CHAPTER 7 Personality and personality disorder Zhong-Lin Tan Ph.D. M.M. Hangzhou Mental Health Center Department of psychiatry, School of Medicine Hangzhou Normal University

2 Aim Grasp the definitions of personality traits and disorders features to all personality disorders Be familiar with the psychotherapeutic and pharmacologic treatment strategies for patients with personality disorder Reference book: Gelder M, Harrison P, Cowen P. Shorter oxford textbook of psychiatry. Fifth Edition. Oxford: Oxford University Press, 2006

3 Personality

4 Personality What is personality? What is personality? Personality refers to enduring qualities of an individual that are shown in his ways of behaving in a wide variety of circumstances. Personality refers to enduring qualities of an individual that are shown in his ways of behaving in a wide variety of circumstances. Mental disorder: differ from previous behaviour. Mental disorder: differ from previous behaviour.

5 The importance of personality Personality as predispostion Personality as predispostion Personality as pathoplastic factor Personality as pathoplastic factor Personality in relation to treatment Personality in relation to treatment

6 Personality types Sociable and outgoing type vs. solitary and self- conscious type Sociable and outgoing type vs. solitary and self- conscious type Extraversion-introversion and neuroticism (Eysenck) Extraversion-introversion and neuroticism (Eysenck) Fives factors: Openness to experience; Conscientiousness, Extraversion-introversion, Agreeableness, Neuroticism(OCEAN) Fives factors: Openness to experience; Conscientiousness, Extraversion-introversion, Agreeableness, Neuroticism(OCEAN) Clinicians: positive attributes vs. negative attributes Clinicians: positive attributes vs. negative attributes

7 The origins of personality Genetic influences Genetic influences Childhood temperament Childhood temperament –Young infants differ in patterns of sleeping and waking, approach or withdrawal from new situations,intensity of emotional responses, and span of attention. Childhood experience Childhood experience

8 The assessment of personality Personality tests are more reliable in healthy people. Personality tests are more reliable in healthy people. Useful in research, seldom used in clinical practice. Useful in research, seldom used in clinical practice. The current behaviour of an ill person reflects the effects of the illness as well as the personality. The current behaviour of an ill person reflects the effects of the illness as well as the personality.

9 Personality disorder

10 1 The concept of abnormal personality Statistical criterion: such as intelligence Statistical criterion: such as intelligence Social criterion: cause individual suffer or cause suffering to others Social criterion: cause individual suffer or cause suffering to others Personality change Personality change –Due to organic disease of the brain –After psychiatric disorder –After a catastrophic experience

11 2 How ideas bout abnormal personality developed? Koch(1891) used the term psychopathic inferiority to denote this group of people who have marked abnormalities of behaviour in the absence of mental illness or intellectual impairment. Koch(1891) used the term psychopathic inferiority to denote this group of people who have marked abnormalities of behaviour in the absence of mental illness or intellectual impairment. Later the word inferiority was replaced by pesonality to avoid judgemental overtones. Later the word inferiority was replaced by pesonality to avoid judgemental overtones.

12 3 The classification of abnormal personalities Continuous vs. categories Continuous vs. categories Cut-off points – distress to the persons or others — arbitrary and inprecise Cut-off points – distress to the persons or others — arbitrary and inprecise Comorbidity: more than one peraonality diagnosis can be made in a single patient Comorbidity: more than one peraonality diagnosis can be made in a single patient Classification Classification

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14 4 Descriptions and diagnostic criteria Cluster A personality disorders Cluster A personality disorders

15 Cluster B personality disorder Cluster B personality disorder

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17 Cluster C personality disorder Cluster C personality disorder

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19 5 Epidemilolgy

20 6 Aetiology Genetic causes Genetic causes Early life experiences Early life experiences

21 7 The prognosis of personality disorder Personality disorders are defined as lifelong conditions, so little change would be expected with time. There is little reliable evidence about their outcome. Personality disorders are defined as lifelong conditions, so little change would be expected with time. There is little reliable evidence about their outcome.

22 8 Treatment(1) important points Comorbidity Comorbidity Treatment and follow-up Treatment and follow-up Collaboration and drop out Collaboration and drop out Outcome measures Outcome measures

23 Treatment(2) Drug treatments Drug treatments Psychological treatments Psychological treatments

24 9 The management of personality disorders Assessment Assessment General aims: conflicts less with their character General aims: conflicts less with their character Overall plan Overall plan Choice of psychotherapy Choice of psychotherapy Choice of medication Choice of medication Organization of services Organization of services progress progress

25 The management of specific personality disorders

26 Small-group therapy Small-group therapy Therapeutic communities Therapeutic communities Other group regimens Other group regimens Antisocial personality disorder

27 Dynamic psychotherapy Dynamic psychotherapy Group psychotherapy Group psychotherapy Dialectical behaviour therapy Dialectical behaviour therapy Psychoanalytically oriented day treatment Psychoanalytically oriented day treatment Borderline personality disorder