Personality Disorders and personality.pptx

Understanding variations in human personality traits is equally important in both clinical and research psychology as well as clinical psychiatry where patient management in psychotic conditions may affect by.This smart presentation consists of a wide and deep look into personality disorders.This contain introduction to normal personality,personality traits,personality changes,personality disorders,aetiology,classifications,differences in ICD-10 and DSM-5, types of personality disorders,assessment,management and relevant complications.This is useful for medical students,psychology students and all who are interested.

1. Personality Disorders Sankalpa Gunathilaka MBBS(Sri Lanka) Dip.in Psychology and Counselling

2. Content What is ‘Personality’ an introduction Personality changes Personality disorders Aetiology Classification Cluster A –B- C Assessment Management Complication References

3. What is ‘Personality’ ? Enduring patterns of thoughts, attitudes, mood and behaviors which help to define us as individuals. Every personality is unique. But every personality has common features. Upon these common features; different aspects of personality can be identified = Personality Traits

4. Personality changes Personality is enduring and stable But small changes often may take place gradually over a period of many years. These gradual changes are not termed as ‘personality changes’ Rather Personality changes can be termed as modifications in one’s personality that occurs more abruptly or in a step-wise manner. Personality changes may occur due to : Injury to or organic disease of the brain. Residual effect of severe mental disorder ( eg –Schizophrenia ) Exceptionally severe stressful experiences . The curious case of Phineas Gage

5. Personality disorder What is personality disorder ? Deeply ingrained, enduring and inflexible patterns of behavior to broad range of personal and social situations. They show either extreme or significant deviation from the way of an average individual in a given culture. Deviations in: Cognition(perceive, feel, think) Affectivity Control over impulses and gratification of needs Manner of relating to others Manner of handling stress Handling interpersonal situations These behavior patterns are stable and can be seen in multiple domains of behavior and psychological functioning And frequently associated with subjective distress and problems in social functioning

6. Cause harm to person and to others. Development conditions Onset: Childhood or Adolescent – continue into adult life But no clear point of onset (differ from mental illness). Making a diagnosis is unusual before adulthood Prevalence : 5% of adult population & 40% of psychiatry inpatients Personality disorders differ from personality changes in timing and mode of emergence Personality disorder Personality changes Development condition Acquired condition Onset : Childhood/ Adolescent Onset: usually in Adult life Not secondary to brain damage/disorder (But can coexist) Following a brain damage/ disorder / exceptionally stressful conditions

7. Aetiology Causes for personality disorders are uncertain. Linked with Genetic factors and Various kind of early life experiences Only minority of those who experience adverse life events develop personality disorders Some personality disorders are linked with the etiology of psychiatric illness .

8. Classification of personality disorders in ICD-10 is compared with that in DMS-5

9. Classification of Personality disorders Personality disorders are classified into three ‘clusters’ Cluster A (odd/eccentric) Cluster B (dramatic/emotional) Cluster C (fearful/anxious) Paranoid Schizoid Schizotypal* * (in DSM-5.Not in ICD-10) Avoidant Dependent Anankastic (Obsessive-compulsion in DSM-5) Histrionic Dissocial (Antisocial in DSM-5) Borderline Narcissistic

10. Suspicious Look upon others as they are about to deceive or exploit the person So difficult to make friends Avoid involvement in group activities Resentful Mistrustful and Jealous. Sensitive Marked sense of self importance – but easily feel shame and humiliation Take offense easily – see criticism where non was intended First degree relatives of Schizophrenic patients > normal populations. Paranoid Personality Disorder Suspicious ideas can be more intense mistaken as Persecutory delusions .

