Personality Disorders

Personality Disorders

Jennifer King

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INDEX

Premise

Introduction

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Passive-Aggressive Personality Disorder

PREMISE

Personality is the characteristic way in which an individual thinks, feels and relates to others; respond to patterns of behavior rooted in the individual and allows the prediction of how likely he will act under certain circumstances. The personality embraces the moods, attitudes and opinions of a person, and is more clearly expressed in his interactions with other people. A personality disorder is a pattern of thought, feelings and behavior deeply ingrained, long-term, inflexible and maladaptive that significantly impairs social behavior and employment of the individual, or the cause subjective distress. Personality disorders are not diseases but rather accents spoken or personality variations in one or more of its features. Individuals with these disorders can have great difficulty in controlling their impulses and emotions, and often have distorted perceptions of self and others. As a result, they can try a lot of suffering and experiencing problems at home, at work and in personal relationships. Family members often report incidents of explosion of anger, extreme depression, self-harm, suicide attempts and abuse of drugs and alcohol. Patients with a personality disorder are often taken to treat the people who are close to them because they recognize the presence of serious problems, or because they have reached their personal limits of endurance. These patients, in fact, usually do not feel they suffer from a personality disorder and consider their patterns of undesirable personality only when they cause symptomatic evidence (depression or anxiety), or when they seem to interfere with important social and occupational aspirations.

INTRODUCTION

Each of us has right from birth a biological foundation: the organic natural heritage that each one receives through inheritance from which the morphological constitution and how vital functions (circulatory, respiratory, digestive, etc..) Dependent on the nervous system and endocrine (physiological constitution). The combination of these elements results in an initial psychic structure or temperament. The conditioning of hereditary factors is added after the influence of environmental factors on the complex interplay of all factors depends on the formation of personality that unifies the biological aspects of temperament and psychical character, influenced by the environment, but also creates values , patterns of behavior, forms of social organization can change the environment and the same personality. The character is the result of the initiative of the person under the influence of the environment. In children, the character cannot be distinguished even-tempered (natural psychological response to outfit inherited organic: it expresses impulses, instinctive tendencies, dispositions, needs, emotional states, etc..), The decision cannot be distinguished from the impulse,. inhibition processes are underdeveloped, thought patterns are too simple, etc.. The term personality we mean the set of psychological characteristics and patterns of behavior perception, thought, and the relationship that the individual develops on the basis of both genetic and acquired, which lie at the core of a person and which is stable in the multiplicity and diversity of environmental situations in which it is expressed or is to operate. Personality is relatively stable and that thing we just arrange the elements cognitive, emotional and sensory-motor of our experience. A personality is abnormal if a considerable tract personological considered of clinical importance is so deviant from the statistical average of the majority of human beings. So when personality traits are rigid and maladaptive and cause significant impairment or subjective distress, they constitute a Personality Disorder (DSM-IV-TR). Even though the subjects do not feel dissatisfied with their personality traits, their behavior is so disruptive or destructive for others to cause a degree of impairment in social and / or meaningful work (DSM-IV-TR, Case Studies).

