PERSONALITY DISORDERS

ANAK AYU SRI WAHYUNI

PERSONALITY
GLOBAL DESCRIPTIVE LABEL FOR PERSON OBSERVABLE BEHAVIOR SUBJECTIVELY RESPONTABLE INNER EXPERIENCE DSM-IV TR, DEFINE PERSONALITY DISORDERS AS ENDURING SUBJECTIVE EXPERIENCE AND BEHAVIOR THAT DEVIATE FROM CULTURAL STANDARD, ARE RIGIDLY PERVASIVE.

Cont,s
Onset adolescence or early adulthood, are stable through time and lead to unhappiness and impairment. When personality traits are rigid and maladaptive and produce functional impairment or subject distress Personality disorders may be diagnose.

 Person with personality Disorders, far more likely refuse psychiatric help and deny their problems than person with anxiety, depressive and OCD. Personality disorders is aloplastic (able to adapt to and alter, the external environment) and ego-syntonic ( ie, acceptable to the ego)

 Person with personality disorders do not feel anxiety about their maladaptive behavior, because they do not routinely acknowledge pay from what others perceive as their symptoms. They often seem disinterested in treatment and impervious to recovery.

CLASSIFICATION
DSM IV-TR grouped into three clusters; Cluster A the paranoid, schizoid, schizotypal personality disorders person with these disorders are often perceived as odd and eccentric. Cluster B the antisocial, borderline, histrionic and narcissistic personality disorders person with these disorders often seem dramatic, emotional and erratic.

Cont,
Cluster C; The avoidant, obsessive compulsive and NOS( not otherwise specified) passive aggressive and depressive. Person with those disorders often seem anxious or fearful

 When the patient meets criteria for more then one personality disorder Should diagnose each. Many persons exhibit trait that are not limited to a single personality disorders Personality disorders are code on Axis 2 of DSM-IV-TR.

Etiology
Genetic factor Cluster A (paranoid, schizoid and schizotypal) > biological relative of patient with Schizophrenia. Cluster B (antisocial, borderline, histrionic and narcissistic associated with alcohol use disorders, more relatives with mood disorders. Histrionic personality disorders somatization disorders

Cont,
Cluster C, avoidant, dependent, obsessivecompulsive and NOS ask dependent high anxiety levels obsessive-compulsive monozygotic twins than dizygotic depressive, REM latency period, Abnormal DST (dexamethason suppression test) result

 Biological Factor Hormones exhibit impulsive 17-estradiol, strong Aggression, sexual behavior androgen Borderline Personality disorders DST results Platelet Monoamine Oxidize student low level social activities >>. Low level Platelet MAO Schizotypal disorders.

Cont,
Smooth pursuits eye movement, are saccadic (i.e. jumpy) introverted ~low self esteem and then to withdraw have schizotypal personality disorders. Neurotransmitters Endorphin analgesia and arousal High endogenous endorphin phlegmatic Dopaminergic dan seretonergic arousal activating function

Cont,
Metabolite serotonin 5- HIAA low ~ attempt suicide, impulsive and aggressive The effect neurotransmitter on personality traits have generated much interest and controversy about whether personality traits are inborn or acquired. Electrophysiology. Changes in electrical conductance on EEG antisocial and borderline, change appear slow wave activity

Psychoanalytic factors
S. Freud personality trait related to fixation at on Psychosocial stage of development. Example: Oral character passive and dependent ~ fixated at the oral stage. Wilhelm Reich character armor to describe person Reich Theory broad influence on contemporary concepts of personality and Personality disorders.

cont,
Human beings unique stamp of personality determined characteristic defense mechanisms axis II clusters help psychodynamic recognize type character pathology present Defenses controlling unpleasant affect work effectively ~ master feeling anxiety, depression, anger, shame, guilt, affect others. their behavior ego-synchronic ~ no distress for them, even thought it may adversely affect other

Defense Mechanism
Fantasy Schizoid Dissociation histrionic Isolation obsessive compulsive Projection sensitive to criticism Splitting ambivalence good and bad Passive aggression masochism Acting out tantrum, child abuse Projective identification borderline

