Personality Disorder

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Personality Disorder

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• Email misulaso_at_yahoo.cn

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• Persona
• Personality
• Personality trait
• Personality disorder

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Poet of Fairy Tale Cheng Gu
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Personality Disorder

• Definition
• Enduring pattern of inner experience and
• behavior that deviates markedly from the
• expectation of the individual's culture,
• is pervasive and inflexible,
• has an onset in adolescence or early adulthood,
• is stable over time, and leads to distress or
• impairment.

From DSM-IV
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About Personality Disorder

• Characteristics
• 3P Persistent Pervasive Problematic
• Diagnostic Features
• cognition
• affect
• interpersonal functioning
• impulse control
• Diagnose
• Coded on Axis II 3 Clusters ? 10 PD

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• Paranoid
• Schizoid
• Schizotypal

Cluster A
odd, eccentric

• Antisocial
• Borderline
• Histrionic
• Narcissistic

Cluster B
dramatic, emotional, erratic

• Avoidant
• Dependent
• Obsessive-Compulsive

Cluster C
anxious, fearful
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About Personality Disorder
Prevalence General People 0.52.5
Inpatient 1030 Outpatient
210 Gender differences Male
Antisocial / Narcissistic PD Female Borderline /
Histrionic PD

From APA,2000
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About Personality Disorder
Adolf Hitler
Comorbidity With Axis I Anxiety Disorder , Mood
Disorder , Substance-related Disorder Within
Categories Paranoid, Avoidant, Borderline with
other PDs Half with Avoidant meet criteria for
Schizotypal
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Cluster A Odd or Eccentric
Paranoid Personality Disorder Schizoid
Personality Disorder Schizotypal Personality
Disorder
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Paranoid Personality Disorder

• Definition
• PPD is characterized by a pervasive
• distrust and suspiciousness of others
• such that their motives are interpreted
• as malevolent

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Beck. Cognitive Effects and Typical Beliefs in
Personality Disorders From Cognitive Therapy of
Personality Disorders
Typical Beliefs

• People are potential adversaries. I cannot
  trust other people. Other people have hidden
  motives. I have to be on guard at all times. It
  isn't safe to confide in other people. People
  will take advantage of me if I give them the
  chance. Other people will deliberately try to
  demean me. I will be in serious trouble if I let
  other people think they can get away with
  mistreating me. If other people find out things
  about me, they will use them against me.

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Diagnostic Criteria ( DSM-IV made easy)

• SUSPECT (4)
• S Spouse fidelity suspected
• U Unforgiving (bears grudges)
• S Suspicious of others
• P Perceives attacks (and reacts quickly)
• E Enemy or friend (suspects associates,
  friends)
• C Confiding in others feared
• T Threats perceived in benign events

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XingHua Qiu
Characteristics Pervasive unjustified
distrust Interpersonal relationship
problems Narrow-minded and paranoid Egocentric
and denying any criticism
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Paranoid PD vs Paranoid Schizophrenia

• PPD
• focuses on the perceived motives and
• intentions of others
• grounded in reality
• PS
• psychotic symptoms such as auditory and
• visual hallucinations
• paranoia delusions bizarre

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Schizoid Personality Disorder

• Definition
• Schizoid PD is primarily characterized by a
• very limited range of emotion, both in
• expression of and experiencing. Persons
• with this disorder are indifferent to social
• relationships and display flattened affect.

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Typical Beliefs

• I need plenty of space
• Relationships are problematic.
• Life is less complicated without other people.
• I am empty inside.
• It is better for me to keep my distance and
  maintain
• a low profile.
• I am a social misfit.
• Life is bland and unfulfilling.
• They consider themselves to be observers rather
• than participants in the world around them.

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Diagnostic Criteria

• DISTANT (4)
• D Detached (or flattened affect)
• I Indifferent to criticism or praise
• S Sexual experiences of little interest
• T Tasks (activities) done solitarily
• A Absence of close friends
• N Neither desires nor enjoys close relations
• T Takes pleasure in a few activities

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• Characteristics
• Autism, aloof, cold, indifferent
• to other people
• Schizoid, narcissistic avoidant PDs
• are relatively rare, occurring in less
• than 1 of the general population.

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Schizotypal Personality Disorder

• Definition
• Schizotypal PD is primarily characterized by
• a need for social isolation, odd behaviour
• and thinking, and often unconventional
• beliefs such as being convinced of having
• extra sensory abilities.

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Typical Beliefs

• I need to consider only my own views I must not
  be
• influenced by anyone.
• I feel like an alien in a frightening
  environment.
• Since the world is dangerous, you have to watch
  out
• for yourself at all times.
• There are reasons for everything. Things don't
  happen
• by chance.
• Sometimes my inner feelings are an indication of
  what
• is going to happen.
• Relationships are threatening.
• I am defective.