The characteristics that shape our personality and related disorders are mostly seen as ego-syntonic, that is, as something that is part of us, that is not a problem. In some cases it may happen that instead we complain for some aspects such as the excessive timidity rather than to be a specifying, meticulous. We feel that these aspects as ego-dystonic, we would like to be a little 'different because maybe these traits will create some difficulties at work or in relationships. From here we could say okay, there is no particular pain, you are able to live our emotional life and relationships, to have and maintain employment, to pursue our interests and goals. There will inevitably be times of crisis, difficulties, problems to be addressed, discouragement, disappointment or fears, but such is life. We are basically able to deal with them, sometimes realizing that something in us has changed, that the experience has made us grow in some way, has sharpened or blunt some of our contract. Some people show characteristics of reactions to events in the excessive emotion often uncontrollable and dramatically expressed, instability of emotional relationships, inability to maintain employment or pursuing an interest or consistency with a purpose, the excessive social isolation or otherwise in an excessive dependence on others, which indicates a strong inner discomfort and impairment of their social functioning. There is talk of Personality Disorder to indicate a pattern of inner experience and behavior markedly different from those of the social and cultural context which the person belongs, which is rigid, difficult to modify from the experiences of life and almost indiscriminately applied in many different situations, you present since adolescence or early adulthood, is stable over time and causes distress or impairment. Usually these procedures are experienced as ego-syntonic so do not do anything to try to change, you do not ask for help. But the experience of discomfort often increases because these ways to get in touch with the world and with others in some way reinforce the situation worse. Take for example a person who appears to be very introverted, timid, shy. We do realize that it is our co-worker, greets barely does not join the others in the coffee breaks for a chat. It is inevitable that after a failed attempt to implicate him, do not you invite more in the group, it seems to intrude on his privacy, to be rude to break his silence and his apparent need for insulation. If we try, as in a movie, to focus on inner of this man, we would realize that it is characterized by feelings of inadequacy, fear of judgment and rejection of their colleagues. In his mind pass thoughts like If you knew me well would notice my inferiority and I refuse, I am incapable and undesirable, Other people can only criticize and devalue, best to keep them at a distance. And in fact the other end to keep it very remote, thus confirming his beliefs and increasing his inner discomfort because there is a desire to share with others, but a kind of impossible to realize. You create that is, in this case, as in most of Personality Disorders, the vicious circles dysfunctional, characterized by the inability to realize its contribution to what is happening and that increasingly make your life problematic relationship.

When the personality traits of an individual are rigid and maladaptive and cause significant impairment or subjective distress, they constitute a Personality Disorder (DSM-IV-TR). Even though the subjects do not feel dissatisfied with their personality traits, their behavior is so disruptive or destructive for others to cause a degree of impairment in social and / or meaningful work (DSM-IV-TR, Case Studies). A personality disorder is a pattern of mental representation, inner experience and behavior that deviates markedly from the expectations of their culture, is pervasive and inflexible, begins in adolescence or early adulthood, and causes distress or impairment. It is a disorder rigid, stable over time, on which we build the organization's mental, affecting his balance. This constantly to think, act, feel and behave is manifested in at least two of the following areas:

- Cognition (ways of perceiving and interpreting self, others and events);

- Affectivity (range, intensity, and appropriateness of emotional response);

- Interpersonal functioning;

- Impulse control.

In the DSM-IV (Diagnostic Statistical Manual of Mental Disorders), they are described in three separate groups.

The first group (A) includes those disorders characterized by eccentric behavior and bizarre and they are:

• Paranoid personality disorder: the sufferer shows a persistent and unrealistic to interpret the intentions and actions of others as threatening or humiliating. It is usually perceived by others as argumentative, stubborn, defensive and not willing to compromise.

• Schizoid personality disorder: the main features of this disorder are the lack of interpersonal relationships and the lack of desire of these relationships. The others are considered as intrusive and not very rewarding and relationships as unstable and undesirable. As a result, these individuals are often described as detached, secluded and isolated.

• Schizotypal personality: main features, as well as social isolation, affection inappropriate and constricted and unusual behavior, the oddities of knowledge that revolve around themes such as the bizarre beliefs or magical thinking.

Group B describes those disorders characterized by strong emotion and unpredictability:

• Antisocial personality disorder that includes criminal acts dangerous to the safety of others and the lack of a sense of guilt for his gestures.

• Borderline personality disorder: the sufferer presents instability of mood, interpersonal relationships and self-image.

• Histrionic personality: it is characterized by excessive emotionality and attention seeking. The speech can be stretched to impress and lacking in detail and the behavior is often seductive and play.

• Narcissistic personality disorder: the sufferer feels unique, important and different from others, may require constant attention and admiration, is unable to recognize and feel the feelings of others and is hypersensitive to criticism.

Group C includes disorders characterized by anxiety and fear:

• Avoidant personality disorder: it is characterized by the avoidance of social situations fueled by cognitive issues such as self-deprecation, the expectation of interpersonal rejection and the belief that emotions and unpleasant thoughts are intolerable.

