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Personality disorder.pptx
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- 4. According to GordonAllport (1937), “Personality is the dynamic organisation within the individual of those psycho- physical systems that determine his unique adjustment to his environment”
- 5. PERSONALITY DISORDERS Personalitydisorders are diagnosed when personality traits become Inflexible (unwilling to change) and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress – emotional sufferings like Dx or Anxiety.
- 6. Clinical features ofpersonality disorders According to general DSM-5 criteria for diagnosing a personality disorder, the person’s enduring pattern of behavior must be pervasive and inflexible, as well as stable and of long duration. It must also cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.
- 7. Contd…. Personality disorderstypically do not stem from debilitating reactions to stress in the recent past, as do posttraumatic stress disorder (PTSD) or many cases of major depression. Rather, these disorders stem largely from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world.
- 9. Cluster A: Odd& Eccentric(unconventional) Includes paranoid, schizoid, and schizotypal personality disorders. People with these disorders often seem odd or eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment
- 10. Cluster B: Dramatic,emotional & Erractic Includes histrionic, narcissistic, antisocial, and borderline personality disorders. Individuals with these disorders share a tendency to be dramatic, emotional, and erratic.
- 11. Cluster C: ANXIOUS& FEARFUL Includes avoidant, dependent, and Obsessive compulsive personality disorders. In contrast to the other two clusters, people with these disorders often show anxiety and fearfulness
- 12. Difficulties in DiagnosingPersonality Disorders
- 13. Cluster A PersonalityDisorders
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- 15. Individuals withparanoid personality disorder have a pervasive suspiciousness and distrust of others, leading to numerous interpersonal difficulties. They tend to see themselves as blameless, instead blaming others for their own mistakes and failures—even to the point of ascribing evil motives to others. They are often preoccupied with doubts about the loyalty of friends and hence are reluctant to confide in others. They commonly bear grudges, refuse to forgive perceived insults and slights, and are quick to react with anger and sometimes violent behavior.
- 16. Criteria for ParanoidPersonality Disorder A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
- 17. Contd.. 4. Reads hiddendemeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.
- 18. Contd… Note: Ifcriteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).”
- 19. Contd.. More commonin men than in women Treatments Psychotherapy – Interpersonal psychotherapy Psychoanalytical psychotherapy Group therapy Behavioral therapy Psychopharmacology • Antipsychotics for psychotic symptoms
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- 22. Individuals withschizoid personality disorder are usually unable to form social relationships and usually lack much interest in doing so. Consequently, they tend not to have good friends, with the possible exception of a close relative. Such people are unable to express their feelings and are seen by others as cold and distant. They often lack social skills and can be classified as loners or introverts, with solitary interests and occupations, although not all loners or introverts have schizoid personality disorder.
- 23. People withthis disorder tend not to take pleasure in many activities, including sexual activity, and rarely marry.
- 24. Criteria for SchizoidPersonality Disorder
- 27. A pervasivepattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following Neither desires nor enjoys close relationships, including being part of a family. Almost always chooses solitary activities. Has little, if any, interest in having sexual experiences with another person. Takes pleasure in few, if any, activities Lacks close friends or confidants other than first-degree relatives. Appears indifferent to the praise or criticism of others. Shows emotional coldness, detachment, or flattened affectivity.
- 28. Contd… B. Doesnot occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “schizoid personality disorder (premorbid).”
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- 30. Difference between schizoidand avoidant personality disorder Avoidant personality disorder shares the symptom of lack of social contact with schizoid and schizotypal disorders, but the reasons for that lack of contact are very different: The avoidant person wants social contact but is afraid of rejection, whereas the schizoid or schizotypal person is completely indifferent to such contact.
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- 32. Schizotypal Personality Disorder =Paranoid + Schizoid Personality Disorder
- 33. Individuals with schizotypalpersonality disorder are also excessively introverted and have pervasive social and interpersonal deficits (like those that occur in schizoid personality disorder), but in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior. Cognitive distortions are thoughts that cause individuals to perceive reality inaccurately.
- 34. criteria for SchizotypalPersonality Disorder . 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 and present in a variety of contexts, as indicated by five (or more) of the following: Ideas of reference* (excluding delusions of reference). Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
- 35. idea of reference An idea of reference—sometimes called a delusion of reference—is the false belief that irrelevant occurrences or details in the world relate directly to oneself. Example: • Bob believes every time a certain song plays on the radio, his long-lost lover is thinking about him. • Ken walks past a group of teens while walking through the mall food court. He hears them laugh a few seconds after he passes. He is convinced they were laughing at him. Jennifer thinks everybody is staring and judging the food choices she makes while at the grocery store. Because of this, she only shops late at night when there aren't many people out shopping.
