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  1. 1. Personality Disorders
  2. 2. Definition <ul><li>Personality disorder is a general term for a type of mental illness in which the ways of thinking, perception of situations and relating to others are dysfunctional. (Mayo Clinic) </li></ul>
  3. 3. Definition <ul><li>Personality disorders, formerly referred to as character disorders , are a class of personality types and behaviors that the American Psychiatric Association (APA) defines as &quot;an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it&quot;. </li></ul>
  4. 4. Personality Disorders, cont. <ul><li>Typically associated with severe disturbances in the behavioral tendencies of an individual </li></ul><ul><li>Involves several areas of the personality </li></ul><ul><li>Associated with considerable personal and social disruption </li></ul><ul><li>Inflexible and pervasive across many situations </li></ul><ul><li>The patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. </li></ul>
  5. 5. Personality Disorders, cont. <ul><li>Inflexible and pervasive behavioral patterns often cause serious personal and social difficulties, as well as a general functional impairment </li></ul><ul><li>Rigid and ongoing patterns of feeling, thinking and behavior are said to be caused by underlying belief systems and these systems are referred to as fixed fantasies or &quot;dysfunctional schemata&quot; </li></ul>
  6. 6. Personality Disorders, cont. <ul><li>The onset of these patterns of behavior can typically be traced back to late adolescence and the beginning of adulthood and, in rarer instances, childhood </li></ul><ul><li>Therefore, a diagnosis of personality disorder will be inappropriate before the age of 16 years </li></ul><ul><li>Diagnosis can be very subjective </li></ul>
  7. 7. Diagnostic and Statistical Manual of Mental Disorders <ul><li>Manual that categorizes psychiatric diagnoses </li></ul><ul><li>Better known as DSM-IV </li></ul><ul><li>Published by the American Psychiatric Association </li></ul><ul><li>Covers all mental health disorders for both children and adults </li></ul><ul><li>Also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches. </li></ul>
  8. 8. Cluster A (odd or eccentric behaviors) <ul><li>Paranoid personality disorder - characterized by irrational suspicions and mistrust of others </li></ul><ul><li>Schizoid personality disorder - lack of interest in social relationships, seeing no point in sharing time with others, misanthropy, introspection </li></ul><ul><li>Schizotypal personality disorder - characterized by odd behavior or thinking </li></ul>
  9. 9. Cluster B (dramatic, emotional or erratic disorders) <ul><li>Antisocial personality disorder - a pervasive disregard for the law and the rights of others </li></ul><ul><li>Borderline personality disorder - extreme &quot;black and white&quot; thinking, instability in relationships, self-image, identity and behavior </li></ul><ul><li>Histrionic personality disorder - pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions </li></ul><ul><li>Narcissistic personality disorder - a pervasive pattern of grandiosity, need for admiration, and a lack of empathy </li></ul>
  10. 10. Cluster C (anxious or fearful disorders) <ul><li>Avoidant personality disorder - social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. </li></ul><ul><li>Dependent personality disorder - pervasive psychological dependence on other people </li></ul><ul><li>Obsessive-compulsive personality disorder - characterized by rigid conformity to rules, moral codes and excessive orderliness </li></ul>
  11. 11. Appendix B <ul><li>Still widely considered amongst psychiatrists as being valid disorders </li></ul><ul><li>Depressive personality disorder - a pervasive pattern of depressive cognitions and behaviors beginning by early adulthood </li></ul><ul><li>Passive-aggressive personality disorder - is a pattern of negative attitudes and passive resistance in interpersonal situations </li></ul>
  12. 12. Deleted from DSM IV <ul><li>Sadistic personality disorder - a pervasive pattern of cruel, demeaning and aggressive behavior </li></ul><ul><li>Self-defeating personality disorder (masochistic personality disorder) - is characterised by behaviour consequently undermining the person's pleasure and goals </li></ul>
  13. 13. Self-defeating Personality Disorder <ul><li>Aka Masochistic Personality Disorder </li></ul><ul><li>Never formally admitted into the DSM although sexual masochism is in DSM-IV </li></ul><ul><li>Historically associated with feminine submissiveness </li></ul><ul><li>Became politically awkward because of association with domestic violence </li></ul><ul><li>Enjoys widespread use among clinicians </li></ul>
