Wk6_PD_ED_DD_13Feb25.pptx (1)

Overview of Today’s Lecture

• A quick look at ‘personality’ and its significance in understanding human behavior.

• An overview of personality disorders, including definitions and classifications.

• A comprehensive examination of the 10 personality disorders categorized into three clusters as defined by the DSM-5.

• Treatment considerations when working with individuals and families living with personality disorders, including therapeutic techniques and approaches.

• The stress response and its impact on individuals with personality disorders, including physiological and psychological aspects.

What is Personality?

Definition: Personality is a complex pattern of characteristics, largely outside of the person’s awareness. It encompasses individual differences in perceiving, feeling, thinking, coping, and behaving that remain consistent over time and across situations.

Formation: Personality emerges from a complex interaction of:

• Biological Dispositions: Genetic makeup and biological factors influencing personality traits.

• Psychological Experiences: Individual life experiences including trauma, education, and social interactions.

• Environmental Situations: Socio-cultural influences, family dynamics, and situational contexts integral to personality development.

Personality Dimensions

Five Dimensions of Personality:

1. Extraversion vs. Introversion: Energy directed outward toward social engagement versus inward toward solitary activities.

2. Antagonism vs. Adherence: The degree of cooperativeness and conformity in social situations.

3. Constraint vs. Impulsivity: Self-regulation and control versus spontaneity and impulsive actions.

4. Emotional Dysregulation vs. Emotional Stability: The ability to manage emotions versus heightened emotional responses.

5. Unconventionality vs. Closedness in Experience: Openness to new experiences versus preference for routine and tradition.

Personality Functioning

Definition: Refers to the degree to which a person has matured psychologically and how this maturity manifests in their adaptation to the environment.Demonstrated by:

• Self-control: Ability to regulate thoughts, feelings, and behaviors.

• Identity Integration: Coherence in self-concept and life history.

• Relational Capacities: Quality of interpersonal relationships and ability to empathize.

• Responsibility: Acknowledgment and acceptance of personal actions and their consequences.

• Social Concordance: Alignment of personal values and behaviors with societal norms.

Personality Disorders

Characteristics:

• Long-term, maladaptive, and often self-defeating behaviors affecting individual functioning.

• Fixed, enduring qualities are essential for diagnosis and manifest in various aspects of life.

• Challenges coping due to inflexibility and difficulties with interpersonal relationships and social/occupational functioning.

• Distinction: Differentiated from personality traits, which may be prominent but do not necessarily present as enduring or consistent across social and personal contexts.

Characteristics and Prevalence of Personality Disorders

Four Characteristics:

1. Maladaptive Cognitive Schema: Distorted beliefs that shape perceptions and responses.

2. Affectivity and Emotional Instability: Difficulty managing emotions leading to volatile reactions.

3. Impaired Self-Identity and Interpersonal Functioning: Confusion about self-concept and challenges forming healthy relationships.

4. Impulsivity and Destructive Behavior: Engaging in risky or harmful activities without considering consequences.

Prevalence:

• Lifetime prevalence of personality disorders ranges between 4-15%, with higher rates found in individuals with comorbid medical and psychiatric conditions as well as substance use disorders.

Comorbidity and Etiology

Comorbidity:

• Personality disorders often predispose individuals to develop additional mental health issues, such as depression, anxiety, substance use disorders, and eating disorders.

Etiology:

• Diathesis Stress Model: This model describes the interplay between genetic predisposition (diathesis) and environmental stressors that can trigger the manifestation of personality disorders.

Disorders of Personality

Ten Specific Disorders Grouped into Three Clusters:

• Cluster A: Unusual and eccentric thinking/behaviors:

  1. Paranoid Personality Disorder

  2. Schizoid Personality Disorder

  3. Schizotypal Personality Disorder

• Cluster B: Dramatic and erratic behaviors:4. Borderline Personality Disorder5. Antisocial Personality Disorder6. Narcissistic Personality Disorder7. Histrionic Personality Disorder

• Cluster C: Severe anxiety and fear:8. Avoidant Personality Disorder

Cluster A: Paranoid Personality Disorder

Case Example: Mr. A, an accountant, exhibits extreme suspiciousness of others.

• Distrust towards family, friends, and colleagues, leading to social isolation.

• Displays strong jealousy and holds persistent grudges against those he perceives as threats.

• Frequently expresses anger and resentment over perceived attacks to his reputation, affecting both personal and professional relationships.

Characteristics of Paranoid Personality Disorder

Key Traits:

• Heightened distrust of others and their intentions, often believing they wish to cause harm or deceive.

• Pervasive doubts about loyalty; tends to hesitate to confide feelings or thoughts in others.

• Perceives innocent remarks as personal attacks and is prone to holding long-lasting grudges against perceived wrongdoers.

Cluster A: Schizoid Personality Disorder

Characteristics:

• Marked difficulty expressing emotions, leading to emotional detachment and a solitary lifestyle.