- 36. Contd…. Unusual perceptualexperiences, including bodily illusions. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) Suspiciousness or paranoid ideation. Inappropriate or constricted affect. Behavior or appearance that is odd, eccentric, or peculiar. Lack of close friends or confidants other than first- degree relatives.
- 37. Contd… Excessive socialanxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality disorder (premorbid).”
- 38. Cluster B PersonalityDisorders
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- 41. criteria for HistrionicPersonality Disorder A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Is uncomfortable in situations in which he or she is not the center of attention. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. Displays rapidly shifting and shallow expression of emotions. Consistently uses physical appearance to draw attention to self.
- 42. Contd…. Has a styleof speech that is excessively impressionistic and lacking in detail. Shows self-dramatization, theatricality, and exaggerated expression of emotion. Is suggestible (i.e., easily influenced by others or circumstances). Considers relationships to be more intimate than they actually are
- 43.
- 46. criteria for NarcissisticPersonality DisordeR A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- 47. Delusions of Grandeur Grandiose delusions are one of the most common types of delusions in bipolar disorder. Examples of grandiosity include: • Exaggerating your own achievements • Criticizing and dismissing other's achievements or talents • Constantly boasting and talking about yourself For example, you may believe that you: • Are a multimillionaire • Found a cure for cancer • Are related to a Hollywood celebrity
- 48. Contd…. Has asense of entitlement (i.e., unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations). Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. Is often envious of others or believes that others are envious of him or her. Shows arrogant, haughty behaviors or attitudes
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- 52. Conduct disorder Conductdisorder is a type of behavior disorder. It's when a child has antisocial behaviuor. He or she may disregard basic social standards and rules. He or she may also: Be irresponsible.
- 53. Clinical Features ofConduct Disorder Four types of symptoms of conduct disorder are recognized: (1) Aggression or serious threats of harm to people or animals; (2) Deliberate property damage or destruction (e.g., fire setting, vandalism); (3) Repeated violation of household or school rules, laws, or both; and (4) Persistent lying to avoid consequences or to obtain tangible goods or privileges.
- 54. Criteria for Anti-socialbehaviour 1. A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest. 2. Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit. 3. Impulsivity or failure to plan. 4. Irritability and aggressiveness, often with physical fights or assaults. 5. Reckless disregard for the safety of self or others. 6. Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations. 7. Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.
- 55. Contd… 1. The individualis at least age 18 years. 2. Evidence of conduct disorder typically with onset before age 15 years. 3. The occurrence of antisocial behaviour is not exclusively during schizophrenia or bipolar disorder."
- 56.
- 58. criteria for BorderlinePersonality Disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.) 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self image or sense of self
- 59. Cont….. 4. Impulsivityin at least two areas that are potentially self damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self mutilating behavior covered in Criterion 5.) 5. Recurrent suicidal behavior, gestures, or threats, or self mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent
- 60.
- 61. People withCluster C personality disorders often show anxiety and fearfulness. These are characteristics that we do not see in the other two clusters. I
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- 65. criteria for AvoidantPersonality DisordeR A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
- 66. Cont….. 4. Ispreoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
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- 69. criteria for DependentPersonality Disorder A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
- 70. Contd…. 4. Hasdifficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself
- 71.
- 73. criteria for Obsessive-Compulsive PersonalityDisordeR A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
- 74. Contd….. 4. Isoverconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness
- 75. General Sociocultural CausalFactors for Personality Disorders Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of: • Your genes. Certain personality traits may be passed on to you by your parents through inherited genes. These traits are sometimes called your temperament. • Your environment. This involves the surroundings you grew up in, events that occurred, and relationships with family members and others.
- 76. Individualistic Vs collectivisticculture There is some evidence that narcissistic personality disorder is more common in Western cultures, where personal ambition and success are encouraged and reinforced (e.g., Widiger & Bornstein, 2001). There is also some evidence that histrionic personality might be expected to be (and is) less common in Asian cultures.
- 77. Treatments and Outcomes forPersonality Disorders Personality disorders are generally very difficult to treat, in part because they are, by definition, relatively enduring, pervasive, and inflexible patterns of behavior and inner experience. Goals might include reducing subjective distress, changing specific dysfunctional behaviors, and changing whole patterns of behavior or the entire structure of the personality. In many cases, people with personality disorders enter treatment only at someone else’s insistence, and they often do not believe that they need to change.
