Personality Disorder

华东师范大学 屠筱青Email: misulaso@yahoo.cn

Persona

Personality

Personality trait

Personality

disorder

Poet of Fairy Tale —— Cheng Gu`

黑夜给了我黑色的眼睛我却用它寻找光明 —— 《黑眼睛》

你一会看我一会看云我觉得你看我时很远你看云时很近 —— 《远和近》

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™

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

Cluster A

Cluster B

• Paranoid• Schizoid• Schizotypal

• Antisocial• Borderline• Histrionic• Narcissistic

• Avoidant• Dependent• Obsessive-Compulsive

odd, eccentric

dramatic, emotional, erratic

anxious, fearfulCluster C

:Prevalence

General People 0.5%~2.5% Inpatient 10%~30% Outpatient 2%~10%

Gender differences

Male: Antisocial / Narcissistic PDFemale: Borderline / Histrionic PD

From APA,2000

About Personality Disorder

About Personality DisorderComorbidity

With Axis I:Anxiety Disorder , Mood Disorder , Substance-related Disorder …

Within Categories:Paranoid, Avoidant, & Borderline with other PDsHalf with Avoidant meet criteria for Schizotypal……

Adolf Hitler

Cluster A Odd or Eccentric

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Paranoid Personality Disorder

Definition

PPD is characterized by a pervasive distrust and suspiciousness of others such that their motives are

interpreted as malevolent

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

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.

Typical Beliefs

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

XingHua Qiu

Characteristics

Pervasive unjustified distrustInterpersonal relationship problemsNarrow-minded and paranoidEgocentric and denying any criticism

Paranoid PD vs Paranoid SchizophreniaPPDfocuses on the perceived motives andintentions of others grounded in reality

PSpsychotic symptoms such as auditory

andvisual hallucinations paranoia & delusions bizarre

Schizoid Personality DisorderDefinition

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.

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 maintaina 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.”

Diagnostic Criteria

DISTANT (4 ＋ )

D : Detached (or flattened affect)I : Indifferent to criticism or praiseS : Sexual experiences of little interestT : Tasks (activities) done solitarilyA : Absence of close friendsN : Neither desires nor enjoys close

relationsT : Takes pleasure in a few activities

Characteristics

Autism, aloof, cold, indifferent

to other people

Schizoid, narcissistic & avoidant PDs

are relatively rare, occurring in less

than 1% of the general population.

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.

Typical Beliefs

I need to consider only my own views; I must not beinfluenced 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.

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

F.

Nietzsche Characteristics

have paranoid thoughts, express little emotion, and may dress or behave in unusual waystelepathy, ghosts, astrology, sixth

sense...

Only a small proportion of individualswith schizotypal PDs go on to develop schizophrenia.

Schizophrenia vs Depersonalization vs Dissociative

Identity

Axis I

Multiple Personality

Dissociative Identity

Cluster B Dramatic, Emotional or Erratic

Antisocial Personality Disorder

Borderline Personality

Disorder

Histrionic Personality Disorder

Narcissistic Personality

Disorder

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. 

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.

Hannibal Mike Tyson

Diagnostic Criteria

CORRUPT （ 3+ ）

C : Conformity to law lackingO : Obligations ignoredR : Reckless disregard for safety of self and othersR : Remorse lackingU : 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 ).

Conduct Disorder

<15, 3 +, 1-6months

aggression to people and animals

destruction of property

deceitfulness or theft

serious violations of rules

ASPD vs Psychopath vs Criminality

Development

Mania without delirium, Moral insanity

Egopathy, Sociopathy, Psychopathy

Psychopath

Cleckley & Hare PCL - R

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

Borderline Personality DisorderDefinition

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.

Diagnostic CriteriaAM SUICIDE (5 ＋ )

A : AbandonmentM : Mood instability

S : Suicidal or self mutilating behaviorU : Unstable and intense relationshipsI : ImpulsivityC : Control of angerI : Identity disturbanceD : Dissociative (or paranoid) symptoms that are transient & stress –relatedE : Emptiness (chronic feelings of)

CharacteristicsAbout 75% of BPD patients are womenHeightened risk for completed suicide 8.5% to 10.0% among BPD patients

ComorbidityMood disorder: depressionEating disorder: bulimiaSubstance-related disorder: drug use

Girl, Interrupted

Fatal Attraction

Satisfy a Craving

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.

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.

Sister

Hibiscus Yang Er

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.

Diagnostic Criteria

PRAISE ME (5+)

P : Provocative (or sexually seductive) behavior

R : Relationships (considered more intimate)A : Attention I : Influenced easilyS : Style of speech (impressionistic, lacks

detail)E : Emotions (rapidly shifting and hollow)

M: Made upE : Emotions exaggerated

Characteristics

Vain, extravagant & seductive

Always onstage

Comorbidity

2/3 of people with HPD also met criteria for ASPD

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

Narcissus

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 otherpeople. 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.

Diagnostic Criteria

SPECIAL (5 ＋ )

S : Special P : Preoccupied with fantasies E : Entitlement EnviousC : Conceited I : Interpersonal exploitationA : Arrogant (haughty) AdmirationL : Lacks empathy

Cluster C Anxious or Fearful

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Avoidant Personality Disorder

Definition

Avoidant PD is characterized by a lifelong

pattern of extreme shyness, feelings of

inadequacy and sensitivity to rejection.

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.

Diagnostic CriteriaCRINGES (4+)

C : Certainty R : Rejection (or criticism) preoccupies one’s thoughts in social occasionsI : Intimate relationshipsN : New interpersonal relationships (is inhibited in)G : Gets around occupational activity E : Embarrassment (potential) prevents new

activity or taking personal risksS : Self-viewed as unappealing, inept or inferior

Avoidant PD vs Schizoid PD

Avoidant PD

Low self-esteemInterpersonally anxious & fearful of rejection

Schizoid PD

Apathetic, affectively flat,relatively uninterested in interpersonal relationships

Dependant Personality DisorderDefinition

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-

confidence, and self-denigration.

Typical BeliefsI 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.

Diagnostic CriteriaRELIANCE (5+)

R : Reassurance required for decisionsE : Expressing disagreement difficult L : Life responsibilities I : Initiating projects difficultA : Alone N : Nurturance C : Companionship sought urgently when close relationship endsE : Exaggerated fears of being left to care for self

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.

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.

Diagnostic CriteriaLAW FIRMS (4+)

L : Loses point of activity A : Ability to complete tasksW: Worthless objects

F : Friendships (& leisure activities) excluded due to preoccupation with workI : Inflexible, scrupulous, over-conscientious R: Reluctant to delegateM: MiserlyS : Stubbornness

OCPD vs OCDCharacteristics

Preoccupied with doing things “ the right way ”

OCPD

Do not have obsessive thoughts & the compulsive behaviors

Treatments & ……

TreatmentBiological TherapySchizotypal / Borderline / Dependent: Psychotropic

drugs

Behavioral TherapySchizoid / Avoidant: Social skill (role playing)

Cognitive-behavioral TherapyAntisocial: Think about moral issues…Borderline: DBTHistrionic: Change beliefs & develop deliberate ways Dependent: Help challenge and change assumptions OCPD: Change dichotomous thinking…

Prevention !!!

Questions to Ponder

Etiology

Diagnostic systemDSM-IV deficiencyCategorical & Dimensional

Models

TreatmentIntervention or notHow to?

Thank You