Personality Disorders
Pervasive, persistent maladaptive patterns of behavior that are deeply ingrained and that are not attributable to axis I disorder,
Axis III disorder, or cultural role difficulties. Disorder of traits, rather than state.
Maladaptive traits can be behavioral, emotional, cognitive, perceptual or psychodynamic.
Diagnosis, Signs and Symptoms
Requires history of long-term difficulties in various spheres of life.
Egosyntonic, acceptable to the ego. Rigidity, underneath protective armor-anxiety. Lacks empathy with others. Developmental fixation, immature. Interpersonal difficulties in love and work.
Epidemiology
Prevalence-6-9%. Early analogue is a disorder of temperament.
Usually personality disorder is first evident in late adolescence or early adulthood. Overall, women and men are affected equally. Family history - nonspecific history of psychiatric disorders is common. With some personality disorders, a partial genetic transmission is established.
Psychological Test
Neuropsychological test can reveal organically (electroencephalogram [EEG], computed tomography [CT] scan and electrophysiologic mapping can be useful. Projective test can reveal preferred personality patterns and styles (Minnesota miltiphasic personality inventory [MMPI], Thematic Apperception Test [TAT], Rorschach, draw-a-person.)
Treatment
Usually, patients are not motivated. Otherwise, multiple and mixed Modalities are employed: psychoanalysis, psychoanalytic psychotherapy, supportive psychotherapy, group therapy, family therapy, milieutherapy, hospitalization (short and long-term), pharmacotherapy.
Paranoid Personality Disorder
Definition
Tendency to attribute malevolent motives to others.
Epidemiology
Prevalence- 0.5-2.5%. Increased incidence in families of probands with schizophrenia and delusional disorders.
More common in men than in women.
Etiology
Genetic component. Nonspecific early family difficulties, childhood Abuse. Role out drug abuse e.g amphetamines.
Treatment
Rarely low dose antipsychotic likes Haloperidol 2 mg a day. Usually supportive psychotherapy is really important for the most cases.
Schizoid Personality Disorder
Definition
Isolated life-style without overt longing for others.
Epidemiology
May affect 7.5% of the general population. Increased
Incidence among family members of schizophrenic probands. Greater incidence
Among men than women.
Etiology
History of disturbed early family relationship often is elicited. Genetic factor is important in most cases.
Treatment
Low dose antipsychotic may be useful for some patients. Haloperidol 2 mg a day is most effective. Supportive and group psychotherapy may be needed in some patients.
Schizotypal Personality Disorder
Definition
Multiple oddities and eccentricities of behavior, thought, affect, speech and appearance.
Epidemiology
More common in, men than women. Common ness is 3%. And increased prevalence in families of schizophrenic probands.
Etiology
Etiological models of schizophrenia apply.
Treatment
Residual schizophrenia treating is the important guidelines. Haloperidol 2 mg per day is effective. Diazepam 10 mg a day is useful. Group and supportive psychotherapy is important also.
Antisocial Personality Disorder
Definition
Maladaptive behavior that does not recognize the rights of others.
Epidemiology
Prevalence 3% of men and 1% of women. Increased incidence of antisocial personality disorders, somatization disorder and Alcoholism in families. More common in lower socioeconomic group.
Etiology
Genetic factors, brain injury, head trauma or Encephalitis And repeated, random and harsh punishment by parents.
Treatment
Treatment is difficult. Long -term hospitalization or therapeutic community sometimes is effective.
Borderline Personality Disorder
Definition
Multiple complexities and controversies in defining this disorder. Often confused with neurosis, psychosis, mood disorder, other personality disorders, cognitive disorders.
Manifestation of separation individuation problems and intense, personal attachments central.
Epidimiology
Prevalence, about 2%of general population. More common in women than men.
Etiology
Organically can be due to perinatal brain injury, encephalitis, head injury and other brain disorders. Physical and sexual abuse abandonment or over involvement.
Treatment
Carbamazepine 200 mg a day, Haloperidol 2 mg a day is effective. Usually mixed supportive and exploratory psychotherapy is also effective.
Histrionic Personality Disorder
Definition
A disorder characterized by dramatic, emotional And impressionistic style.
Epidemiology
Prevalenee 3% in population. Greater prevalence in women than men.
Etiology
Suggestion that early interpersonal difficulties were resolved by dramatic behavior.
Treatment
Psychoanalysis is appropriate for some patients. Group therapy can be useful. Diazepam 10 mg per day is effective.
Narcissistic Personality Disorder
Definition
Pervasive pattern of showiness and over concern With issue of self-esteem.
Epidemiology
Less than 1% in the general population.
Etiology
Failure in maternal sympathy, early rejection or loss.
Treatment
Milieu therapy is important for some patients.
Individual psychotherapy, supportive or insight oriented psychotherapy depending on ego strength. Treatment challenge is preservation of self-esteem, Threatened by psychiatric interventions.
Obsessive - Compulsive Personality Disorder
Definition
A personality disorder characterized by perfectionism and inflexibility predominate.
Epidemiology
Greater prevalence in men than in women.
Etiology
Patients often have backgrounds characterized by harsh discipline.
Treatment
Clomipramine and Fluoxetine may be useful. Group therapy may be beneficial.
Avoidant Personality Disorder
Definition
Shy or nervous personality.
Epidemiology
1 % in the general population.
Etiology
Possible overt parental deprecation.
Treatment
Insight oriented psychotherapy, group therapy Behavior therapy is useful.
Dependent Personality Disorder
Definition
Mainly dependent and submissive.
Epidemiology
More prevalent in women than in men.
Etiology
Early childhood parental loss in some patients.
Treatment
Behavior therapy and group therapy is useful as well as effective.
Passive - aggressive personality disorder
Definition
Covert obstructionism, procrastination, stubbornness, and inefficiency.
Epidemiology
Oppositional insolent disorder may incline
Etiology
Learned behavior, parental modeling.
Treatment
Supportive psychotherapy may be useful if patient is willing.
Depressive Personality Disorder
Definition
Persons are pessimistic, Anhedonia, duty bound, self Doubting and chronically unhappy.
Epidemiology
Common, but no hard data.
Etiology
Unknown. May involve early loss, poor parenting, disciplinary Ego and extreme guilt feelings.
Treatment
Fluoxetine 20 mg per day is useful. Cognitive therapy, Group therapy and interpersonal therapy are also effective. Language and learning problems are increased in families of autistic children. Associated genetic disorders include tuberous sclerosis and fragile X syndrome. Prenatal and perinatal insults are increased.n
Submitted By:
DR. A. H. MOHAMMAD FIROZ
The Author is a teacher in medical profession and a devoted clinician in Psychiatry. He is now the Director, National Institute of Mental Health.
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