Antisocial personality disorder (APD)
Antisocial personality disorder (APD) is a personality disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, the handbook used to diagnose mental disorders most frequently. APD is generally considered to be the same as, or similar to, the disorder that was previously known as psychopathic or sociopathic personality disorder.
Antisocial personality disorder (APD) is a personality disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, the handbook used to diagnose mental disorders most frequently. APD is generally considered to be the same as, or similar to, the disorder that was previously known as psychopathic or sociopathic personality disorder.
It is characterized by a number of symptoms:
· Failure to conform to social norms or lawful behaviors
· Deceitfulness, as indicated by repeated lying, or conning others for personal profit or pleasure
· Irresponsibility, impulsivity or failure to plan ahead
· Irritability and aggression, as indicated by repeated physical fights or assaults
· Reckless disregard for safety of self or others
· Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
Some research has shown that individuals with APD are indifferent to the threat of physical pain, and show no indications of fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy for the suffering of others. Although criminal activity is not a necessary requirement for the diagnosis, these individuals often encounter legal difficulties due to their disregard for societal standards and the rights of others. Therefore, many of these individuals can be found in prisons. However, it should be noted that criminal activity does not automatically warrant a diagnosis of APD.
Nor, necessarily, does APD imply that a person is necessarily exhibiting visible criminal behavior. It is hypothesized that many high achievers exhibit APD characteristics. The recent, controversial science of sociobiology attempts to explain animal and human behavior and social structures, largely in terms of evolutionarily stable strategies. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.
The DSM-IV estimates that 3% of men and 1% of women have some form of antisocial personality disorder.
Avoidant personality disorder
Avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation. People with avoidant personality disorder consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed or humiliated.
Research suggests that people with avoidant personality disorder, in common with social phobics, excessively monitor their own internal reactions when they are involved in social interaction. However, unlike social phobics they also excessively monitor the reactions of the people with whom they are interacting. The extreme tension created by this monitoring may account for the hesitant speech and taciturnity of many people with avoidant personality disorder – they are so preoccupied with monitoring themselves and others that producing fluent speech is difficult. Avoidant personality disorder usually is first noticed in early adulthood, and is associated with rejection during childhood by parents and peers. Whether the rejection is due to the extreme interpersonal monitoring attributed to people with the disorder is still an open question.
Borderline personality disorder (BPD)
In psychiatry, borderline personality disorder (BPD) is a personality disorder characterised by extreme 'black and white' thinking, mood swings, disrupted relationships and difficulty in functioning in a way society accepts as normal.
Psychiatrists describe borderline personality disorder as a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depression), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicidal intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.
Symptoms
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury including cutting, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthlessness. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury including cutting, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthlessness. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
Treatment
Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. In 1991, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.
Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. In 1991, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.
Recent research findings
Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.
National Institute of Mental Health-funded neuroscience research is revealing brain mechanisms underlying the impulsively, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.
Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.
National Institute of Mental Health-funded neuroscience research is revealing brain mechanisms underlying the impulsively, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.
Future progress
Studies that translate basic findings about the neural basis of temperament, mood regulation and cognition into clinically relevant insights?which bear directly on BPD?represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.
Effects on family members
An interesting area of research relating to BPD is the study of the effects of the disorder on other family members and significant others in the lives of those with traits of borderline personality disorder. These people refer to themselves as NonBPs. Living with someone with BPD traits is often disorienting and difficult. NonBPs require support from the mental health community as they help those with the disorder while maintaining strength in their own view of reality.
An interesting area of research relating to BPD is the study of the effects of the disorder on other family members and significant others in the lives of those with traits of borderline personality disorder. These people refer to themselves as NonBPs. Living with someone with BPD traits is often disorienting and difficult. NonBPs require support from the mental health community as they help those with the disorder while maintaining strength in their own view of reality.
Dependent personality disorder
Dependent personality disorder is difficult to diagnose due to the other personality traits which cross over or interfere with the diagnosis. There is a general inability to make decisions and a difficult time in performing activities due to lack of self esteem. These people live a frustrated life in which they can not express their feelings due to the need for acceptance from their peers.
