personality disorder
Introduction
Introduction to personality disorder Personality disorder, also known as morbid personality or abnormal personality, refers to the abnormal development of personality, forming a unique, obvious, deviating social and cultural background, and the cognitive behavior patterns recognized by most people. The deviation of personality traits is unsuitable for the environment, which obviously interferes with its social and professional functions, resulting in the inability of this person to maintain harmonious interpersonal relationships and difficulties in adapting to social life. Not only does it cause harm to others, but it also suffers from it or causes pain. The pathological personality is a generalized concept. It refers to all types of personality abnormalities. Later, some scholars found that the initial definition of pathological personality is in line with the current title. Anti-social personality, and thus the concept of the narrow sense of morbid personality, specifically refers to anti-social personality, proposed to replace the generalized morbid personality with personality disorder. According to the different manifestations of personality disorder, personality disorder can be divided into different types. The ninth edition of the World Health Organization's International Classification of Diseases divides it into paranoid, emotional, split, violent, obsessive, snoring, powerless, antisocial or non-group. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: schizophrenia
Cause
Cause of personality disorder
Genetic factors (25%)
The Italian criminal psychologist Rombroso has conducted a large sample survey of the families of many criminals and found that many of the offenders have anti-social personality disorder, the crime rate is much higher than other people, and some scholars have found that the personality disorder of the relatives, The rate of personality disorder is significantly higher than that of the normal population. Therefore, the genetic factors of personality disorder cannot be ignored. The rate of abnormal EEG in patients with personality disorder is higher than that of normal people, suggesting that biological factors have a certain impact on personality disorder.
Psychological factors (21%)
The psychological development process of children is traumatic and has a major impact on the development of personality. It is the main factor in the formation of personality disorder in the future. If a child has the function of quickly eliminating the autonomic nervous system of fear response, it must be rapid, powerful and good. Learned inhibition ability; conversely, if the autonomic nervous system is slow, the acquired inhibition ability is slow and weak, and the personality disorder and the autonomic function of the perpetrator are abnormal. Some people have proposed low autonomic responsiveness and skin electrical recovery. The slowness can be used as a susceptibility to criminals and personality disorders.
Environmental factors (15%)
Bad ethos in society, irrational phenomena, money worship, etc. will affect the moral values of young people, and they will develop confrontation, anger, oppression, self-destruction and other bad psychology and develop into personality disorders.
At present, it is generally believed that the relationship between personality disorder and mental illness is: personality traits can become a susceptibility factor or incentive for mental illness; some personality traits are latent or residual manifestations of mental illness; personality disorder and clinical syndrome can have a common Quality and environmental background, both can coexist, but not necessarily the cause of the cause.
Pathogenesis
Personality disorder is clearly a heterogeneous collection, each type has a common pathogenic factor, and now only the general pathogenesis is described as follows:
1. Genetic factors Some aspects of personality or personality psychological characteristics are genetically affected. The single-oval twin study of Shields (1962) indicates that the twin-child personality test scores that are separately raised after birth are similar to those grown together. In addition, the results of the schizophrenia lineage study showed that the prevalence of schizophrenic personality disorder in the immediate relatives of the foster families was significantly higher than that of the control foster flocks (10.5% vs. 1.5%), and the prevalence of paranoid personality disorder. It was also significantly higher than the control group (3.8% vs. 0.7%).
2. Body type Kretschmer (1936) created the theory of body type and temperament, but his conclusion comes from the subjective judgment of personality, which has no practical significance. Sheldon et al. (1940) applied more accurate measurement methods and modern statistical techniques, although their research has Improvement, but did not find a correlation between body type and personality.
3. Psychobiological factors The biological research of personality based on objective diagnostic criteria and fixed examinations has led to a significant increase in the credibility of personality disorder assessment.
According to the four dimensions of cognition, emotion, impulsive control and anxiety regulation, personality disorder can be divided into four categories (Siever et al., 1991), which are respectively connected with mental illness, thus forming a pedigree concept:
1 cognitive/perceptual disorder is linked to schizophrenia and eccentric personality disorder (split type);
2 impulsive control is related to the type of personality (edge type, anti-social type) personality disorder;
3 emotional instability and severe affective disorder and other performance types (marginal, performance) personality disorder are spectrally related;
4 Anxiety/depression (referring to an inhibition with anxiety) is associated with an anxiety disorder and an anxiety type (avoidance) personality disorder.
4. Cognitive/perceptual structural disorder The disorder manifests in mental illness as thinking disorder, mental symptom and social isolation. The slight disorder of cognitive control often appears in the form of quirky, special speech, social dissociation, etc. The cognitive/perceptual structure is reflected. A person's understanding and attention to the stimuli of entry, and the processing of information according to his past experience, the ability to properly choose the response, schizophrenic personality disorder and schizophrenia belong to the two poles of this dimension band, the test of attention/information process shows two Similar disorders (Kendler et al., 1981), eye movement dysfunction is not only seen in patients with chronic schizophrenia and their relatives (Holzman et al., 1984), but also in patients with schizophrenic personality disorder (Siever et al., 1984). Associated with defective symptoms of schizophrenic personality, schizophrenic personality, schizophrenia patients and their relatives can be found to have visual or audible damage, such as reverse masking test, continuous operation test, sensory sluice test, etc. Consistently, in the blood and cerebrospinal fluid of schizophrenia and schizophrenic personality, the dopamine metabolite HVA increased.
