The personality it is the peculiar way of each think, feel and behave in relation to each other and to their environment.
How to manifest personality disorders?
The personality disorders they are the constants of thought, behavior and relationship that differ significantly from what you expect, that is, deviate from the norms and social expectations of their environment.
Those who suffer from personality disorders deviates markedly and so hard and persistent:
- the way of think to themselves, to others and to the events;
- the way you react emotionally (in terms of variety, intensity, lability and appropriateness of emotional response)
- the way of relate with other people
- the way of control behaviour (excessive or reduced by adjusting pulse)
Usually someone who has a personality disorder, not aware of the problematic nature of his mode of thought, relationship, and behavior, in most cases, the traits of personality are, in fact, egosintonici.
Personality disorders are generally recognizable in adolescence, the beginning of adulthood or sometimes even childhood.
If not diagnosed and adequately treated cause interpersonal problems, inadequate coping skills, and suffering for the whole of life, from the moment that the structure of the personality develops early and tends to remain stable over time. In general, personality disorders are diagnosed in 40-60% of psychiatric patients, making them the most frequent psychiatric diagnoses.
What are personality disorders?
The DSM-5 (Manual of diagnostic and statistical of mental disorders – 5th and most recent edition) provides two modes of classification of sisturbi personality: a categoryin continuity with the previous edition of the manual, which treats them as the clinical syndromes distinct and qualitatively and identifies 10 different types of disorder, which are grouped into 3 groups (clusters); and a dimensional, according to which personality disorders are variants disadattive of personality traits that blend imperceptibly with the normality and between them.
According to this perspective, there are 3 groups of personality disorders that share similarities descriptive:
It is characterized by behaviors “strange” or eccentric, distrust and a tendency to isolation. Includes:
- Personality paranoid: characterized by mistrust and suspiciousness pervasive to others, so much so that the tendency to attribute their bad intentions; he is afraid to be damaged or deceived, even in the face of a lack of concrete evidence.
- Schizoid personality: it is characterized by a pervasive detachment from social relationships and a restricted range of emotional expressions in interpersonal situations. Don't seem to want intimacy and appear indifferent to the opportunity to establish relationships, they are isolated r feel pleasure in few, if any, activities.
- Personality schizotipica: as the schizoid personality, show social withdrawal, and emotional detachment, but the behavior and the thoughts are bizarre and atypical. It can be magical thinking, and paranoid.
It is characterized by dramatic behaviour, and from the strong emotions expressed, self-centeredness and lack of empathy. Includes:
- Antisocial personality: also defined psychopathy or sociopathy, refers to a person who ignores or violates the rights of others, does not give value to the social norm, and uses the other to reach their goals (unlike the narcissistic personality is the exploitation of another is purely utilitarian, and not justified by their supposed superiority).
- Borderline personality: presents a pattern of instability in personal relationships, in the image of the self and the mood. Makes desperate efforts to avoid real or imagined abandonment, has a vision of the self and of the other unstable, which can quickly pass from the opposite images (idealization – devaluation). Experiences intense emotions, and poor ability to control, intense anger, impulsivity, meaning the chronic of emptiness and loneliness, which can lead to recurrent behaviors, gestures, and threats suicidarie.
- Histrionic personality: it is characterized by a constant search for attention on the part of the other, so as to feel uncomfortable when not the center of attention, and the theatrical expression and superficial feelings, and emotions. Always concerned with their image, people who suffer from it can use the physical appearance and seduction to attract attention, but also show behaviors in childhood or aggravate a condition of fragility to receive care and protection.
- Narcissistic personality: characterized by a sense of superiority, a need for admiration and lack of empathy for others. He has a sense of grandeur and brings him to overestimate successes and talents and feel superior to others, from whom they believe to be admired and envied. It moves as if it had particular the right to satisfy their needs and desires, whereas the other as a means to reach this goal, and feel that having to attend only people with “special” or of social class is high. Are sensitive to failure and criticism, disconfermando their grandeur, can arouse anger but also induce depressive states.
