Personality disorders


Published on

1 Comment
  • Hey article . I learned a lot from the points ! Does someone know if my company might be able to acquire a blank CMS-40B example to fill in ?
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Personality disorders

  2. 2. • The DSM – IV – TR (American PsychiatricAssociation, 2000) defines personality traits as“Enduring patterns of perceiving, relatingto, & thinking about the environment & oneselfthat are exhibited in a wide range of social &personal contexts.”
  3. 3. 1. Paranoid Personality Disorder2. Schizoid Personality Disorder3. Schizotypal Personality Disorder4. Antisocial Personality Disorder5. Borderline Personality Disorder6. Histrionic Personality Disorder7. Narcissistic Personality Disorder8. Avoidance Personality Disorder9. Dependent Personality Disorder10. Obsessive-compulsive PersonalityDisorder11. Passive-aggressive
  4. 4.
  5. 5. The DSM-IV-TR defines paranoidpersonality disorder as “a pervasive distrust &suspiciousness of others such that theirmotives are interpreted asmalevolent, beginning by early adulthood &present in a variety of contexts” (APA, 2000)
  6. 6. The prevalence of paranoidpersonality disorders is estimated at 0.5%to2.5% of the general population, it’s morecommon in
  7. 7. The hallmarks of paranoid personality disorder aresuspicion & distrust of others’ motives. Other featuresinclude:Refusal to confide in othersInability to collaborate with othersHypersensitivityInability to relax (hypervigilance)Self-righteousnessDetachment & social isolationPoor self – imageSullenness, hostility, coldness & detachmentHumorlessnessAnger, jealousy & envyBad temper, hyperactivity & irritabilityLack of social support
  8. 8. • The specific cause of paranoid personalitydisorder is unknown. Its higher incidence infamilies with a schizophrenic member suggests apossible genetic influence.• Some expert believe that the disorder result(at least partly) from negative childhoodexperiences & a threatening domestic atmosphere– for example, extreme unfounded rage orcondescension by the parents, which can produceprofound insecurity in the
  9. 9.
  10. 10. Schizoid personality disorder ischaracterized primarily by a profound defectin the ability to form personal relationships orto respond to others in any meaningful,emotional way (Phillips, Yen, & Gunderson,2003). These individual displays a lifelongpattern of social withdrawal & theirdiscomfort with human interaction is
  11. 11. Epidemiological Statistics:-The prevalence of schizoidpersonality disorder within general populationhas been estimated at between 3 & 7.5%. it isdiagnosed more frequently in
  12. 12. Clinical Features• Emotional detachment• Inability to experience pleasure• Lack of strong emotions & little observable change in mood• Avoidance of activities that involve significant interpersonalcontact• Little desire for or enjoyment of close relationships• No desire to be part of a family• Strong preference for solitary activities• Little or no interest in sexual experiences with another person• Lack of close friends or confidants other than immediatefamily members• Shyness, distrust & discomfort with intimacy• feeling of superiority• loneliness• self-consciousness• Oversensitivity to
  13. 13. Predisposing FactorsAs with the other personality disorders,the exact cause of schizoid personality disorderisn’t known. Some researchers think it may beinherited. Other possible causes may include:A sustained history of isolation duringinfancy & childhoodCold or grossly deficient early parentingParental modeling of interpersonalwithdrawal, indifference, &
  15. 15. EPIDEMIOLOGICAL STATISTICS:-SCHIZOTYPAL PERSONALITYDISORDER IS FOUND IN ABOUT 3% OF THEGENERAL POPULATION. IT’S SLIGHTLY MORECOMMON IN MEN THAN IN WOMEN.Definition:-Schizotypal personality disorder is markedby a pervasive pattern of social & interpersonaldeficits, along with acute discomfort with others.People with this disorder have odd thought &behavioural