5. Impulsive/attack damage Impulsive control is characterized by a reduced ability to delay or inhibit movement, reflected in mental illness: such as intermittent outbreak disorder, pathological gambling or stealing; as long-lasting and severe impulsive qualities, Defiant behaviors and antisocial behaviors, such as marginal and antisocial personality disorder, Claridge (1985) found that cortical inhibition and alertness were reduced in socially morbid patients, EEG had more slow waves, sedation threshold decreased, and psychology Physiological studies have found that impulsive and socially ill patients have reduced ability to inhibit motor responses, sympathetic responses are diminished, and galvanic electrical responses are rapidly formed (Hare, 1978). Animal studies have shown that serotonergic system mediated behavior Inhibition, serotoninergic system damage, leading to the suppression of disciplinary behavior, similar findings are also seen in suicide attempters (Asberg et al., 1987), violence and aggressive behavior (Brown et al, 1982) personality disorder patients, patients with borderline personality disorder Reduced prolactin response to serotonin-releasing agent fenfluramine, suggesting serotonin in this type of human Reduced function (Coccaro et al., 1990), a drug that enhances serotonergic function, can improve or mitigate criminal aggression and suicidal behavior (Meyendorff et al., 1986; Sheard et al., 1976), norepinephrine in patients with personality disorders ( NE) can function hyperactively, in addition to its elevated metabolite levels, the growth hormone response to NE agonist: clonidine (chlorine) is also increased (Coccaro, 1991), known to the NE system mediated to the environment Alertness and orientation, strengthening NE activity, can increase outward aggressiveness, and attacks are prone to occur when NE activity is enhanced and 5-HT activity is reduced (Hodge et al., 1975).
6. Emotional instability This condition is characterized by changes in mood and intensity, which are characterized by persistent and endogenous mood disorders, and very transient environmentally relevant emotional fluctuations are seen in marginal personality disorder.
Emotional instability is a major feature of borderline personality disorder, and many of these patients later developed into a state of depression (Silverman et al., 1991; Zanarini et al., 1988; Links et al., 1988). In the relatives of patients with borderline personality disorder, the emotions were not The incidence of stable personality is higher (Silverman et al., 1991). The biological data suggest that affective disorder is related to emotional instability or marginal personality, both of which show that REM latency is shortened and latent time is variable; The reaction of the muscarinic agonist arecoline shortened for further REM latency (Nurnberger et al., 1989; Bell et al., 1983); the DST assay showed de-inhibition; the NE energy system was overreacted (Suhulz et al., 1988).
7. Anxiety/inhibition When the unintended consequences are expected, fear and autonomic alert thresholds are reduced, often accompanied by behavioral inhibition, anxiety disorder, forced ritual or fear and avoidance group personality disorder with the above characteristics, avoidance group personality disorder and mental illness There are few studies linked together, and some studies have shown that anxiety/inhibition populations show higher levels of cortical and sympathetic alertness, lower sedation thresholds, and reduced habituation of new stimuli (Claridge, 1985; Gray, 1982; Kagon, 1988). ).
In short, psychobiology research is developed along some personality disorders and some mental illness-related methods. The relationship between personality disorder and mental illness is still under discussion. The following opinions exist:
1 certain personality characteristics increase the susceptibility of some mental illnesses and induce them;
2 Some personality traits are the hidden manifestations of some mental illness or their residues;
3 Personality characteristics and clinical syndromes are not yet clear, but they are the common background and environmental impact;
4 The simultaneous occurrence of personality disorder and clinical syndrome is purely coupled, and there is no etiology connection between the two.
8. Psychosocial factors It is well known that family parenting can affect the development of normal personality, but how much do these effects play a role in the configuration of abnormal personality? What is the nature of abnormal personality configuration? Unreasonable education during the period can lead to the morbid development of personality. Children's brain has greater plasticity. Some personality tendencies can be corrected through normal education. If you let it go, you can develop abnormal personality and the family environment is also vital. No, often quarreling, or even separation or divorce, will have a negative impact on the development of children's personality. Parents' education methods for children are also factors that affect the normal development of personality. Rough and fierce, indulgence and excessive demand are not conducive to the formation of personality and development of.
Prevention
Personality disorder prevention
Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood. Life restraint pays attention to rest, work and rest, life orderly, and maintain an optimistic, positive and upward attitude towards life. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
Complication
Personality disorder complications Complications schizophrenia
Abnormal personality can also be caused by diseases, mainly diseases of the frontal lobe (such as brain trauma, encephalitis, etc.), schizophrenia can also have symptoms of personality disorder, or may be caused by frontal dysfunction.
Symptom
Personality disorder symptoms Common symptoms Suspicion is prone to pathology, beliefs, social sensitivity disorder, impulsive personality disorder, performance personality disorder, split personality disorder, irritability, expression, indifference, excitement
1. The characteristics of common clinical characteristics of personality disorder, domestic data will be summarized as:
(1) Beginning in early years, usually at the beginning of puberty, men can perform earlier.
