personality disorder- faizah binti nordin (2007288102)

8/7/2019 PERSONALITY DISORDER- FAIZAH BINTI NORDIN (2007288102)

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PERSONALITY DISORDER


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WHAT IS A PERSONALITY DISORDER?

According to DSMIV personality disorder can bedefined as enduring pattern of inner experienceand behavior that leads to distress orimpairment(Maj ,2005)

People with personality disorders have traits thatcause them to feel and behave in sociallydistressing ways, typically resulting in discordand instability in many aspects of their lives(Port,2007).

These personalities are generally described innegative terms such as hostile, detached, needy,antisocial or obsessive (Port, 2007).


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WHAT ARE THE CAUSES OF PERSONALITY

DISORDER?

Unknown causes

The causes of personality disorder still debated and controversy(Wagner, 2010)

Genatic In the identical twin study shows that even they are raises in

difference household, they have similar trait of personality. Thereare greater chance one of a pair of twin have personality disorder,the other will also have similar condition (Rethink, 2006).

Psychological factor

A research finding shows that the majority of personality disorderpeople were abused as children

75% of borderline personality disorder were abuse physically orsexually (Rethink, 2006)


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HOW ARE PERSONALITY DISORDER

DIAGNOSED?

An individual must exhibit symptoms that meet thediagnostic criteria established in the DSM-IV

Behavior pattern must be chronic and pervasive that affect

many different aspects of the individuals life, includingsocial functioning, work, school, and close relationships.

The symptoms shows must meet two or more of thefollowing areas: thoughts, emotions, interpersonalfunctioning, and impulse control.

The behaviors pattern must be stable across time and have

an onset These behaviors cannot be determined other mental

disorders, substance abuse, or medical condition.

(Wanger, 2010)


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CLASSIFICATION OF PERSONALITY

DISORDER

CLUSTERA

PARANOID(PPD)

PARANOID(PPD)

SCHIZOID(SdPD)

SCHIZOID(SdPD)

SCHIZOTYPAL(SPD)

SCHIZOTYPAL(SPD)

CLUSTERB

ANTISOCIAL

ANTISOCIAL

BORDERLINE

BORDERLINE

HISTRIONIC

HISTRIONIC

NARCISSISTIC

NARCISSISTIC

CLUSTERC

AVOIDENT

AVOIDENT

DEPENDENT

DEPENDENT

OBSESSIVE-COMPULSIVE

OBSESSIVE-COMPULSIVE


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PARANOID PERSONALITY DISORDER


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DSM-IV diagnostic criteria

A) A pervasive distrust and suspicion 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


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1. reads benign remarks orevents as threatening or demeaning.

2. persistently bears grudges, i.e., is unforgiving of insults, injuries, or

slights

3. perceives attacks on his or her character or reputation that are not

apparent to others and is quick to react angrily or to counterattack4. has recurrent suspicions, without justification, regarding fidelity of

spouse or sexual partner.


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B) Does not occurexclusively during the

course of schizophrenia, a mood

disorder with psychotic features or

another psychotic disorder and is not due

to the direct physiological effects of a

general medical condition.


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EPIDEMIOLOGY

Paranoid personality disorder has avariously detected prevalence of 0.5-2.5%of the general population

A large long-term Norwegian twin studyfound paranoid personality disorder to bemodestly heritable and to share a portion ofits genetic and environmental risk factors

with schizoidschizoid and schizotypalschizotypal personalitypersonalitydisorderdisorder

More common in menmen than women


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SCHIZOID PERSONALITY DISORDER


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A. A pervasive pattern ofdetachment from social relationships and a

restricted range of expression of emotions in interpersonal

settings, beginning by early adulthood (age eighteen or older)

and present in a variety of contexts, as indicated by four (ormore) of the following: neither desires nor enjoys close

relationships, including being part of a family

1. almost always chooses solitary activities

2. has little, if any, interest in having sexual experiences with another

person

3. takes pleasure in few, if any, activities

4. lacks close friends or confidants other than first-degree relatives

5. appears indifferent to the praise or criticism of others

6. shows emotional coldness, detachment, or flattened affect


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B. Does not occurexclusively during the

course of schizophrenia, a mood

disorder with psychotic features, another

psychotic disorder, or a pervasive

developmental disorder and is not due to

the direct physiological effects of a

general medical condition.


