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Understanding PERSONALITY Disorder

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Presentation on theme: "Understanding PERSONALITY Disorder"— Presentation transcript:

1 Understanding PERSONALITY Disorder
Dr Ivona Amleh psychiatrist

2 Lat. Persona - mask Persona offers protection against many stresses of living and interacting with others

3 The First Classification of Personalities
Hippocrates (ca.460 – 370 BC) Four temperaments Phlegmatic Choleric Sanguine Melancholic Temperament – more innate, constitutional aspects of behaviour

4 Definition of Personality
Totality of emotional and behavioural traits that characterize the person in everyday living under ordinary conditions مجمل الميزات العاطفية والسلوكيه وهي التي تميز الشخص تحت الظروف العادية في الحياة اليومية Traits – enduring patterns of perceiving, relating to and thinking about environment and oneself ميزات الشخصية- نماذج من الملاحظة والارتباط والتفكير حول البيئة المحيطة والذات Modern concept is firmly rooted in trait psychology.

5 Traits / Classification
C. G. Jung (1921) extroversion / introversion K. Schneider (1923) “abnormal personalities are those who suffer or make others suffer” – “psychopaths” Freud, Horney (those who move towards-against-away from people), Millon (1981) P offers protection against the many psych. and interpersonal stresses of living

6 “The Big Five Factors” Model
Costa & McRea’s (1992) descriptive and comprehensive structure behind all personality traits: OPENNESS (curiosity, liking variety) CONSCIENTIOUSNESS (discipline, achievements) EXTRAVERSION (assertiveness, talkativeness) AGREEABLENESS (helpfulness, cooperation) NEUROTICISM (anxiety, impulsivity) Twin studies suggest that heredity and environment contribute in roughly equal proportion; O 57%h., C 49%, E 54%, A 42%, N 48% CA increase with time, OEN decrease, women more AN, men CE

7 Where is the dividing line between ‘NORMAL’ personality / Personality PROBLEM / Personality DISORDER? We try to put in categories something that comes on continuum. Many major features of Pd are exaggeration of adaptive features

8 Definition of Personality Disorder
Enduring behavioural patterns manifested as inflexible, maladaptive responses in personal and social situations انماط السلوكية الدائمة التي تتسم الاستجابات غير مرنة وغير متكيفه في مختلف الأوضاع الشخصية والاجتماعية Significant deviations from the average in a given culture Associated with subjective distress and problems in social functioning Recognisable from early adulthood Persist until middle age when at least some (cluster B) seem to vane. Dividing line – impairment in relationships, in social and occupational functioning and and/or presence of subjective distress

9 Are PDs Illnesses or Not?
Barely fit to medical concept of disease: - almost impossible to define - may have no actual symptoms - unknown cause - lacking specific treatment But, impossible to ignore, can cause a lot of damage, elevated morbidity/mortality If medical services do not take care, who will?

10 Etiology heredity / physiology psychological factors interpersonal factors Give two examples from PD script The Turin Study (Gunderson, 2000) heritability was 0,69 for aggression, impulsivity and emotional discontrol

11 Classification of Personality Disorders
Paranoid Schizoid Schizotypal Narcissistic Histrionic Borderline Antisocial Obsessive-Compulsive Avoidant Dependent Passive-Aggressive

12 Paranoid PD Distrustful See enemies everywhere
Live lonely, tortured lives Outbursts of rage Project their malevolence to others maintaining thereby their self-esteem May decompensate into delusion or depression P 1% Distrustful toward authority, for that rarely present for help, anxiety related to any attachment, deep rooted feeling of inferiority/vulnerable for attack

13 Schizoid PD A quiet loner Aloof and distant
Loving relationships neither felt nor sought No fear of rejection, because no desire for acceptance Like reading (may like religion, science, philosophy…), solitary activities Well preserved reality testing P 0,3% A shell like existence, no need and no skills to engage with others

14 Schizotypal PD Seem to lack a core Vivid fantasy, vague speech
They sense ghostlike presences, magic influences, telepathy Withdrawn, but have some relatedness Rejection sensitive May develop micro-psychotic episodes P 0,3% May socially isolate themselves for the long period; have normal medial temporal lobes and lat.ventricles

15 Narcissistic PD The stable variant: Feel superior, enjoy themselves
Not seeing the needs of others Spoiled upbringing, sharing was not common Difficult to get along with If rejected in something important to them, may become depressed P up to 0,2%

16 Narcissistic PD The unstable variant: The mask of narcissism
Life is a constant threat Easily wounded and enraged or sad May have reasonably good impulse control in public or on the job, keeping more primitive qualities in specific relationships Pretend to be Napoleon, but deep in their hearts they know they are a sham, fearing others recognise it as well

17 Histrionic PD Demand central stage Feel little responsibility
The past is a collection of images Life is exciting for them, a long string of over-reactions, tantrums and lost loves Behind is a painfully fragile self-esteem Their tragedy: adults are not made to live as children P 1,3 % High heritability like other B cluster 0,67 Superficial, limited capacity for self-introspection, the outside world is everything

18 Borderline PD Feeling of emptiness Fear of abandonment
Unstable relationships Impulsivity and self-harm Affective instability and aggression Face a harsh world over which they have no control, vulnerability for addiction Develop depression and micro-psychosis P 1,1% Like a dress, empty until filled by the presence of others, others giving meaning No control neither over themselves

19 Antisocial PD Charming or nasty No responsibility, no anxiety
Playing games in which others exist as pieces to be manipulated and utilized At their worst – cruel, sadistic and violent Their amoral behaviour at least in a part a reflection of defenses to some intense pain

20 Obsessive-Compulsive PD
Hard on themselves Any failure – the ultimate one Love and resent their work Must prove themselves worthy of being loved Appear serious, cool and distant Even free-time has to be well spent Angry if someone is disrespectful for rules May develop depression Costly life style, filled with stress; very angry if someone is disrespectful for rules

21 Avoidant PD Extremely low self-esteem Desperate hope for affection
Do not dare to approach others Unsure of their identity and self worth, sometimes denigrating and self-ridicule Frequently appear aloof and cool, living a lonely, painful and introspective existence P 1,1% great psychic pain

22 Dependent PD Craving for safety Extremely rejection sensitive
View themselves as weak and ineffectual, do not want to make any decision Their unfortunate answer to insecurity is the safety of slavery May develop depression P 1,9 % Very low self-esteem, “ a poor little me feeling”, the world as a dangerous place; may be dependent on parents until middle age

23 Passive-Aggressive PD
Negativistic or late Perplexing ambivalence Intentionally ineffective Fearing rejection, they attack by passive means The result is world lived through the eyes of someone bitterly resigned to sitting on the bench Control has already been lost in the world that is seen as hostile (unlike obs.-comp. PD in which they struggle to control).

24 The dg mostly based on history
The dg mostly based on history. Important to see the person behind the dg

25 Signal Behaviours Complaints about clinician or the system Antisocial Paranoid Borderline Narcissistic Passive-Aggressive

26 Flirtatious behaviour
Signal Behaviours Flirtatious behaviour Antisocial Narcissistic Histrionic

27 Dramatic behaviour or dress
Signal Behaviours Dramatic behaviour or dress Histrionic Borderline

28 Helpless and child-like
Signal Behaviours Helpless and child-like Dependent Histrionic Borderline

29 Signal Behaviours Manipulative Antisocial Narcissistic
Borderline Histrionic Passive-Aggressive

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