Over time relationships with these people tend to deteriorate. The constant neediness and dependency at some point will never be able to be filled. The analogy of a deep hole that a person continues to pour dirt into but that can never be completely filled describes the emotional investment a person has in relationships with these people. This occurs to the point that the lives of the people around the dependent personality are consumed only to the point they are willing to let it consume them. When the break occurs the dependent persons life has in turn become the life of the other person. The dependent person has difficulty in letting the relationship go. The dynamic of the relationship is one where in a dysfunctional way the two lives become one. The dependent person does not understand why the supportive persons are leaving them and always feel as if they did something wrong and if that could be changed that everything will get better.
The reality is that everyone (other than controlling persons) can only invest a certain amount into someone else until it begins to consume them. And when they leave the relationship it creates a vacuum because the dependent person suffers the loss of the relationship and the loss of what they became. This only increases the feelings of failure over and over. It is not unusual that in the times of desperation the dependent person will threaten suicide or break all ties with their support system in reaction to the failed relationship.
Dependent personality disorder is difficult to diagnose due to the other personality traits which cross over or interfere with the diagnosis. There is a general inability to make decisions and a difficult time in performing activities due to lack of self esteem. These people live a frustrated life in which they can not express their feelings due to the need for acceptance from their peers.
Over time relationships with these people tend to deteriorate. The constant neediness and dependency at some point will never be able to be filled. The analogy of a deep hole that a person continues to pour dirt into but that can never be completely filled describes the emotional investment a person has in relationships with these people. This occurs to the point that the lives of the people around the dependent personality are consumed only to the point they are willing to let it consume them. When the break occurs the dependent persons life has in turn become the life of the other person. The dependent person has difficulty in letting the relationship go. The dynamic of the relationship is one where in a dysfunctional way the two lives become one. The dependent person does not understand why the supportive persons are leaving them and always feel as if they did something wrong and if that could be changed that everything will get better.
The reality is that everyone (other than controlling persons) can only invest a certain amount into someone else until it begins to consume them. And when they leave the relationship it creates a vacuum because the dependent person suffers the loss of the relationship and the loss of what they became. This only increases the feelings of failure over and over. It is not unusual that in the times of desperation the dependent person will threaten suicide or break all ties with their support system in reaction to the failed relationship.
Histrionic personality
In psychiatry, histrionic personality disorder is a personality disorder which involves a pattern of excessive emotional expression and attention-seeking, including an excessive need for approval and inappropriate seductiveness, that usually begins in early adulthood. The essential feature of the histrionic personality disorder is a pervasive and excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.
The cause of this disorder is unknown, but childhood events and genetics may both be involved. It occurs more frequently in women than in men, although some feel it is simply more often diagnosed in women because attention-seeking and sexual forwardness is less socially acceptable for women. People with this disorder are usually able to function at a high level and can be successful socially and at work. They may seek treatment for depression when romantic relationships end. They often fail to see their own situation realistically, instead tending to overdramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others.
In psychiatry, histrionic personality disorder is a personality disorder which involves a pattern of excessive emotional expression and attention-seeking, including an excessive need for approval and inappropriate seductiveness, that usually begins in early adulthood. The essential feature of the histrionic personality disorder is a pervasive and excessive pattern of emotionality and attention-seeking behavior. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.
The cause of this disorder is unknown, but childhood events and genetics may both be involved. It occurs more frequently in women than in men, although some feel it is simply more often diagnosed in women because attention-seeking and sexual forwardness is less socially acceptable for women. People with this disorder are usually able to function at a high level and can be successful socially and at work. They may seek treatment for depression when romantic relationships end. They often fail to see their own situation realistically, instead tending to overdramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others.
Symptoms
The symptoms include:
· Constant seeking of reassurance or approval
· Excessive dramatics with exaggerated displays of emotions
· Excessive sensitivity to criticism or disapproval
· Inappropriately seductive appearance or behavior
· Excessive concern with physical appearance
· A need to be the center of attention (self-centeredness)
· Low tolerance for frustration or delayed gratification
· Rapidly shifting emotional states that may appear shallow to others
· Opinions are easily influenced by other people, but difficult to back up with details.
· Tendency to believe that relationships are more intimate than they actually are.
Diagnosis
The person's appearance, behavior, and history, and a psychological evaluation are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed.
Treatment
Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with complications such as depression. Psychotherapy may also be of benefit. Histrionic personality disorder does not usually affect the person's ability to function adequately in a superficial work or social environment. However, problems often arise in more intimate relationships, where deeper involvements are required. Histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.