  16. 16. • Odd or eccentric behaviour or appearance• Inaccurate beliefs that other’s behaviour or environmentalphenomena are meant to have an effect on the patient• Odd beliefs or magical thinking (such as thinking that one’sthought or desires can influence the environment or causeevents to occur)• Unusual perceptual experiences, including bodily illusions• Vague, circumstantiallty, or stereotypical speech or thinking• Unfounded suspicious of being followed, talked about,persecuted, or under surveillance• Inappropriate or constricted affect• Lack of close relationships other than immediate familymembers• Social isolation• Excessive social anxiety• A sense of feeling different & not fitting in with others
  17. 17. Predisposing Factors:-Schizotypal personality disorder may have a genetic basis. Family,twin & adoption studies show an increased risk of the condition inpeople with a family history of schizophrenia. Environmental factors(such as severe stress) may determine whether schizotypalpersonality disorder or schizophrenia manifests.Dopamine Deviance: Some evidence suggests that patients withschizotypal personality disorder have poor regulation of dopaminepathways in the brain.Psychological & Cognitive theories: psychological & cognitiveexplanations for schizotypal personality disorder focus on deficits inattention & information processing. These patients perform poorly ontests that assess continuous performance tasks, which require theability to maintain attention on one object & to look at new stimuliselectively.Psychoanalytic theories: One proposes that patients with thisdisorder have ego boundary problems; the other, that these patientswere raised by patients with inadequate parenting skills, poorcommunication skills & loose association of
  19. 19. Definition:-The highlight of antisocial personality disorderis chronic antisocial behaviour that violates other’srights or generally accepted social norms. Thisdisorder predisposes a person toward criminalbehaviour.Epidemiological Statistics:-In the general population, the prevalence ofantisocial personality disorder is about 2% to 3%.Roughly one-half of people with this disorder have ahistory of arrest. It affects three to four times asmany males than
  20. 20. Clinical Features:-A patient with antisocial personality disorder has a long-standing patternof disregarding other’s right & society’s values. Other assessmentfinding may include:• Repeatedly performing unlawful acts• Reckless disregard for his own or others’ safety• Deceitfulness• Lack of remorse• Consistent irresponsibility• Power-seeking behaviour• Destructive tendencies• Impulsivity & failure to plan ahead• Superficial charm• Manipulative nature• Inflated, arrogant self-appraisal• Irritability & aggressiveness• Inability to maintain close personal or sexual relationships• Disconnection between feelings & behaviours• Substance
  21. 21. Predisposing Factors:-Genetic & biological factors may influence the development of antisocialpersonality disorder. Biological factors include: Poor serotonin regulation in certain brain regions, which may decreasebehavioural inhibition. Reduce autonomic activity & developmental or acquired abnormalities in theprefronatal brain systems.• Such biological factors may underlie the low arousal, poor fearconditioning & decision-making deficits seen in patients withantisocial personality disorder.Children at risk• Other possible causes or risk factors include attention deficithyperactivity disorder, large families & childhood exposure to theseconditions: Substance abuse Criminal behaviour Physical or sexual abuse Neglectful or unstable parenting Social isolation Transient friendships Low socioeconomic
  22. 22.
