfits, shoes

, hats

•

Prevalence: 2%.• Women are more likely to have HPD than men.

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Diagnosis and DSM-5 Criteria

Pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts.

At

least five

of the following must be present

:

1. Uncomfortable when not the center of attention

2

. Inappropriately seductive or provocative behavior

3

. Rapidly shifting but shallow expression of emotion4. Uses physical appearance to draw attention to self5. Speech that is impressionistic and lacking in detail6. Theatrical and exaggerated expression of emotion7. Easily influenced by others or situation8. Perceives relationships as more intimate than theyactually are

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Narcissistic Personality Disorder

• Inflated sense of self - Brags, thinks everything he does is great -

Lacks empathy for others

-

Other people are competitors

• Wants to hear they are great

• They

consider themselves “special” and

will exploit

others for their own gain.

• Despite their grandiosity, however, these patients often have fragile self-esteem, Overreacts to criticism with anger/rage • Prevalence is 6%.

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Pattern of grandiosity, need for admiration, and lack of

empathy beginning by early adulthood and present in a variety of contexts. Five or more of the following must be present:

1-Exaggerated

sense of self-importance

2-Preoccupation

with fantasies of unlimited money,

success, brilliance

,

etc.

3-Believes

that he or she is “special” or unique and can associate only with other high-status individuals 4-Requires excessive admiration4-Has sense of entitlement5-Takes advantage of others for self-gain6-Lacks empathy7-Envious of others or believes others are envious of him or her8-Arrogant or haughtyDiagnosis and DSM-5 Criteria

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Usually has a chronic course; higher incidence

of depression and midlife crises since these patients put such a high value on youth and power.Treatment-Psychotherapy is the treatment of choice.

-Antidepressants

may be used if a comorbid

mood disorder

is diagnosed

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C

1.

Avoidant

:

C

oward

2.

Obsessive

-

Compulsive3.Dependent: Clingy.

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Avoidant

Personality Disorder • Avoids social interactions • “Social inhibition” • Feels inadequate

• Afraid people won’t like them

• Afraid of embarrassment

• Struggles with intimate relationships

-“

Maybe he/she doesn’t like me”

• Different

from schizoid: wants to socialize but

can’t

• Schizoid prefers to be alone (aloof) • 2.4%.• Equally frequent in males and females

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Treatment

-Psychotherapy, including assertiveness and social skills training, is most effective.-Group therapy may also be beneficial.

- Selective

serotonin reuptake inhibitors (SSRIs) may be

prescribed for

comorbid social anxiety disorder or major depression.

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Obsessive-Compulsive

Personality Disorder • Preoccupied with order and control

-

Loves “To Do” lists

-

Always needs a plan

•

Inflexible

at work or in relationships

• Behaviors help to achieve goals (contrast with OCD)• Prevalence is 1–2%.• Men are two times more likely to have OCPD than women

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Ego: • Mediates id (desire) and super-ego (rules, society) Egosyntonic:• Behaviors that achieve goals of the ego • Obsessions/compulsions used to achieve goals

• Seen in obsessive-compulsive personality disorder

Egodystonic

:

• Behaviors that conflict with goals of the ego

• Obsessions/compulsions are barriers to goals

• Seen in obsessive-compulsive disorder

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Diagnosis and DSM-5 Criteria

Pattern of preoccupation with orderliness, control, and perfectionism at the expense of efficiency and flexibility, present by early adulthood and in a variety of contexts. At

least four of the following

must be present

:

1. Preoccupation with details, rules, lists, and

organization such

that the major point of the activity is lost

2

. Perfectionism that is detrimental to completion of task

3. Excessive devotion to work4. Excessive conscientiousness and scrupulousness about morals and ethics5. Will not delegate tasks6. Unable to discard worthless objects7. Miserly spending style8. Rigid

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Dependent Personality Disorder

• Clingy • Low self-confidence • Struggle to care for themselves • Depend on others excessively -

Rarely alone, always in a relationship

•

Hard to make decisions on their own

-

Want someone to tell them what to do

•

Difficulty expressing an opinion

•

May be involved in abusive relationships

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A 23-year-old medical student attempted to slit

her wrist because things did not work out with a guy she was going out with over the past 3 weeks. She states that guys are jerks and “not worth her time.” She often feels that she is “alone in this world.”

Borderline personality disorder

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A 30-year-old unemployed male has been accused

of killing three senior citizens robbing them. He is surprisingly charming in the interview. In his adolescence, he was arrested several times for stealing cars and assaulting other kids.Antisocial personality disorder

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A 35-year-old man dresses in a space suit every

Tuesday and Thursday. He has computers set up in his basement to “detect the precise time of alien invasion.” He has no evidence of auditory or visual hallucinations.Schiztotypal personality disorder

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Borderline personality disorder is called in Arabic:

اضطراب الشخصية الحدية