personality disorders classification

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  • 1. Dr.SRIRAM.R

2. Allport in 1937 defined personality as the dynamic organization within the individual of those psychophysical systems that determine his unique adjustments to his environment Mischel in 1976 told that it consists of the distinctive patterns of behavior, including thoughts and emotions that characterzeeach individuals adaptation to the situations of his or her life 3. Traits are ENDURING patterns of thinking/perceiving/relating about environment and oneself which are exhibited in a wide range of social/personal contexts DSM IV-TR 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 When personality TRAITS are rigid and maladaptive, and produce funtional impairment or subjective distress DISORDER 4. Categorical Classification - ICD-10 (F60 Specific PD)-WHO DSM-5-American Psychiatric Association Millons description Additional classification Severity, Social functioning and Attribution Dimensional Classification - (ICD-11?) Thomas Widigers Five-factor model 5. a. Marked disharmonious attitude and behaviour involving several areas of functioning b. Enduring/long standing c. Pervasive and maladaptive d. Childhood to adulthood e. Personal distress f. Socio-occupational dysfunction 6. F60 Specific personality disorders F60.0 Paranoid personality disorder F60.1 Schizoid personality disorder F60.2 Dissocial personality disorder F60.3 Emotionally unstable personality disorder .30 Impulsive type .31 Borderline type F60.4 Histrionic personality disorder F60.5 Anankastic personality disorder F60.6 Anxious [avoidant] personality disorder F60.7 Dependent personality disorder F60.8 Other specific personality disorders F60.9 Personality disorder, unspecified F61 Mixed and other personality disorders F61.0 Mixed personality disorders F61.1 Troublesome personality changes 7. Cluster A (odd disorders) MAD CLUSTER Paranoid personality disorder (301.0): characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent Schizoid personality disorder (301.20): lack of interest and detachment from social relationships, and restricted emotional expression Schizotypal personality disorder (301.22/F21 SSD ICD- 10): a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions 8. Cluster B (dramatic, emotional or erratic disorders) BAD CLUSTER Antisocial personality disorder(301.7/DISSOCIAL PD IN ICD- 10): a pervasive pattern of disregard for and violation of the rights of others, lack of empathy Borderline personality disorder(301.83): pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity Histrionic personality disorder(301.50): pervasive pattern of attention-seeking behavior and excessive emotions Narcissistic personality disorder(301.81/F60.81 OTHER PD ICD- 10): a pervasive pattern of grandiosity, need for admiration, and a lack of empathy 9. Cluster C (anxious or fearful disorders) SAD CLUSTER Avoidant personality disorder (301.82):pervasive feelingsofsocialinhibitionandinadequacy,extreme sensitivitytonegativeevaluation Dependent personality disorder (301.6):pervasive psychologicalneedtobecaredforbyotherpeople. Obsessive-compulsive personality disorder (301.4/ Anankastic PD in ICD-10):characterizedbyrigid conformitytorules,perfectionismandcontrol 10. the most common estimations range of all P.D. is about 10-23%. Paranoid 0.5-2.5% Schizoid ?% Schizotypal 3% Antisocial 3% Borderline 2% Histrionic 2-3% Narcissistic less than 1% Avoidant 0.5-1% Dependent >2.5% 11. Paranoid personality disorder (1)Excessivesensitivity to setbacks and rebuffs (2)Beargrudgespersistently (3)Suspiciousnessandmisconstruing (4)Personal rights (5)Sexualfidelitysuspicions (6)Self-referential attitude (7)Conspiratorial" explanations 12. Schizoid personality disorder (1)Few,ifany,activitiesprovidepleasure (2)emotional coldness (3)Inabilitytoexpressfeelings (4)indifferencetopraise/criticism (5)little sexualinterest (6)solitaryactivities (7)preoccupationwithfantasy /introspection (8)Noconfidingrelationships (9)insensitivitytosocialnorms/conventions 13. Dissocial personality disorder (1)unconcernforthefeelings of others (2)irresponsibility and disregardforsocialnorms, rules,obligations (3)incapacitytomaintainenduringrelationships,no difficultyinestablishingthem (4)low tolerance for frustration/aggression (5)incapacitytoexperienceguiltortoprofitfrom adverseexperience (6)blame others and rationalize their behaviour 14. Emotionally unstable personality disorder Impulsive type (1)tendencytoact unexpectedlywithout considerationoftheconsequences (2)quarrelsomebehavior/conflicts with others (3)behavioral explosions and inability to control (4)difficultyinmaintaininganycourseofactionthat offersnoimmediate reward (5)unstablemood 15. Emotionally unstable personality disorder Borderline type Atleastthreeofthesymptomsmentionedincriterionfor impulsivetype,and: (1)disturbancesinanduncertainty about self-image, aims, and internal preferences (2)liabilitytobecomeinvolvedinintenseandunstable relationships,oftenleadingtoemotional crises (3)excessiveeffortstoavoidabandonment (4)recurrentthreatsoractsofself-harm (5)chronicfeelings of emptiness 16. Histrionic personality disorder (1)self-dramatization,theatricality,orexaggeratedexpression ofemotions (2)suggestibility (3)labile affectivity (4)continualseeking for excitementandactivitiesinwhichis thecenter of attention (5)seductivenessinappearanceorbehavior (6)overconcernwithphysicalattractiveness Egocentricity, continuous longing for appreciation, lack of consideration for others, and persistent manipulative behaviorcompletetheclinicalpicture,butarenotrequired forthediagnosis. 17. Anankastic personality disorder (1) feelings of excessive doubt and caution (2) preoccupation with details, rules, order, organization, or schedule (3) perfectionism that interferes with completion (4) conscientiousness and scrupulousness (5) preoccupation with productivity to the exclusion of pleasure and relationships (6) pedantry and adherence to conventions (7) rigidity/stubbornness/unwelcome thoughts and impulses (8) unreasonable insistence that others submit to exactly way of doing things, or unreasonable reluctance to way of doing of them 18. Anxious (avoidant) personality disorder (1) persistent feelings of tension and apprehension (2) Inferior to others attitude (3) Cannot stand criticism/rejection (4) unwillingness to become involved with people unless certain of being liked (5) restrictions in lifestyle because of need for physical security (6) avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval, or rejection. 19. Dependent personality disorder (1) encouraging or allowing others to make the most of one's important life decisions (2) subordination of own needs to others on whom is dependent, and compliance with their wishes (3) unwillingness to make reasonable demands on the people one depends on (4) feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself (5) preoccupation with fears of being left to care for oneself (6) limited capacity to make everyday decisions without an advice and reassurance from others 20. Theodore Millon was a psychologist, and he proposed a system of classification of personality disorders These included all the types of personality disorders previously discussed, plus there were in addition, 4 more These are Depressive, passive-aggressive (negativistic), sadistic and self defeating (masochistic) 21. [21] Tyrer, P. (2000) Personality Disorders: Diagnosis, Management and Course. Second Edition. London: Arnold Publishers Ltd., pp. 12632. 22. There are several advantages to classifying personality disorder by severity: Addresses comorbidity Represents the influence of personality disorder on clinical outcome This system accommodates the new diagnosis of severe personality disorder, particularly "dangerous and severe personality disorder" (DSPD) 23. TYPE R - Do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders TYPE S - treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment Cluster C are mostly Type S, Cluster A personality disorders significantly more likely to be Type R 24. Source: Goldberg, L. R. (1990). An alternative description of personality: The big-five factor structure. Journal of Personality & Social Psychology, 59, 12161229. MALADAPTIVE TRAITS/DIMENSIONS