  23. 23. A disorder of poor regulation of emotions,borderline personality disorder is marked by apattern of instability in interpersonalrelationships, mood, behaviour & self image.Although people with this disorder mayexperience it in various ways, most find it hard todistinguish reality from their own misperceptionsof the world. Their emotions overwhelm theircognitive functioning, creating many conflictswith
  24. 24. Epidemiological Statistics:-The prevalence of borderline personality disorder affects 2% to3% of the general population, about 11% of psychiatric outpatients, &nearly 20% of psychiatric inpatients. It’s three times more common infemales than in males.Clinical Features:-Major signs & symptoms of borderline personality disorder fallinto four main categories – unstable relationships, unstable self-image, unstable emotions, & impulsivity. Symptoms are more acutewhen the patient feels isolated & without social support.Assessment findings may include:• A pattern of unstable & intense interpersonal relationships• Splitting (viewing others as either extremely good or extremely bad)• Intense fear of abandonment, as displayed in clinging & distancingmaneuvers• Rapidly shifting attitudes about friends & loved ones• Desperate attempts to maintain
  25. 25. Unstable perceptions of relationshipsManipulation, as in pitting people against one anotherLimited coping skillsDissociation (separating objects from their emotional significance)Transient, stress-related paranoid ideation or severe dissociative symptomsInability to develop a healthy sense of oneselfUncertainty about major issues, such as self-image, identity, life goals, sexualorientation, values, career choices or types of friendsImitative behaviourRapid, dramatic mood swings, from euphoria to intense anxiety to rage,within hours or daysActing out of feelings instead of expressing them appropriately or verballyInappropriate, intense anger or difficulty controlling angerChronic feelings of emptinessUnpredictable self-damaging behaviour, such as driving dangerously,gambling, sexual promiscuity, overeating, spending & abusing substancesSelf-destructive behaviour, such as physical fights, recurrent accidents, self-mutilation & suicidal
  26. 26. The precise causes of borderline personalitydisorder are unknown, but several theories are beinginvestigated. Because it’s five time more common infirst-degree relatives of people who have it,researchers suspect genetic may play a role.Biological factors may involve:• Dysfunction in the brain’s limbic system or frontal lobe• Decreased serotonin activity• Increased activity in alpha-2-noradrenergic receptors.• Early losses & abuse:-Prolonged separation from their parents, othermajor losses early in life, & physical, sexual, oremotional abuse or neglect seem to be more commonin patients with this disorder than in the
  27. 27.
  28. 28. Definition:-This disorder is characterized bycolorful, dramatic, & extroverted behaviour inexcitable, emotional people. They have difficultymaintaining long-lasting relationships, althoughthey require constant affirmation of approval &acceptance from others.Epidemiological Statistics:-The prevalence of the disorder is thought to beabout 2 to 3%, & it is more common in womenthan in
  29. 29. Assessment of a patient with histrionic personalitydisorder may reveal:• Constant craving for attention, stimulation, & excitement• Intense affect• Shallow, rapidly shifting expression of emotions• Flirting & seductive behaviour• Overinvestment in appearance• Exaggerated, vague speech• Self-dramatization• Impulsivity• Exhibitionism• Suggestibility & impressionability• Egocentricity, self-indulgence, & lack of consideration for others• Intolerance of frustration, disappointment, &
  30. 30. Somatic (physical) preoccupations & symptomsAngry outbursts & tantrumsSudden enraged, despairing, or fearful statesIntense anger toward people viewed as withholdingDivisive, manipulative behaviourIntolerance of being aloneSuppression or denial of internal distress, weakness,depression or hostilityDread of growing oldDemanding & manipulative natureUse of alcohol or drugs to quickly alter negative feelingsDepressionSuicidal gestures &
  31. 31. • The cause of histrionic personality disorderisn’t known. A genetic component may beinvolved, as hysterical traits are more commonin relatives of those with this disorder.However, little research has been done on thebiological origins of this disorder.• Childhood events may come into play aswell. Psychoanalytic theories focus onseductive & authoritarian attitudes by fathersof these
  32. 32.
  33. 33. Definition:-Persons with narcissistic personality disorderhave an exaggerated sense of self-worth. They lackempathy, & are hypersensitive to the evaluation ofothers. They believe that they have the inalienableright to receive special consideration & that theirdesire is justification for possessing whatever theyseek.Epidemiological Statistics:-Narcissistic personality disorder is found in lessthan 1% of the general population. It affects aboutthree times as many males as
  34. 34. In a patient with narcissistic personalitydisorder, assessment finding may include:• Arrogance or naughtiness• Self-centeredness• Unreasonable expectations of favorable treatment• Grandiose sense of self-importance• Exaggeration of achievements & talents• Preoccupation with fantasies ofsuccess, power, beauty, brilliance or ideal love• Manipulative behaviour• Constant desire for attention & admiration• Lack of empathy• Lack of concern over whom he offends• Taking advantage of others to achieve his own goals• Rage, shame or humiliation in response to
  35. 35.  The exact cause of narcissistic personality disorder isunknown. A psychodynamic theory purposes that itarises when a child’s basic needs go unmet. Love thyself, hate thyself:• Another theory holds that patients with thisdisorder have an ambivalent self-perception: anidealized (or overidealized) view of the self coexistswith deep feelings of inferiority & low self-esteem.Thus, the grandiose image is an effort to coverfeelings of inferiority.• According to this theory, the patient receivedlittle encouragement & support from his parentsduring childhood & tends to internalize the processby looking for these feelings within
  36. 36.
