Personality disorders-prof.fareed minhas

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Personality disorders-prof.fareed minhas

  1. 1. DISORDERS OF ADULT PERSONALITY FAREED MINHAS Professor of Psychiatry HEAD, Institute of Psychiatry Rawalpindi Medical College Rawalpindi
  2. 2. Introduction Clinically significant conditions and behavior patterns which tend to be persistent Are the expression of an individual’s characteristic lifestyle and mode of relating to self and others Some of these conditions emerge early in the course of an individual’s development Result of both constitutional factors and social experience While others are acquired later in life
  3. 3. What is normal personality?    Many definitions given by psychiatrists and psychologists Simplest definition : “the characteristic patterns of behavior and modes of thinking that determine a person’s adjustment to the environment” Important features: - present since adolescence - stable over time despite fluctuations in mood - manifest in different environments - recognizable to friends and acquaintances
  4. 4. Normal Personality (contd.)  Classification of normal personality Type model Interaction Model Trait model  Psychodynamic model Situational model Consistency of normal personality More theory than proof in various longitudinal studies
  5. 5. Abnormal Personality  Deeply ingrained and enduring behavior patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations  They represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels and particularly relates to others  These behavior patterns are stable, encompass multiple domains of behavior and psychological functioning and frequently associated with subjective distress and problems in social functioning and performance  Appear in childhood or adolescence and continue into adulthood and are not secondary to mental disorder or brain damage
  6. 6. Important Contributions of the Past…  Schneider’s Psychopathic Personalities(1950) Abnormal personalities who either suffer personally because of their own abnormality or make the community suffer because of it. Various subtypes described were of little clinical value. Inborn characteristics believed to be the sole source of personality, no role of external factors  Peter Tyrer and Nottingham group(1988) Classified personality disorders into mature and immature types. Mature type are evident in adolescence and don’t change with age. Immature type change and have late onset
  7. 7. Important Contributions of the Past…  Graham Foulds Models relating personality disorder and psychiatric illness PSYCHIATRIC PERSONALITY ILLNESS DISORDER NORMALITY MODEL 1 PERSONALITY DISORDER PSYCHIATRIC ILLNESS NORMALITY MODEL 2
  8. 8. PSYCHIATRIC ILLNESS PERSONALITY DISORDER = PERSONALITY PSYCHIATRIC ILLNESS DISORDER NORMALITY NORMALITY MODEL 3 PSYCHIATRIC ILLNESS PERSONALITY MODEL 4 NORMAL PERSONALITY DISORDER DISORDER NORMALITY MODEL 5 Alternative MODEL 4 PSYCHIATRIC ILLNESS
  9. 9. Classification of Personality Disorders          ICD 10 Paranoid Schizoid (schizotypal) Dissocial Emotionally unstable (Impulsive/Borderline) Histrionic Anankastic (obsessive compulsive) Anxious (avoidant) Dependent Other          DSM IV Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Obsessive-compulsive Avoidant Dependent Passive-aggressive
  10. 10. Clinical Features of abnormal personalities  Paranoid Personality Disorder - suspicious - stubborn - mistrustful  - argumentative - sensitive - self important Schizoid Personality Disorder - Emotionally cold - Aloof - Introspective - Detached - Humorless
  11. 11. Clinical Features of abnormal personalities (contd.)  Schizotypal Personality Disorder -  Social Anxiety - Unable to form close relations Eccentric behavior – Oddities of speech Inappropriate affect - Unusual perceptual experiences Suspiciousness - Ideas of reference/odd ideas Dissocial (Antisocial) Personality Disorder - Failure to sustain relationships (Disregard for others’ feelings) - Impulsive actions (Low tolerance of frustration) (Tendency to violence) - Lack of guilt - Failure to learn from experience
  12. 12. Clinical Features(contd.)  Emotionally unstable personality disorder Impulsive type Borderline type - Emotional instability -Unstable relationships - Lack of impulse control -Impulsive behavior - Outbursts of anger in the form of -Variable moods words, physical violence etc -Lack of control of anger -Recurrent suicidal threats/behavior -Uncertainty about personal identity -Chronic feelings of emptiness -Efforts to avoid abandonment -Transient stress-related paranoid symptoms
  13. 13. Clinical Features(contd.)  Histrionic Personality Disorder - Self-dramatization; exaggerated expression of emotion Suggestibility; easily influenced Shallow and labile affect Continual seeking for excitement and attention - Over-concern with physical attractiveness  Narcissistic Personality Disorder - Grandiose sense of self-importance Preoccupation with fantasies of unlimited success Exploit others with no return Crave attention
  14. 14. Clinical Features(contd.)  Anankastic personality disorder -  Feelings of excessive doubt and caution Preoccupation with details/rules/order/schedule Perfectionism that interferes with task completion rigidity and stubborness Inflexible and judgemental Anxious (avoidant) personality disorder - Persistent/pervasive feelings of apprehension Belief that one is inferior/socially inept Excessive preoccupation with criticism and rejection Avoidance of interpersonal contact
  15. 15. Clinical Features(contd.)  Dependent Personality Disorder -  Allowing others to make important life decisions subordination of one’s needs to those of others unwillingness to make even reasonable demands feeling helpless when alone because of fears of inabilty to take care of self Passive-aggressive Personality Disorder - When demands made for adequate performance, response is of passive resistance eg. Deliberate inefficiency
  16. 16. Etiology of Personality Disorders  Genetic Causes  Relation to mental disorders  Personality disorder and upbringing
  17. 17. Prognosis  Age factor – Anxious, Dependent and Passiveaggressive type decrease slightly with age  Few studies mostly on borderline and antisocial types show poor prognosis
  18. 18. Management of Personality Disorders  Thorough assessment  Three levels of management (biological/psychological and social)  Biological methods- Anti-psychotics (short-term benefits for borderline) - Monoamine oxidase inhibitors (also in borderline) - Anti-epileptic drugs (control of anger outbursts)
  19. 19. Management of Personality Disorders(contd.)   Psychological treatment - Counselling - Dynamic psychotherapy - Cognitive therapy - Individual or group therapy as appropriate Social treatment - Help the individual to change present life circumstances to as less discordant with personality as possible
  20. 20. THANKYOU References : -OXFORD TEXTBOOK OF PSYCHIATRY (Third Edition) -COMPANION TO PSYCHIATRIC STUDIES (Fifth Edition) -ICD 10 (Clinical and Diagnostic Guildlines)

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