Diagnosis
The person's appearance, behavior, and history, and a psychological evaluation are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed.
The person's appearance, behavior, and history, and a psychological evaluation are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed.
Treatment
Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with complications such as depression. Psychotherapy may also be of benefit. Histrionic personality disorder does not usually affect the person's ability to function adequately in a superficial work or social environment. However, problems often arise in more intimate relationships, where deeper involvements are required. Histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.
Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with complications such as depression. Psychotherapy may also be of benefit. Histrionic personality disorder does not usually affect the person's ability to function adequately in a superficial work or social environment. However, problems often arise in more intimate relationships, where deeper involvements are required. Histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.
Narcissism
Narcissism is the pattern of traits and behaviors which involve infatuation and obsession with one's self to the exclusion of others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition. Psychologists and psychiatrists believe all individuals have, out of need for survival, a certain amount of egoism and self-centeredness, which ideally takes the form of healthy self-esteem and self-confidence. However, individuals who have excessive, unhealthy amounts of these traits are considered narcissistic. In addition to exaggerated self-esteem, narcissists are also characterized by a lack of empathy, that is, a lack of sensitivity to the feelings of others.
The term narcissism was coined by Sigmund Freud, who named the phenomenon after the figure of Narcissus in Greek mythology. Narcissus was a handsome Greek youth who rejected the desperate advances of the nymph Echo. As a punishment, he was doomed to fall in love with his own reflection in a pool of water. Unable to consummate his love, Narcissus pined away and changed into the flower that bears his name.
Clinical experience
Narcissistic Personality Disorder (NPD) is the clinical term for narcissism. It was added as a mental health category to the Diagnostic and Statistical Manual (DSM) in 1980. NPD is one of a "family" of personality disorders (known as "Cluster B"). (Other Cluster B personality disorders include Borderline, Antisocial, and Histrionic.) It is estimated that 0.7-1% of the general population suffer from NPD. Most narcissists (75%) are men.
NPD is often diagnosed with other mental health disorders ("co-morbidity") — or with substance abuse, or impulsive and reckless behaviors ("dual diagnosis"). There is only scant research regarding pathological narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.
The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.
There is a whole range of narcissistic reactions, from the mild, reactive and transient to the permanent personality disorder.
Narcissists are either Cerebral (derive their narcissistic supply from their intelligence or academic achievements) — or Somatic (derive their narcissistic supply from their physique, exercise, physical or sexual prowess and "conquests").
Narcissists are either "Classic" or they are "Compensatory", or Inverted narcissists
The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviors (such as mood or affect disorders and obsession-compulsion) — usually with some success. NPD is also treated in talk therapy (psychodynamic or cognitive-behavioral).
Narcissism is the pattern of traits and behaviors which involve infatuation and obsession with one's self to the exclusion of others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition. Psychologists and psychiatrists believe all individuals have, out of need for survival, a certain amount of egoism and self-centeredness, which ideally takes the form of healthy self-esteem and self-confidence. However, individuals who have excessive, unhealthy amounts of these traits are considered narcissistic. In addition to exaggerated self-esteem, narcissists are also characterized by a lack of empathy, that is, a lack of sensitivity to the feelings of others.
The term narcissism was coined by Sigmund Freud, who named the phenomenon after the figure of Narcissus in Greek mythology. Narcissus was a handsome Greek youth who rejected the desperate advances of the nymph Echo. As a punishment, he was doomed to fall in love with his own reflection in a pool of water. Unable to consummate his love, Narcissus pined away and changed into the flower that bears his name.
Clinical experience
Narcissistic Personality Disorder (NPD) is the clinical term for narcissism. It was added as a mental health category to the Diagnostic and Statistical Manual (DSM) in 1980. NPD is one of a "family" of personality disorders (known as "Cluster B"). (Other Cluster B personality disorders include Borderline, Antisocial, and Histrionic.) It is estimated that 0.7-1% of the general population suffer from NPD. Most narcissists (75%) are men.
NPD is often diagnosed with other mental health disorders ("co-morbidity") — or with substance abuse, or impulsive and reckless behaviors ("dual diagnosis"). There is only scant research regarding pathological narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.
The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.
There is a whole range of narcissistic reactions, from the mild, reactive and transient to the permanent personality disorder.