(2) Serious personality defects, the personality is seriously deviated from normal, uncoordinated, and some characteristics of personality are excessively developed.
(3) The firmness of personality deviation does not change once it is formed, it is difficult to correct, and the prognosis is poor, but it can be gradually relieved after 40 to 50 years old.
(4) Lack of self-knowledge of personality defects, and cannot learn from past life experiences.
(5) The purpose and motivation of the behavior are not clear, and the behavior is mostly driven by emotional impulses, accidental motivation, lack of purpose, planning and integrity.
(6) Maladap, I feel painful and hurt around.
2. Clinical classification
(1) Paranoid personality disorder: Paranoid personality is a type of personality disorder characterized by obvious suspicion or paranoia. It is more common in men. Similar names include fanatic personality and querulant personality. Such people are stubborn, sensitive, suspicious, over-vigilant, narrow-minded, well-informed; self-evaluation is too high, experiencing their own over-importance, tending to be objective, refusing to accept criticism, being overly sensitive to setbacks and failures, and arguing if questioned , sophistry, and even impulsive attacks and aggressiveness; often have some overpriced ideas and insecurities, unpleasantness, lack of sense of humour; such people are often in a state of alert and tension, looking for the basis of suspected prejudice, against others Sexual or benign actions, distorted and adopting hostility and contempt, lack of correct evaluation of the context of the situation; prone to pathological paralysis, prone to paranoia or paranoid schizophrenia, summarized as follows:
1 Sensitive and suspicious, patients often misunderstand that other people's unintentional or even friendly behaviors are hostile or contemptuous, or that there is not enough evidence to suspect others hurt themselves.
2 There is a preconceived notion that interprets surrounding events as having some sort of "conspiracy" that is not true.
3 Extremely confident, conceited, and self-respecting.
4 Being stubborn, I often think that only myself is the most correct, I can't listen to different opinions, and I don't believe in negative evidence.
5 hate, rejection, insult, injury can not be tolerant, long time sighed, and the reasons for setbacks and failures blamed others.
6 strong personality, strong subjectivity, strong work ability, good to argue with others, and stubbornly pursue personal interests or rights, do not believe others, it is difficult to change their understanding or ideas by fact or reason.
7 is prone to pathology, belief, excessive suspicion that the spouse or lover is unfaithful to himself, but not delusion.
(2) schizophrenia personality disorder: schizoid personality disorder (shut-in personality, Hoth, 1913) or introversion (autism, Bleuler E, 1950), generally beginning in early childhood Existence, its main manifestations are retreat, loneliness, silence, concealment, not love of communication; lack of emotion and indifference, not only can not experience joy, but also lack of warmth, lack of hobbies; excessive sensitivity and shyness, timidity, quirks, praise and Criticism is unresponsive; does not lose the ability to recognize reality, but often shows isolated behavior, tends to daydream and introspective concealment; poor ability to act, lack of initiative, non-intervention attitude towards interpersonal relationship; lack of sexual interest; lack Intimate and close friends.
In addition to schizophrenic personality disorder, DSM-III increases schizophrenic personality disorder and avoidant personality disorder, with the aim of narrowing the scope of schizophrenia.
The characteristics of the split type are quirky thinking. Although they are abnormal in perception, social interaction and behavior, they do not reach the level of schizophrenia. Their thinking characteristics are abnormal, stubborn, and sometimes visible short-lived weird thoughts. The concept of price and special behavior, these people are usually considered to be marginal schizophrenia, the family of this type of personality disorder has a higher prevalence of chronic schizophrenia (Kety et al., 1982), ICD-10 call caution This diagnosis is because it has no obvious boundary with simple schizophrenia, schizophrenia, and paranoid personality disorder.
Although avoidance personality disorder has a certain degree of social isolation, but he is eager to contact with the surrounding, it is different from splitting and splitting. Such people are very sensitive to the negative consequences of socialization and perform in the process of resisting this sensitivity. Anxiety, shyness and sorrow, the contempt and neglect of them and other negative social influences are not tolerated by them. Because they are always expecting the above situations, they are isolated from society, and they often feel that they cannot get along well with people around them. Depressed and lacking self-esteem.
The schizophrenic personality disorder is not the case for life, and the proportion of schizophrenia has not yet been clarified. Domestic and foreign data indicate that more than half of the schizophrenia patients have pre-divisional personality.
(3) Antisocial personality disorder is the most serious type of personality disorder in society. It is more common in men. The personality disorder is characterized by a high degree of aggression and lack of shame. Lessons learned, behavior driven by accidental motivation, social maladaptation, etc., but these are relative.
1 Highly aggressive: Psychopathic patients have a high degree of impulsivity and attack, and individuals also have no aggressive behavior. Cleckley (1941) distinguishes between ill-conditioned personality into two categories, one is impulsive-aggressive, and the other is social retreat, Buydeus -Branchey et al. (1989) found that people who were violent before the age of 15 were prone to violence when they were adults, and those who did not have such behavior before the age of 15, were classified as having aggressive behavior and not having sex. The former category has a tendency to cause physical violence throughout life.