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EPIDEMIOLOGY

SPD is uncommon in clinical settings.

It occurs slightly more commonly in

males. SPD is rare compared with other

personality disorders.

Its prevalence is estimated at less than1% of the general population.

(Wapedia, 2009)


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SCHIZOTYPAL PERSONALITY DISORDER


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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 (in persons older than aged

eighteen years) and present in a variety of contexts, as

indicated by five (or more) of the following: Ideas of

reference (excluding delusions of reference)

1. Odd beliefs or magical thinking that influences behavior and isinconsistent with subcultural norms (e.g., superstitiousness, bizarre

fantasies or preoccupations)

2. Unusual perceptual experiences, including bodily illusions

3. Odd thinking and speech (e.g., vague, circumstantial, metaphorical,

overelaborate, or stereotyped)


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3. Suspiciousness orparanoid ideation

4. Inappropriate or constricted affect

5. Behavior or appearance that is odd, eccentric, or peculiar

6. Lack of close friends or confidants other than first-degree

relatives

7. Social anxiety that tends to be associated with paranoid fears

rather than negative judgments about self.


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EPIDEMIOLOGY

Schizotypal personality disorder occurs in

3% of the general population

occurs slightly more commonly in males(Wapedia, 2009)


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ANTISOCIAL PERSONALITY DISORDER


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A) There is a pervasive pattern ofdisregard for and the rightsof others occurring since the age of 15, as indicated bythree (or more) of the following: failure to conform to socialnorms with respect to lawful behaviors as indicated byrepeatedly performing acts that are grounds for arrest;

1. deceitfulness, as indicated by repeatedly lying, use ofaliases, or conning others for personal profit or pleasure;

2. impulsivity or failure to plan ahead;

3. irritability and aggressiveness, as indicated by repeatedphysical fights or assaults;

4. reckless disregard for safety of self or others;

5. consistent irresponsibility, as indicated by repeated failure tosustain consistent work behavior or honor financialobligations;

6. lack of remorse, as indicated by being indifferent to orrationalizing having hurt, mistreated, or stolen from another.


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B) The individual is at least 18 years of age.

C) There is evidence of Conduct disorder with

onset before age 15.

D) The occurrence of antisocial behavior

is not exclusively during the course of

schizophrenia or a manic episode. Deceit

and manipulation are consideredessential features of the disorder.


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EPIDEMIOLOGY

Antisocial personality disorder in the generalpopulation is about 3% in males and 1% in females.

It is seen in 3% to 30% of psychiatric outpatients.

The prevalence of the disorder is even higher in

selected populations, such as people in prisons (whoinclude many violent offenders).

Similarly, the prevalence of ASPD is higheramongpatients in alcohol or other drug (AOD) abusetreatment programs than in the general population

(Hare 1983), suggesting a link between ASPD andAOD abuse and dependence.

(Wapedia,2009)


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BORDERLINE PERSONALITY DISORDER


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A pervasive pattern of instability ofinterpersonal relationships,self-image and affects, as well as marked impulsivity,beginning by early adulthood and present in a variety ofcontexts, as indicated by five (or more) of the following:Frantic efforts to avoid real or imagined

abandonment. Note: Do not include suicidal or self-injuringbehavior covered in Criterion 51. A pattern of unstable and intense interpersonal

relationships characterized by alternating between extremes ofidealization and devaluation.

2. Identity disturbance: markedly and persistently unstable self-

image orsense of self.3. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, bingeeating, substance abuse, reckless driving) Note: Do notinclude suicidal or self-injuring behavior covered in Criterion 5


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5. Recurrent suicidal behavior, gestures, threats orselfinjury behaviorsuch as cutting, interfering with thehealing of scars (excoriation) or picking at oneself.