Narcissists are either Cerebral (derive their narcissistic supply from their intelligence or academic achievements) — or Somatic (derive their narcissistic supply from their physique, exercise, physical or sexual prowess and "conquests").
Narcissists are either "Classic" or they are "Compensatory", or Inverted narcissists
The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviors (such as mood or affect disorders and obsession-compulsion) — usually with some success. NPD is also treated in talk therapy (psychodynamic or cognitive-behavioral).
Diagnostic Criteria
Narcissists are characterized by an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts. Five (or more) of the following criteria are considered necessary for the clinical diagnosis to be met:
· Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
· Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
· Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
· Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (narcissistic supply);
· Feels entitled. Demands automatic and full compliance with his unreasonable expectations for special and favorable priority treatment.
· Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;
· Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
· Constantly envious of others and seeks to hurt or destroy the objects of his frustration. Suffers from persecutory (paranoid) delusions as he believes that they feel the same about him or her and are likely to act similarly;
· Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he considers inferior to him and unworthy.
The criteria above are based on or summarized from: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) 2000. American Psychiatric Association, Washington, DC.
Narcissists are characterized by an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts. Five (or more) of the following criteria are considered necessary for the clinical diagnosis to be met:
· Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
· Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
· Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
· Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (narcissistic supply);
· Feels entitled. Demands automatic and full compliance with his unreasonable expectations for special and favorable priority treatment.
· Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;
· Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
· Constantly envious of others and seeks to hurt or destroy the objects of his frustration. Suffers from persecutory (paranoid) delusions as he believes that they feel the same about him or her and are likely to act similarly;
· Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he considers inferior to him and unworthy.
The criteria above are based on or summarized from: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) 2000. American Psychiatric Association, Washington, DC.
Obsessive-compulsive personality
Obsessive-compulsive personality disorder is a personality disorder involving repeated urges to perform compulsive acts. It is often confused with Obsessive-compulsive disorder.
Obsessive-compulsive personality disorder is a personality disorder involving repeated urges to perform compulsive acts. It is often confused with Obsessive-compulsive disorder.
Paranoid personality disorder
Paranoid personality disorder is a psychiatric diagnosis that denotes a personality disorder with paranoid features. The use of the term paranoia in this context is not meant to refer to the presence of frank delusions or psychosis, but implies the presence of ongoing, unbased suspiciousness and distrust of people.
Paranoid personality disorder is a psychiatric diagnosis that denotes a personality disorder with paranoid features. The use of the term paranoia in this context is not meant to refer to the presence of frank delusions or psychosis, but implies the presence of ongoing, unbased suspiciousness and distrust of people.
Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders defines paranoid personality disorder as the following:
Pervasive distrust of others in which motives are perceived as malevolent, beginning in early adulthood, as indicated by four (or more) of the following criteria:
· suspects, without sufficient basis, that others are maliciously exploiting or deceiving him or her.
· reluctant to confide in others due to unwarranted suspicion that information will be used against him or her.
· preoccupied with unsubstantiated doubts of loyalty of friends or acquaintances.
· reads slight or threatening meanings into benign remarks.
· quick to react angrily to perceived attacks on his or her character.
· persistently bears grudges, unforgiving of perceived insult or slight.
· unjustified recurrent suspicions of fidelity of spouse.
The Diagnostic and Statistical Manual of Mental Disorders defines paranoid personality disorder as the following:
Pervasive distrust of others in which motives are perceived as malevolent, beginning in early adulthood, as indicated by four (or more) of the following criteria:
· suspects, without sufficient basis, that others are maliciously exploiting or deceiving him or her.
· reluctant to confide in others due to unwarranted suspicion that information will be used against him or her.
· preoccupied with unsubstantiated doubts of loyalty of friends or acquaintances.
· reads slight or threatening meanings into benign remarks.
· quick to react angrily to perceived attacks on his or her character.
· persistently bears grudges, unforgiving of perceived insult or slight.
· unjustified recurrent suspicions of fidelity of spouse.
For these behaviors to be attributed to Paranoid Personality Disorder, they cannot occur exclusively during the course of Mood Disorder with Psychotic Features or Schizophrenia.
Schizoid personality disorder (SPD)
Schizoid personality disorder (SPD) is a personality disorder characterised by a detachment from social interactions and a tendency towards a solitary lifestyle. Specifically, SPD is characterised by at least three of the following:
· Emotional coldness, detachment or reduced affectivity.
