Personality disorders

Personality disorders Enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual's culture Behaviour pattern is pervasive and inflexible Maladaptive pattern of perceiving and responding to other people and to stressful circumstances Onset in adolescence or early adulthood Stable over time Leads to distress or impairment

Types of personality disorders Clusters Personality disorders Cluster A: Odd, eccentric Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder Cluster B: Dramatic, emotional Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder Cluster C: Anxious, fearful Avoidant personality disorder Dependent personality disorder Obsessive-compulsive personality disorder

Personality disorders prone for drug use Antisocial personality disorder Borderline personality disorder Narcissistic personality disorder Paranoid personality disorder

Antisocial personality disorder Display a pervasive pattern of disregard for and violation of the rights of others and the rules of society Onset by age 15 years Features Repeated violations of the law Pervasive lying and deception Physical aggressiveness Reckless disregard for safety of self or others Consistent irresponsibility in work and family environments Lack of remorse

Borderline personality disorder Pervasive pattern of unstable and intense interpersonal relationships, self-perception, and moods Transiently, such patients may appear psychotic Features (at least five of the following) Frantic efforts to avoid expected abandonment Unstable and intense interpersonal relationships Markedly and persistently unstable self-image Impulsivity in at least 2 areas that are potentially self-damaging (eg, sex, substance abuse, reckless driving) Recurrent suicidal behaviors or threats or self-mutilation Affective instability Chronic feelings of emptiness Inappropriate and intense anger Transient paranoia or dissociation

Narcissistic personality disorder Patients are grandiose and require admiration from others Features Exaggeration of their own talents or accomplishments Sense of entitlement Exploitation of others Lack of empathy Envy of others An arrogant, haughty attitude

Paranoid personality disorder Display pervasive distrust and suspiciousness Features Others are exploiting or deceiving the person Friends and associates are untrustworthy Information confided to others will be used maliciously There is hidden meaning in remarks or events others perceive as benign The spouse or partner is unfaithful

Etiology of personality disorders Antisocial personality disorder: A genetic contribution to antisocial behaviors There may also be developmental or acquired abnormalities in the prefrontal brain systems and reduced autonomic activity Borderline personality disorder: High prevalence of early abuse (sexual, physical, and emotional) Mood disorders in first-degree relatives Paranoid personality disorder: A genetic contribution to paranoid traits A possible genetic link between this personality disorder and schizophrenia exist

Treatment Psychotherapy is at the core of care for personality disorders Cognitive behaviour therapy identifies the distortions and engages the patient in efforts to reformulate perceptions and behaviors Group psychotherapy allows interpersonal psychopathology to display itself among peer patients, whose feedback is used to identify and correct maladaptive ideas, communication, and behavior Dialectical behavior therapy is useful in borderline personality disorders

Patient/family education Share personality disorder with the patient and educate families on the disorder Work with patient and family to identify the most troublesome behaviours and work with them on alternative responses and to anticipate triggers Therapeutic relationship is prerequisite for change Disorders can be frustrating to treat and require time and patience