6. Affective instability due to a marked reactivityof mood (e.g., intense episodic dysphoria, irritability

or anxiety usually lasting a few hours and only rarelymore than a few days).

7. Chronic feelings ofemptiness

8. Inappropriate angeror difficulty controlling anger (e.g.,frequent displays of temper, constant anger, recurrentphysical fights).

9. Transient, stress-related paranoid ideation, delusions orsevere dissociative symptoms


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EPIDEMIOLOGY

2% or 3% of the general population areaffected

Most common personality disorder in clinical

settings Diagnosed in 11% of psychiatricoutpatients, 19% of inpatients, and abouthalf of all personality disordered patients

3x as common in women as in men 5x more common in first degree relatives ofaffected persons

(Rathbun)


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NACISSISTIC PERSONALITY DISORDER


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A pervasive pattern ofgrandiosity (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:

has a grandiose sense of self-importance (e.g.,

exaggerates achievements and talents, expects to be

recognized as superior without commensurate

achievements)


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1. is preoccupied with fantasies of unlimited success, power, brilliance,

beauty, or ideal love

2. believes that he or she is "special" and unique and can only be

understood by, or should associate with, other special or high-status

people (or institutions)

3. requires excessive admiration

4. has a sense of entitlement, i.e., unreasonable expectations of

especially favorable treatment or automatic compliance with his or her

expectations

5. is interpersonally exploitative, i.e., takes advantage of others to

achieve his or her own ends6. lacks empathy: is unwilling to recognize or identify with the feelings and

needs of others

7. is often envious of others or believes others are envious of him or her

8. shows arrogant, haughty behaviors or attitudes


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EPIDEMIOLOGY

Lifetime prevalence is estimated at 1% in

the general population and 2% to 16% in

clinical populations

(Wapedia, 2009)


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HISTRIONIC PERSONALITY DISORDER


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A pervasive pattern ofexcessive

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


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1. interaction with others is often characterized byinappropriate sexually seductive orprovocativebehavior

2. displays rapidly shifting and shallow expression ofemotions

3. consistently uses physical appearance to drawattention to self

4. has a style of speech that is excessively impressionisticand lacking in detail

5. shows self-dramatization, theatricality, and

exaggerated expression of emotion6. is suggestible, i.e., easily influenced by others orcircumstances

7. considers relationships to be more intimate than theyactually are.


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EPIDEMIOLOGY

Major character traits may be inherited.

Other character traits due

to phenotypical combination of genetics

and environment, including childhood

experiences


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AVOIDANT PERSONALITY DISORDER


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A pervasive pattern of social inhibition,feelings of inadequacy, andhypersensitivity to negative evaluation,

beginning by early adulthood and presentin a variety of contexts, as indicated byfour (or more) of the following:avoidsoccupational activities that involve

significant interpersonal contact, becauseof fears of criticism, disapproval, orrejection


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1. is unwilling to get involved with people unless certain ofbeing liked

2. shows restraint initiating intimate relationships because ofthe fear of being ashamed, ridiculed, or rejected due tosevere low self-worth

3. is preoccupied with being criticized or rejected in socialsituations

4. is inhibited in new interpersonal situations because offeelings of inadequacy

5. views self as socially inept, personally unappealing, or

inferior to others6. is unusually reluctant to take personal risks or to engage inany new activities because they may prove embarrassing


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EPIDEMIOLOGY

According to the DSM-IV-TR, AvPD

occurs in approximately 0.5% to 1% of

the general population.

It is seen in about 10% of psychiatric

outpatients.


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DEPENDENT PERSONALITY DISORDER


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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: has difficulty making everydaydecisions without an excessive amount of

advice and reassurance from others


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1. needs others to assume responsibility for most major areas ofhis or her life

2. has difficulty expressing disagreement with others because offear of loss of support or approval. Note: do not include realisticfears of retribution.