It is characterized by behaviors anxious or fearful, and low self-esteem. Includes:
- Personality-avoidant: characterized by social inhibition, feelings of inadequacy, and extreme sensitivity to negative judgment; the difficulty of being in relation leads to isolation, which, however, unlike the schizoid personality, lived with suffering and conceals a strong desire for acceptance and closeness to the other. The feelings most proven are shame and sadness.
- Dependent personality: characterized by a pervasive and excessive care that determines behavior is submissive and dependent, and the fear of separation, and comes from a perception of the self as unable to function properly without the other. They may have difficulty in daily decisions without being reassured by the others feel uncomfortable or helpless when alone and to allow others (often to a single person) to take the initiative and assume responsibility for most areas of their lives.
- Obsessive-compulsive personality: characterized by a concern for the order, the perfection, and the mind-control and interpersonal skills, at the expense of flexibility, openness and efficiency. Intolerance of uncertainty and error makes it less adaptable to change and extremely slow in the decision-making process, so much to work hard in the completion of a task or an activity undertaken. She is worried about the details, the rules and the order of the point that is lost the main purpose of the activity; fatigue delegate or collaborate unless the other does not submit to exactly his way of doing things and adopt a mode of expenditure based on greed. It may be over-conscientious, scrupulous, and inflexible in themes of morality, ethics or values.
In clinical practice, patients often meet the criteria for several personality disorders, or have the characteristic features of the various disorders. For this reason, the DSM-5 introduces a new method of classifying personality disorders according to two dimensions:
- impairment of operation personality: includes operation of the self (that is, the definition of the identity and autodirezionalità, understood as the ability to pursue key objectives) and the operation interpersonal (that is, the ability to feel empathy and intimacy in your relationships with others). The clinician will assess the degree of impairment of each of these items (on a scale from 0-little or no impairment to the 4 - extreme impairment).
- personality traits of pathological: are organized 25 facets grouped into 5 major domains: affectivity, negative, detachment, antagonism, disinhibition, and psicoticismo.
How we deal with personality disorders in the Centre Tice?
International guidelines indicate in drug therapy and cognitive-behavioral therapy treatments demonstrated at the time the most effective.
The reduction of the symptoms of anxiety and depression and high-risk behaviours is the first objective of treatment. In this sense, the drug therapy may be a valuable help and for this, Tice collaborated with many doctors, psychiatrists, to ensure continuity and monitoring of the intervention in a coordinated and synergistic.
However, drug therapy does not intervene on the characteristics of personality on which it is necessary to act with psychotherapy.
Until recently, it was believed that the treatment psychotherapy is not effective for the treatment of personality disorders. But it has been found that certain types of psychotherapy, first of all, cognitive-behavioral, are found to be effective in helping people with these personality disorders.
Since the personality is built of patterns starting from the beginning of life, the treatment of personality disorders, especially of the schemas and interpersonal aspects of identity takes time. In the path of psychotherapy the subject can understand the sources of their suffering (learning experiences) and to recognize their maladaptive behaviour (manipulation, lack of empathy, arrogance, distrust, avoidance, etc), can learn to tolerate and better manage their emotions, communicate more effectively and appropriately. Psychotherapists of TICE, are in constant training to learn about the approaches that have demonstrated effectiveness in the treatment of personality disorders (e.g. DBT - Lisa Behavior Therapy, EMDR - Eye Movement Desensitization Reprocessing, ACT - Acceptance and Commitment Therapy).
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Mindfulness is a meditative practice that consists in the pay attention to the present moment with an attitude that is friendly and non-judgmentalby helping to mull less on the past and worry less about the future. Programs, cognitive-behavioral, integrating the mindfulness approach (MBCT), help patients better tolerate the painful emotions and to take away from one's own thoughts negativthe, and are especially useful in the relapse prevention. To TICE, we propose individual paths or in a group to raise awareness through meditation.
Depending on the need, we provide support for parental and family for the patients with a diagnosis of personality disorder. The psychological counseling helps family members to develop the emotional impact of having a loved one and explores the how can better support them, avoiding keeping their behaviors through their reactions.
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