Personality disorder

and sexual problems

Department of psychology
The first affiliated hospital of ZZU
Huirong guo
Personality and its disorders
 The need to understand the personalities for four
reasons:
 First, they may react in unusual ways to physical
illness or its treatment, for example by becoming
either over-dependent or untrusting and non—
compliant
 Second, when personality is abnormal the clinical
picture of psychiatric disorder changes, making
diagnosis more difficult
Personality and its disorders
 Third, abnormal personalities may react differently to
stressful events, for example, with aggressive or
histrionic behavior instead of anxiety
 Fourth, abnonna1 personalities may behave in ways
that are stressful or even dangerous to other people,
for example, a husband who is persistently aggressive
may cause his wife to become depressed or act
violently towards her
What is personality?
 The term personality' refers to the enduring characteristics
of an individual as shown in ways of behaving in a wide
variety of circumstances
 Personality can be thought of as being made up of more
circumscribed characteristics known as traits, such as
sociability, aggressivity, and impulsivity
What is personality?
 When describing abnormal personality it is usually better
to list the principal traits, rather than attempt to apply a
diagnostic label
 However, some abnormal personalities are dominated by a
single trait and for these a single descriptive term is useful,
as will be explained later. However, even for abnormal
personalities it is important to note other features,
especially those positive features than might be developed
further in treatment
What is personality disorder?
 Extreme deviations of personality can be recognized
as disordered but it is difficult to define a dividing line
between normal and abnormal
 If personality could be measured like intelligence, a
statistical cut-off could be used
 However, although psychologists have devised
measures of some aspects of personality there are no
reliable and valid measures of the aspects of
personality that are most important to clinical
practice
What is personality disorder?

 In the absence of such measures, a simple pragmatic

criterion is used: a personality is disordered when it
causes suffering to the person or to other people.
This definition may appear simplistic but it is useful
in clinical practice, and leads to reasonable
agreement between those using it
Common personality traits
 (For brevity, only negative attributes are listed.
Corresponding positive features should also be noted)
 Prone to worry
 Strict, fussy, rigid
 Lacking self-confidence
 Sensitive
 Suspicious, jealous
 Untrusting, resentful
Common personality traits
 Impulsive
 Attention seeking
 Dependent
 Irritable, quarrelsome
 Aggressive
 Lacking concern for others
Is there personality disorder?
 The interviewer decides whether to diagnose a personality
disorder by reviewing evidence from the clinical history to
decide whether the patient or others has suffered as a
result of the patient’s personality
 This judgement is subjective and it may be difficult to
decide how much the patient’s problems have been caused
by personality and how much by circumstances
 Despite these difficulties a judgement about personality
disorder is useful in planning management
 Types of personality disorder
 Anxious, moody, and prone to worry
 Avoidant (ICD: anxious)
 Obsessive-compulsive (ICD: anankastic)
 Depressive
 Hyperthymic
 Cyclothymic
 Aggressive and antisocial
 Antisocial (ICD: dissocial)
Types of personality disorder
 Sensitive, and suspicious
 Paranoid
 Schizoid
 Schizotypal
 Dramatic and impulsive
 Histrionic
 Borderline (ICD: impulsive)
 Dependent
The management of personality disorder
 General aspects of management
 The general approach should be to help the person gain
confidence and learn from mistakes. To achieve these aims,
setbacks should be discussed with the patient as opportunities to
find out more about the problem, not as signs of failure
 The aim is to help the patient to take a series of small steps over
a long time, not to bring about a rapid change. The plan should
be realistic, clearly understood by the patient, and carried out
consistently. The aim is to help patients solve their own
problems, not to remove responsibility from them
The management of personality disorder

 Also the doctor should recognize that progress will be

slow and punctuated by failures. Patience is needed
when managing personality disorders
 The relationship between patient and doctor is
particularly important when treating personality
disorder. The patient should feel valued as a person,
and able to trust and confide in the doctor
Management
 At the same time, the relationship should not
become too intense or dependent. When more than
one person is involved in treatment, their respective
roles should be defined and made clear to the
patient
 Any attempt to play one off against the other
should be discussed between the professionals and
with the patient
Management
 Great care is needed in setting limits for some
patients with personality disorder, especially for
those with over-dependent histrionic or
aggressive personalities
 These limits should be agreed by all those
involved in the patient’s care and explained to
the patient
Management
 Building on strengths. Management should not
focus exclusively on defects in the personality.
Whenever possible patients should be encouraged
to recognized and develop their talents and skills
by obtaining further training, changing to a job
better suited for their skills or interests, or by
developing more satisfying leisure activities
Management
 Such actions improve low self-esteem, which is a
frequent problem among people with all kinds of
personality disorder
 Provoking factors. The patient should be helped
to identify and find new ways of dealing with any
situations that regularly cause problems
 Management
 Abuse of alcohol and drugs. When abnormal
behavior is provoked by the use of alcohol or
drugs, help should be given to limit the use of
these substances
 Help for the family. This may be needed,
especially when the personality disorder is of the
aggressive or antisocial kind
Management
 Specific treatment methods
 Drug treatment has little general value in treating
personality disorder but there are a few specific uses
 Antipsychotic drugs may be calming at a time of
increased stress especially for aggressive and antisocial
personalities
 Lithium carbonate has been claimed to benefit some
people with recurrent mood changes; a specialist opinion
should be obtained before prescribing
Management
 Antidepressants are of value when there is an associated
depressive disorder. It has been claimed that, in the
absence of a depressive disorder, SSRIs (selective
serotonin reuptake inhibitors) diminish impulsive
behavior and repeated self-harm but their long-term
value is uncertain at the time of writing
 Carbamezepine has been claimed to reduce aggressive
behavior in some patients. The value is uncertain and, if
real, applies to a minority of such patients
Management
 Anxiolytic drugs should generally be avoided because
although they may improve well-being they may produce
disinhibition and dependency
 Psychotherapy may help for people with low self-esteem
and difficulties in social relationships. Sensitive and
suspicious and antisocial and aggressive personalities
seldom benefit Cognitive-behavioral methods are
generally more appropriate than in changing this
Problems of sexuality and gender
 Problems of sexuality and gender are common.
Doctors may be asked to give advice about four types
of problem :
 Sexual dysfunction: impaired or dissatisfying sexual enjoyment
or performance
 Abnormalities of sexual preference: unusual sexual interests
and activities that are preferred to heterosexual intercourse
 Disorders of gender identity: in which the patient feels as if
they are of the sex opposite to their biological sex
 Psychological problems encountered by homosexual people
Disorders of preference of the sexual object
 Fetishism
 In this condition, an inanimate object is the preferred or
only means of achieving sexual excitement. Almost all
fetishists are men and most are heterosexual
 Among the many objects that can evoke arousal in
different people, common examples are rubber garments,
women’s underclothes and high-heel shoes. The smell and
texture of these objects is often as important as their
appearance in evoking sexual arousal. Some fetishists buy
the objects, but other steal them and so come to the notice
of the police
Disorders of preference of the sexual object

