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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