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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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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DSM-IV diagnostic criteria
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.
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