Post on 04-Jun-2018
8/13/2019 Cluster c Ning
1/20
PERSONALITY
Ones set of stable, predictableemotional and behavioral
traits
8/13/2019 Cluster c Ning
2/20
1856 - 1939
Father of Psycho-sexual Theory of
Development
Sigmund Freud
8/13/2019 Cluster c Ning
3/20
Psychoanalytic theory
Behavior and personality derives from the constantand unique interaction of conflicting psychologicalforcesthat operate at three different levels of
awareness: the preconscious, the conscious, and theunconscious
Mind divided into 2 parts The conscious the part of which we are aware
The unconscious the part of which we are not aware
* The unconscious mind has more influence than the conscious has
on our personality development & behaviour
8/13/2019 Cluster c Ning
4/20
Super Ego is part ofthe Preconscious mind
Ego*
Id is part of theUnconscious mind
* Ego is floating is all 3states
8/13/2019 Cluster c Ning
5/20
The unconscious mind is further divided into 3 parts:
the id encourages us to seek physical satisfaction
(sexual, nutritional) the superego prompts us to do the moral thing, not the
one that feels the best
the ego referees between the id and superego, and
deals with external reality (our conscious self)
*our early childhood experiences, usually involving ourrelationships with our parents & family, are stored inour unconscious mind
8/13/2019 Cluster c Ning
6/20
According to Freud, the key to a healthy personality
is a balance between the id, the ego, and the
superego.
8/13/2019 Cluster c Ning
7/20
8/13/2019 Cluster c Ning
8/20
Prevalence: 10-20% in the general population
PD is a predisposing factor for other psychiatricdisorders; e.g. substance use, suicide, affectivedisorders, impulse-control disorders, eatingdisorders and anxiety disorders
8/13/2019 Cluster c Ning
9/20
DSM IV-TR
A pattern of behavior/inner experience that deviatesfrom culture in 2 ways:
-Cognition
-Affect
-Personal relations-Impulse control
B inflexible & pervasive pattern
C significant distress/ impairment in functioning
D stable & long duration w onset no later thanadolescence or early adulthood
E not accounted by other mental illness
F not d/t other GMC/substance abuse
8/13/2019 Cluster c Ning
10/20
CLUSTER CWORRIED
SAD
CLUSTER BWILDBAD
CLUSTER AWEIRD
MAD
8/13/2019 Cluster c Ning
11/20
8/13/2019 Cluster c Ning
12/20
Example of caseA 35 year-old computer programmer , has always had
difficulty forming close friendships, not because of alack of desire but because of an intense fear of
rejection and disapproval. He looked for work thatwould minimize social interaction and opportunitiesto be judged by others. He describes himself as being
painfully shysince childhood.
8/13/2019 Cluster c Ning
13/20
DSM IV Avoidant PDA pattern of social inhibition, hypersensitivity, and feelingof inadequacysince early adulthood, with at least 4 of thefollowing
1. Avoid occupation that involves interpersonal contact due to
fear of criticism and rejection2. Unwilling to interact unless certain of being liked
3. Cautious of intrapersonal relationships
4. Preoccupied with being criticized or rejected in social
situation
5. Inhibited in new social situations because he/she feels
inadequate
6. Believes he/she is socially inept and inferior
7. Reluctant to engage in new activities for fear of
embarrassment.
8/13/2019 Cluster c Ning
14/20
Assertiveness training For people who are abnormally shy or socially awkward
Socially acceptable expression of thoughts and feelingsis encourage as follow :
1.Analyze the problem in terms of facial expression, eyecontact, posture and tone of voice
2. Exchange of roles to help pt understand the viewpointof the other person in the situation
3. Demonstrateappropriate social behaviour4.Practice appropriate behaviorwithin the session
5. Practice appropriate social behavior in everyday life
6.Record the outcome of this practice
8/13/2019 Cluster c Ning
15/20
1. Realize where changes are needed and believe inyour rights.
2. Figure out appropriate ways of asserting yourselfin each specific situation that concerns you
3. Practice giving assertive responses
4. Try being assertive in real life situations
8/13/2019 Cluster c Ning
16/20
Example of caseA 55 year-old lady has trouble deciding on choosing
which dress to wear to attend a wedding ceremony. Shecalls her mother and her best friends several times to
ask the opinion.
8/13/2019 Cluster c Ning
17/20
DSM IV Dependent PD
1. has difficulty making everyday decisionswithout an excessive amount of advice andreassurance from others
2. needs others to assume responsibility for most major areas of his or her life3. has difficulty expressing disagreementwith others because of fear of loss of support orapproval. Note: does not include realistic fears of retribution.
4. has difficulty initiating projects or doing things on his or her own (because of a lack ofself-confidence in judgment or abilities rather than a lack of motivation or energy)
5. goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant6. feels uncomfortable or helpless when alone because of exaggerated fears of being
unable to care for himself or herself
7. urgently seeks another relationship as a source of care and supportwhen a closerelationship ends
8. is unrealistically preoccupied with fears of being left to take care of himself or herself
A pattern of submissive and clinging behaviour due to excessive
need to be taken care of. At least 5 of the following must be
present:
8/13/2019 Cluster c Ning
18/20
Avoidant Dependent OCPD
Shy/ timidAvoiding social inhibition d/tintense fear of rejection
Dependent and submissivePoor self-confidentOthers decide for them
Perfectionism, inflexibity &extreme orderlinessstiff, serious and formal withconstricted affect
1 to 10% ~1% (females>) ~1% (males>; oldest child)
Chronic course
associated anxiety anddepressive disorders
associated depression Comorbid- MDD, schizophrenia,anorexia nervosa, bulimia
DDSchizoid PDSocial phobia/ anxiety d/s
DDAvoidant PDBorderline & histrionic PD
DDOCDNarcissistic PD
TreatmentPsychotherapyBehavior therapy (Assertive
training & desensitization)Group therapy (understanding)Good rapport & reassurance
PharmacotherapyAnxiolytic (B-blocker)SSRI (depression)
TreatmentPsychotherapyFamily/couple therapy
Assertive training- autonomy/decision making
PharmacotherapyAnxiolytic (B-blocker duringcrisis)SSRI(depression)
TreatmentPsychotherapyBehavior therapy
Group therapy
PharmacotherapyAnxiolyticSSRI
*Anti-psychotics
(severe case)???
8/13/2019 Cluster c Ning
19/20
Example of case
30 year-old gentlemen tells you that his 6throommatehas just moved out because he makes unreasonable
rules and schedules concerning the care of theapartment
8/13/2019 Cluster c Ning
20/20
DSM IV OCPD
Pattern of pre-ocupation with orderliness, control andperfectionismat the expense of efficiency, present by early
adulthood and in a variety of contexts. At least 4 of the following
must present:
1. Preoccupation with details, rules, lists, and organizationsuch that the major point of the activity is lost
2. Perfectionismthat is detrimental to completion of task
3. Excessive devotion to work
4. Excessive conscientiousness and scrupulousness about
morals and ethics5. Will not delegrate tasks
6. Unable to discard worthless objects
7. Miserly
8. Rigid and stubborn