  14. 14. Paranoid Personality Disorder <ul><li>A psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others </li></ul><ul><li>Those with the condition are hypersensitive, are easily slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions to validate their prejudicial ideas or biases </li></ul><ul><li>Guarded and suspicious and have quite constricted emotional lives </li></ul><ul><li>Incapacity for meaningful emotional involvement and the general pattern of isolated withdrawal </li></ul>
  15. 15. Schizoid Personality Disorder <ul><li>Characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, and emotional coldness </li></ul><ul><li>Increased prevalence of the disorder in families with schizophrenia </li></ul><ul><li>A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen or older) and present in a variety of contexts </li></ul>
  16. 16. Schizoid Personality Disorder <ul><li>Characteristically detached from social relationships </li></ul><ul><li>Show a restricted range of expressed emotions </li></ul><ul><li>Weak social skills </li></ul><ul><li>Typically do not express a need for attention or approval </li></ul><ul><li>May be perceived by others as somber and aloof and are often referred to as “loners” </li></ul><ul><li>Incidence is less than 1% - 3% of the general population </li></ul>
  17. 17. Schizotypal Personality Disorder <ul><li>Characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs </li></ul><ul><li>A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood (in persons older than aged eighteen years) and present in a variety of contexts </li></ul>
  18. 18. Antisocial Personality Disorder <ul><li>A pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood </li></ul><ul><li>The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15 </li></ul><ul><li>Sometimes referred to as &quot;sociopaths&quot; and &quot;psychopaths” </li></ul><ul><li>Deceit and manipulation are considered essential features of the disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed </li></ul>
  19. 19. Borderline Personality Disorder <ul><li>A prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods </li></ul><ul><li>Unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation </li></ul>
  20. 20. Histrionic Personality Disorder <ul><li>A personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness , usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and flirtatious </li></ul><ul><li>May be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Associated features may include egocentrism, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve their own needs. </li></ul>
  21. 21. Narcisisstic Personality Disorder <ul><li>Defined by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy </li></ul><ul><li>The narcissist is described as being excessively preoccupied with issues of personal adequacy, power, and prestige. Narcissistic personality disorder is closely linked to self-centeredness </li></ul>
  22. 22. Avoidant Personality Disorder <ul><li>A personality disorder in a person over the age of eighteen years characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction </li></ul><ul><li>People with AvPD often consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked </li></ul><ul><li>Usually first noticed in early adulthood, and is associated with perceived or actual rejection by parents or peers during childhood </li></ul>
  23. 23. Dependent Personality Disoder <ul><li>Characterized by a pervasive psychological dependence on other people </li></ul><ul><li>Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina. </li></ul><ul><li>Dependent personality disorder occurs in about 0.5% of the general population. It is more frequent in females. </li></ul>
  24. 24. Obsessive-Compulsive Disorder <ul><li>A personality disorder which involves an obsession with perfection, rules, and organization . People with OCPD may feel anxious when they perceive that things are not right </li></ul><ul><li>This can lead to routines and rules for ways of doing things, whether for themselves or their families </li></ul><ul><li>A preoccupation with details, rules, lists, order, organization, and schedules; being very rigid and inflexible in their beliefs; showing perfectionism that interferes with completing a task </li></ul><ul><li>Obsessive need for cleanliness </li></ul>
  25. 25. Depressive Personality Disorder <ul><li>A controversial psychiatric diagnosis that denotes a personality disorder with depressive features </li></ul><ul><li>Usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness </li></ul><ul><li>Brooding and given to worry </li></ul><ul><li>Pessimistic </li></ul>
