Personality disorders.pptx Personality disorders.pptx

Personality disorders.pptx Personality disorders.pptx

1. Personality Disorders Dr Bile

2. Introduction Personality is defined as a deeply ingrained(fixed) pattern of behavior that is difficult to change and includes modes of perception, Relating to and thinking about oneself and the surrounding environment .

3. Cont … Personality traits are normal, prominent aspects of personality. Personality disorders result when these personality traits become abnormal, i.e. become inflexible and maladaptive, and cause significant social or occupational impairment, or Significant subjective distress

4. Unlike the patients with neurotic disorders, several personality disorder patients do not usually seek psychiatric help unless other psychiatric symptoms co-exist

5. Although personality disorders are usually recognisable by early adolescence, they are not typically diagnosed before early adult life. The symptoms continue unchanged through the adult life and usually become less obvious in the later years of life (after 40 years of age).

6. The life-time prevalence of personality disorders in the general population is about 5-10%. Often symptoms of more than one personality disorder are present in one person.

7. Personality Traits Personality Traits Fixed patterns of behavior Way of interacting with environment No significant distress or impaired function Positive traits: kind, confident Negative traits: lazy, rude Person often aware of own traits

8. Personility disorders Fixed patterns of behavior Way of interacting with environment Cause distress or impaired function Person often unaware All treated with psychotherapy Difficult to treat (“enduring”) • Often strains doctor-patient relationship Egosyntonic

9. Personality Disorders Cluster A (Weird) • Paranoid, schizoid, schizotypal • Odd and eccentric behavior Cluster B (Wild) • Antisocial, borderline, histrionic, narcissistic • Dramatic, erratic(unpredictable) behavior Cluster C (Wacky) • Avoidant, obsessive-compulsive, dependent • Anxious, fearful behavior

10. Paranoid Personality Disorder Distrust of others, even friends/family Guarded(careful) Significant Suspiciousness Misinterprets benign events Struggles to build close relationships • Attributing unacceptable thoughts to others • Often accuses others of being suspicious

11. Cont … These patients are often preoccupied with questioning the loyalty or trustworthiness of friends, even when this is unjustified . Patients are unforgiving of mistakes or slights.

12. Cont … The disorder is commoner in men, and it is more common in minority groups and immigrants.

13. Treatment 1 . Individual psychotherapy. 2. Supportive psychotherapy. The response to treatment is usually poor. The patients often do not seek treatment on their own and may resent treatment. Drug treatment has a very limited role.

14. Schizoid Personality Disorder Chooses social isolation More comfortable alone Does not enjoy close relationships Little/no interest in sexual experiences Few/no pleasure activities ( hobbies) Lacks close friends Detachment Flat affect

15. Cont … The features of this disorder may overlap with paranoid and schizotypal personality disorders, which too belong to the Cluster-A. Psychotic features are typically absent. The disorder is usually more common in men

16. Cont … Like all personality disorders, schizoid personality disorder has an onset in early childhood with stable course over the years

17. Schizotypal Personality Disorder Fear of social interactions and few close friends Odd beliefs or magical thinking • Superstitious Ideas of reference • e.g. feeling that people on television or radio are either talking about them or talking directly to them

18. Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Cluster B : Personality disorders

19. Antisocial Personality Disorder Antisocial Personality Disorder • More common in men • Disregard for rights of others • Often breaks the law •

20. Antisocial Personality Disorder Impulsive and lacks remorse Child (< 18) version: conduct disorder 25 % girls and 40% boys with CD → ASPD Must be at least age 18 years old Must have evidence of conduct disorder before 15

21. Antisocial Personality Disorder gross and persistent attitude of irresponsibility disregard for social norms, rules and obligations, incapacity to maintain enduring relationships , very low tolerance to frustration and a low threshold for discharge of aggression, incapacity to experience guilt and to profit from experience, particularly punishment, and marked proneness to blame others

22. Cont … This disorder is diagnosed more commonly in males. The course is usually chronic; however, there is some decrease in the symptoms after the fifth decade of life in some patients

23. Treatment Patients often do not seek psychiatric help and if they do , it is usually under pressure from the legal authorities. The therapeutic alliance is often not sustained. The treatment methods include: 1. Individual psychotherapy. 2. Psychoanalysis or psychoanalytical psychotherapy. 3. Group psychotherapy and self-help groups

24. Borderline Personality Disorder More common in women Unstable personal relationships • All people are very good or very bad • Stormy relationships • “My boyfriend is the greatest guy in the world !” Fear of abandonment • May accuse others of abandoning them

25. Cont … Borderline Personality Disorder Significant and persistent disturbance of identity of self , e.g. ‘who am I’. There is marked uncertainty about major issues in life Impulsivity (doing without careful thinking) Patients are depressed and can have transient psychotic disorder

26. Cont … Deliberate self-harm is common in the form of self-mutilation (damage) suicidal gestures (sign), or accident proneness (liability)

27. Treatment Psychoanalysis or psychoanalytical psychotherapy . Supportive psychotherapy

28. Histrionic Personality Disorder Wants to be the center of attention Talks loudly, tells wild stories, uses hand gestures Inappropriate sexually provocative behavior Often wears provocative clothing Touching others frequently Very concerned with physical appearance

29. Histrionic Personality Disorder Excessive emotionality and attention seeking uncomfortable in settings where they are not the center of attention. Their emotions are rapidly shifting and shallow, and they often interact with others in a seductive (very attractive) manner. They are dramatic and theatrical and exaggerate their emotional expressions .

30. Narcissistic Personality Disorder Narcissistic Personality Disorder Inflated sense of self Brags , thinks everything they do is great Lacks empathy for others Other people are competitors Wants to hear they are great Overreacts to criticism with anger

31. Narcissistic Personality Disorder Grandiosity A need for admiration (respect) They often exaggerate their accomplishments and are jealous of the achievements or possessions of others. They believe they are special or are deserving of special treatment. They have fantasies(imagination) about obtaining unlimited power and success.

32. Cluster C Personality Disorder

33. Avoidant Personality Disorder Avoids social interactions • “Social inhibition” • Feels inadequate • Afraid people won’t like them • Afraid of embarrassment • Struggles with intimate relationships • “Maybe he/she doesn’t like me” • Different from schizoid: wants to socialize but can’t • Schizoid prefers to be alone (aloof)

34. Cont … Patients with schizoid personality disorders do not really wish for close relationships and are happy without them. Patients with dependent personality disorder cling to others in their inner circle because they are afraid to function on their own.

35. Dependent Personality Disorder Dependent Personality Disorder Clingy(grasp) Low self-confidence Struggle to care for themselves Depend on others excessively • Rarely alone, always in a relationship Hard to make decisions on their own • Want someone to tell them what to do Difficulty expressing an opinion

36. Obsessive-Compulsive Personality Disorder Preoccupied with order and control • Loves “To Do” lists • Always needs a plan • Inflexible at work or in relationships • Behaviors help to achieve goals (contrast with OCD)

37. When recurrent obsessions or compulsions are present, OCD rather than obsessive-compulsive personality disorder should be considered