  37. 37. Definition:-Avoidant personality disorder is marked byfeelings of inadequacy, extreme socialanxiety, social withdrawal, & hypersensitivity toother’s opinions. People with this disorder have lowself-esteem & poor self-confidence. They dwell onthe negative & have difficulty viewing situations &interactions objectively.Epidemiological Statistics:-The prevalence of the disorder in thegeneral population is between 0.5 & 1%, & itappears to be equally common in men &
  38. 38. A patient with avoidant personality disorder may exhibit or report:Shyness, timidity, & social withdrawalBehaviour or appearance that’s meant to drive others away (which gives hima sense of control)overtalkativenessConstant mistrust or wariness of othersTesting of others’ sincerityDifficulty starting & maintaining relationshipsPerfectionismRejection of people who don’t live up his impossibly high standardsLimited emotional expressionTenseness & anxietyLow self-esteemFeelings of being unworthy of successful relationshipsSelf-consciousnessLonelinessReluctance to take personal risks or engage in new activitiesFrequent escapes into fantasy, such as by excessive reading, watching TV,
  39. 39. Avoidant personality disorder most likely results from acombination of genetic, biological, environmental, & otherfactors – although the evidence for genetic & biological causesis weak. From a psychodynamic view, the disorder has beenattributed to an overly critical parental style• Avoidant personality disorder is closely linked totemperament. Studies of children under age 2 found thatsome have an apparently inborn tendency to withdrawfrom new situation or people. In fact, roughly 10% oftoddlers are habitually fearful & withdrawn when exposedto new people & situation. Some evidence suggests that atimid temperament in infancy may predispose a person todeveloping avoidant personality disorder later in
  40. 40. - Information overload: The inherited tendency to be shymay result from overstimulation or an excess ofincoming information. The patient cant’s cope with theexcess information & withdraws in defense. Inability tocope with the information overload may stem from alow autonomic arousal threshold.- Low threshold, grater response: Research suggests thatin people with this disorder, certain structures in thebrain’s limbic system may have a lower threshold ofarousal & a more pronounced response when activated.• Some expert believe that significant environmentalinfluences during childhood, such as rejections orpeers, leads to the full development of avoidantpersonality
  41. 41.
  42. 42. Dependent personality disorder ischaracterized by “a pervasive & excessive needto be taken care of that leads to submissive &clinging behaviour & fear of separation”.Epidemiological Statistics:-In the general population, its prevalence isabout 1.5%. it affects slightly more femalesthan
  43. 43. Assessment findings in a patient with dependent personalitydisorder may include:SubmissivenessSelf-effacing, apologetic mannerLow self-esteemLack of self-confidenceLack of initiativeIncompetence & a need for constant assistanceIntense, unremitting need to be loved in a stable longtermrelationship that goes through minimal changeAnxiety & insecurity, especially when deprived of asignificant relationshipFeelings of inferiority, & unworthinessHypersensitivity to
  44. 44. • In females, little need to overtly control orcomplete with others• Demanding behaviour• Use of cajolery, bribery, promises to change, &even threats to maintain key relationships• Fear & anxiety over losing a relationship or beingalone• Dependence on a number of people, any one ofwhom could substitute for the other• Difficulty making everyday decisions withoutadvice & reassurance• Avoidance of change & new situations• Exaggerated fear of losing support &
  45. 45.  The exact cause of dependent personality disorder isn’tknown. Because it tends to run in families, it may involve agenetic component. According to some expert, authoritarian or overprotectiveparenting may lead to high levels of dependency. Theseparenting styles may cause the child to believe that shecan’t function without other’s guidance & protection & thatthe way to maintain relationships is to give in to others’demand Possible contributing factors may include:- Childhood trauma- Closed family system that discourages outside relationships- Childhood physical or sexual abuse- Social
  47. 47. Individual with obsessive –compulsivepersonality disorder are very serious & formal &have difficulty expressing emotions. They are overlydisciplined, perfectionistic, & preoccupied withrules. They are inflexible about the way in whichthings must be done & have a devotion toproductivity to the exclusion of personal pleasure.The prevalence of the disorder in the generalpopulation is 1.5%, - about twice as many males asfemales.
