1. / 171 Common Psychiatric Problems in Family Practice Personality Disorders Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net

2. / 172 5-Axis model adopted in 1980 –Axis 1 Clinical disorders (e.g., mood & anxiety disorders) –Axis 2 Personality disorders (e.g., narcissism, antisocial) & mental retardation –Axis 3 Medical (physical) conditions influencing Axis 1 & 2 disorders –Axis 4 Psychosocial & environmental stress influencing Axis 1 & 2 disorders –Axis 5 Global Assessment of Functioning score: highest level of functioning patient has achieved in work, relationships, and activities DSM - IV

3. / 173 Personality - Usual Emotional + Behavioral Characteristics Personality Traits - Components of Personality Temperament - Affective Tone, Intensity, Reactivity Character - Moral + Personality Traits Definitions

4. / 174 Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive DSM IV Personality Disorders

5. / 175 Relation to Axis I 10% - 20% of General Population Gender : ♂ ASPD, Schizoid ♀ Avoidant, Dependent Etiological Theories –Dynamic –Biological / Genetic Characteristics of PD

6. / 176 Paranoid PD Pervasive Distrust + Suspiciousness, Interpret Motives as Evil 4 + of : –Suspicious –Feels attacked –Preoccupation with distrust –Jealous –Won’t confide –Grudges –Misinterprets motives

7. / 177 Schizoid PD Detached + Few Emotions 4 + of : –Eschew (avoids) closeness –No close friends –Solitary –Indifferent –No sex interest –Cold –Not enjoy activities

8. / 178 Discomfort with Relationships, Cognitive Distortions + Eccentric 5 + of : –Ideas of reference –Odd magical beliefs –Perceptual disturbances –Odd thoughts/speech –Paranoia –Inappropriate affect –Odd behavior/appearance –Loner –Anxious socially Schizotipal PD

9. / 179 Disregard Rights of Others (and meet Conduct Disorder) 3 + of : –Unlawful –Reckless –Deceitful –Irresponsible –Impulsive –Lack remorse –Aggressive Antisocial PD (ASPD)

10. / 1710 Unstable Relationships, Affect, Self-Image Plus Impulsiveness 5 + of : –Fears abandonment –Mood shifts –Unstable relationships –Feels empty –Changing self-Image –Anger –Impulsive sex, spending, etc –Temporary paranoia –Suicidal behavior Borderline PD

11. / 1711 Excessive Emotionality, Attention Seeking 5 + of : –Needs attention –Preens –Seductive –Dramatic –Mood shifts –Suggestible –Impressionistic, vague speech –Exaggerates relationships Histrionic PD

12. / 1712 Grandiose, Needs Admiration, Without Empathy 5 + of : –Self important –Exploitative –Fantasies of success –Lacks empathy –Feels special –Envious –Needs admiration –Arrogant –Entitled Narcistic PD

13. / 1713 Inhibited, Inadequate, Sensitive 4 + of : –Avoids social activity –Reluctant relationships –Fears intimacy –Fears criticism –Avoids new activities –Sees self inferior –Fears embarrassment Avoidant PD

14. / 1714 Needs to be Taken Care of, Fears Separation 5 + of : –Indecisive –Seeks nurturance –Avoids responsibility –Fears solitude –Avoids disagreements –Frantic for relationships –Lacks initiative –Fears abandonment Dependent PD

15. / 1715 Obsessive – Compulsive PD Orderliness, Perfectionist, Inflexible 4 + of : –Detail oriented –Unable to discard –Perfectionism –Can’t delegate –Work oriented –Miserly –Over conscientious –Rigid

16. / 1716 Passive – Aggressive PD Negative Attitudes with Passive Resistance to Demands 4 + of : –Passive –Envious, resentful –Misunderstood,unappreciated –Exaggerated complaints –Sullen, argumentative –Defiant then contrite –Scorns authority

17. / 1717 A. Odd or Eccentric Paranoid, Schizotypal, Schizoid B. Dramatic or Erratic Antisocial, Histrionic, Borderline, Narcistic C. Anxious Avoidant, Obsessive – Compulsive, Dependent Clusters