11. Schizoid Personality disorder Emotionally cold Detached and aloof Introspective. Lack of enjoyment in activities most people enjoy Leads to the separation from others Show little interest in sexual activities Do not form intimate relationships Show little family feeling – remain unmarried Follow a solitary course through life(seclusive) Interested in intellectual matters Have a complex inner world of excessive fantasy

12. Socially anxious Lack of friends They feel different from others and do not fit in (differ from Schizoid individuals) Behave eccentrically Unusual choices of clothes Odd mannerisms Experience cognitive and perceptual distortions (NOT delusions) Ideas of reference Magical thinking Suspicious beliefs Schizotypal Personality disorder This appears to be related to Schizophrenia. So not classified as a personality disorder in ICD-10

13. CLUSTER B

14. Histrionic Personality Disorder • warm and nice dressing • Shallow and labile affect ( rapid changing of mood) • outwardly confident • Self dramatisation ( blackmail) and acting • Suggestibility • seeks excitement and wants to be centre of attention • inappropriate seductiveness • very concerned with physical attractiveness • Self centred and vain •marked capacity for self deception

15. Borderline personality disorder • act impulsiveness without thinking the consequences • inability to control anger • conflict with others • labile mood • feelings of emptiness • efforts to avoid abundance • intense and unstable relationships • uncertainty about self image • Self harm – common • Alcohol /substance abuse Also common • Confused by strength and unpredictability of their needs • Strong and fluctuating emotions • Transient stress reaction /paranoid /dissociative symptoms

16. Narcissistic personality disorder Grandiose Sense of self importance Fantasies of success , power , Beauty and ideal love Need for excessive admiration Lacks empathy Arrogant Envious

17. Dissocial Personality Disorder ( Antisocial) • Blames others Unconcern for others Gross and persistent irresponsibility Failure to have sustained relationships Incapacity to experience guilt and remorse Low threshold for violence Low tolerance for frustration Impulsive and irritable Fail to learn from adverse experiences Recklessness Risk of alcohol/ substance use

18. CLUSTER C

19. Anankastic personality Disorder Preoccupation with detail and rules Perfectionism interferes with completing the tasks Feeling of excessive doubts Rigid and stubborn Overemphasis on the work And productivity in the expense of leisure Common among professionals

20. Dependent personality disorder Allows others to make important decisions Unwillingness to make reasonable demands on others Feels helpless when alone Fear of being abandoned Shifts quickly to a new relationship when the older one ends Lacks initiative

21. Avoidant personality disorder Feeling of tension and apprehension Preoccupation with being criticised Believe that they are socially inept and inferior to others Restrictions in Lifestyle because of the need for security Avoid risk and social involvement Feeling of inadequacy in New interpersonal situations

22. Assessment History MSE MRI if organic causes suspected ( frontal lobe tumors ) Collateral history Psychometric assessments Comorbidities – depression; Anxiety disorder ; substance abuse ; somatisation; Eating disorders

23. Mx Treatment of comorbid Disorders ( Anxiety; depression) Psychotherapy ( individual or group or Therapeutic community) Supportive – help to develop insight Analytical- Analyse and enlighten them Behavioural- Low dose antipsychotics If needed Antidepressants – may used in BPD ( SSRI) Lithium / antiepileptics – may used in episodic behavioural issues and aggression Dialectical behavioural therapy for BPD

24. Complications Adverse effects On relationships/ Society Depressive illnesses Alcohol and substance abuse Deliberate self harm and suicide Violence towards others and other criminal activities Subjective distress Poor response to treatment of Psychiatric disorders

25. Paranoid: Continue to have marital, Social and occupational difficulties Schizoid : Relationship problems Dissocial : abuse of alcohol/ drugs , forensic hx Histrionic : improve with age,abuse of alcohol/drugs results in bad outcome BPD : may improve with age, abuse of substance may result in poor outcome , increased risk of Depression and suicide Anankastic : may develop OCD Dependant : If they lose dependant person ,can go into poor prognosis

26. References Shorter oxford text book of psychiatry 7 th edition The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines (www.who.int/docs/default-source/classification/other-classifications/bluebook.pdf?sfvrsn=374758f7_2)

27. Thank you !