3. Personality disorders(causes)
Personality- is formed and exists in
interaction between hereditary factors
and large psychosocial contact
Hereditary factors seem to be basic to
establish the type of personality
Various influences in ontogenetical
expierience can modify it.
4. Definition of Personality
“Enduring patterns of perceiving,
relating to, and thinking about the
environment and oneself, which
are exhibited in a wide range of
important social and personal
contexts”
5. Definition of Personality
Disorders
Personality disorders are “enduring
patterns of perceiving, relating to, and
thinking about the environment and
oneself” that “are exhibited in a wide
range of important social and personal
contexts,” and “are inflexible and
maladaptive, and cause either
significant functional impairment or
subjective distress” (DSM-IV, p. 630)
6. Main Features of PDs
Extreme patterns of thinking, feeling, and
behaving that deviate from a person’s culture
Listed on Axis II of the DSM-IV-TR
Begin early in life and remain stable
- not contextual or transient
Inflexible and maladaptive
Cause significant functional impairment and
subjective distress
8. Cluster A: Odd or Eccentric
Paranoid PD – is a pattern of distrust and
suspiciousness such that others’ motives are
interpreted as malevolent
Schizoid PD – is a pattern of detachment from
social relationships and restricted range of
emotional expression
Schizotypal PD – is a pattern of acute discomfort
in close relationships, cognitive or perceptual
distortions, and eccentricities of behaviour
9. Paranoid Personality Disorder
suspicious of other’s motives
interprets actions of others as deliberately
demeaning/threatening
expectation of being exploited
see hidden messages in benign comments
easily insulted/ bears grudges
appear cold and serious
10. Schizoid Personality Disorder
indifferent to relationships
limited social range (some are hermits)
aloof, detached, called loners
no apparent need of friends, sex
solitary activities
seem to be missing the “human part”
11. Schizotypal Personality
Disorder
peculiar patterns of thinking and
behaviour
perceptual and cognitive disturbances
magical thinking
not psychotic
perhaps a distant “cousin” of schizophrenia
12. Cluster B: Dramatic, Emotional,
or Erratic
Antisocial PD – is a pattern of disregard for, and
violation of, the rights of others
Borderline PD – is a pattern of instability in
interpersonal relationships, self-image, and
affects, and marked impulsivity
Histrionic PD – is a pattern of excessive
emotionality and attention seeking
Narcissistic PD – is a pattern of grandiosity,
need for admiration, and lack of empathy
13. Antisocial Personality Disorder
pattern of irresponsibility, recklessness, impulsivity
beginning in childhood or adolescence (e.g., lying,
truancy)
adulthood:
criminal behaviour
little adherence to societal norms,
little anxiety
conflicts with others
callous/exploitive
14. Psychopathy
Egocentric, deceitful, shallow, impulsive
individuals who use and manipulate others
Callous, lack of empathy
Little remorse
Thrill-seeking
“human predators” (Hare, 1993)
No “conscience”
15. Psychopathy Checklist-Revised
(Hare, 1991) – 2 Factors
Glib and superficial
Egocentric and
grandiose
Lack of remorse or
guilt
Lack of empathy
Deceitful and
manipulative
Shallow emotions
Impulsive
Poor behavior
controls
Need for excitement
Lack of responsibility
Early behavior
problems
Adult antisocial
behavior
16. Borderline Personality Disorder
marked instability of mood,
relationships, self-image
intense, unstable relationships
uncertainty about sexuality
everything is “good” or “bad”
chronic feeling of “emptiness”
recurrent threats of self-harm/
“slashers”
17. Borderline and comorbidity
High degree of overlap with both Axis I
and Axis II disorders
24%-74% also diagnosed with major
depression; 4% to 20% bipolar
25% of bulimics also diagnosed with BPD
67% also diagnosed with substance use
disorder
19. Narcissistic Personality Disorder
grandiose, sense of self-importance
lack of empathy
hyper-sensitive to criticism
exaggerate accomplishments/ abilities
special and unique
entitlement
below surface is fragile self-esteem
20. Cluster C: Anxious or Fearful
Avoidant PD – is a pattern of social inhibition,
feelings of inadequacy, and hypersensitivity to
negative evaluation
Dependent PD – is a pattern of submissive and
clinging behaviour related to an excessive need
to be taken care of
Obsessive-Compulsive PD – is a pattern of
preoccupation with orderliness, perfectionism,
and control at the expense of flexibility
21. Avoidant Personality Disorder
over-riding sense of social discomfort
easily hurt by criticism
always need emotional support
occasionally try to socialize
so distressing they retreat into
loneliness
24. Complications
-secondary mental illnesses (depression,
medicament, drug or alcohole abuse or
addiction, eating disorders, impulse-control
disorders, anxiety disorders, short psychosis)
-suicidal behavior
-acts of self-harm
-violence and crime behaviour
-risk behaviour (sexualy transmitted infections,
drug application...)
25. Treatment
Motivation to the therapy, compliance
and efficiency is different from case to
case.
- Psychoterapy - basis
- Pharmacotherapy -in some cases,
symptomatic
- few controled studies of efficiency
- difficult but helpful
26. Psychoterapy
- the choise of the type of psychoterapy
depends
on specific type of P.D. and other factors as
motivation to therapy, intelectual state, age
and another.
- basic psychoterapeutic support
- psychoanalytic: individual or group
- cognitive-behavioral therapy
27. Pharmacotherapy
- symptomatic, follows symptoms
- target: permanent symptoms (long-
term) or actual state (acute anxiety,
disquiet, suicidal beh., agitation,
emotional crises...)
28. Pharmacotherapy for
symptoms
depression- SRI, IMAO, atyp.AP
acute anxiety and agitation- BZD, AP
anxiety- (S)SRI, buspiron, IMAO, low dose AP
em. instability- VAL, CBZ, Li, low dose AP
em. flateness- atyp.AP, SSRI, IMAO
dysforia- SSRI, low dose atyp.AP
aggression- Li, antikonv., AP
impulsivity- SSRI, anticonv., Li, low dose AP
psychotic- AP