  48. 48. A patient with obsessive-compulsive personality disorder may describehis symptoms in a logical way, attaching little emotion to any physicaldiscomfort. Assessment findings commonly include:• Behavioural, emotional, & cognitive rigidity• Perfectionism• Severe self-criticism• Indecisiveness• Controlling manner• Difficulty expressing tender feelings• Poor sense of humor• Cool, distant, formal manner• Emotional constriction• Excessive discipline• Aggression, competitiveness, & impatience• Bouts of intense anger when things stray from the patient’s idea ofhow things “should be”
  49. 49. • Difficulty incorporating new information into his life• Psychosomatic complaints• Hypochondriasis• Sexual dysfunction• Chronic sense of time pressure & inability to relax• Indirect expression of anger despite an apparentundercurrent of hostility• hoarding of memory & other possessions• Preoccupation with orderliness, neatness &cleanliness• Discuss about morality, ethics or values• Signs & symptoms of depression• Physical complaints (commonly stemming fromoverwork)
  50. 50. • Genetic & developmental factors mayplay a role in the development of thisdisorder. A twin & adoption study suggeststhat it runs in families.• Psychodynamic theories view the patientas needing control as a defense againstfeelings of powerlessness or
  51. 51.
  52. 52. Definition:-The DSM-IV-TR defines this disorderas a pervasive pattern of negativistic attitudes& passive resistance to demands for adequateperformance in social & occupationalsituations that begins by early adulthood &occurs in a variety of
  53. 53. Features:-• Feels cheated & unappreciated• Passively resists fulfilling routine social & occupational tasks• Complains of being misunderstood & unappreciated byothers• Argumentative• Unreasonably criticizes & scorns authority• Expresses envy & resentment toward those apparentlymore fortunate• Voices exaggerated & persistent complaints of personalmisfortune.• Alternates between hostile defiance &
  54. 54. Contradictory parental attitude &behaviour are implicated in the predisposingto passive-aggressive personality disorder.Through this type ofenvironment, children learn to control theiranger for fear of provoking parentalwithdrawal & not receiving love & support –even on an inconsistent basis. Overtly thechild appears polite & undemanding; hostility& inefficiency are manifested only covertly &indirectly.
