第十一章 人格障碍及其治疗
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DSM－IV强调病人在认知、情感、人际关系和 冲动控制方面的偏离，指出这种偏离类型在 长时间内相当稳定，至少可以追溯到青少年 或早期成年时。
Personality Disorders: Facts and Statistics
Prevalence of Personality Disorders
回避型 依赖性 强迫型
9
PERSONALITY DISORDERS Historical perspective
Roots in psychoanalysis – narcissism, masochism, etc. Karl Abraham – first theorist to focus on personality disorders
第十一章人格障 碍及其矫正
(personality disorders)
于丽琴
一、人格障碍概述(Personality Disorders: An Overview)
What is a personality disorder?
maladaptive personality traits traits are relatively enduring features of a person that are persistent over time and situations people with personality disorders tend to be: rigid and inflexible, show a restricted range of traits, have a dominant single trait personality disorders are egosyntonic, more than egodystonic
About 0.5% to 2.5% of the general population
6-9% （Kathleen ，1986）
0.13‰（我国，1986） Rates are higher in inpatient and outpatient settings。prevalence higher among people with other mental disorders
Treatment Options
Few seek professional help on their own Treatment focuses on development of trust Cognitive therapy to counter negativistic thinking Lack good outcome studies
16
17
18
Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. Reads hidden demeaning or threatening meanings into benign remarks or events.
12
13
（一）偏执型人格障碍（paranoid PD)
1、临床特征 2、形成原因 3、治疗
临床特征
主要特征：猜疑、偏执
表现为对他人持久的不信任，社会隔离，过分
警惕
临床发现男性居多
0.5-2.5% of the population. o Men > Women. o Higher incidence in relatives of schizophrenics. o Higher among minorities, immigrants, and the deaf.
Gender bias exists in diagnosis Criterion vs. assessment gender bias
6
分类DSM-IV and DSM-IV-TR Personality Disorder Clusters
DSM-IV将10种人格障碍划分为3大类群:
20
形成原因
生物学原因
在精神分裂症患者亲属中较多
心理分析
偏执来自无意识中强烈的仇恨和敌意的外向投射
认知的观点
与歪曲的认知或想法有关
文化因素
特殊人群，如犯人、难民、有听力障碍的人等易形成这
种人格障碍
22
23
治疗
建立信任关系非常重要 心理动力and honest. Have a professional and not overly warm style. Don‘t confront Set limits. Clearly explain procedures, medications and results.
summary: Paranoid Personality Disorder
Overview and Clinical Features
Pervasive and unjustified mistrust and suspicion
The Causes
Biological and psychological contributions are unclear Early learning that the world is a dangerous place
31
形成原因
生物学
可能有与孤独症类似的生理机能缺陷
心理动力学
基本的接触需要没有获得满足
认知治疗
C类群：紧张、焦虑行为 Cluster C
Fearful or anxious Examples include avoidant, obsessive-compulsive
人格障碍类型
cluster A
偏执型 分裂型 分裂样
cluster B
表演型 自恋型 反社会型 边缘型
cluster C
男性多见 7.5% of the population. o A 2-to-1 male-to-female ratio.
29
Neither desires nor enjoys close relationships, including being part of a family. Almost always chooses solitary activities. Has little, if any, interest in having sexual experiences with another person. Takes pleasure in few, if any, activities. Lacks close friends or confidants other than first-degree relatives.
6-9% of population have one or more personality disorder most people with personality disorders never come to the attention of mental health professionals
10
PERSONALITY DISORDERS Diagnostic issues
poor understanding of etiology of most personality disorders comorbidity and diagnostic overlap gender and cultural issues reliability of diagnosis
19
Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. Has recurrent suspicions, without justification,regarding fidelity of spouse or sexual partner. Does not occur exclusively during the course of a Psychotic Disorder and is not due to a general medical condition.
5
Origins and Course of Personality Disorders
Thought to begin in childhood Run a chronic course Comorbidity rates are high
Gender Distribution and Gender Bias
A类群：行为古怪、奇异 Cluster A Odd or eccentric Examples include paranoid, schizoid
B类群：戏剧化、情感强烈、不稳定 Cluster B
Dramatic, emotional, erratic Examples include antisocial, borderline
11
PERSONALITY DISORDERS Etiology – Theoretical perspectives
Psychodynamic theory Attachment theory – particularly for dramatic, emotional, erratic Cognitive-behavioural perspectives Biological – particularly for odd, eccentric and dramatic, emotional, erratic
25
（二）分裂样人格障碍（Schizoid PD）
1、临床特征 2、形成原因 3、治疗
临床特征
特征：社会隔绝、情感疏远
表现为孤单、冷淡的沉默，不介入日常事务，不交际，不关心他人。将 精力投注于非人类的事物（如数学）
患病率
美、德等国采用PDQ（人格障碍诊断问卷）、SCID等得
到的患病率为0.7－1.6％
30
Appears indifferent to the praise and criticism of others. Shows emotional coldness, detachment, or flattened affectivity. Does not occur exclusively during the course of a Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to a general medical condition.