 Fetishistic transvestism
 In this condition, the person repeatedly wears clothes of
the opposite sex as kind of fetishism
 Nearly all transvestites are men
 At first, the clothes are worn only in private; a few
people, however, go on to wear the clothes in public,
usually hidden under male outer garments, but
occasionally without precautions against discovery
Disorders of preference of the sexual object

 Paedophilia
 Paedophilia ia repeated sexual activity (or fantasy of
such activity) with prepubertal children as the
preferred or only means of sexual excitement. Most
paedophiles are men
 Of the few paedophiles who seek the help of doctors,
most are of middle age although the behavior has often
started earlier
 Disorders of preference of the sexual act

 The second group of disorders of sexual preference involves

variations in the behavior carried out to obtain sexual
arousal. Generally, the act are directed towards other
adults but sometimes towards children
Disorders of preference of the sexual act

 Exhibitionism
 In this condition, sexual arousal is obtained
repeatedly by exposure of the genitalia to an
unprepared stranger
 Nearly all exhibitionists are men. The act of
exposure is usually preceded by a period of
mounting tension which is released by the act
Disorders of preference of the sexual act

 Exhibitionism
 Usually, the exhibitionist seeks to shock or surprise
a female. Most exhibitionists fall into two groups.
The first consists of men with inhibited
temperament who generally expose a flaccid penis
and feel much guilt after the act
 The second consists of men with aggressive
personality traits who expose an erect penis while
masturbating, and feel little guilt afterwards
Disorders of preference of the sexual act

 When exhibitionism begins in middle or late life

the possibility of organic brain disorder,
depressive disorder, or alcoholism should be
considered since these conditions occasionally
“release” this pattern of behavior. In other people
the exhibitionism may start during a period of
temporary stress
Disorders of preference of the sexual act

 Voyeurism
 Voyeurism is observing the sexual behavior of
others as the preferred and repeated way of
obtaining sexual arousal. Most voyeurs are
inhibited heterosexual men. Some voyeurs spy
on couples who are having intercourse, others
on women who are undressing or naked
Disorders of preference of the sexual act
 Sexual sadomasochism
 Sadomasochism is a preference for sexual activity that
involves bondage or inflicting pain on another person. If
the individual prefers to receive such stimulation, the
disorder is called masochism
 If the individual prefers to administer such stimulation,
the disorder is called sadism. Beating, whipping, and tying
are common forms of such activity. Sometimes the acts
are symbolic and cause little actual damage, but
occasionally the acts cause serious injuries from which the
partner may die
Disorders of preference of the sexual act

 Some people engage in solitary acts of self-injury; a

particularly dangerous example is producing
suffocation by covering the head with a plastic bag
 Mild degrees of sadomasochistic behavior are common
and are considered to be part of normal sexual activity.
The disorder should only be diagnosed if
sadomasochistic activity is the most important source of
gratification or necessary for sexual stimulation
Disorders of identify
 Transsexualism
 In this rare disorder, the person has the conviction of being of
the sex opposite to that indicated by the external genitalia.
The person wishes to alter the external genitalia to resemble
those of the opposite sex, and to live as a member of that sex
 Most transsexuals are men; most women who cross-dress and
imitate men are homosexual not transsexual. In transsexuals,
the conviction of being a woman usually dates from before
puberty, but medical help is not requested until early adult
life, when most transsexuals have begun to dress as women
Disorders of identify
 Unlike transvestites, they report no sexual arousal from cross-
dress; and unlike the homosexuals who dress as women, they
not seek to attract people into a homosexual relationship
 Many transsexuals go to great lengths in their attempts to appear as
women
 They practise female styles of speaking, gesturing, and walking; they
remove body hair by electrolysis; they attempt to increase breast
tissue by taking oestrogen or by obtaining a surgical implant; and
they may seek an operation to remove the male external genitalia and
form and artificial ‘vagina’
Thank you

See you next time

Thank you

See you next time