Paranoid personality disorders

Suspects, without basis,exploiting, harming. Preoccupied, trust worthiness of friend Reluctant to confide in other Reads hidden demeaning Persistently bears grudges(unforgiving) Perceives attacks (quick to react agrily) Recurrent suspicions without justification(spouse/patner sex)

Schizoid Personality Disorder

Neither desires nor enjoys close relationship, including being part of family Almost always chooses solitary activities Has little, interest in having sexual with another person Takes pleasure in few, if any, activities Lack close friend Appears indifferent to the praise Show emotional coldness

Shizotypal Personality Disorder

Ideas of reference Odd beliefs or magical thinking behavior Unusual perceptual experiences bodily illusions Odd thinking and speech(circumstancial) Suspiciousness or paranoid ideation Inappropriate & constricted affect Behavior appearance odd, eccentric. Lack of close friend(first degree relatives) Excessive social anxiety (paranoid fear)

Antisocial personality disorder

Failure to conform to social norm respect lawful ground to arrest. Repeated lying, conning others for personal profit or pleasure Impulsivity or failure to plan ahead Irretabelity and aggresiveness by repeated physical fight or assaults Reckless disregards for safety of self or others, Man 3% :Women 1% can be found in prison Generally compares to sociopathy

Borderline personality disorder

Frantic efforts to avoid real A pattern of unstable Identity disturbance Impulsivity in at least two areas that are potentially Recurrent suicidal behavior Affective instability due to a mark reactivity of mood Chronic feelings of emptiness Inappropriate Transient, stress-related paranoid ideation

Histrionic Personality Disorders

Uncomfortable in situations(is not the center of attention) Interaction with other(sexually seductive, provoactive behavior) Display rapidly shifting Consistenly use Psysical app attention Style of speech that is excessively impressionistic and lacking in detail Shows self-dramatization Threatically Suggestible(easy influence by others) Considers relationship to be intimate

Narcissistic personality disorder

Grandiose sense of self-importance Preoccupied with fantasies Believes that he or she is special and unique Requires excessive admiration Sense of entitlement Interpersonally exploitative Lacks empathy Often envious of others Shows arrogant, naughty behaviors or attitudes

Avoidant personality disorder

Avoids occupational activities Unwilling to get involved Shows restraint Preoccupied with being criticized Inhibited in new interpersonal situations Views self as socially inept Unusually reluctant to take personal risks

Dependent personality disorder

Difficulty making everyday decisions Needs others to assume responsibility for most major areas of his/her life Difficulty expressing disagreement with others Difficulty initiating project Excessive lengths to obtain nurturance Feels uncomfortable Urgently seeks another relationship as a source of care Unrealistically preoccupied with fears

Obsessive-compulsive personality disorder

Preoccupied with details Shows perfectionism Excessively devoted Over conscientious Unable to discard worn-out Reluctant to delegate tasks Adopts a miserly spending style toward both self. Show rigidity and stubbornness

Personality disorder not otherwise specified

Passive aggressive Depressive; usual mood is dominated by dejection, unhappiness, joylessness, pesimisstic Sadomasochistic Psychological abusive; sadism or masochism com. Of both Sadistic not include in DSM-IV TR derive sexual arousal behavior. Paraphilia sexual sadism

Personality change due to a general medical condition

Head trauma Cerebrovascular diseases Cerebral tumors Epilepsy Huntingtons diseases Multiple sclerosis Endocrine disorders Heavy metal poisoning Neurosyphilis Acquired immune deficiency syndrome

Psychotherapy
Is treatment of choise for personality disorders. Ie ; Insight oriented therapy, group therapy, behavior therapy, cognitive behavior therapy. Countertransferance problems, often long and complex

Pharmacotherapy
Target symptom Domain of Personality disorders; Behavior dyscontrols Lithium, serotonergic drug, anticonvulsan, low dose antipsychotic Mood dysregulation serotonergic, antopsychotic Anxiety benzodiazepines, MAOIs, antipsychotic. Psychotic symptoms antipsychotic low dose