DSM－IV强调病人在认知、情感、人际关系和 冲动控制方面的偏离，指出这种偏离类型在 长时间内相当稳定，至少可以追溯到青少年 或早期成年时。
Personality Disorders: Facts and Statistics
Prevalence of Personality Disorders
回避型 依赖性 强迫型
9
PERSONALITY DISORDERS Historical perspective
Roots in psychoanalysis – narcissism, masochism, etc. Karl Abraham – first theorist to focus on personality disorders
第十一章人格障 碍及其矫正
(personality disorders)
于丽琴
一、人格障碍概述(Personality Disorders: An Overview)
What is a personality disorder?
maladaptive personality traits traits are relatively enduring features of a person that are persistent over time and situations people with personality disorders tend to be: rigid and inflexible, show a restricted range of traits, have a dominant single trait personality disorders are egosyntonic, more than egodystonic
About 0.5% to 2.5% of the general population
6-9% （Kathleen ，1986）
0.13‰（我国，1986） Rates are higher in inpatient and outpatient settings。prevalence higher among people with other mental disorders
Treatment Options
Few seek professional help on their own Treatment focuses on development of trust Cognitive therapy to counter negativistic thinking Lack good outcome studies
16
17
18
Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. Reads hidden demeaning or threatening meanings into benign remarks or events.
12
13
（一）偏执型人格障碍（paranoid PD)
1、临床特征 2、形成原因 3、治疗
临床特征
主要特征：猜疑、偏执
表现为对他人持久的不信任，社会隔离，过分
警惕
临床发现男性居多
0.5-2.5% of the population. o Men > Women. o Higher incidence in relatives of schizophrenics. o Higher among minorities, immigrants, and the deaf.
Gender bias exists in diagnosis Criterion vs. assessment gender bias
6
分类DSM-IV and DSM-IV-TR Personality Disorder Clusters
DSM-IV将10种人格障碍划分为3大类群:
20
形成原因
生物学原因
在精神分裂症患者亲属中较多
心理分析
偏执来自无意识中强烈的仇恨和敌意的外向投射
认知的观点
与歪曲的认知或想法有关
文化因素
特殊人群，如犯人、难民、有听力障碍的人等易形成这
种人格障碍
22
23
治疗
建立信任关系非常重要 心理动力and honest. Have a professional and not overly warm style. Don‘t confront Set limits. Clearly explain procedures, medications and results.
summary: Paranoid Personality Disorder
Overview and Clinical Features
Pervasive and unjustified mistrust and suspicion
The Causes
Biological and psychological contributions are unclear Early learning that the world is a dangerous place
31
形成原因
生物学
可能有与孤独症类似的生理机能缺陷
心理动力学
基本的接触需要没有获得满足
认知治疗
C类群：紧张、焦虑行为 Cluster C
Fearful or anxious Examples include avoidant, obsessive-compulsive
人格障碍类型
cluster A
偏执型 分裂型 分裂样
cluster B
表演型 自恋型 反社会型 边缘型
cluster C
男性多见 7.5% of the population. o A 2-to-1 male-to-female ratio.
29
Neither desires nor enjoys close relationships, including being part of a family. Almost always chooses solitary activities. Has little, if any, interest in having sexual experiences with another person. Takes pleasure in few, if any, activities. Lacks close friends or confidants other than first-degree relatives.
6-9% of population have one or more personality disorder most people with personality disorders never come to the attention of mental health professionals
10
PERSONALITY DISORDERS Diagnostic issues
poor understanding of etiology of most personality disorders comorbidity and diagnostic overlap gender and cultural issues reliability of diagnosis
19
Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. Has recurrent suspicions, without justification,regarding fidelity of spouse or sexual partner. Does not occur exclusively during the course of a Psychotic Disorder and is not due to a general medical condition.
5
Origins and Course of Personality Disorders
Thought to begin in childhood Run a chronic course Comorbidity rates are high
Gender Distribution and Gender Bias
A类群：行为古怪、奇异 Cluster A Odd or eccentric Examples include paranoid, schizoid
B类群：戏剧化、情感强烈、不稳定 Cluster B
Dramatic, emotional, erratic Examples include antisocial, borderline
11
PERSONALITY DISORDERS Etiology – Theoretical perspectives
Psychodynamic theory Attachment theory – particularly for dramatic, emotional, erratic Cognitive-behavioural perspectives Biological – particularly for odd, eccentric and dramatic, emotional, erratic
25
（二）分裂样人格障碍（Schizoid PD）
1、临床特征 2、形成原因 3、治疗
临床特征
特征：社会隔绝、情感疏远
表现为孤单、冷淡的沉默，不介入日常事务，不交际，不关心他人。将 精力投注于非人类的事物（如数学）
患病率
美、德等国采用PDQ（人格障碍诊断问卷）、SCID等得
到的患病率为0.7－1.6％
30
Appears indifferent to the praise and criticism of others. Shows emotional coldness, detachment, or flattened affectivity. Does not occur exclusively during the course of a Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to a general medical condition.