From Wikipedia, the free encyclopedia
Personality disorder, formerly referred to as a Character
Disorder is a class of mental disorders characterized by rigid and
on-going patterns of thought and action (Cognitive
modules). The underlying belief systems informing these patterns are
referred to as fixed
fantasies. The inflexibility and pervasiveness of these behavioral
patterns often cause serious personal and social difficulties, as well as a
general impairment of functioning.
Personality disorders are defined by the American
Psychiatric Association (APA) as "an enduring pattern of inner
experience and behavior that deviates markedly from the expectations of the
culture of the individual who exhibits it". [1]
These patterns, as noted, are inflexible and pervasive across many situations,
due in large part to the fact that such behavior is ego-syntonic
(i.e., the patterns are consistent with the ego
integrity of the individual), and therefore, perceived to be appropriate
by that individual. The onset of these patterns of behavior can typically be
traced back to the beginning of adulthood, and, in rare instances, early
adolescence. [1]
This definition allows significant deviance
from societal
norms, such as conscientious objection to a social regime, to be
classified as a mental
disorder. In the former Soviet
Union and elsewhere this has been used to justify treatment of political
dissidents as though they were psychologically disturbed.[2]
[edit]
DSM-IV-TR criteria
Personality disorders are noted on Axis
II of the Diagnostic
and Statistical Manual of Mental Disorders, or DSM-IV-TR (fourth edition,
text revision), of the American
Psychiatric Association.
[edit]
General diagnostic criteria
Diagnosis of a personality disorder must satisfy the following general
criteria in addition to the specific criteria listed under the specific
personality disorder under consideration.
A. Experience and behavior that deviates markedly from the expectations of
the individual's culture. This pattern is manifested in two (or more) of the
following areas:
-
- cognition
(perception and interpretation of self, others and events)
- affect
(the range, intensity, lability,
and appropriateness of emotional
response)
- interpersonal
functioning
- impulse
control
B. The enduring pattern is inflexible and pervasive across a broad range of
personal and social situations.
C. The enduring pattern leads to clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be traced
back at least to adolescence
or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or
consequence of another mental
disorder.
F. The enduring pattern is not due to the direct physiological effects of a
substance
or a general medical condition such as head
injury.
People under 18 years old who fit the criteria of a personality disorder
are usually not diagnosed with such a disorder, although they may be diagnosed
with a related disorder. In order to diagnose an individual under the age of
18 with a personality disorder, symptoms must be present for at least one
year. Antisocial
personality disorder, by definition, cannot be diagnosed at all in persons
under 18.
[edit]
List of personality disorders defined in the DSM
The DSM-IV
lists ten personality disorders, grouped into three clusters. The DSM also
contains a category for behavioral patterns that do not match these ten
disorders, but nevertheless exhibit characteristics of a personality disorder.
This category is labeled Personality Disorder NOS (Not Otherwise
Specified).
Cluster A (odd or eccentric disorders)
-
Cluster B (dramatic, emotional, or erratic disorders)
-
Cluster C (anxious or fearful disorders)
-
[edit]
Revisions and exclusions from past DSM editions
The revision of the previous edition of the DSM, DSM-III-R, also contained
the Passive-Aggressive Personality Disorder, the Self-Defeating
Personality Disorder, and the Sadistic Personality Disorder. Passive-Aggressive
Personality Disorder is a pattern of negative attitudes and passive
resistance in interpersonal situations. Self-defeating
personality disorder is characterised by behaviour that consequently
undermines the person's pleasure and goals. Sadistic
Personality Disorder is a pervasive pattern of cruel, demeaning, and
aggressive behavior. These categories were removed in the current version of
the DSM, because it is questionable whether these are separate disorders.
Passive-Aggressive Personality Disorder and Depressive
personality disorder were placed in an appendix of DSM-IV for research
purposes.
[edit]
Etiological studies
A study of almost 600 male college students, averaging almost 30 years of
age and who were not drawn from a clinical sample, examined the relationship
between childhood experiences of sexual and physical abuse and presently
reported personality disorder symptoms. Childhood abuse histories were found
to be definitively associated with greater levels of symptomatology. Severity
of abuse was found to be statistically significant, but clinically negligible,
in symptomatology variance spread over Cluster A, B and C scales. Miller
and Lisak. Journal of Interpersonal Violence. June 1999
Child abuse and neglect consistently evidence themselves as antecedent
risks to the development of personality disorders in adulthood. In this
particular study, efforts were taken to match retrospective reports of abuse
with a clinical population that had demonstrated psychopathology from
childhood to adulthood who were later found to have experienced abuse and
neglect. The sexually abused group demonstrated the most consistently elevated
patterns of psychopathology. Officially verified physical abuse showed an
extremely strong role in the development of antisocial and impulsive behavior.