2 no shame: Traditionally, such people are not ashamed and lack autonomic nervous response (including skin DC response) related to anxiety.
The antisocial personality with anxiety and depression is dysphoric psychopathy. Compared with antisocial personality patients without anxiety, these people have difficulty in mental function, have suicidal idea, and are easy to provoke. Other neurological features, long hospital stays, poor response to treatment, they believe that psychosis associated with anxiety and depression may represent a special syndrome.
3 behavioral unplanned: the behavior of psychopathic patients is mostly driven by accidental motivation, emotional impulses or instinctive desires, lack of planning or premeditated.
4 Social maladaptation: Antisocial personality disorder is often noticed because its behavior is significantly different from recognized social norms. Because it lacks self-knowledge of its personality defects and cannot learn from experience, this disease is a kind of disease. A model of persistent and strong maladaptive behavior.
A. These people often have some kind of episodic anti-social behaviors in children and adolescents, such as poor academic performance, truancy, violation of school discipline, repeated lying, stealing, confronting the elderly, attacking people, participating in or provoking fights, etc. Or have been punished or expelled by the school.
B. After the growth, the emotions are superficial and cold, the temper is violent, the self-control is bad, the person is not frank, lacks responsibility, and is incompatible with the person; lacks planning and purpose, and often changes his position.
C. The concept of law and discipline is poor. The behavior is driven by instinctive desires, accidental motives and emotional impulses. There are behaviors that do not conform to the code of conduct or violate social norms. They are highly impulsive and aggressive; such as destroying public property, repeatedly fighting or attacking. Other forms of crime, such as others, are accompanied by drug or alcohol abuse, compulsory education or reeducation through the community or public security agencies, detention or punishment.
D. Lack of sense of responsibility, sense of obligation, no responsibility and obligation, such as frequent absenteeism, long-term unemployed or many times unplanned change of career, no care or support for the wife and children, indifferent to the family.
E. Low tolerance to frustration, irritability, mild irritation can cause violence or aggressive behavior, behavior has some impulsiveness, poor tolerance to setbacks, and failure to be objective or suggestive The reason is to excuse yourself or cause a reaction.
F. Lack of guilt, can not learn from the failure or punishment of experience, and easy to blame others, lack of conscience, lack of awareness of their personality defects; lack of remorse and shame, can not learn lessons; selfish, Self-evaluation is too high, fanatical but unmoving behavior.
G. They can't keep a long-term, intimate and loyal relationship with family, friends, and spouses (female companions). The relationship between the two sexes is chaotic. The marriage relationship is often changed, and the children are not ignorant. For example, the relationship between husband and wife is difficult to maintain for more than one year.
H. Premature activity.
Such people are generally reluctant to seek medical help. Therefore, outpatient clinics are extremely rare. They are often imprisoned or forced into labor camps in violation of social laws. Sometimes they are forced to come to see a doctor. Most of them are nervous, depressed, and think that they are discriminating against him. Hate, this kind of understanding and emotional state can be postponed, even when the older (early adult) disciplinary behavior is reduced. The term anti-social is a political and social term, but it also highlights from this aspect. The harm of society, such people account for a considerable proportion (40% to 78%) in prisons and labor camps, many of them are recidivists or recidivists, often sent to psychiatric institutions for medical identification due to the state of reaction.
(4) Impulsive personality disorder: also known as aggressive personality disorder, ICD-10 divides emotionally unstable personality disorder into impulsive type and marginal type. Both types are impulsive and lack self-control as outstanding performance, impulsive The main characteristics of the type are emotional instability and lack of impulsive control. Violent or threatening behavioral outbreaks are common, especially when others criticize them. Such people often burst into very strong anger and impulses due to minor stimuli. You can't restrain yourself at all. You can have violent assaults at the time. You can experience happiness, satisfaction, or relaxation when you act. This sudden change in mood and behavior is different from peace. They are normal when they are not attacking. Resentment at the time of the attack, but can not prevent recurrence, this impulse episode is often caused by a small amount of drinking, the clinical manifestations are summarized as follows:
1 Easy to conflict or quarrel with others, especially when they are criticized by others.
2 There is a sudden anger and violent tendency, and the resulting impulsive behavior cannot be controlled.
3 The ability to plan and anticipate things is significantly impaired.
4 can not adhere to any behavior without immediate reward.
5 unstable and capricious mood.
6 Self-image, purpose and internal disorder (including sexual desire) disorder and uncertainty.
7 is prone to tension or instability in interpersonal relationships, often leading to emotional crisis.