• Dependent personality disorder: the sufferer is strongly dependent on others, to which it delegates the decision making. Tends to be dominated by the fear of being abandoned and lacking in self-confidence.

No doubt, even today, the diagnostic classification of personality disorders offers considerable difficulties, so that is still valid observation, namely that the nosologic group is the Achilles' heel of psychiatry. Although the classifications proposed by DSM present themselves as a system-theoretical, well it is possible to detect that the distinctions it proposes for personality disorders are derived from different theoretical approaches as regards both the bases of the personality is compared to criteria specific nosological. According to Kernberg, because it Personality Disorders have different levels of severity and appear different from one another (the schizotypal is a more severe form of schizoid, the borderline is a more severe form of histrionic, the histrionic is a more severe form of ' hysterical, etc.. ), it is clear from the clinical point of view we need both categorical and dimensional approach. The other area of conflict concerns the conceptualization of Personality Disorders. There is a growing trend, says Kernberg, to conceptualize Personality Disorders as an entity within a neurobiological approach that can translate some neurobiological systems in psychological symptoms that reflect what's going on in the operation of the orbital cortex and prefrontal amygdala, etc.. This tendency to marry a vision neurobiological radical, is strongly influenced by the pharmacological, looking for characteristics that allow the treatment of the symptoms with drugs, and is supported by the need to find alternative treatments to psychological therapies in the long term, expensive both from the point economically and time. Of the 10 Personality Disorders in the DSM-IV committee in view of the preparation of the DSM 5, saved only 5 that have been the subject of empirical research in recent times. As there is, for example, significant research on paranoid disorder, it has been deleted from the diagnostic manual though an important clinical syndrome. It has been maintained schizotypal disorder, but the disorder schizoid, was held on BPD, but not the histrionic. With particular reference to Narcissistic Personality Disorder is observed depletion of the diagnostic criteria than the DSM IV disorder in the DSM 5 is characterized by deficits in the functioning of the self, identity problems, empathy and intimacy in addition to the grandeur and the need for attention. Among the important features of the disorder disappears psychopathology of envy, and the criterion of lack of intimacy does not account for the severe inability to depend on and establish relationships of these patients.

PARANOID PERSONALITY DISORDER (PPD)

General Characters

Paranoid Personality Disorder is basically characterized by the tendency, persistent and unjustified, to perceive and interpret the intentions, words and behaviors of others as malicious, degrading or threatening: the world is experienced as hostile and always looked in the most varied contexts with distrust and suspicion, with the consequent and compulsory choice of a solitary lifestyle. Distrust and suspiciousness lead people who suffer from this disorder have a hyper-vigilant attitude (seeking signs of threat, deceit and hidden meanings in the words and actions of others), to act in a cautious and wary, to appear cold and devoid of feelings . These subjects are also overly touchy, argumentative, stubborn and always ready to react when they think of being criticized or mistreated. The suspicion can be expressed by an open debate, recurrent complaints or hostile detachment. If individuals with paranoid personality disorder may seem cold and rational, show manifestations frequently hostile and stubborn. May join cults or groups with others who share their beliefs paranoid. The prevailing feeling, almost constant in people with Paranoid Personality Disorder, is that of threat, danger, aggression. This leads to a state of alertness and physical tension intense and unbearable. The paranoid traits may occur in a certain degree in a significant proportion of the normal population. Indications of a paranoid style are often quite subtle, paranoid characters may form a portion of the latent personality that emerges under stress.

