• Personality Disorders Etiology Symptoms Treatment and Prognosis

    Chronic, deeply ingrained, maladaptive, inflexible, recognizable traits or patterns of behavior whereby individual always behave in exaggerated, unusual or abnormal way, even in absence of stressful events.
    Personality is abnormal either in balance of its components, its quality of expression, or in its total aspect. This deviation has adverse effect upon individual, people associated with him, and on society.
    Individual with disordered personality may or may not experience discrete episodes of psychiatric illness. But they increase individual’s vulnerability to particular disease.

    ETIOLOGY
    Exact cause is not known.
    Predisposing causes:
    – Genetic contribution.
    – Influence of familial, social and cultural factors.
    – Body build, e.g.
    . Schizoid personality is common in leptosomes.
    . Cyclothymic personality is common in pyknic build.

    Age:
    Usually recognizable by adolescence or earlier.
    Usually run in families.


    PSYCHOPATHOLOGY
    Personality disorder occurs as a result of:
    – Difficulties in stages of psychological development.
    – Early childhood experiences.

    CLINICAL FEATURES OF DISORDERED PERSONALITY TYPES
    Type A Personality

    – This, in fact, is not a disordered personality.
    – Traits are exaggerations of characteristics recognized in normal subjects.

    Features include
    – Impatient.
    – Sense of urgency.
    – Aggressive.
    – Easily angered.
    – Competitive.
    – Exaggerated need for achievement.
    – Compares himself with others.
    – Fear of failure.
    – Attempts to control environment.
    – Does not like to be slowed down.
    – Anxiety prone.
    Prone to develop
    – Hypertension.
    – Coronary artery disease.
    – Peptic ulcer syndrome.
    Anxious Personality
    – Worrisome attitude towards life.
    – Worrying over trivial things.
    – Highly strung, irritable.
    – Apprehensive, fearful.
    – Panicky, tense, restless.
    – Constant anticipation of setback and stress.
    . Feeling of impending doom.
    . Self-doubting.
    – Prone to develop neurotic and psychosomatic disorders.
    Hypomanic Personality
    – Happy go lucky type.
    – Energetic, pleasure loving.
    – Witty, jovial, lively, cheerful.
    – Extrovert, outgoing, friendly, sociable.
    – Talkative; hypomanic woman is often a chatterbox.
    – Buoyant, confident, optimistic.
    – Unstable exhilarated reactions: Fleeting enthusiasms, Easily swayed by new impressions.
    – Judgement is often superficial.
    – Presents ready excuses for failures.
    – Cannot subordinate him.
    – Resents frustrations and disappointment.
    Aggressive Personality
    – Explosive type.
    – Sudden outbursts of irritability, anger.
    – Assertive, thrusting, demanding.
    – Tends to demand for their rights and fight for them.
    – Dominating; gets other people to do what he wants by frightening them.
    – Cold, humorless.
    – Treats people under his control (child, student, patient, prisoner) harshly.
    – Humiliates or demeans people in presence of others.
    – Excessive suspicion and mistrust of others.
    – Impulsive behavior and aggression, with mini mal provocation.
    – Aggression may be of: Verbal stirring up, Physical violence.
    – Homicide.
    – Suicide.
    Anankastic (Obsessive) Personality
    – Inflexible, rigid, perfectionist.
    – Sets for himself very high ethical standards, and is his own severest critic.
    – Conscientious, regular, punctual.
    – Excessive devotion to work to extent of exclusion of leisure and rest.
    – Meticulous, fastidious.
    – Wants everything neat and clean, and in order.
    – Needs to check everything repeatedly.
    – Indecisive, tendency to doubt.
    – Overcautious, self-doubting.
    – Persistent and unwelcome thoughts.
    – Restricted expressions of affection.
    – Lack of generosity in giving time, money, or gifts.
    – Unable to discard worthless or worn out items.
    – Unreasonable insistence to others to do things his way.
    Histrionic Personality
    – Inappropriate exaggerated display of emotions and behavior.
    – Emotions are vivid, shallow, unstable, characterized by vain.
    – Labile, emotionally capricious.
    – Prone to emotional outbursts.
    – Weeping and temper tantrums.
    – Exhibitionistic, dramatizing.
    – Demands attention.
    – Seductive concerned with physical attractiveness.
    – Egocentric, self-centered.
    – Manipulative gets others to do her bidding by indirect tactics.
    – Immature, highly suggestible behavior.
    – With family, behavior is regressive, childish, appears helpless.
    – Lying and deceitful behavior.
    – Untruthful, unreliable.
    – Speech excessively impressionistic, lacking in detail.
    – Prone to develop conversion reaction.
    Melancholic Personality
    – Depressed, sad, gloomy.
    – Feels little of the normal joy of living.
    – Pessimistic, submissive, self-depreciatory.
    – Feelings of inadequacy and hopelessness.
    – Inclined to be lonely and solemn.
    – Broods about misfortune, worries unduly.
