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A brief psychiatry 101 Tim Wallace 444 Kb 11/01/2006
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"a brief psychiatry 101"
--
11/01/2006, Tim Wallace

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A brief psychiatry 101

Personality disorders

Pervasive, inflexible, and stable personality traits that deviate from cultural norms and cause distress or functional impairment.

Personality traits are patterns of thinking, perceiving, reacting and relating that are relatively stable over time and in various situations.
Personality disorders occur when these traits are so rigid and maladaptive that they impair interpersonal or vocational functioning.
Personality traits and their potential maladaptive significance are usually evident from early adulthood and persist throughout much of life.
Mental coping mechanisms (defences) are used unconsciously at times by everyone.
But in persons with personality disorders, coping mechanisms tend to be immature and maladaptive.
Repetitious confrontation in prolonged psychotherapy or by peer encounters is usually required to make such persons aware of these mechanisms.
Without environmental frustration, persons with personality disorders may or may not be dissatisfied with themselves. They may seek help because of symptoms (eg, anxiety, depression) or maladaptive behaviour (eg, substance abuse, vengefulness) that results from their personality disorder.
Often they do not see a need for therapy and they are referred by their peers, their families, or a social agency because their maladaptive behaviour causes difficulties for others.
Because these patients usually view their difficulties as discrete and outside of themselves, mental health professionals have difficulty getting them to see that the problem is really based on who they are.
Persons with severe personality disorders are at high risk of hypochondriasis, alcohol or drug abuse and violent or self-destructive behaviours.
They may have inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, leading to medical and psychiatric problems for their children.
Persons with a personality disorder are less likely to comply with a prescribed treatment regimen.
Even when they do, their symptoms--whether psychotic, depressive, or anxious--are far less responsive to drugs. Persons with personality disorders are often very frustrating to those around them, including physicians--who have to deal with their unrealistic fears, excessive demands, sense of entitlement, unpaid bills, noncompliance and angry vilification.
Such persons can also cause stress for other patients who are exposed to their dramatic or demanding behaviours.

DIAGNOSIS AND CLASSIFICATION

Diagnosis is based on observing repetitive patterns of behaviour or perception that cause distress and impair social functioning, even when the patient lacks insight about these patterns and despite the fact that the patient often resists change.
The DSM-IV divides personality disorders into three clusters: A) odd/eccentric, B) dramatic/erratic, and C) anxious/inhibited.

CLUSTER A PARANOID PERSONALITY:

Persons with this personality disorder are generally cold and distant in interpersonal relationships or are controlling and jealous if they become attached.
They tend to react with suspicion to changes in situations and to find hostile and malevolent motives behind other people's trivial, innocent or even positive acts.
Often these hostile motives represent projections of their own hostilities onto others.
When they believe they have confirmed their suspicions, they sometimes react in ways that surprise or scare others. They then use the resulting anger of or rejection by others (ie, projective identification) to justify their original feelings. Paranoid persons tend to take legal action against others, especially when they feel a sense of righteous indignation. However, they cannot see their role in a conflict.
In their occupations, these persons may be highly efficient and conscientious, although they usually need to work in relative isolation.
Paranoid tendencies may develop among persons who feel particularly alienated because of a defect or handicap.
For example, a person with chronic deafness may mistakenly think he is being talked about or laughed at.

SCHIZOID PERSONALITY:

Persons with this personality disorder are introverted, withdrawn, solitary, emotionally cold and distant.
They are most often absorbed in their own thoughts and feelings and fear closeness and intimacy with others.
They are reticent, are given to daydreaming and prefer theoretic speculation to practical action.

SCHIZOTYPAL PERSONALITY:

Like schizoid persons, persons with this personality disorder are socially isolated and emotionally detached but in addition, they express oddities of thinking, perception and communication, such as magical thinking, clairvoyance, ideas of reference or paranoid ideation.
These oddities suggest schizophrenia but are never severe enough to meet its criteria.
Nonetheless, persons with this personality disorder are believed to have a muted phenotypic expression (spectrum variant) of the genes that cause schizophrenia.

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