Personality Disorders

Transcription

1 Personality s The Good, the Bad and the Really, Really Ugly: Borderline and other Cluster B Personality s BY CHRIS OKIISHI, MD! Long standing! Often life long! Developmental origins! Genetic origins! Resistant to change! Difficult to treat! Colors a person s entire perspective! Really more of a world view Personality s Personality s! Must affect the following:! self (identity or self-direction) and interpersonal (empathy or intimacy) functioning! Inflexible across a broad range of experiences! Not due to substance abuse or another mental illness alone! Cluster A! Unusual, odd, eccentric, weird! Almost psychotic, but not quite! Cluster B! Dramatic, moody, in-your-face, destructive! Cluster C! Avoidant, shy, anxious, inhibited, removed 1

2 The Cluster B Personality s! Histrionic! Narcissistic! Borderline! Antisocial Histrionic Personality! Uncomfortable if not the center of attention! Inappropriately sexual or provocative! Rapid, shallow shifts of emotion! Uses physicality to attract attention! Impressionistic, low-detail speech pattern! Theatrical, high drama form of expression! Easily suggestible! Over interprets strength of relationships Histrionic Personality! 2-3 % of general population! 10-15% of mentally ill population! More often diagnosed in women, but may be likely equally prevalent! Tend to court the victim or princess role! Highly dislike delayed gratification Narcissistic Personality! Grandiose sense of self-importance! Fantasies of unlimited success! Believes self to be special and should only associate with other special people! Requires excessive admiration! Strong sense of entitlement! Exploitative! Lacks empathy! Envious of others and thinks others are similarly envious of self! Arrogant, haughty in behavior and attitude 2

3 Narcissistic Personality! 1% of general population! 2-16% of mentally ill population! 50-70% male! Seems to exist to cover a supremely low self esteem! Easily injured! Can become violent if challenged Borderline Personality! Frantic efforts to avoid real or imagined abandonment! Unstable and intense relationships! Poor sense of self! Impulsively self-destructive! Frequent suicidal gestures, threats or selfmutilation! Mood instability! Chronic feelings of emptiness! Inappropriate, intense anger! Stress-related paranoid ideation or severe dissociative symptoms Borderline Personality! 2% of general population! 30-60% of mentally ill population! 75% of those diagnosed are female! Also known as Emotional Intensity! Strong family component! Higher risk of substance abuse, mood disorders, Antisocial PD What is Bipolar?! Criteria according to DSM IV for Manic Episode! Elevated mood and DIGS FAST! Distractibility! Irritability! Grandiosity! Sleep! Flight of ideas (racing thoughts)! Activity (hyper)! Spending, sex and stupid stuff! Talkitivity (hyper) 3

4 What is Bipolar?! Additional criteria! Must last 1 week! Must be a distinct change from baseline! Must be impairing! Must NOT be due to a medical condition (hyperthyroid, HIV) or drug use/abuse (steroids, stimulants, ecstasy)! Do NOT need a history of depressive episode! Though most do have them Antisocial Personality! Failure to follow laws and rules! Deceitful! Impulsive, poor advance planning! Chronically irritable, aggressive multiple physical fights! Reckless disregard for safety of self or others! Chronic irresponsibility! Lack of remorse Antisocial Personality! 3% in males, 1% in females in general population! 3-30% of mentally ill population! Less evident as a person gets older-- Burning out! Both adopted and biologic children of antisocial parents are more likely to have ASPD, and also Somatization, Substance abuse disorders! Adopted away children still at high risk Treatment of Personality s! Establish clear boundaries! Do not cross! Ever! Ever! Ever!! Keep your role clear! Avoid personal involvement! Including taking things personally! Remind self and patient of treatment goals 4

5 Treatment of Personality s! Medications! Symptom management only! Depression! Serotonin meds in particular! Impulse control! Hard to overdose! Anti-psychotics! Anti-seizure meds! Anger, aggression, self-harm! Anti-psychotics! Anti-seizure meds 5