    – Tends to suffer in silence.
    – Cries easily, usually not in presence of others.
    – Inherent feeling of insecurity.
    – Tendencies to hesitation, indecision, caution.
    – Easily discouraged under new conditions.
    – Fearful of disapproval.
    – Prone to develop endogenous depression.
    Cyclothymic Personality
    – Alternating, fluctuating moods.
    – Sudden oscillations of emotions.
    – Variable personality according to prevailing mood.
    – At one time, he is bright, gay and optimistic.
    – Then suddenly bursts into tears, and the out look is dismal, gloomy and grim; with pessimism.
    – But after a moment is as cheerful as ever.
    – Prone to develop manic depressive psychosis.
    Paranoid Personality
    – Pervasive and unwarranted suspiciousness of others.
    – Tendency to misinterpret friendly actions of others as hostile and contemptuous.
    – Extremely sensitive: Ordinary frustrations are taken personally, Very sensitive to criticism and humiliation, Bears grudges, and is unforgiving.
    – Exaggerate sense of own importance and personal rights.
    – Rigid, cold, humourless.
    – Unable to adjust with society.
    – Blames others for his failure.
    – Proneness to jealousy.
    – Aggressive.
    – During illness: Develops persecutory symptoms, Readily misinterprets medical advice, Becomes critical about treatment given.
    Schizoid (Schizothymic) Personality
    – Lack of spontaneity; appears dull, indifferent, and indolent.
    – Cold, lack of emotional warmth.
    – Quiet, doesn’t talk much.
    – Shy, timid, introvert, reserved.
    – Aloof, detached, callous.
    – Solitary interests and hobbies of eccentric nature.
    – Does not make intimate interpersonal contacts and friendships.
    – Philosophical, imaginative, idealistic.
    – Frail, sensitive individual: Feels lonely, imperfectly understood and isolated, Frequently feels hurted, Expects and detects disapproval and insult, Others are rarely admitted into their confidence.
    – In severe cases: Harsh realities and frustrating experiences of life become too painful, Retreats into world of fantasy, Neglect of personal appearance, family and home.
    Inadequate Personality
    – In spite of average educational and other opportunities, and of normal intelligence, he fails in emotional, economic, occupational and social adjustments.
    – Good-natured and easy-going, but inept, ineffective and unconcerned.
    – Judgment is defective.
    – Lacks ambition and initiative.
    – Lacks self-confidence.
    – Low self-esteem.
    – Lack of physical and emotional stamina.
    – Avoids activities that involve significant interpersonal contact.
    – Reserved in social situations because of fear of: Saying something inappropriate or foolish, Being unable to answer a question, Embarrassment by blushing, crying or showing signs of anxiety.
    – Hypersensitivity to rejection, apprehension and mistrust.
    – Avoids responsibility.
    – Lonely isolated.
    – Form very poor relations with others.
    – Frequent changes of job.
    – Lack of money.
    – Exaggeration of risks and dangers in everyday life.
    Passive – Dependent Personality
    – Lack of mature self-confidence and self-reliance.
    – Submissive, unduly compliant.
    – Falls passively with wishes of others.
    – Weak willed, indecisive.
    – Inability to function independently.
    – Difficulty in: Making decisions, Initiating projects, Coping with daily responsibilities.
    – Passively allows others to assume responsibility for major areas of life, e.g. where to live, what job to take.
    – Overwhelmed by feelings of helplessness.
    – Requires constant approval and reassurance from others.
    – Easily hurt by disapproval and criticism.
    – Agrees with people with whom he disagrees to avoid disturbing relationship, or for fear of being left alone.
    – When close relationship ends he feels devastated and abandoned.
    Passive — Aggressive Personality
    – Passive resistance: Deliberate inefficiency and stubbornness, Pretense of forgetfulness, hesitation.
    – Works poorly with others and causes demoralizing effect on group.
    – Procrastinates, i.e. Works slowly deliberately, or Does bad job.
    – Becomes sulky, irritable or argumentative when asked to do something he does not want to do.
    – Avoids obligations and suggestions from others regarding improving himself.
    – Unreasonably criticises or scorns people in positions of authority.
    Narcissistic Personality
    – Grandiose sense of self-importance.
    – Preoccupied with fantasies of unlimited success, power, beauty, and fame.
    – Exaggerates achievements and talents.
    – Expects to be noticed as ‘special’.
    – Requires constant attention and admiration.
    – Keeps fishing for admiration.
    – Reacts to criticism with feelings of rage, shame, or humiliation.
    – Selfish, feelings of envy.
    – Tends to exploit others for his needs.
    – Seeks favors, which he never returns.
    – Arrogant, haughty.
    – Lack of empathy.
    – Inability to recognize and experience how others feel.
    – Shows few warm feelings to others.

