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Li Meixiu (Ellen) JMS University

Chapter 9

Disorders of adult personality & behavior

Personality • Deeply ingrained pattern of behavior that include modes of perception ,relating to & thinking about oneself & the surrounding environment.

Personality

• a complex mix of traits & behaviors. • personality -- relationship with the world. • A man’s usual thought process & interaction with his environment are what makes him “himself.”

Personality traits • Normal ,prominent aspects of personality . • Abnomal ---personality disorder inflexible & maladaptive impairment / subjective distress

Personility disorder • 5~10% • Mixed --------comorbidity • Single --------pure

Diagnosis • Diagnosis – subjective • Conditions not directly attributable to gross brain damage/disease another psychiatric disorder

Personality Disorders character disorders, are a class of personality styles which deviate from the contemporary expectations of a society.

Personality Disorders inflexibile & pervasive behavioral patterns – difficulties / functional impairment. Rigid & on-going patterns of feeling, thinking & behavior are said to be caused by underlying belief systems -- fixed fantasies or "dysfunctional schemata" (Cognitive modules).

General diagnostic criteria A. Experience & behavior that deviates markedly from the expectations of the individual's culture. cognition (perception & interpretation of self, others & events) – affect (the range, intensity, lability & appropriateness of emotional response) – interpersonal functioning – impulse control

Cluster A (odd or eccentric disorders)

• Paranoid personality disorder: irrational suspicions & mistrust of others. 1/3. • Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others • Schizotypal personality disorder: odd behavior or thinking

Cluster B (dramatic, emotional, or erratic disorders) • Borderline personality disorder: extreme "black & white" thinking, instability in relationships, self-image, identity & behavior 1~2% • Histrionic personality disorder: " attention-seeking behavior including inappropriate sexual seductiveness & shallow or exaggerated emotions" • Narcissistic personality disorder: grandiosity, need for admiration & a lack of empathy 疑病 • Antisocial personality disorder: " disregard for the law & the rights of others."

Antisocial personality disorder (ASPD) • Deceit & manipulation are considered essential features of the disorder. • 18 or older + conduct disorder history before 15y. • "sociopaths" & "psychopaths"

Antisocial Personality Disorder -- Diagnostic criteria • Failure to conform to social norms with respect to lawful behaviors : repeatedly performing acts that are grounds for arrest; • Deceitfulness: repeatedly lying, aliases, or conning others for personal profit or pleasure; • Impulsivity or failure to plan ahead;

• Irritability & aggressiveness: fights or assaults; • Reckless disregard for safety of self or others; • irresponsibility: work behavior or honor financial obligations; • Lack of remorse 懊悔 : being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Symptoms • • • • • • • •

Persistent lying or stealing Superficial charm remorse or empathy; hurting others jobs / school Impulsivity and/or recklessness Lack of realistic, long-term goals – Friends / relationships such as marriage Poor behavioral controls -- irritability, annoyance, impatience, threats, aggression, abuse

• • • • • • • • • •

Narcissism, elevated self- entitlement agitated or depressed feeling (dysphoria烦躁 ) conduct disorders history Recurring difficulties with the law violate the boundaries & "rights" of others Substance abuse Aggressive, often violent behavior; fights Inability to tolerate boredom Disregard for the safety of self or others experience difficulties with authority figures.

Cluster C (anxious or fearful disorders) • Avoidant personality disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation & avoidance of social interaction • Dependent personality disorder: psychological dependence on other people. • Obsessive-compulsive personality disorder 十全十美 (≠obsessive-compulsive disorder): rigid conformity to rules, moral codes & excessive orderliness

Enduring personality changes, not attributable to brain damage & disease • without previous personality disorder following exposure to catastrophic or excessive prolonged stress, or following a severe psychiatric illness.

Habit & impulse disorders • • • •

Pathological gambling Pathological fire-setting [pyromania] Pathological stealing [kleptomania] Trichotillomania

• Gender identity disorders • Disorders of sexual preferece • Psychological & behavioral disorders associated with sexual development & orientation • Factitious disorder(munchausen syndrome) 病理谎言

Disorders of sexual preference • • • • • • • • •

Fetishism Fetishistic transvestism Exhibitionism Voyeurism Paedophilia 童 Sadomasochism 虐 Multiple disorders of sexual preference Other disorders of sexual preference Disorder of sexual preference, unspecified

Psychological & behavioural disorders associated with sexual development & orientation • • • • •

Sexual maturation disorder Egodystonic sexual orientation 自我排斥 Sexual relationship disorder Other psychosexual development disorders Psychosexual development disorder, unspecified

Chapter 11 Sleep Disorders

sleep disorder (somnipathy) • medical disorder of the sleep patterns of a person . • interfere with normal physical, mental & emotional functioning. • polysomnogram.

COMMON TYPES • Insomnia: • Bruxism: grinding or clenching of the teeth • Delayed sleep phase syndrome (DSPS): awaken & fall asleep , 能 sleep maintenance, a disorder of circadian rhythms. • Hypopnea syndrome: shallow or slow breathing • Narcolepsy: daytime sleepiness • Cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor.

• nocturnal myoclonus 肌阵挛 . • Rapid eye movement behavior disorder (RBD): Acting out violent or dramatic dreams in REM sleep • Restless legs syndrome (RLS): An irresistible urge to move legs. • Situational circadian rhythm : shift work sleep disorder (SWSD) & jet lag

• Night terror 夜惊 • Parasomnias异态睡眠 : sleep actions - sleep walking & night-terrors. • Periodic limb movement disorder (PLMD): Sudden involuntary movement of arms and/or legs during sleep ： kicking the legs.

Psychiatry