8 Suicide often occurs and self-injury.
(5) Historic personality disorder, also known as attention-seeking personality disorder or hysterical personality disorder, attracts attention with highly emotional and exaggerated behavior. The main characteristics of a type of personality disorder, generally considered that women are more common, can gradually improve with age, this type can coexist with marginal personality disorder, mainly characterized by immature personality and emotional instability, often self-performed, excessive The act of exaggeration and exaggeration is noticeable; the suggestiveness and dependence are particularly strong, self-indulgence, not considered by others, and highly self-centered; extreme emotional, emotionally variable, and irritating; superficial and superficial, difficult to maintain around Long-lasting social connections; long-cherished desire to be understood and evaluated, feel vulnerable, highly imaginative, often imagined as reality; constantly pursuing excitement, can't stand loneliness, hope life is as lively and unsettled as acting; appearance and Behavior shows inappropriate provocation, dress up and show off, Even flirting, tempting people, but sexual life is passive, although sometimes experience sexual music, but often sexy lack; speech, manners and behavior may be similar to children, emotional immature, this kind of relationship with snoring is not like the past imagined As close as this, the pre-existing personality of snoring is only 20% of the performance type, while the very serious performance personality disorder can not cause snoring for life, and the performance personality can also be the pre-existing characteristics of mental illness such as depression and anxiety.
Performance personality often involves judicial psychiatric identification. This is because such people have a certain overlap with anti-social personality and are prone to violations of social law. It is also often a pre-existing personality characteristic of depression, anxiety, and clinical manifestations. as follows:
1 Excessive affection, that is, self-drama, that is, excessively exaggerated emotional expression, the patient's entire mental activity is rendered with a very strong emotional color, and the emotional response is clear, strong and rapid changes, making the surrounding people feel that the patient's performance is excessively exaggerated It seems to be acting, deliberately attracting attention.
2 Emotional superficial, volatility, extremely unstable, often from one emotional state to another, even the opposite emotional state, the emotion is also easy to envy, worship to hostility, from obedience to confrontation, patients The judgment reasoning is also variable, mainly because the patient's thinking activities are also greatly affected by emotions. For example, if someone thinks that someone is perfect, he may be dissatisfied because of a small incident. People say nothing.
3 suggestive high, emotional good and evil determines the suggestive, such as the feeling is positive, that is easy to accept such hints, negative is difficult to accept the hint.
4 Focusing on yourself, you need to be the center of attention. If you can't be the center of attention, you will feel very unhappy. The patient is also willing to be in the public and become the focus of everyone's attention. They are on the outside and behave in behavior. To be overly attractive, I hope to get people's praise, sometimes in the eyes of the public to sway through the city or alarmist, sensational.
5 self-centered tendencies, patients indulge in self, only consider themselves, consider others or ignore others, not only often boast of their talents, wisdom, and sometimes force others to meet their own will or needs, if not satisfied, often give Others are embarrassed or express strong dissatisfaction.
6 rich and fascinating illusions, patients often think of or enrich their imaginations, exaggerate their speeches, sometimes even imaginary things and real things are indistinguishable, which may give people a seemingly lying Impression, this is the so-called pathological lie (pseudologia phantastica).
7 patients also seek stimulation or excitement, craving for novelty and satisfactory activities, patients often temper, emotional vulnerability, but also prone to intentional self-harm or suicide attempts and behavior.
8 interpersonal relationship is poor, patients are conceited, self-willed, self-indulgent, they often want to dominate or manipulate others, and often are moody, difficult to get along with the people around them, often angering people around, being bored by people around or Causes resentment.
3. Obsessive-compulsive personality disorder (anankastic personality disorder) is characterized by excessive demand and perfection. Men are more than twice as many as women. These people are characterized by inertia, hesitancy, suspicion and step-by-step. They demanded themselves with perfect standards, hoped that the things they did were perfect, repeated tests afterwards, and demanding details. For this reason, they expressed anxiety, nervousness and distress. Their moral sense was too strong, too self-restraint, excessive self-concern and responsibility. Too strong, often manifested as being too strict on anything, too high, in accordance with the rules, step by step, can not change, otherwise feel anxious and affect their work efficiency; usually stick to the details, be careful, and even program the life section, Some are very clean and timid. If they don't follow the requirements, they feel uneasy or even redo; they are too cautious about their own safety, often have insecurities, often think hard or think twice, and repeatedly check and check the plan. There are negligence or mistakes, and the thoughts are not slack; all actions are planned in advance, and Consider too detailed; excessively pedantic, stereotyped; subjective, more authoritarian, requiring others to act in accordance with his methods, otherwise it is unpleasant, often do not worry about others; often hesitate when he needs to solve problems, postpone or avoid making Decisions; often too frugal, even embarrassing; excessive indulgence in duties and ethics, excessive sense of responsibility, excessive work, less hobbies, lack of social friendship, often lack of enjoyment and satisfying inner experience after work, on the contrary Remorse and guilt, although such people can get a stable marriage and achieve success in their work, there are very few friends.
People with obsessive-compulsive personality disorder are prone to obsessive-compulsive disorder, while those with obsessive-compulsive disorder are 72% of those who are forced to have personality (Kringlon, 1965), and those with pre-menopausal depression are mostly forced (Titley, 1936). The pre-existing personality of depression is compulsive and easily associated with obsessive-compulsive symptoms (Gelttleson, 1966). Normal people may have some coercion and should not be confused with obsessive-compulsive personality. The latter's professional or social ability may be seriously damaged. the difference.