  55. 55. Most cliniciansbelieve it best to strive forlessening the inflexibility ofthe maladaptive traits &reducing their interferencewith everyday functioning& meaningful relationship.Selection of intervention isgenerally based on thearea of greatestdysfunction, such ascognitive, affect, behaviouror interpersonal
  56. 56.  Interpersonal psychotherapy may be particularlyappropriate because personality disorders largely reflectproblems in interpersonal style. Long-term psychotherapyattempts to understand & modify the maladjustedbehaviours, cognition, & affects of clients with personalitydisorders that dominate their personal lives &relationships. The core element of treatment is the establishmentof an empathic therapist-client relationship, based oncollaboration & guided discovery in which the therapistfunctions as a role model for the client. Interpersonal psychotherapy is suggested for clientswithparanoid, schizoid, schizotypal, borderline, dependent, narcissistic, & obsessive-compulsive personality
  57. 57. The treatment of choice forindividuals with histrionic personality disorderhas been psychoanalytical psychotherapy.Treatment focuses on the unconsciousmotivation for seeking total satisfaction fromothers & for being unable to commit oneselfto a stable, meaningful
  58. 58.  This treatment is especially appropriate forindividuals with antisocial personality disorder,who respond more adaptively to support &feedback from peers. In milieu or group therapy,feedback from peers is more effective than inone-to-one interaction with a therapist. Group therapy – particularly homogeneoussupportive groups that emphasize thedevelopment of social skills – may be helpful inovercoming social anxiety & developinginterpersonal trust & rapport in clients withavoidant personality
  59. 59.  Behavioural strategies offer reinforcementfor positive change. Social skills training &assertiveness training teach alternative waysto deal with frustration. Cognitive strategies help the clientrecognize & correct inaccurate internal mentalschemata. This type of therapy may be useful forclients with obsessive-compulsive, passive-aggressive, antisocial, & avoidant
  60. 60. Drugs have no effect in the treatment of the disorderitself, some symptomatic relief can be achieved• Antipsychotic medications are helpful in the treatment ofpsychotic decompensation experienced by clients withparanoid, schizotypal, & borderline personality disorder.Antipsychotic have resulted in improvement in illusions,ideas of reference, paranoid thinking, anxiety & hostility insome clients.• The selective serotonin reuptake inhibitors (SSRIs) &monoamine oxidase inhibitors (MAOIs) have beensuccessful in decreasing impulsivity & self-destructive actsin the clients with borderline personality disorder.• Lithium carbonate & propranolol (Inderal) may be useful forthe violent episodes observed in the clients with antisocialpersonality disorder.• Anxiolytics are useful for clients with avoidant
  61. 61.
  62. 62. 1. R/t rage reactions, negativerole-modeling, and inability to tolerate frustration.• Convey an accepting attitude towards this client. Work ondevelopment of trust, keep all promises & convey themessage that it is not him or her but the behaviour that isunacceptable.• Maintain low level of stimuli in client’s environment (lowlighting, few people, simple décor, low noise level).• Observe client’s behaviour frequently during routineactivities & interactions, avoid appearing watchful &suspicious.• Remove all dangerous objects from client’s
  63. 63. Help client identify the true object of his or herhostility.Encourage client to verbalize hostile feelingsgradually.Explore with client alternative ways of handlingfrustration.Staff should maintain & convey a calm attitude.Administer tranquilizing medications as ordered byphysician or obtain an order if necessary. Monitorfor effectiveness & for adverse side effects.If client is not calmed by “talking down” or bymedication, use of mechanical restraints may
  64. 64. R/t dysfunctional familysystem, evidenced by disregards for societal norms& laws, absence of guilty feelings, or inability todelay gratification.• From the onset, client should be made aware ofwhich behaviour are acceptable & which are not.Explain consequences of violation of the limits.• Do not attempt to coax or convince client to do the“right thing.” Do not use the words “you should (orshouldn’t)….”,• Provide positive feedback or reward for
  65. 65. • Being to increase the length of time requirementfor acceptable behaviour in order to achieve thereward.• A milieu unit provides the appropriateenvironment for the client with antisocialpersonality.• Help client to gain insight into his or her ownbehaviours.• Talk about past behaviours with client. Discussbehaviours that are acceptable by society & thosewhich are not.• Throughout relationship with client, maintainattitude of “It is not you, but your behaviour, thatis unacceptable.”
  66. 66. 3. Chronic low self-esteem R/t repeated negativefeedback resulting in diminished self-worth, evidenced by manipulation of others tofulfill own desires or inability to formclose, personal relationships.4. Impaired social interaction R/t to negative rolemodeling & low self-esteem, evidenced by inabilityto develop a satisfactory, enduring, intimaterelationship with another.5. Deficient knowledge (self-care activities to achieve& maintain optimal wellness) R/t lack of interest inlearning & denial of need forinformation, evidenced by demonstration ofinability to take responsibility for meeting basichealth practices.
  67. 67. THANK