On the other hand, cases of abuse of the neglectful type that created
childhood pathology were found to be subject to partial remission in
adulthood. Cohen, Patricia, Brown, Jocelyn, Smailes, Elizabeth. "Child
Abuse and Neglect and the Development of Mental Disorders in the General
Population" Development and Psychopathology. 2001. Vol 13, No 4,
pp981-999. ISSN 0954-5794
In 2005, psychologists Belinda Board and Katarina Fritzon at the University
of Surrey, UK, interviewed and gave personality tests to high-level
British executives and compared their profiles with those of criminal
psychiatric patients at Broadmoor
Hospital in the UK. They found that three out of eleven personality
disorders were actually more common in managers than in the disturbed
criminals, they were:
They described the business people as successful psychopaths
and the criminals as unsuccessful psychopaths. [3]
[edit]
References
- ^ a
b Diagnostic
and Statistical Manual of Mental Disorders
- ^
Lyons, Declan; O'Malley, Art (December
2002). "The labelling of dissent — politics and psychiatry behind
the Great Wall". Psychiatric Bulletin 26 (12): 443-444.
doi:10.1192/pb.26.12.443.
ISSN
1472-1473.
OCLC 46851972.
- ^ Board, B.J. &
Fritzon, Katarina, F. (2005). Disordered personalities at work.
Psychology, Crime and Law, 11, 17-32
[edit]
Further reading
- American Psychiatric Association. (2000). Diagnostic and Statistical
Manual of Mental Disorders. 4th ed. (text revision). (DSM-IV-TR).
Arlington, VA.
- Häcker, H. O. Stapf (2004). Dorsch Psychologisches Wörterbuch,
Verlag Hans Huber, Bern
- Marshall, W. & Serin, R. (1997) Personality Disorders. In Sm.M.
Turner & R. Hersen (Eds.) Adult Psychopathology and Diagnosis. New
York: Wiley. 508-541
- Millon, Theodore (and Roger D. Davis, contributor) - Disorders of
Personality: DSM IV and Beyond - 2nd ed. - New York, John Wiley and
Sons, 1995 ISBN
0-471-01186-X
[edit]
See also
[edit]
External links
| [show]
WHO
ICD-10 mental
and behavioural
disorders (F ·
290–319) |
| Neurological/symptomatic |
Dementia
(Alzheimer's
disease, multi-infarct
dementia, Pick's
disease, Creutzfeldt-Jakob
disease, Huntington's
disease, Parkinson's
disease, AIDS
dementia complex, Frontotemporal
dementia) · Delirium ·
Post-concussion
syndrome |
| Psychoactive
substance |
Intoxication
(drunkenness) ·
Physical
dependence (alcohol
dependence, opioid
dependency, cocaine
dependence) · Withdrawal
(benzodiazepine
withdrawal, delirium
tremens) ·
Amnesic: (Korsakoff's
syndrome) |
| Psychotic
disorder |
Schizophrenia
(disorganized
schizophrenia) · Schizotypal
personality disorder ·
Delusional
disorder · Folie
à deux · Schizoaffective
disorder |
| Mood
(affective) |
Mania ·
Bipolar
disorder · Clinical
depression · Cyclothymia ·
Dysthymia |
Neurotic,
stress-related
and somatoform |
Agoraphobia ·
Anxiety
disorder · Panic
disorder · Generalized
anxiety disorder · Social
Anxiety Disorder · OCD ·
Acute
stress reaction · PTSD ·
Adjustment
disorder · Conversion
disorder (Ganser
syndrome) · Somatoform
disorder · Somatization
disorder · Neurasthenia |
Physiological/physical
behavioural |
Eating
disorder (anorexia
nervosa, bulimia
nervosa) · Sleep
disorder (dyssomnia,
insomnia,
hypersomnia,
parasomnia,
night
terror, nightmare) ·
Sexual
dysfunction (erectile
dysfunction, premature
ejaculation, vaginismus,
dyspareunia,
hypersexuality) ·
Postpartum
depression |
Adult
personality
and behaviour |
Personality
disorder · Passive-aggressive
behavior · Kleptomania ·
Trichotillomania ·
Voyeurism ·
Factitious
disorder · Munchausen
syndrome · Ego-dystonic
sexual orientation |
| Mental
retardation |
Mental
retardation |
Psychological
development
(developmental
disorder) |
Specific:
speech
and language (expressive
language disorder, aphasia,
expressive
aphasia, receptive
aphasia, Landau-Kleffner
syndrome, lisp) ·
Scholastic skills (dyslexia,
dysgraphia,
Gerstmann
syndrome) · Motor
function (developmental