While thinking paranoid is not in itself pathological and consists of dividing and project onto others feelings considered dangerous and unacceptable (i.e. splitting and projection), the paranoid personality disorder consists of a pervasive and rigid style feel, think and relate to others , which are constantly experienced as threatening, dangerous, engaged in conspiracies against him. Giving to others thoughts and feelings experienced as negative or dangerous, the person shall exercise his own self-esteem. All that is unpleasant is moved outside, which makes it easier to control: the individual is very involved in control operations on the environment that surrounds it. His thinking style is characterized by mistrust, suspicion, suspiciousness, search for hidden meanings in the behavior of others, often read as a behavior intended to cause him harm. Typically, people with this disorder have thoughts such as: You can never let your guard down!, Just relax you are ready to screw you. Sometimes the internal sensation takes on a different nuance, that of derision, and others, more than dangerous, they are perceived as derogatory or provocative. The emotional reaction and, therefore, the resulting behavior varies: when the conviction is being unfairly victims of a hostile world and humiliating prevail anger, resentment or irritation, and the tendency will be to respond by attacking and attacking, and when, instead, the feeling that you live is painful to be excluded, as they do not want, to be excluded from the group, will prevail anxiety, sadness, loneliness and fatigue, with the consequent tendency to isolate themselves, to withdraw from the world. Individuals with this disorder may also be insanely jealous and suspicious, with no real reason, that the spouse or partner is unfaithful. The thought of a person with a paranoid personality disorder is extremely rigid, their ideas and beliefs have no chance of being challenged. It goes without saying that social relations are to be anything but peaceful and satisfying: it can lead to a closure increasingly clear to others and others can get to them no longer tolerate the attitudes of the subject. In fact they are almost always friends or family members to propose contact with a professional who can plan an intervention. As already mentioned, the subject does not feel to have dysfunctional behaviors are others to be perceived as problematic. Exercise constant control over others is probably mirror of his own fear of being controlled and therefore limited in their autonomy: it betrays an 'important gap in self-esteem. These subjects are also two major difficulties that are mutually reinforcing. The first is the inability to stand in the other's perspective, to distinguish his own point of view from that of others, and the second is the difficulty to distinguish between the external (objective reality) and inner world (feelings and ideas): the pervasive sense of threat, for example, is never considered as a subjective experience, a fantasy or a hypothesis, but as a matter of absolute reality and reliable. Often people with this disorder feel that they have sufficient capacity to handle certain situations and then feel a sense of oppression by the outside world than their choices. Those who suffer from this disorder is, or often say they, too resentful or jealous and above all always suspicious, the who goes there. Others do not inspire confidence almost never. The person with paranoid disorder, in fact, think that under there is always a rip-off and expects to be damaged in any way, exploited and humiliated. Generally prefer to limit contact with others and tend to isolate themselves and to lead, albeit with suffering, a solitary lifestyle. Can alternate periods of prevailing anxiety and tension, periods angry and resentful or even feelings of depression and despondency, what is certain is that it does not lead a peaceful life, but still prevails a state of suffering and a general difficult to live well in the world with others. Some of these symptoms, however, are also found in other diseases (e.g. Paranoid disorder are often the symptoms of anxiety and / or depression that could indicate anxiety or mood disorder), so it is necessary to contact to professionals who can make a serious and accurate diagnosis. Distrust and suspiciousness lead the subject to have attitudes and behaviors that cause several problems. The mode of interaction often controlling, aggressive and suspicious, for example, does not encourage others to approach nice and friendly, but on the contrary, gives rise to other people their hostile behavior or away from the subject feared paranoid: in this way the person with this disorder is still the correctness of the paranoid life, with the result that the relationship will always be experienced with unpleasant moods (anxiety, anger, irritable mood, hostility). Over time, the Paranoid Personality Disorder can cause problems business, marital, relational and, in some cases, can lead to isolation, which reinforces and exacerbates the disorder itself, enough to lead to a deterioration of the relationship with reality. The paranoia or paranoid ideation is not limited to those disorders that have paranoia in the name. There are at least five mental constructs that contain paranoia in the DSM-IV ™: paranoid personality disorder, schizotypal personality disorder (with suspiciousness and paranoid ideation), borderline personality disorder (paranoid ideation with transient, stress-related); schizophrenia paranoid disorder and delusions of persecution. The symptoms of paranoia may also be associated with substance abuse, with abstinence these symptoms subside. It is proposed that the paranoia is seen as a continuum ranging from normal supervision to the potential threat to the paranoid behavior in the transitional and interpersonal suspiciousness (paranoid personality disorder) to a state of delirium until all paranoid schizophrenia. The paranoid personality disorder is distinct from psychosis due to the lack of delusions or hallucinations E 'was suggested to call personality disorder vigilante to make the variation of personality disorder disorders of paranoia more easily recognizable.

