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CoCommon Psychiatric Problemsmmon Psychiatric Problemsin Family Practice in Family Practice

Personality DisordersPersonality Disorders

Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine

Dr. Zekeriya Aktürkzekeriya.akturk@gmail.com

www.aile.net

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• 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

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• Personality - Usual Emotional + Behavioral Characteristics

• Personality Traits - Components of Personality

• Temperament - Affective Tone, Intensity, Reactivity

• Character - Moral + Personality Traits

Definitions

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• Paranoid

• Schizoid

• Schizotypal

• Antisocial

• Borderline

• Histrionic

• Narcissistic

• Avoidant

• Dependent

• Obsessive-Compulsive

DSM IV Personality Disorders

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• Relation to Axis I

• 10% - 20% of General Population

• Gender : ♂ ASPD, Schizoid♀ Avoidant, Dependent

• Etiological Theories

– Dynamic

– Biological / Genetic

Characteristics of PD

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Paranoid PD

• Pervasive Distrust + Suspiciousness, Interpret Motives as Evil

• 4 + of :– Suspicious– Feels attacked– Preoccupation with distrust– Jealous– Won’t confide– Grudges– Misinterprets motives

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Schizoid PD

• Detached + Few Emotions• 4 + of :

– Eschew (avoids) closeness– No close friends– Solitary– Indifferent– No sex interest– Cold– Not enjoy activities

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• 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

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• Disregard Rights of Others (and meet Conduct Disorder)

• 3 + of :– Unlawful– Reckless– Deceitful– Irresponsible– Impulsive– Lack remorse– Aggressive

Antisocial PD (ASPD)

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• 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

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• Excessive Emotionality, Attention Seeking• 5 + of :

– Needs attention

– Preens

– Seductive

– Dramatic

– Mood shifts

– Suggestible

– Impressionistic, vague speech

– Exaggerates relationships

Histrionic PD

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• Grandiose, Needs Admiration, Without Empathy• 5 + of :

– Self important– Exploitative– Fantasies of success– Lacks empathy– Feels special– Envious– Needs admiration– Arrogant– Entitled

Narcistic PD

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• Inhibited, Inadequate, Sensitive• 4 + of :

– Avoids social activity– Reluctant relationships– Fears intimacy– Fears criticism– Avoids new activities– Sees self inferior– Fears embarrassment

Avoidant PD

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• 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

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Obsessive – Compulsive PD

• Orderliness, Perfectionist, Inflexible• 4 + of :

– Detail oriented– Unable to discard– Perfectionism– Can’t delegate– Work oriented– Miserly– Over conscientious– Rigid

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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

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A. Odd or EccentricParanoid, Schizotypal, Schizoid

B. Dramatic or ErraticAntisocial, Histrionic, Borderline, Narcistic

C. AnxiousAvoidant, Obsessive – Compulsive, Dependent

Clusters