4. Anxiety personality disorder is characterized by a long-lasting and extensive inner nervousness and anxiety experience, such as excessive sensitivity, insecurity and inferiority; consistently nervous, fearful, always needs to be liked and accepted, unless Ensuring that they are accepted and not criticized by others, otherwise they refuse to establish interpersonal relationships with others; they are too sensitive to rejection and criticism, often avoiding many normal social activities by exaggerating the potential dangers in life, and thus their lifestyles are significantly restricted. Studies have shown that it is significantly associated with anxiety disorders such as panic attacks, social phobias, obsessive-compulsive disorder, and the like.
5. Other personality disorders
(1) Circulating personality disorder (also known as affecitve personality disorder), more common in women, this type includes emotional growth, emotional depression or depression of the opposite subtype.
People with emotional growth are emotionally high, full of confidence and joy, ambitious, energetic, enthusiastic, optimistic, eager, and eager to do things. They often make a lot of plans and ideas, but not all are well thought out. On the contrary, people with low emotions are depressed, pessimistic, frowning, lack of self-sufficiency, lack of confidence, ignorance, and difficulty in finding things; cyclical personality disorder is alternating with good mood and sadness. To be characterized, this conversion is not caused by external factors. 30% to 80% of patients with bipolar disorder have a circulating personality before the illness. This personality disorder usually occurs in adolescence, the degree/duration of the mood is high or low, and its periodic frequency. Degree is not the same, but with age, it tends to increase, which is different from other types of personality disorder, mood swings in the middle of the middle of the year, should pay attention to the possibility of organic diseases.
(2) The main characteristics of borderline personality disorder are high impulsiveness, emotional instability, interpersonal tension and instability, identity recognition disorder, self-injury behavior, persistent emptiness and boredom, which are easy to cause Sexual psychosis episodes, ICD-10 (1992) pointed out that in addition to emotional instability, borderline personality disorder, self-image, purpose and inner preference are often ambiguous or distorted, emptiness is common, often involved in strong and Extremely unstable interpersonal relationships may lead to continuous emotional crisis, try to avoid being abandoned, commit suicide attempts, marginal personality is related to affective diseases, and marginal personality may be a variant of primary affective diseases. Marginal personality and affective psychosis have a high concomitant rate. Marginal personality is often hospitalized in an emergency when there is a bad mood or self-injury. At this time, symptoms similar to depression can be found. Depression is common in marginal personality and antisocial personality. Although the marginal personality has been widely studied by psychiatrists in the United States, Britain, and the Nordic countries, but China's mental illness Who feel that the concept of borderline personality disorder is a strange and vague, has not yet formally applied.
(3) Inadequate personal personality disorder (also known as passive personality disorder), characterized by lack of effective response to social interactions and emotional stimuli, lack of ability, planning deficit, instability, judgment Poor force, can not adapt to the challenges of life, but the inspection can not find any physical or mental defects, they do not argue with the surrounding people, can not establish a close relationship with people, it is often ignored in the crowd, not Appropriate personality disorder is more widely used in the UK, but Oxford University psychiatrist Gelder (1983) suggested avoiding the name because it is not only derogatory, but rather than telling them how to adapt to life in detail. .
(4) Dependent personality disorder is a kind of personality disorder that attaches one's needs to others in a unique way. It is more common in women. The characteristics of such people are lack of self-confidence. Independent activities, often without the repeated advice or assurance of others, can not make daily decisions, it is generally difficult to take the initiative to determine the plan, willing to put themselves in a subordinate position, all listening to other people's decisions, such as children or teenagers, food and clothing and The free time schedule must be decided by the parents; because they cannot live independently, they are allowed to take responsibility for the main aspects of their lives. The careers of women are decided by their spouses. They need someone to be there at any time in order to get help from others. Whenever you are alone, you feel great discomfort. When you are disconnected or lonely from an intimate person, the patient feels helpless or anxious, feels lonely and helpless and clumsy, because of multiple factors, social culture, psychosocial society. Factors are important. Some people think that in early childhood, when they do something independently, they are often reprimanded by their parents. Responsibility or punishment or excessive restrictions, so that children's autonomous behavior patterns may never be established, and anxiety, performance, and divisive personality disorder may coexist, the clinical manifestations are summarized as follows:
1 Because he has no ability to play his role independently, he passively relies on others to make decisions on important issues in his life.
2 Think of yourself as incompetent, clumsy, and lacking self-confidence.
3 Obey the needs of the people on which they depend, such as enduring the poor treatment or abuse of the dependent spouse.
(5) Passive-aggressive personality disorder: The prevalence of passive-aggressive personality disorder in Germany (Maior et al., 1992) was 1.8%, and in the United States (Zimmermax et al., 1990) was 0.4% to 3. O%, this type of personality disorder is characterized by passive rejection of the requirements to make full use of his work and social skills. This rejection is not directly expressed, but indirect ways such as procrastination, idleness, stubbornness, pretense Incompetent or fragile, the result is a serious and persistent lack of performance in social and work situations. In fact, they have potential. This type of name is based on the assumption of passively expressing covert attacks. The situation is seen in normal people and different types of personality disorders, and it seems that there is no need to establish a new type.