Diagnostic Criteria

The diagnostic criteria for Paranoid Personality Disorder according to DSM-IV-TR are as follows:

A. Pervasive distrust and suspiciousness toward others (so that their intentions are interpreted as malevolent), beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1) suspects, without sufficient basis, to be exploited, deceived or damaged

2) without justification doubts the loyalty or trustworthiness of friends or colleagues

3) is reluctant to confide in others because of unwarranted fear that the information could be used against him

4) sees hidden meanings humiliating or threatening in reprimands or other benevolent events

5) constantly brings resentment, that is, do not forgive insults, insults or offenses

6) perceives attacks on his role or reputation is not apparent to others and is quick to react angrily or to counterattack

7) suspected recurrent basis, without justification, the fidelity of spouse or sexual partner.

The ICD-10 (1994, p. 224-225) describes the paranoid personality disorder as characterized by:

• Excessive sensitivity to obstacles;

• unwillingness to forgive perceived insults;

• suspiciousness;

• tendency to distort experience by interpreting the neutral actions as hostile;

• suspicion of sexual infidelity by the partner and combative and tenacious adherence to personal rights.

There may also be an excessive importance of self and self-reference.

The rigidity of beliefs, which is found in individuals with PPD, isolates them from an environmental corrective feedback, they are subject to an increasing distortion of reality, hypersensitivity to interpret events and an inflated view of the self which results in battles raging with others who are baffled by the whole situation.

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

There are two types of paranoid personality united by the core belief that others are threatening, obstructing:

• Active: suspicious, hostile, easy to take offense, quarrelsome, jealous morbid levels (may commit acts of violence in response to imaginary injustice);

• Passive: The world is open to a position of submission and humiliation, it assumes that any event should happen to him will be harmful, not assertive, surrendered to an inevitable, unfortunate fate. (Sims, 1997)

In general, the paranoid disorder is characterized by fixed ideas that pervade all aspects of life, for which it is sought disconfirmation, but on the contrary, every circumstance is read in order to confirm the veracity of the ideas themselves. It differs from schizophrenia since there are no delusions, the reality is perceived correctly, what is distorted is the meaning that is given to the same.

It is important to explore issues that may have been crucial for the onset of the disorder: type of link object (the paranoia comes from a splitting and projection of negative feelings towards the object), representations of the internal mode in which they were lived stages of development with special attention to anal fixations where the predominant theme of control.

Interpersonal Relations

Individuals with paranoid personality disorder assume that others will exploit them, cause him harm or deceive them, they are troubled by doubts about the loyalty of others. They may feel that they were deeply and irreversibly injured by others even when there is little objective evidence that this is true. People are seen as devious, manipulative and treacherous, one must be careful not to be belittled, controlled or discriminated against. These individuals are consumed by their lack of confidence and anticipation of betrayal. They expect the worst from others and are, therefore, apprehensive, suspicious, uncompromising and controversial. They are on guard against a hostile world. When a friend or colleague shows loyal to individuals with PPD, I'm so surprised that they cannot believe it, if they get into trouble, they expect others to attack them or ignore them. These individuals often misinterpret compliments as a criticism or a hidden compulsion to do even better. May see an offer of help as an implication of the fact that they are not doing well enough alone (DSM-IV ™, 1994, p. 634). Kantor (1992, p. 113-119) suggests that individuals with PPD show six core beliefs (which necessarily affect the way they see themselves):

• The disaster is on the horizon (a continuing sense of foreboding)

• The world is full of enemies

• The cases are doubts, negative events are initiated by others with bad intent

• All events are related to the self

• Individuals with PPD are never to blame and they