- 78. Adapting Therapeutic Techniquesto Specific Personality Disorders For people with severe personality disorders, therapy may be more effective in situations where acting-out behavior can be constrained.
- 79. Treating Borderline PersonalityDisorder
- 80. Of allpersonality disorders, most clinical and research attention has been paid to the treatment of BPD. This is due to the severity of this disorder and the high risk of suicide that is associated with it. Treatment often involves both psychological and biological treatment approaches, with medications being used as an adjunct to psychological treatment, which is considered essential
- 81. Biological Treatments Theuse of medications is controversial with this disorder because it is so frequently associated with suicidal behavior. Today, antidepressant medications (most often from the SSRI – Selective serotonin reuptake inhibitors) category) are considered most safe and useful for treating rapid mood shifts, anger, and anxiety . In addition, low doses of antipsychotic medication have modest effects that are broad based; that is, patients show some improvement in depression, anxiety, suicidality, impulsive aggression, rejection sensitivity, and especially transient psychotic symptoms and cognitive and perceptual distortions
- 82. Contd… However, theconsensus to date is that drugs are only mildly beneficial for BPD
- 83. Psychosocial Treatments Clinical trialssuggest that several types of psychotherapy may be effective for BPD. However, these treatments share two common weaknesses. These are their relative complexity and long duration, both of which makes them difficult to disseminate to the broader population
- 84.
- 85. Dialectical behavior therapy Developed by Marsha Linehan, is a unique kind of cognitive and behavioral therapy specifically adapted for BPD He believes that patients’ inability to tolerate strong states of negative affect is central to this disorder. One of the primary goals of treatment is to encourage patients to accept this negative affect without engaging in self- destructive or other maladaptive behaviors. Accordingly, Linehan has developed a problem-focused treatment based on a clear hierarchy of goals, which prioritizes decreasing suicidal and self-harming behavior and increasing coping skills.
- 86. Dialectical Behavior TherapyTechniques Settings in which DBT are often used include: • Group therapy where patients are taught behavioral skills in a group setting. • Individual therapy with a trained professional where a patient's learned behavioral skills are adapted to their personal life challenges. • Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.
- 87. Other Techniques CoreMindfulness Mindfulness helps you focus on the present or "live in the moment." This helps you pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what's happening around you (what you see, hear, smell, and touch) in nonjudgmental ways. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior.
- 88. Distress Tolerance Distresstolerance skills help you accept yourself and your current situation. DBT teaches several techniques for handling a crisis, including: • Distraction • Improving the moment • Self-soothing • Thinking of the pros and cons of not tolerating distress Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.
- 89. Interpersonal Effectiveness Interpersonaleffectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say "no") while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.
- 90. Emotion Regulation Emotionregulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions.6 When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.
- 91. Effectiveness of DialecticalBehavior Therapy For BPD: Studies have found that DBT is effective in the treatment of borderline personality disorder (BPD) and reducing suicide risk in individuals with BPD. One study found that after a year of treatment, more than 75% of people with BPD no longer met the diagnostic criteria for the condition.
- 92. Treating Other PersonalityDisorders Cluster A – psychoactive drugs likes SSRI, antipsychotic drugs, Antidepressants for schizotypal personality disorder Other than uncontrolled studies or single cases, no systematic, controlled studies of treating people with either medication or psychotherapy yet exist for paranoid, schizoid, narcissistic, or histrionic disorder . One reason for this is that these people (because of the nature of their personality pathology) rarely seek treatment Cluster C disorders using a form of short-term psychotherapy that is active and confrontational like CBT
- 93. Antisocial Personality Disorder andPsychopathy
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- 95. • Antisocial behavior •Narcissism • Superficial charm • Impulsivity • Callous, unemotional traits • Lack of guilt • Lack of empathy
- 96. Psychopathic traitsinclude antisocial behaviors, lack of empathy, disregard for others, and narcissism. While such traits might indicate that someone is high in psychopathy, this does not necessarily mean that they are a psychopath.
- 97. Is There aPsychopath Test? While there may be plenty of free "psychopath tests" floating around on the internet, two tests that are most often used are the Psychopathy Checklist-Revised (PCL-R) and the Psychopathic Personality Inventory (PPL).
- 98. Signs of aPsychopath Psychopathic traits may emerge during childhood and grow worse over time.5 The following are some of the most common signs of a psychopath.
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- 102. Grandiose Sense ofSelf-Worth
- 103. OTHERS Manipulative Lackof Remorse Shallow Affect Lack of Empathy Parasitic Lifestyle Poor Behavioural Controls Lack of Realistic, Long-Term Goals Impulsivity Irresponsibility Many Marital Relationships Criminal Versatility