Examine
Personality disorder check
The examination of this disease is mainly a laboratory imaging examination to exclude organ functional diseases, such as diseases of the brain frontal lobe (such as brain trauma, encephalitis, etc.). Most patients with brain organic diseases have brain function (including intelligent) disorders and neurological signs, combined with EEG, computed tomography (CT) and other auxiliary examinations.
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Diagnosis
Diagnosis of personality disorder
diagnosis
Personality disorder usually begins in the early years. Such deviating normal personality, once formed, is constant and difficult to change. Their intelligence is not low, but some aspects of personality are very prominent and excessively developed, and I have personal defects. Lack of correct judgment, if you have the above characteristics, and can rule out personality changes caused by organic diseases and mental illness, it is not difficult to determine personality disorder.
1. The diagnosis of personality disorder is the same as the diagnosis of other mental illnesses. It is generally divided into clinical diagnosis and research diagnosis.
(1) Clinical diagnosis: relying on medical history collection, examination (physical examination, neurological examination and mental examination) and control diagnostic criteria.
Collecting medical history In addition to asking myself, the information provided by the informed person is very important. The diagnosis of personality disorder is different from the diagnosis of ordinary psychiatric disease. It is necessary to systematically understand the important aspects of the patient's personality, that is, its life behavior pattern. the following:
1 Living arrangements, to understand how to arrange their daily life, especially when they are living alone or at home? What are the interests and hobbies?
2Social relations include getting along with superiors, peers, and the opposite sex? Is it easy to get friendships? Are there many close friends? Are there many friends who can trust and maintain lasting friendship?
3 What is the usual mood? Is it pleasant or melancholy? Is it stable or variable? How long does it last? Is the change spontaneous or environmentally related? When there is dissatisfaction, it reveals emotion or conceals.
4 Personality is an important part of personality. First, the patient should summarize what kind of person he is. Many people may have difficulty describing it. Then you can ask for help. If you have problems, are you too distressed? Are you strict or generous? Easy-going or loving-hearted? Stereotyped or flexible? Do you feel that you deserve to be liked, confident and capable? Are you too concerned about other peoples opinions or hurt because they are rejected? Some personality traits are suspicious The embarrassment and lack of trust are often not perceived by the patient. They need to rely on the insider to ask them whether the examinee is prone to excitement and quarrel with others. Is the behavior impulsive? Do you care about others? Do you feel dependent on others?
5 Attitudes and guidelines relate to the patient's religious beliefs, whether they are members of a religious group and the ethical standards they follow, and their attitudes toward health and disease. The mental examination is mainly to observe the patient's behavior during the interview and examination.
ICD-10 (1992), DSM-IV (1994) and CCMD-II-R (1994) provide clear diagnostic criteria for personality disorders that require diagnosis of personality disorder to be consistent with general criteria and corresponding types of personality disorders. Symptom indicators (CCMD-II-R and ICD-10 regulations meet at least 3).
(2) Research Diagnostics: For clinical research and epidemiological surveys, two types of assessment tools are required, namely questionnaires and interviews.
Questionnaire tools are self-reported or surveyed. Commonly used tools are SCID-IIPQ (SCID-II patient questionnaire, Spitzer et al., 1990), which is matched with DSM-III-R. Personality Diagnostic Questionnaire-Revised (PDQ-R, Hyler et al., 1992) The MIL clinical multi-axis questionnaire (MCMI, Millon et al., 1985), etc., the function of the questionnaire is to screen out suspicious personality disorder objects.
The interview tool is fixed or semi-finished. The suspicious objects screened by the psychiatrist are used to determine the personality disorder. Commonly used international personality disorder examination (IPDE, WHO, 1994), DSM-III-R personality disorder examination (SCID-II, Spitzer et al., 1989), DSM-III personality disorder interview (PDI-IV, Thomas et al., 1994), etc., SCID-II, PDI-IV can also be used for clinical diagnosis, currently IPDE, SCID-II, SCID -IIPQ and PDI-IV have been translated into Chinese in China.
(3) Diagnosis of personality disorder: The diagnostic criteria for personality disorder in the Chinese mental illness classification scheme and diagnostic criteria are as follows.
1 symptom standard: at least 3 of the following:
A. Patients have special behavior patterns, which are usually expressed in many aspects, such as emotion, alertness, perception and way of thinking, and have distinct attitudes and behaviors.
B. The patient's special behavioral pattern is long-term, persistent, and is not limited to the onset of mental illness.
C. The patient's special behavior patterns are universal, making the patient socially maladaptive.
2 Severity criteria: one of the following two items is required:
A. The social or professional function of the patient is significantly impaired.
B. The patient is subjectively painful.
3 course of disease criteria: starting in childhood, adolescents or early adulthood, now 18 years of age or older.
4 Exclusion criteria: Personality disorder is not caused by physical or mental illness or mental stimulation.
(4) Classification criteria:
1 Paranoid personality disorder: This is a personality disorder characterized by suspicion and paranoia. The diagnostic criteria are as follows.
