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Personality

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Title: Personality


1
Personality Disorders
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  • Common
  • Chronic
  • 10-20 of general population
  • aggravating,de-manding,or parasitic
  • Poor prognosis
  • 50 of psychiatric patients have a personality
    disorder

3
  • apredisposingfac-torforotherpsychiatricdisorders
  • (e.g.,substanceuse,
  • suicide,
  • affectivedisorders,
  • impulse-controldisorders,
  • eatingdisorders,
  • anxietydisorders)i

4
  • interferes with treatment out-comes of AxisI
    syndromes
  • Increases
  • personal incapacita-tion,
  • morbidity,
  • mortality of these patients

5
  • Persons with personality disorders are far more
    likely to refuse psychiatric help and to deny
    their problems
  • Personality disorder symptoms are allo-plastic
    (i.e.,able to adapt to,and alter,the external
    environment) and egosyntonic (i.e.,acceptable to
    the ego)

6
  • Persons with personality disorders do not feel
    anxiety about their maladaptive behavior
  • Enduring subjective experiences and
  • behavior that deviate from cultural standards,
    are rigidly pervasive, have an onset in
    adolescence or early adulthood, are stable
    through time, and lead to unhappiness and
    impairment.

7
  • When personality traits are rigid and maladaptive
    and produce Functional impairment or subjective
    distress, a personality disorder may be diagnosed

8
  • Personality disorder subtypes classi?ed in
    DSM-IV-schizotypal,schizoid,andparanoid(ClusterA)
    odd,aloof
  • narcissistic,borderline,antisocial,andhistrionic(C
    lusterB) dramatic, impulsive,and erratic
    features,
  • obsessive-compulsive,dependent,andavoidant(Cluster
    C). anxiousandfearfulf

9
  • Personality disorders are coded on AxisII of
    DSM-IV-TR.
  • GeneticFactors
  • Twin studies
  • Cluster A Schizophrenia
  • Cluster B
  • Alcohol and ASPD
  • Borderline and depression mood diisorders
  • Histrionic and Somatization
  • Cluster C
  • Avoidant PD anxious
  • OCPD-depressive features

10
Biological factors
  • Impulsive traits-High testorsterione, 17
    estradiol, estrone levels
  • Androgens increase the like lihood of aggression
    and sexual behavior,
  • Boderline personality abnormal DST test

11
Lowplateletmonoamineoxidase(MAO)levels
  • Activity and sociability in monkeys.
  • Collegestudents- lowplatelet MAO levels report
    spending more time in social activities
  • Schizotypal disorders.

12
Smooth pursuit eye movements
  • Are saccadic (i.e.,jumpy) in persons who are
    introverted,who have low self-esteem and tend to
    withdraw,and who have schizotypal personality
    disorder.

13
Neuro tranmsitters
  • High endogenous endorphin levels maybe associated
    with persons who are phlegmatic.
  • Levels of 5-HIAA,a metabolite of serotonin, are
    low in persons who attempt suicide and in
    patients who are impulsive and aggressive

14
  • In many persons, serotonin reduces
    depression,impulsiveness,and rumination,and can
    produce a sense of general well-being.
  • Increased dopamine concentrations in the central
    nervous system, produced by certain
    psychostimulants (e.g.,amphetamines) can induce
    euphoria.

15
  • antisocial and borderline types slow-wave
    activity on EEG

16
  • Sigmund Freud suggested that personality traits
    are related to a ?xation at one psychosexual
    stage of development
  • Those with an oral character are passive and
    dependent because they are ?xated at the oral
    stage,when the dependence on others for food is
    prominent.

17
  • Those with an anal character are
    stubborn,parsimonious, and highly conscientious
    because of struggles over toilet training during
    the anal period.

18
  • Wilhelm Reich subsequently coined the term
    character ar-mor to describe persons
    characteristic defensive styles for protecting
    themselves from internal impulses and from
    interpersonal anxiety in signi?cant
    relationships.Reichs theory has had a broad
    in?uence on contemporary concepts of personality
    and personality disorders.For example, each human
    beings unique stamp of personality is considered
    largely determined by his or her characteristic
    defense mechanisms.Each personality disorder in
    AxisII has a cluster of defenses that help
    psychodynamic clinicians recognize the type of
    character pathology present.
  • Persons with paranoid personality disorder, use
    projection,
  • Schizoid personality disorder is associated with
    withdrawal

19
  • When defenses work effectively, persons with
    personality disorders master feelings of anxiety,
    depression, anger, shame, guilt, and other
    affects.
  • They often view their behavior as ego-syntonic
    that is,it creates no distress for them, even
    though it may adversely affect others. They may
    also be reluctant to engage in a treatment
    process because their defenses are
  • important in controlling unpleasant affects, they
    are not interested in surrendering them.

