Personality

Personality disorders and Dissociative disorders

20th dec 2015 monday

Individuals with personality disorders (PDs) show chronic, lifelong, rigid, unsuitable patterns of relating to others that cause social and occupational difficulties (e.g., few friends, job loss).
Persons with PDs generally are not aware that they are the cause of their own problems (do not have “insight”), do not have frank psychotic symptoms, and do not seek psychiatric help.

DSM classificaiton

clusters: A (paranoid, schizoid, schizotypal);
B (histrionic, narcissistic, borderline, and antisocial); and
C (avoidant, obsessive-compulsive, and dependent); and not otherwise specified (NOS) (passive-aggressive).

a PD must be present by early adulthood. Antisocial PD cannot be diagnosed until the age of 18; prior to this age, the diagnosis is conduct disorder

Cluster A (family hx of psychosis)

Cluster B (family: mood disorders, substance abuse, somatoform disorders)

Borderline

Cluster C (family hx. Anxiety)

Management

1. For those who seek help, individual and group psychotherapy may be useful.
2. Pharmacotherapy also can be used to manage symptoms such as depression and anxiety, that may be associated with the PDs.

Dissociative disorders

The dissociative disorders are characterized by abrupt but temporary loss of memory (amnesia) or identity, or by feelings of detachment owing to psychological factors.

In contrast to the cognitive disorders in which memory loss is caused by biological brain dysfunction (see Section I), dissociative disorders are related to disturbing emotional experiences in the patient’s recent or remote past.

Classification

Amnesia
Fugue
Identity
Depersonalization
NOS

Diss. Amnesia

Failure to remember important information about oneself after a stressful life event Amnesia usually resolves in minutes or days but may last years


Diss. Fugue
Amnesia combined with sudden wandering from home after a stressful life event Adoption of a different identity

Diss. Identity dis.

At least two distinct personalities (“alters”) in an individual
More common in women (particularly those sexually abused in childhood)
In a forensic (e.g., jail) setting, malingering and alcohol abuse must be considered and excluded

Depersonalization dis.

Recurrent, persistent feelings of detachment from one’s own body, the social situation, or the environment (derealization) when stressed
Understanding that these perceptions are only feelings, i.e., normal reality testing

Diss. NOS

Dissociative symptom (e.g., trance-like state, memory loss) (1) in persons exposed to intense coercive persuasion (e.g., brainwashing) or (2) indigenous to particular locations or cultures (e.g., “Amok” in Indonesia)

Management of the dissociative disorders includes hypnosis and drug-assisted interviews as well as long-term psychoanalytically oriented psychotherapy to recover “lost” (repressed) memories of disturbing emotional experiences.

Quizz

1. Which of the following PD have more prevalence of schizophrenia in family hx
• Schizotypal PD
• Multiple identity disorder
• Narcisstic PD
• Avoidant PD
• All of the above


2. Which of the following PD have self-mutilation in their clinical features
• Schizotypal
• Avoidant
• Schizoid
• borderline
• Paranaoid