dyspraxia)
Pervasive:
Autism ·
Rett
syndrome · Asperger
syndrome |
Behavioural
and emotional,
childhood and adolescence onset |
ADHD ·
Conduct
disorder · Oppositional
defiant disorder · Separation
anxiety disorder · Selective
mutism · Reactive
attachment disorder ·
Tic
disorder · Tourette
syndrome · Speech
(stuttering ·
cluttering) |
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反社會型人格異常是病態人格的一種，在精神疾病診斷與統計手冊（DSM）中歸類於第二軸發育障礙/人格異常的類別B裡，而且必須超過18歲才能被診斷為反社會人格。
反社會人格患者在初識時，往往予人聰明、人緣佳的印象，但實際上他們會殘酷無情的利用他們身邊的人，以達到他們的目的。此種人格傾向常見於狡猾的政客、詐欺犯、奸商等之中。他們的社會化不足，因此缺乏對人、社會、團體的認同與忠誠。
[編輯]
臨床現象
[編輯]
良心發展不足
他們無法接受或了解道德的價值，嚴重的缺乏良心譴責，所以不會因不道德行為而焦慮或有罪惡感。他們甚至會輕視那些被他們利用的人。
[編輯]
不負責任和衝動的行為
他們很少為未來長期的利益考量，所以傾向於尋求立即的滿足，他們也較難忍受例行性的事物。
[編輯]
善於利用它人
他們看來幽默、樂觀、討人喜歡，容易解除別人的武裝。他們似乎對別人的需要和弱點有敏銳的觀察力。他們也擅長辯解與說服別人。
[編輯]
無法建立良好的人際關係
雖然他們容易得到他人的友誼，但因為他們的自我中心與不負責任，讓他們難以維持一個真正且良好的關係。他們欠缺同情心、感激和悔意。據臨床診斷發現有相當大的比例男性反社會人格者有暴力傾向。他們也是不忠實和不負責的伴侶。
[編輯]
成因
對於此病的成因學者仍無定論，有人認為他們生理上的缺陷使得他們難以學得制約反應，也有人認為他們只是善於逃避心中不舒服的感受而已。
[編輯]
治療和效果
因為反社會人格不像一般心理疾病會有心理上的異常行為，也能正常的生活，所以他們通常不會求助於醫院或輔導中心。而已經因為觸犯法律而接受監獄的心理治療，效果也是相當不樂觀。一般的治療方法在他們身上成效不彰，這應該歸因於他們本身的欠缺焦慮和罪惡感、無法相信他人、難以學到教訓等的人格特質。有趣的是，即使沒有接受治療，許多反社會人格者到了40歲以後會逐漸改善，這或許是因為累積的社會制約所造成的。
From Wikipedia, the free encyclopedia
Dissocial
personality disorder
Classification & external resources
| ICD-10 |
F60.2 |
| ICD-9 |
301.7 |
Antisocial personality disorder (APD) is a psychiatric
condition characterized by an individual's common disregard for social rules,
norms, and cultural codes, as well as impulsive behavior, and indifference to
the rights and
feelings of others. Antisocial personality disorder is terminology used by the
American Psychiatric Association's Diagnostic
and Statistical Manual, while the World Health Organization's ICD-10
refers to Dissocial
personality disorder.
Antisocial personality disorder is often misunderstood by both
professionals and laypeople. The term antisocial is often, incorrectly,
confused with unsociable or shy.
- Failure to conform to social
norms 社會－基準,模範,標準,智力水準,平均數with respect
to lawful behaviors as indicated by repeatedly performing acts that are
grounds for arrest逮捕,拘留;阻礙,阻止,抑制;吸引,引人注目
- Deceitfulness虛假;騙人, as indicated by repeated lying, use of aliases別名,化名,
or conning親切， 熱烈， 充滿熱情 others for personal profit or
pleasure
- Impulsivity沖動,受感情驅使,任性 or failure to plan ahead
- Irritability易怒,過敏性,興奮性 and aggressiveness侵略;攻勢,
as indicated by repeated physical fights or assaults攻擊,突襲
- Reckless不注意的,大意的,鹵莽的,不顧後果的 disregard for
safety of self or others
- Consistent irresponsibility無責任, as indicated by repeated failure
to sustain steady work or honor financial obligations
- Lack of remorse後悔,懊悔,自責;憐憫,寬恕,
as indicated by being indifferent to or rationalizing使合理,合理地處理
having hurt, mistreated濫用,侮辱,虐待,辱罵;弊病,陋習, or
stolen from another
- Insensitivity to pain
The manual lists the following additional necessary criteria:
[edit]
Criticism of the DSM-IV criteria
The DSM-IV confound: some argue that an important distinction has
been lost by including both sociopathy and psychopathy together under APD. As
Hare et al
write in their abstract, "The Axis II Work Group of the Task Force on
DSM-IV has expressed concern that antisocial personality disorder (APD)
criteria are too long and cumbersome and that they focus on antisocial
behaviors rather than personality traits central to traditional
conceptions", concluding, "... conceptual and empirical arguments
exist for evaluating alternative approaches to the assessment of psychopathy
... our hope is that the information presented here will stimulate further
research on the comparative validity of diagnostic criteria for psychopathy;
although too late to influence DSM-IV."[1]
Sex differences: APD is diagnosed much more frequently in men than
in women.[citation
needed] The DSM-IV diagnostic criteria does not take into
account relational
aggression, in which women are more likely to engage than physical
aggression.