• A strong preference for solitude, with little inclination toward forming social relationships or engaging socially.

• May exhibit delusional thought processes, and there is potential for the eventual onset of schizophrenia.

Case Example: Schizoid Personality Disorder

Mr. B: Engages in solitary activities, showing indifference to both criticism and praise.

• Experiences anxiety when compelled to engage with others, resulting in poor emotional responses and a generally robotic demeanor.

Cluster A: Schizotypal Personality Disorder

Key Characteristics:

• Exhibits unusual thinking, beliefs, and behaviors; may display a flat affect during interactions.

• Often experiences social anxiety and discomfort in forming close personal connections, leading to isolation and further withdrawal from social situations.

The Stress Response

Key Concepts

• General Adaptation Syndrome (GAS) (Selye):

  • Alarm Stage: Activation of the sympathetic nervous system.

  • Resistance Stage: Adaptation to ongoing stress.

  • Exhaustion Stage: Depletion of resources, leading to burnout.

• Types of Stress:

  • Distress: Negative stress that overwhelms coping abilities.

  • Eustress: Positive stress that motivates and enhances performance.

• Coping Mechanisms:

  • Adaptive: Cognitive reframing, meditation, exercise.

  • Maladaptive: Substance abuse, avoidance, aggression.

    Eating Disorders

• Anorexia Nervosa: Restriction of food intake, fear of gaining weight, distorted body image. Complications include severe malnutrition, osteoporosis, and cardiac issues.

• Types of Anorexia Nervosa: 

  1. Restricting Type: The individual restricts their food intake and engages in behaviors like excessive exercise to prevent weight gain. 

  2. Binge Eating and Purging Type: In this type, the individual engages in both binge eating (eating large amounts of food in a short period) and purging (through vomiting or excessive use of laxatives).

  Symptoms and Physical Signs: 

  ● Mental Symptoms: 

  ○ Depressive and obsessive-compulsive symptoms. 

  ○ Absence of at least three menstrual cycles (amenorrhea). 

  ● Physical Symptoms: 

  ○ Constipation, abdominal pain, cold intolerance, fatigue, emaciation, low blood pressure, body temperature and pulse rate. 

  ○ Dry skin, languo (fine body hair), dental erosion, and Russell’s Sign (scarring or calluses on the dorsum of the hands from self-induced vomiting). 

  Laboratory Findings: 

  ○ Leukopenia (low white blood cell count), anemia (low red blood cell count), increased liver function tests (LFTs), BUN (blood urea nitrogen), cholesterol, decreased estrogen, and electrolyte imbalances.

  Bulimia Nervosa: Binge eating followed by purging behaviors (vomiting, laxative use). Complications include electrolyte imbalances, esophageal tears, and dental erosion.

  • ● Characteristics: Cycle of binge eating and purging; non-purging behaviors like laxative, enema, and diuretic use.

    Non-Purging Behaviors: 

    ● Some individuals may avoid purging but use methods like fasting, excessive exercise, or other extreme dieting behaviors to compensate for overeating. 

    Weight: 

    ● Individuals with bulimia nervosa are often within a normal weight range but may fluctuate slightly above or below their ideal weight. Unlike anorexia nervosa, they are not underweight, which can sometimes make the disorder harder to detect. 

    Physical Signs and Symptoms: 

    ● Dental Issues: Loss of dental enamel, dental erosions, chipping, and cavities due to repeated vomiting. 

    ● Russell’s Sign: Calluses or scars on the back of the hands, often from self-induced vomiting. 

    ● Cardiac and Skeletal Anomalies: Due to the imbalance of electrolytes and other medical consequences of purging. 

    ● Menstrual Irregularities: Amenorrhea or irregular periods. 

    ● Esophageal Tears: Caused by frequent vomiting, leading to potential complications like aspiration pneumonia. 

    ● Fluid and Electrolyte Imbalances: Vomiting and laxative use can result in dangerous metabolic alkalosis, low potassium levels, and dehydration. 

    ● Increased Serum Amylase Levels: Elevated levels in blood due to repeated purging.

  • Binge Eating Disorder: Recurrent binge eating without compensatory purging, leading to obesity and associated health risks.

  • Characteristics: 

    ● People with BED may often be overweight or obese, though the disorder can affect individuals at various weights. 

    ● The behavior is accompanied by persistent overeating, often driven by emotional distress, boredom, or stress, leading to a cycle of binge eating followed by feelings of shame or guilt. 

    Medical Complications: 

    ● BED can lead to obesity and its associated medical complications, such as: ○ Type 2 diabetes 

    ○ Hypertension 

    ○ Hyperlipidemia (high cholesterol) 

    ○ Heart disease 

    ○ Gastrointestinal problems (e.g., acid reflux, bloating) 

• Treatment:

  • CBT and DBT to address dysfunctional thoughts and behaviors.

  • Nutritional rehabilitation for weight restoration and balanced eating.

  • Medication (SSRIs) may help reduce binge episodes and depressive symptoms.