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Diagnostic Criteria

• ME PECULIAR (5)
• M Magical thinking or odd beliefs
• E Experiences unusual perceptions
• P Paranoid ideation
• E Eccentric appearance or behavior
• C Constricted (or inappropriate) affect
• U Unusual (odd) thinking and speech
• L Lacks close friends
• I Ideas of reference
• A Anxiety in social situations
• R Rule out psychotic disorders pervasive
  development disorder

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F. Nietzsche

• Characteristics
• have paranoid thoughts, express little
• emotion, and may dress or behave in
• unusual ways
• telepathy, ghosts, astrology, sixth sense...
• Only a small proportion of individuals
• with schizotypal PDs go on to develop
• schizophrenia.

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Schizophrenia vs Depersonalization vs
Dissociative Identity

• Axis I
• Multiple Personality
• Dissociative Identity

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Cluster B Dramatic, Emotional or Erratic
Antisocial Personality Disorder Borderline
Personality Disorder Histrionic Personality
Disorder Narcissistic Personality Disorder
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Antisocial Personality Disorder

• Definition
• ASPD is characterized by a lack of regard for
• the moral or legal standards in the local
• culture. There is a marked inability to get
• along with others or abide by societal rules. 

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Typical Beliefs

• People are there to be taken.
• Force or cunning is the best way to get things
  done.
• We live in a jungle and the strong person is the
  one who survives.
• People will get at me if I don't get them first.
• It is not important to keep promises or honor
  debts.
• Lying and cheating are OK as long as you don't
  get caught.
• I have been unfairly treated and am entitled to
  get my
• fair share by whatever means I can.
• If people can't take care of themselves, that's
  their problem.

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Hannibal
Mike Tyson
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Diagnostic Criteria

• CORRUPT (3)
• C Conformity to law lacking
• O Obligations ignored
• R Reckless disregard for safety of self and
  others
• R Remorse lacking
• U Underhanded (deceitful, lies, cons others)
• P Planning insufficient (impulsive)
• T Temper (irritable and aggressive )
• The individual is at least 18 years old ( under
  15 see Conduct Disorder ).

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Conduct Disorder

• lt15, 3 , 1-6months
• aggression to people and animals
• destruction of property
• deceitfulness or theft
• serious violations of rules

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ASPD vs Psychopath vs Criminality

• Development
• Mania without delirium, Moral insanity
• Egopathy, Sociopathy, Psychopathy
• Psychopath
• Cleckley Hare
• PCL - R

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Not all people with ASPD are criminals (or in
jails) Not all people in jail or considered
criminal have ASPD Not all people with ASPD are
psychopaths
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Borderline Personality Disorder

• Definition
• BPD is characterized by a lack of ones own
• identity, with rapid changes in mood, intense
• unstable interpersonal relationships, marked
• impulsively, instability in affect, and
  instability
• in self image.

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Diagnostic Criteria

• AM SUICIDE (5)
• A Abandonment
• M Mood instability
• S Suicidal or self mutilating behavior
• U Unstable and intense relationships
• I Impulsivity
• C Control of anger
• I Identity disturbance
• D Dissociative (or paranoid) symptoms that
• are transient stress related
• E Emptiness (chronic feelings of)

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Characteristics About 75 of BPD patients are
women Heightened risk for completed suicide 8.5
to 10.0 among BPD patients Comorbidity Mood
disorder depression Eating disorder
bulimia Substance-related disorder drug use
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Girl, Interrupted
Fatal Attraction
Satisfy a Craving
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Typical Beliefs

• Other people must satisfy my needs.
• No one would love me or want to be close to me if
  they
• really got to know me.
• I can't cope on my own. I need someone to rely
  on.
• I must subjugate my wants to the desires of
  others or
• they'll abandon me or attack me.
• People will hurt me, attack me, take advantage of
  me.
• I must protect myself.
• It isn't possible for me to control myself or
  discipline myself.
• I must control my emotions or something terrible
  will happen.
• No one is ever there to meet my needs, to be
  strong for
• me, to care for me.

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Histrionic Personality Disorder

• Definition
• A pervasive pattern of excessive emotionality
• and attention-seeking, including an excessive
• need for approval and inappropriate
• seductiveness, usually beginning in early
• adulthood.

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Sister Hibiscus
Yang Er
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Typical Beliefs

• I need to impress.
• In order to be happy I need other people to pay
• attention to me.
• Unless I entertain or impress people, I am
  nothing.
• If I don't keep others engaged with me, they
  won't like me.
• The way to get what I want is to dazzle or amuse
  people.
• It is awful for people to ignore me.
• I should be the center of attention.
• If I entertain people, they will not notice my
  weaknesses.
• People will pay attention only if I act in
  extreme ways.