A. Diagnostic criteria for personality disorder.
B. Symptoms meet at least 3 of the following items:
a. Extensive suspicion, often misunderstanding other people's unintentional, non-malicious or even friendly behavior as hostility or discrimination, or lack of sufficient basis, suspected of being exploited or harmed by others, so excessive vigilance and defense.
b. Interpret the surrounding things as "conspiracy" that does not conform to the actual situation, and can become a concept of over-price.
c. Easy to produce morbid convulsions.
d. Excessive self-confidence, if there is setback or failure, it is blamed on people, always think that you are correct.
e. Remember to hate others and be intolerant of others' faults.
f. Deviate from the actual argument and hostility, stubbornly pursue the "power" or "interest" that the individual is not reasonable.
g. Neglect or disbelief of objective evidence that is inconsistent with the patient's idea, making it difficult to justify or use facts to change the patient's mind.
2 schizophrenic personality disorder: This is a personality disorder with obvious concepts, appearance and behavior, as well as obvious defects in interpersonal relationships, and emotional coldness. The diagnostic criteria are as follows:
A. Diagnostic criteria for personality disorder.
B. Symptoms meet at least 3 of the following items:
a. There are strange beliefs, or behaviors that are not commensurate with the cultural background, such as the perception of perspective, telepathy, specific functions and sixth senses.
b. Strange, abnormal or special behaviors or appearances, such as strange costumes, unruly margins, untimely behavior, unclear habits or purposes.
c. The words are weird, such as digression, inappropriate words, complicated and inappropriate, and unclear opinions, not caused by factors such as education level or intellectual obstacles.
d. Unusual perceptual experiences, such as transient illusions, hallucinations, seeing people who do not exist.
e. Indifferent to people, no exception to relatives, lack of warmth and thoughtfulness.
f. Indifferent expression, lack of deep or vivid emotional experience.
g. Multiple individual activities, active interaction with people is limited to the necessary contacts in life or work, and there are no close friends except first-degree relatives.
3 Anti-social personality disorder: This is a personality disorder characterized by behaviors that do not conform to social norms. The diagnostic criteria are as follows.
A. Diagnostic criteria for personality disorder.
B. Patients have evidence of conduct disorder before the age of 18, at least 3 of the following:
a. Frequent truancy.
b. Expelled from school, or at least suspended for one time due to misconduct.
c. Detained or disciplined by the public security organs.
d. Go out overnight for at least 2 unspecified instructions.
e. Repeat lying (not to avoid corporal punishment).
f. Habitual smoking, drinking.
g. Repeated theft.
h. Participated in many times to disrupt public property activities.
i. Repeatedly provoke or participate in the fight.
j. Repeated violations of family rules or school rules.
k. Premature sexual activity.
l. Animal cruelty or weak companions.
C. There are irresponsible violations of social norms after the age of 18, at least three of the following:
a. It is not possible to maintain long-term work (or study), such as frequent absenteeism (class), or long-term (six months or longer) unemployed work, or multiple unplanned changes.
b. There are behaviors that are inconsistent with social norms, and these acts constitute the grounds for arrest (whether arrested or not), such as the destruction of public property.
c. Irritability, and aggressive behavior, such as repeated fights or attacks on others, including beating spouses or children (not to protect others or self-defense).
d. Often do not bear economic obligations, such as defaulting on debt, not raising children or not supporting parents.
e. Behave unplanned or impulsive, such as traveling without prior planning, or traveling without purpose.
f. Do not respect the facts, such as often lying, using a pseudonym, deceiving others to obtain personal interests or happiness.
g. Indifference to the safety of yourself or others.
h. Lack of responsibility for the family, such as malnutrition due to lack of care, lack of minimum sanitation, often sick, sick and not seeking medical treatment, not enough food and clothing, wasting money and not buying a family necessity.
i. It is impossible to maintain a long-term (more than one year) relationship.
j. There is no feeling of guilt when harming others.
4 impulsive personality disorder: This is a personality disorder with behavior and emotions with obvious impulsiveness, also known as fulminant or aggressive personality disorder. The diagnostic criteria are as follows.
A. Diagnostic criteria for personality disorder.
B. Symptoms meet at least 3 of the following items:
a. There are behavioral tendencies that are unpredictable and do not take into account the consequences.
b. Behavioral outbreaks are difficult to control.
c. Can not control inappropriate anger, easy to quarrel or conflict with others, especially when behavior is blocked or criticized, when accused.
d. Emotional volatility, unpredictability, violent and violent behavior.
e. Life has no purpose, no plan in advance, lack of predictability for what is likely to happen, or lack of persistence in doing things. If you do not give rewards, it will be difficult to complete a more time-consuming work.
f. Strong and unstable interpersonal relationships, relationships with people are excellent, sometimes extremely bad, and there are few lasting friends.
g. Self-injury.
5 performance type (sickness type) personality disorder: This is a personality disorder characterized by excessive emotional use or exaggeration of words and deeds to attract the attention of others. The diagnostic criteria are as follows:
A. Diagnostic criteria for personality disorder.
B. Symptoms meet at least 3 of the following items:
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b.
c.
d.
e.
f.
g.
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Differential diagnosis
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