[edit]
Causes
The cause of this disorder is unknown, but biological or genetic factors
may play a role.
A family history of the disorder — such as having an antisocial parent
— increases the chances of developing the condition. A number of
environmental factors within the childhood home, school and community, such as
an overly punitive home or school environment may also contribute.[2]
Robins (1966) found an increased incidence of sociopathic characteristics
and alcoholism
in the fathers of individuals with antisocial personality disorder. He found
that, within such a family, males had an increased incidence of APD, whereas
females tended to show an increased incidence of somatization
disorder instead.[3]
Bowlby (1944) saw a connection between antisocial personality disorder and
maternal deprivation in the first five years of life. Glueck and Glueck (1968)
saw indications that the mothers of children who developed this personality
disorder tended to display a lack of consistent discipline and affection, and
an abnormal tendency to alcoholism and impulsiveness. These factors all
contribute to a failure to create a stable and functional home with consistent
structure and behavioral boundaries.[3]
Adoption
studies support the role of both genetic and environmental contributions to
the development of the disorder. Twin studies also indicate an element of
hereditability of antisocial behaviour in adults and have shown that genetic
factors are more important in adults than in antisocial children or
adolescents where shared environmental factors are more important. (Lyons et
al., 1995)[3]
[edit]
Symptoms
Common characteristics of people with antisocial personality disorder
include:
- Persistent lying or stealing
- Recurring difficulties with the law
- Tendency to violate the rights and boundaries of others (property,
physical, sexual, emotional, legal)
- Substance abuse
- Aggressive, often violent behavior; prone to getting involved in fights
- A persistent agitated or depressed feeling (dysphoria)
- Inability to tolerate boredom
- Disregard for the safety of self or others
- A childhood diagnosis of conduct disorders
- Lack of remorse for hurting others
- Superficial charm
- Impulsiveness
- A sense of extreme entitlement
- Inability to make or keep friends
- Lack of guilt
- Relentlessness
- being completely insensitive to pain
- Recklessness, impulsivity[4][2]
People who have antisocial personality disorder often experience
difficulties with authority figures.[5]
[edit]
Prevalence
The National Comorbidity Survey, which used DSM-III-R criteria, found that
5.8 percent of males and 1.2 percent of females showed evidence of a lifetime
risk for the disorder.[6]
In penitentiaries, the percentage is estimated to be as high as 75 percent.
Prevalence estimates within clinical settings have varied from three to 30
percent, depending on the predominant characteristics of the populations being
sampled. {Diagnostic and Statistical Manual of Mental Disorders} Perhaps not
surprisingly, the prevalence of the disorder is even higher in selected
populations, such as people in prisons (who include many violent offenders)
(Hare 1983). Similarly, the prevalence of ASPD is higher among patients in
alcohol or other drug (AOD) abuse treatment programs than in the general
population (Hare 1983), suggesting a link between ASPD and AOD abuse and
dependence.[7]
[edit]
Relationship with other mental disorders
Antisocial personality disorder is negatively correlated with all DSM-IV
Axis I disorders except substance
abuse disorders. Antisocial personality disorder is most strongly
correlated with psychopathy
as measured on the Psychopathy
Checklist-Revised (PCL-R).
[edit]
Potential markers
Although antisocial personality disorder cannot be formally diagnosed
before age 18, three markers for the disorder, known as the MacDonald
Triad, can be found in some children. These are, a longer-than-usual
period of bedwetting,
cruelty
to animals, and pyromania[8].
It is not known how many children who exhibit these signs grow up to
develop antisocial personality disorder, but these signs are often found in
the histories of diagnosed adults. Because it is unknown how many children
have these symptoms and who do not develop antisocial personality disorder,
the predictive value (ie, the usefulness of these symptoms for predicting
future antisocial personality disorder) is unclear.
These three traits are now included in the Diagnostic
and Statistical Manual of Mental Disorders IV-TR under conduct
disorder.
A child who shows signs of antisocial personality disorder may be diagnosed
as having either conduct
disorder or oppositional
defiant disorder. Not all of these children, however, will grow up to
develop antisocial personality disorder.
[edit]
See also
[edit]
References
[edit]
External links