20
  • In addition to characteristic defenses in
    personality disorders, another central feature is
    internal object relations. During development,
    particular patterns of self in relation to others
    are internalized. Through introjection, children
    internalize a parent or another signi?cant person
    as an internal presence that continues to feel
    like an object rather than a self. Through
    identi?cation, children internalize parents and
    others in such a way that the traits of the
    external object are incorporated into the self
    and the child owns the traits. These internal
    self-representations and object representations
    are crucial in developing the personality and
    ,through externalization and projective
    identi?cation, are played out in interpersona
    lscenarios in which others are coerced into
    playing a role in the persons internal
    life.Hence, persons with personality disorders
    are also identi?ed by particular pat-terns of
    interpersonal relatedness that stem from these
    interna l object relations patterns.

21
DefenseMechanisms.
  • The unconscious mental processes that the ego
    uses t resolve con?icts among the four lodestars
    of the innerlife instinct(wish or need),
    reality, important persons, and conscience.

22
  • When defenses are most effective, especially in
    those with per-sonality disorders, they can
    abolish anxiety and depression.
  • Thus, abandoning a defense increases conscious
    anxiety and depression a major reason that those
    with personality disorders are reluctant to alter
    their behavior

23
FANTASY
  • Many persons who are often labeled schizoidthose
    who are eccentric, lonely, or frightened seek
    solace and satisfaction within themselves by
    creating imaginary lives, especially imaginary
    friends. In their extensive dependence on
    fantasy, these persons often seem to be
    strikingly aloof.
  • Therapists must understand that the
    unsociableness of these patients rests on a fear
    of intimacy.
  • Rather than criticizing the morfeeling rebuffed
    by their rejection,therapists should maintain a
    quiet,reassuring,and considerate interest without
    insisting on recip-rocal responses.
  • Recognition of patients fear of closeness and
    respect for their eccentric ways are both
    therapeutic and useful

24
Dissociation
  • Dissociation or denial is a Pollyanna-like
    re-placement of unpleasant affects with pleasant
    ones.Persons who frequently dissociate are often
    seen as dramatizing and emotion-ally shallow
  • They may be labeled histrionic personalities.
  • They behave l ike anxious adolescents who, to
    erase anxiety, carelessly exposethemselves to
    exciting dangers.
  • Accepting such patients a sexuberant and
    seductive is to overlook their anxiety, but
    confronting them with their vulnerabilities and
    defects makes them still more defensive. Because
    these patients seek appreciation of their courage
    and attractiveness, therapists should not behave
    with inordinate reserve.
  • While remainingcalm and ?rm,clini-cians should
    realize that these patients are often inadvertent
    liars, but they bene?t from ventilating their own
    anxieties and may in the process remember what
    theyforgot.
  • Often therapists deal best with dissociation and
    denial by using displacement.
  • Thus, clinicians may talk with patients about an
    ssue of denial in an unthreatening circumstance.
  • Empathizing with the denied affect without
    directly confronting patients with the facts may
    allow them to raise the original topic themselves

25
ISOLATION.
  • Isolation is characteristic of the orderly,
    controlled persons who are often labeled
    obsessive-compulsiveperson-alities.
  • Unlike those with histrionic personality, persons
    with obsessive-compulsivepersonality remember the
    truth in?ne de-tail but without affect.
  • In a crisis, patients may show intensi-?ed
    self-restraint, overly formal social behavior,
    and obstinacy. Patients quests for control may
    annoy clinicians or maket hem anxious. Often,
    such patients respond well to precise,
    systematic, and rational explanations and value
    ef?ciency, cleanliness, and punctuality as much
    as they do clinicians effective responsive-ness.
    Whenever possible,therapists should allow such
    patients to control their own care and should not
    engage in a battle of wills.

26
PROJECTION
  • In projection, patients attribute their own
    unac-knowledged feelings to others.
  • Patients excessive fault?nding and sensitivity
    to criticism may appear to therapists as
    preju-diced, hypervigilantin justice collecting,
    but should not be met by defensiveness and
    argument.
  • Instead,clinicians should frankly acknowledge
    even minor mistakes on their part and should
    dis-cuss the possibility of future dif?culties.
  • Strict honesty, concern for patients rights, and
    maintaining the same formal, concerned distance
    as used with patients who use fantasy defenses
    are all helpful.
  • Confrontation guarantees a lasting enemy and
    early termination of the interview.
  • Therapists need not agree with patients in
    justice collecting, but they should ask whether
    both can agree to disagree.
  • The technique of counterprojection is especially
    helpful. Clinicians acknowledge and give paranoid
    patients full credit for their feelings and
    perceptions
  • They neither dispute patients complaints nor
    reinforce them, but agree that the world
    described by patients is conceivable.
  • Interviewers can then talk about real motives
    and feelings, misattributed to some one else, and
    begin to cement an alliance with patients

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