Cluster c Ning

8/13/2019 Cluster c Ning

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PERSONALITY

Ones set of stable, predictableemotional and behavioral

traits


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1856 - 1939

Father of Psycho-sexual Theory of

Development

Sigmund Freud


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Psychoanalytic theory

Behavior and personality derives from the constantand unique interaction of conflicting psychologicalforcesthat operate at three different levels of

awareness: the preconscious, the conscious, and theunconscious

Mind divided into 2 parts The conscious the part of which we are aware

The unconscious the part of which we are not aware

* The unconscious mind has more influence than the conscious has

on our personality development & behaviour


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Super Ego is part ofthe Preconscious mind

Ego*

Id is part of theUnconscious mind

* Ego is floating is all 3states


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The unconscious mind is further divided into 3 parts:

the id encourages us to seek physical satisfaction

(sexual, nutritional) the superego prompts us to do the moral thing, not the

one that feels the best

the ego referees between the id and superego, and

deals with external reality (our conscious self)

*our early childhood experiences, usually involving ourrelationships with our parents & family, are stored inour unconscious mind


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According to Freud, the key to a healthy personality

is a balance between the id, the ego, and the

superego.


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Prevalence: 10-20% in the general population

PD is a predisposing factor for other psychiatricdisorders; e.g. substance use, suicide, affectivedisorders, impulse-control disorders, eatingdisorders and anxiety disorders


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DSM IV-TR

A pattern of behavior/inner experience that deviatesfrom culture in 2 ways:

-Cognition

-Affect

-Personal relations-Impulse control

B inflexible & pervasive pattern

C significant distress/ impairment in functioning

D stable & long duration w onset no later thanadolescence or early adulthood

E not accounted by other mental illness

F not d/t other GMC/substance abuse


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CLUSTER CWORRIED

SAD

CLUSTER BWILDBAD

CLUSTER AWEIRD

MAD


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Example of caseA 35 year-old computer programmer , has always had

difficulty forming close friendships, not because of alack of desire but because of an intense fear of

rejection and disapproval. He looked for work thatwould minimize social interaction and opportunitiesto be judged by others. He describes himself as being

painfully shysince childhood.


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DSM IV Avoidant PDA pattern of social inhibition, hypersensitivity, and feelingof inadequacysince early adulthood, with at least 4 of thefollowing

1. Avoid occupation that involves interpersonal contact due to

fear of criticism and rejection2. Unwilling to interact unless certain of being liked

3. Cautious of intrapersonal relationships

4. Preoccupied with being criticized or rejected in social

situation

5. Inhibited in new social situations because he/she feels

inadequate

6. Believes he/she is socially inept and inferior

7. Reluctant to engage in new activities for fear of

embarrassment.


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Assertiveness training For people who are abnormally shy or socially awkward

Socially acceptable expression of thoughts and feelingsis encourage as follow :

1.Analyze the problem in terms of facial expression, eyecontact, posture and tone of voice

2. Exchange of roles to help pt understand the viewpointof the other person in the situation

3. Demonstrateappropriate social behaviour4.Practice appropriate behaviorwithin the session

5. Practice appropriate social behavior in everyday life

6.Record the outcome of this practice


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1. Realize where changes are needed and believe inyour rights.

2. Figure out appropriate ways of asserting yourselfin each specific situation that concerns you

3. Practice giving assertive responses

4. Try being assertive in real life situations


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Example of caseA 55 year-old lady has trouble deciding on choosing

which dress to wear to attend a wedding ceremony. Shecalls her mother and her best friends several times to

ask the opinion.


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DSM IV Dependent PD

1. has difficulty making everyday decisionswithout an excessive amount of advice andreassurance from others

2. needs others to assume responsibility for most major areas of his or her life3. has difficulty expressing disagreementwith others because of fear of loss of support orapproval. Note: does not include realistic fears of retribution.

4. has difficulty initiating projects or doing things on his or her own (because of a lack ofself-confidence in judgment or abilities rather than a lack of motivation or energy)

5. goes to excessive lengths to obtain nurturance and support from others, to the point of

volunteering to do things that are unpleasant6. feels uncomfortable or helpless when alone because of exaggerated fears of being

unable to care for himself or herself

7. urgently seeks another relationship as a source of care and supportwhen a closerelationship ends

8. is unrealistically preoccupied with fears of being left to take care of himself or herself

A pattern of submissive and clinging behaviour due to excessive

need to be taken care of. At least 5 of the following must be

present:


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Avoidant Dependent OCPD

Shy/ timidAvoiding social inhibition d/tintense fear of rejection

Dependent and submissivePoor self-confidentOthers decide for them

Perfectionism, inflexibity &extreme orderlinessstiff, serious and formal withconstricted affect

1 to 10% ~1% (females>) ~1% (males>; oldest child)

Chronic course

associated anxiety anddepressive disorders

associated depression Comorbid- MDD, schizophrenia,anorexia nervosa, bulimia

DDSchizoid PDSocial phobia/ anxiety d/s

DDAvoidant PDBorderline & histrionic PD

DDOCDNarcissistic PD

TreatmentPsychotherapyBehavior therapy (Assertive

training & desensitization)Group therapy (understanding)Good rapport & reassurance

PharmacotherapyAnxiolytic (B-blocker)SSRI (depression)

TreatmentPsychotherapyFamily/couple therapy

Assertive training- autonomy/decision making

PharmacotherapyAnxiolytic (B-blocker duringcrisis)SSRI(depression)

TreatmentPsychotherapyBehavior therapy

Group therapy

PharmacotherapyAnxiolyticSSRI

*Anti-psychotics

(severe case)???


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Example of case

30 year-old gentlemen tells you that his 6throommatehas just moved out because he makes unreasonable

rules and schedules concerning the care of theapartment


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DSM IV OCPD

Pattern of pre-ocupation with orderliness, control andperfectionismat the expense of efficiency, present by early

adulthood and in a variety of contexts. At least 4 of the following

must present:

1. Preoccupation with details, rules, lists, and organizationsuch that the major point of the activity is lost

2. Perfectionismthat is detrimental to completion of task

3. Excessive devotion to work

4. Excessive conscientiousness and scrupulousness about

morals and ethics5. Will not delegrate tasks

6. Unable to discard worthless objects

7. Miserly

8. Rigid and stubborn

Cluster c Ning

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