· Limited capacity to express either positive or negative emotions towards others.
· Consistent preference for solitary activities.
· Very few (if any) close friends or relationships, and a lack of desire for such. Indifference to either praise or criticism.
· Taking pleasure in few, if any, activities.
· Indifference to social norms and conventions.
· Preoccupation with fantasy and introspection.
· Lack of desire for sexual experiences with another person.
Schizoid personality disorder (SPD) is a personality disorder characterised by a detachment from social interactions and a tendency towards a solitary lifestyle. Specifically, SPD is characterised by at least three of the following:
· Emotional coldness, detachment or reduced affectivity.
· Limited capacity to express either positive or negative emotions towards others.
· Consistent preference for solitary activities.
· Very few (if any) close friends or relationships, and a lack of desire for such. Indifference to either praise or criticism.
· Taking pleasure in few, if any, activities.
· Indifference to social norms and conventions.
· Preoccupation with fantasy and introspection.
· Lack of desire for sexual experiences with another person.
This description is provided by the ICD-10 (International Classification of Diseases).
SPD is relatively rare compared with other personality disorders, being estimated at less than 1% of the general population. It is believed by some to correlate with the INTJ and INTP personality types in the Myers-Briggs type indicator. SPD is far more common amongst males than females, although this could be due in part to the fact that schizoid symptoms are far less socially acceptable in women.
SPD shares several aspects with depression, avoidant personality disorder and Asperger's Syndrome, and can be difficult to distinguish from these other disorders. However, there are some important differentiating features:
Unlike depression, SPD does not involve feelings of helplessness, worthlessness or sadness. People with SPD do not generally consider themselves inferior to others, although they will probably recognise that they are different.
Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships.
Unlike Asperger's Syndrome, SPD does not involve physical symptoms such as hand-flapping or lack of eye-contact, and sufferers of SPD are not awkward in social situations (although they may well be bored). SPD does not affect the ability to express oneself or communicate effectively with others, and is not believed to be related to any form of autism.
SPD is relatively rare compared with other personality disorders, being estimated at less than 1% of the general population. It is believed by some to correlate with the INTJ and INTP personality types in the Myers-Briggs type indicator. SPD is far more common amongst males than females, although this could be due in part to the fact that schizoid symptoms are far less socially acceptable in women.
SPD shares several aspects with depression, avoidant personality disorder and Asperger's Syndrome, and can be difficult to distinguish from these other disorders. However, there are some important differentiating features:
Unlike depression, SPD does not involve feelings of helplessness, worthlessness or sadness. People with SPD do not generally consider themselves inferior to others, although they will probably recognise that they are different.
Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships.
Unlike Asperger's Syndrome, SPD does not involve physical symptoms such as hand-flapping or lack of eye-contact, and sufferers of SPD are not awkward in social situations (although they may well be bored). SPD does not affect the ability to express oneself or communicate effectively with others, and is not believed to be related to any form of autism.
It is disputed whether SPD should be considered a "disorder" at all, since it does not necessarily involve any suffering either for the affected individual or those around him. Many people are critical of society's tendency to pathologise certain personality traits simply because they are not compatible with the status quo. However in some cases, strong SPD symptoms may result in an affected person living a dull and unfulfilling life.
There is also disagreement about the relationship between SPD and schizophrenia. Some argue that the two conditions are entirely unrelated except by the origin of the word (meaing "split", in the case of SPD it is the individual that is "split" from society, rather than the actual mind being damaged), while others maintain that SPD exhibits a subset of the symptoms of schizophrenia and may, in rare cases, be an indicator of the onset of the more serious disease.
Schizotypal personality disorder
Some people believe that schizotypal personality disorder represents a milder form of the much more serious schizophrenia. This particular personality disorder is most often characterized by a want for social isolation, odd forms of thinking and perception, the belief that they have extra sensory abilities, and over-elaborate speech patterns that are difficult to follow.
Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder (or OCD), as categorized by the DSM-IV, is an anxiety disorder. It is characterised by the obsessive need to perform some task. These tasks are often known as rituals. Note that the DSM-IV Axis II Obsessive-compulsive personality disorder is considerably different from Obsessive-compulsive disorder, and is often what people mean when they refer to somebody as "obsessive-compulsive".