    Dissocial (Psychopathic) Person
    – Nonconformist to social norms with res” lawful behaviors.
    – Antisocial traits before age of i: Lying, Stealing, Frequent fighting, Cruelty to animals, Truancy from school, Running away from home, Substance abuse.
    – Cannot evolve and sustain stable and emotional relationship.
    – Self centered, greedy, extortionate: Appears charming, mature and sincere, but behavior is inconsistent with words, Does not follow through his promises or obligations, Deceives and defrauds others for personal profit or pleasure, Callous unconcern for feelings of others.
    – Lacks feelings of shame, guilt, remorse.
    – Marked tendency to blame others for behavior that brings patient into conflict with society.
    – Impulsive.
    – Wants instant results.
    – Vagrancy (wandering aimlessly).
    – Belligerency (hostile, rebellious, over-bearing attitude).
    – Delinquency (not observing ethical, social and cultural codes).
    – Chronic violation of rules.
    – Disruption and instability in multiple areas of life:

    Family:
    . Frequent fights with partner, even to physical assault.
    . Squanders money that should be spent on child.
    . Failure to sustain monogamous sexual relationship for prolonged period.
    . Frequent divorces.
    . Child abuse.

    Work:
    • Unstable work record.
    e Repeated episodes of absence from work.
    . Walking out of jobs without genuine cause.
    . Significant periods of unemployment.
    – Frequently drifts into alcoholism and drug addiction.
    – Disregard for own personal safety and safety of others: Drives while drunk or disqualified, Recurrent speeding offences.

    PROGNOSIS
    – Persistent.
    – Relatively unchanged throughout most of adult life.
    – Tends to become less disordered, as person grows older.
    – Problems of personal relationships tend to persist throughout life.
    – Resistant to attempts at modification.

    PREDOMINANT MIASM
    Type A personality: Psoro-sycotic traits.
    Anxious personality: Psoro-sycotic traits.
    Hypomanic personality: Psoro-sycotic traits.
    Aggressive personality: Psoro-sycotic traits.
    Arzankastic personality: Psoro-sycotic traits.
    Histrionic personality: Psoro-sycotic traits.
    Melancholic personality: Psoro-syphilitic traits.
    Cyclothymic personality: Psoro-sycotic traits.
    Paranoid personality: Sycotic traits.
    Schizoid personality: Psoric traits.
    Inadequate personality: Mixed miasmatic traits.
    Passive – dependent personality: Psoro-syphilitic traits.
    Passive — aggressive personality: Psoro-sycotic traits.
    Narcissistic personality: Sycotic traits.
    Dissocial personality: Sycotic traits.

    THERAPEUTIC AIM
    – Personality disorder is not illness, so concepts of ‘treatment’ and ‘recovery’ are simply irrelevant.
    – Aim should be to make acceptable changes in patient’s circumstances, so that he: Has less contact with situations that provoke difficulties, Gets more opportunity to develop assets in personality.

    GENERAL MANAGEMENT
    – Personality disorder is not so easy task to manage.
    – Even slightest effort to modify behavior in valves great deal of time and effort, if it succeeds at all.
    – However, family physician has tremendous role to perform in such situations.
    – Supervision and support are beneficial.
    – Role of psychotherapy is beneficial.

    HOMOEOPATHIC TREATMENT OF PERSONALITY DISORDER

    DRUGS HAVING VERY CLOSE SIMILARITY TO PERSONALITY TRAITS
    Type A personality: Arsenicum Album, Nux Vomica.
    Anxious personality: Argentum Nitricum, Gelsemium.
    Hypomanic Personality: Cannabis Indica, Hyoscyamus.
    Aggressive personality: Nux Vomica, Staphysagria.
    Anankastic Personality: Arsenicum Album, Sulphur.
    Histrionic Personality: Ignatia, Pulsatilla.
    Melancholic Personality: Aurum Metallicum, Natrium Muriaticum, Staphysagria.
    Cyclothymic personality: Cimicifuga, Ignatia, Pulsatilla.
    Paranoid Personality: Anacardium, Lachesis, Thuja Oc.
    Schizoid Personality: Sulphur.
    Inadequate Personality: Lycopodium.
    Passive — Dependent Personality: Lycopodium.
    Passive — Aggressive Personality: Staphysagria.
    Narcissistic Personality: Nux Vomica, Platina.
    Dissociai Personality: Thuja Oc.
    Borderline Personality: Nux Vomica, Pulsatilla, Staphysagria, Thuja Oc.

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    Categories: Mind

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    2 thoughts on “Personality Disorders Etiology Symptoms Treatment and Prognosis

    • Ade says:

      IMHO Manic Depression (as I prefer to call it) is an exmrete form of mental illness after schizophrenia it is quite possibly the most exmrete form of mental illness. To me, the term disorder fits into a far larger context of politically correct speech which waters things down to make them less offensive and scary. The genetic component of bipolar disorder closes the debate for me. Ironically, I do not feel the same way about alcoholism, which I regard as a personality disorder. In AA people like to call alcoholism a disease, it makes it easier for them to forgive themselves, which is essential. But to me, alcoholism is no more a disease than gambling addiction is.

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