3. has difficulty initiating projects or doing things on his or her own(because of a lack of self-confidence in judgment or abilitiesrather than a lack of motivation or energy)

4. goes to excessive lengths to obtain nurturance and support fromothers, to the point of volunteering to do things that areunpleasant

5. feels uncomfortable or helpless when alone because ofexaggerated fears of being unable to care for himself or herself

6. urgently seeks another relationship as a source of care andsupport when a close relationship ends

7. is unrealistically preoccupied with fears of being left to take careof himself or herself


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EPIDEMIOLOGY

Dependent personality disorder occurs in

about 0.5% of the general population.

It is more frequent in females.


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OBSESSVE-COMPULSIVE PERSONALITY

DISORDER


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A pervasive pattern of preoccupation withorderliness, perfectionism, and mental andinterpersonal control, at the expense of

flexibility, openness, and efficiency,beginning by early adulthood and present ina variety of contexts, as indicated by four (ormore) of the following: Is preoccupied with

details, rules, lists, order, organization, orschedules to the extent that the major pointof the activity is lost


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1. Shows perfectionism that interferes with task completion (e.g., isunable to complete a project because his or her own overly strictstandards are not met)

2. Is excessively devoted to work and productivity to the exclusionof leisure activities and friendships (not accounted for by obviouseconomic necessity)

3. Is overconscientious, scrupulous, and inflexible about matters ofmorality, ethics, or values (not accounted for by cultural orreligious identification)

4. Is unable to discard worn-out or worthless objects even whenthey have no sentimental value

5. Is reluctant to delegate tasks or to work with others unless they

submit to exactly his or her way of doing things6. Adopts a miserly spending style toward both self and others;

money is viewed as something to be hoarded for futurecatastrophes

7. Shows rigidity and stubbornness


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EPIDEMIOLOGY

Obsessive-compulsive personality

disorder occurs in about 1% of the

general population. It is seen in 3%-10%

of psychiatric outpatients.

It is twice as common in males as

females.


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HOW TO TREAT PEOPLE WTH

PERSONALITY DISORDER?

Drugtherapy

Grouptherapy

RelaxationCognitive-behaviortherapy


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DRUG THERAPY

selective serotonin reuptake inhibitors (SSRIs)

help both depression and impulsivity

Anticonvulsant drugs can help reduce

impulsive, angry outbursts

Risperidone (Risperidal) have been helpful with

both depression and feelings ofdepersonalization in people with borderline

personality


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drug therapy does not generally affect

the personality traits themselves

these traits take many years to develop,

treatment of the maladaptive traits may take

many years as well


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GROUP THERAPY

In group therapy approximately 6-10

individuals meet face-to-face with a trained

group therapist.

During the group meeting time, members

decide what they want to talk about.

The members will share their experience

and opinion on positive manner. Members are encouraged to give feedback

to others


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Relaxation

ProgressiveMuscle

Relaxation

PassiveMuscle

Relaxation

Meditation

Visualisation Autogenics

Yoga

Exercise

Tai Chi Massage

RelaxationBreathing


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Relaxation techniques are helpful tools for coping

promoting long term health by slowing down thebody and quieting the mind

Practicing relaxation techniques can reduce stress

symptoms by: Slowing your heart rate

Lowering blood pressure

Slowing your breathing rate

Increasing blood flow to major muscles

Reducing muscle tension and chronic pain Improving concentration

Reducing anger and frustration

Boosting confidence to handle problems


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COGNITIVE-BEHAVIOR THERAPY

Psychotherapeutic approach that

Promote negative change in

individual

Alleviate emotional distress

Address psychosocial behavior

issues

The treatment focus on changingindividual negative thought in

order to change behavior and

emotional stage.


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The goal of CBT is restructure thoughts,

perceptions and beliefs and to facilitate

behavior and emotional change.

Cognitive-Behavioral Therapist use

imagery, self instruction and other

technique to alter distorted attitude,

perception and behavior.

personality disorder- faizah binti nordin (2007288102)

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