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Diagnostic Criteria

• PRAISE ME (5)
• P Provocative (or sexually seductive) behavior
• R Relationships (considered more intimate)
• A Attention
• I Influenced easily
• S Style of speech (impressionistic, lacks
  detail)
• E Emotions (rapidly shifting and hollow)
• M Made up
• E Emotions exaggerated

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• Characteristics
• Vain, extravagant seductive
• Always onstage
• Comorbidity
• 2/3 of people with HPD also met
• criteria for ASPD

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Narcissistic Personality Disorder

• Definition
• NPD is characterized by a pervasive
• pattern of grandiosity (in fantasy or
• behavior), need for admiration, and lack
• of empathy, beginning by early adulthood
• and present in a variety of contexts

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Narcissus
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Typical Beliefs
I am special. Since I am so superior, I am
entitled to special treatment and privileges. I
don't have to be bound by the rules that apply to
other people. If others don't respect my status,
they should be punished. Other people should
satisfy my needs. Other people should recognize
how special I am. Since I am so talented, people
should go out of their way to promote my career.
No one's needs should interfere with my own.
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Diagnostic Criteria

• SPECIAL (5)
• S Special
• P Preoccupied with fantasies
• E Entitlement
• Envious
• C Conceited
• I Interpersonal exploitation
• A Arrogant (haughty)
• Admiration
• L Lacks empathy

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Cluster C Anxious or Fearful
Avoidant Personality Disorder Dependent
Personality Disorder Obsessive-Compulsive
Personality Disorder
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Avoidant Personality Disorder

• Definition
• Avoidant PD is characterized by a lifelong
• pattern of extreme shyness, feelings of
• inadequacy and sensitivity to rejection.

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Typical Beliefs
I may get hurt. I am socially inept and socially
undesirable in work or social situations. Other
people are potentially critical, indifferent,
demeaning, or rejecting. If people get close to
me, they will discover the "real" me and reject
me. Being exposed as inferior or inadequate will
be intolerable. I should avoid unpleasant
situations at all costs. Unpleasant feelings will
escalate and get out of control. If I ignore a
problem, it will go away.
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Diagnostic Criteria

• CRINGES (4)
• C Certainty
• R Rejection (or criticism) preoccupies ones
• thoughts in social occasions
• I Intimate relationships
• N New interpersonal relationships (is inhibited
  in)
• G Gets around occupational activity
• E Embarrassment (potential) prevents new
  activity
• or taking personal risks
• S Self-viewed as unappealing, inept or inferior
  

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Avoidant PD vs Schizoid PD
Avoidant PD Low self-esteem Interpersonally
anxious fearful of rejection Schizoid
PD Apathetic, affectively flat, relatively
uninterested in interpersonal relationships
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Dependant Personality Disorder

• Definition
• DPD is primarily characterized with a extreme
• need of other people, to a point where the person
  
• is unable to make any decisions or take an
• independent stand on their own. There is a fear
  of
• separation, cling, and submissive behavior. They
• have a marked lack of decisiveness, self-confidenc
  e,
• and self-denigration.

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Typical Beliefs

• I am helpless.
• I am needy and weak.
• I need somebody around available at all times to
  help me carry out
• what I need to do or in case something bad
  happens.
• I am helpless when I am left on my own.
• I am basically alone--unless I can attach myself
  to a stronger person.
• The worst possible thing would be to be
  abandoned.
• I must do nothing to offend my supporter or
  helper.
• I must be subservient in order to maintain his or
  her good will.
• I need others to help me make decisions or tell
  me what to do.

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Diagnostic Criteria

• RELIANCE (5)
• R Reassurance required for decisions
• E Expressing disagreement difficult
• L Life responsibilities
• I Initiating projects difficult
• A Alone
• N Nurturance
• C Companionship sought urgently when close
• relationship ends
• E Exaggerated fears of being left to care for
  self

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Obsessive-Compulsive Personality Disorder

• Definition
• OCPD is characterized by a general
• psychological inflexibility, rigid conformity
• to rules and procedures, perfectionism,
• moral code, and/or excessive orderliness.

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Typical Beliefs
Errors are bad. I must not err. I have to depend
on myself to see that things get done. Others
tend to be too casual, often irresponsible,
self-indulgent, or incompetent. It is important
to do a perfect job on everything. If I don't
have systems, everything will fall apart. Any
flaw or defect of performance may lead to a
catastrophe. I need to be in complete control of
my emotions. People should do things my way.
Too Perfect When Being In Control Gets Out Of
Control.
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Diagnostic Criteria

• LAW FIRMS (4)
• L Loses point of activity
• A Ability to complete tasks
• W Worthless objects
• F Friendships ( leisure activities) excluded
• due to preoccupation with work
• I Inflexible, scrupulous, over-conscientious
• R Reluctant to delegate
• M Miserly
• S Stubbornness

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OCPD vs OCD
Characteristics Preoccupied with doing things
the right way OCPD Do not have obsessive
thoughts the compulsive behaviors

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Treatments
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Treatment

• Biological Therapy
• Schizotypal / Borderline / Dependent
  Psychotropic drugs
• Behavioral Therapy
• Schizoid / Avoidant Social skill (role playing)
• Cognitive-behavioral Therapy
• Antisocial Think about moral issues
• Borderline DBT
• Histrionic Change beliefs develop deliberate
  ways
• Dependent Help challenge and change assumptions
• OCPD Change dichotomous thinking
• Prevention !!!

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Questions to Ponder

• Etiology
• Diagnostic system
• DSM-IV deficiency
• Categorical Dimensional Models
• Treatment
• Intervention or not
• How to?

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Thank You