Obsessive-compulsive disorder (or OCD), as categorized by the DSM-IV, is an anxiety disorder. It is characterised by the obsessive need to perform some task. These tasks are often known as rituals. Note that the DSM-IV Axis II Obsessive-compulsive personality disorder is considerably different from Obsessive-compulsive disorder, and is often what people mean when they refer to somebody as "obsessive-compulsive".
Causes and related disorders
Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Violence is rare among OCD sufferers, but the disorder is often debilitating to the quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. More often, they avoid certain situations or places altogether.
Some people with OCD also suffer from other conditions such as Tourette syndrome, attention deficit disorder, trichotillomania, hypochondria or Pure Obsessional OCD (rumination).
Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Violence is rare among OCD sufferers, but the disorder is often debilitating to the quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. More often, they avoid certain situations or places altogether.
Some people with OCD also suffer from other conditions such as Tourette syndrome, attention deficit disorder, trichotillomania, hypochondria or Pure Obsessional OCD (rumination).
Symptoms and prevalence
Today it is well-accepted that OCD is much more common than was thought previously. Typically 2–3 % of the general population is believed to have OCD or OCD-like symptoms.
In many cases the task that an OCD sufferer does may seem simple to the layperson, but the sufferer feels that they must perform it in some particular way for fear of dire consequences. Examples might include checking that one has locked one's car many times over before leaving it parked, or turning the lights on and off a set number of times every time one leaves a room. Such a person, when addicted to cigarettes, may argue that they can only quit smoking on the 13th or 27th of each month, and only when they possess four cigarettes at noon. Some people who have OCD may be completely aware that such obsessions are not rational, but feel bound to comply with them because otherwise they suffer from panic or irrational dread.
Obsessions are ideas that the person cannot stop thinking about. These are often fears about getting a disease, getting hurt, or causing harm to someone. The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of. Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. These are often cleansing or avoidance actions. Common compulsions include excessive washing and cleaning, checking, repetitive actions such as touching, counting, arranging and ordering, hoarding, ritualistic behaviours that lessen the chances of provoking an obsession. Compulsions can be observable actions, for example washing, but they can also be mental rituals such as, repeating words or phrases, counting, or saying a prayer.
Today it is well-accepted that OCD is much more common than was thought previously. Typically 2–3 % of the general population is believed to have OCD or OCD-like symptoms.
In many cases the task that an OCD sufferer does may seem simple to the layperson, but the sufferer feels that they must perform it in some particular way for fear of dire consequences. Examples might include checking that one has locked one's car many times over before leaving it parked, or turning the lights on and off a set number of times every time one leaves a room. Such a person, when addicted to cigarettes, may argue that they can only quit smoking on the 13th or 27th of each month, and only when they possess four cigarettes at noon. Some people who have OCD may be completely aware that such obsessions are not rational, but feel bound to comply with them because otherwise they suffer from panic or irrational dread.
Obsessions are ideas that the person cannot stop thinking about. These are often fears about getting a disease, getting hurt, or causing harm to someone. The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of. Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. These are often cleansing or avoidance actions. Common compulsions include excessive washing and cleaning, checking, repetitive actions such as touching, counting, arranging and ordering, hoarding, ritualistic behaviours that lessen the chances of provoking an obsession. Compulsions can be observable actions, for example washing, but they can also be mental rituals such as, repeating words or phrases, counting, or saying a prayer.
Treatment
OCD can be treated with a variety of anti-depressants, such as Anafranil, or selective serotonin reuptake inhibitors such as Paxil, Zoloft, Prozac, Luvox, and Anafranil. Some medications like Gabapentin have also been found to be useful in the treatement of OCD. Symptoms tend to return, however, once the drugs are discontinued. There are claims that long-term remission of symptoms has been achieved without medications through cognitive-behavioral therapy making use of the principles of extinction and habituation.
OCD can be treated with a variety of anti-depressants, such as Anafranil, or selective serotonin reuptake inhibitors such as Paxil, Zoloft, Prozac, Luvox, and Anafranil. Some medications like Gabapentin have also been found to be useful in the treatement of OCD. Symptoms tend to return, however, once the drugs are discontinued. There are claims that long-term remission of symptoms has been achieved without medications through cognitive-behavioral therapy making use of the principles of extinction and habituation.
No comments:
Post a Comment