  26. 26. Passive-Aggressive Personality Disorder <ul><li>Is passive, sometimes obstructionist resistance to following through with expectations in interpersonal or occupational situations </li></ul><ul><li>Marked by a pervasive pattern of negative attitudes and passive, usually disavowed resistance in interpersonal or occupational situations </li></ul><ul><li>Can manifest itself as learned helplessness, procrastination, stubbornness, resentment, sullenness, or deliberate/repeated failure to accomplish requested tasks for which one is responsible </li></ul>
  27. 27. Sadistic Personality Disorder <ul><li>A pervasive pattern of cruel, demeaning, and aggressive behavior , beginning by early adulthood </li></ul><ul><li>This disorder was dropped from DSM-IV for 2 reasons: </li></ul><ul><li>1. Relatively low prevalence rate of the disorder in many settings </li></ul><ul><li>2. Sadistic personalities are most often male and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behaviour </li></ul>
  28. 28. Treatment of Personality Disorders <ul><li>Depends on the particular personality disorder, its severity and the patient’s life situation </li></ul><ul><li>Often, a team approach is appropriate to make sure all of your psychiatric, medical and social needs are met </li></ul><ul><li>Because personality disorders tend to be chronic and can sometimes last much of your adult life, you may need long-term treatment </li></ul>
  29. 29. Treatment Teams <ul><li>Family or primary care doctor </li></ul><ul><li>Psychiatrist </li></ul><ul><li>Psychotherapist </li></ul><ul><li>Pharmacist </li></ul><ul><li>Family members </li></ul><ul><li>Social workers </li></ul>
  30. 30. Treatment Options <ul><li>Psychotherapy – main way to treat personality disorders </li></ul><ul><li>Medications - There are no medications specifically approved by the FDA to treat personality disorders </li></ul><ul><li>Hospitalization - when the client cannot practice proper self-care or when in immediate danger of harming self or someone else. </li></ul>
  31. 31. Psychotherapy <ul><li>Cognitive behavioral therapy </li></ul><ul><li>Dialectical behavior therapy </li></ul><ul><li>Psychodynamic psychotherapy </li></ul><ul><li>Psychoeducation </li></ul>
  32. 32. Medications <ul><li>Antidepressant medications </li></ul><ul><li>Mood-stabilizing medications. </li></ul><ul><li>Anti-anxiety medications. </li></ul><ul><li>Antipsychotic medications </li></ul>
  33. 33. Hospitalization <ul><li>24-hour inpatient care </li></ul><ul><li>Partial or day hospitalization </li></ul><ul><li>Residential treatment, which offers a supportive place to live </li></ul>
  34. 34. Self-participation in Treatment <ul><li>Stick to your treatment plan </li></ul><ul><li>Take your medications as directed </li></ul><ul><li>Learn about your condition </li></ul><ul><li>Pay attention to warning signs </li></ul><ul><li>Get active </li></ul><ul><li>Avoid drugs and alcohol </li></ul><ul><li>Get routine medical care </li></ul>
  35. 35. Prevention <ul><li>For the health professional: Identify those most at risk such as neglected or abused children </li></ul><ul><li>Taking steps to control stress, increase resilience and boost low self-esteem may also help </li></ul><ul><li>Getting appropriate treatment early, and sticking with it for the long term </li></ul>
  36. 36. Coping and Support <ul><li>Simplify your life </li></ul><ul><li>Write in a journal </li></ul><ul><li>Read reputable self-help books </li></ul><ul><li>Don't become isolated </li></ul><ul><li>Take care of yourself by eating a healthy diet and getting sufficient sleep </li></ul><ul><li>Join a support group </li></ul><ul><li>Stay focused on your goals </li></ul><ul><li>Learn relaxation and stress management </li></ul><ul><li>Structure your time </li></ul><ul><li>Time your big decisions </li></ul>
  37. 37. Risk Factors <ul><li>A family history of personality disorders or other mental illness </li></ul><ul><li>Verbal, physical or sexual abuse during childhood </li></ul><ul><li>An unstable or chaotic family life during childhood </li></ul><ul><li>Being diagnosed with childhood conduct disorder </li></ul><ul><li>Loss of parents through death or divorce during childhood </li></ul>
  38. 38. Complications <ul><li>Depression </li></ul><ul><li>Anxiety </li></ul><ul><li>Eating disorders </li></ul><ul><li>Suicidal behavior </li></ul><ul><li>Self-injury </li></ul><ul><li>Reckless behavior </li></ul><ul><li>Risky sexual behavior </li></ul><ul><li>Child abuse </li></ul><ul><li>Alcohol or substance abuse </li></ul><ul><li>Aggression or violence </li></ul><ul><li>Incarceration </li></ul><ul><li>Relationship difficulties </li></ul><ul><li>Social isolation </li></ul><ul><li>School and work problems </li></ul><ul><li>Strained relationships with health care providers </li></ul>