人格障碍,原名性格障碍,构成一种异构的特点是慢性精神疾病的困扰,不适应,和僵化的模式的认知,影响和行为。他们编码轴II的美国精神病学协会的精神障碍诊断与统计手册第四版(dsm - iv)和反映的思想模式,影响,行为偏离的期望一个人的文化和损害社会和职业功能。一些,但不是全部,引起情绪困扰。人格障碍并不源于对急性应激反应不足,而是,他们逐渐发展和表达在青春期或成年早期。许多特征与人格障碍可能是由nondisordered个人共享。虽然人格障碍的症状和体征可能描述特征,所有人表现出不时在某种程度上,一个人格障碍定义的不适应的某些性格特征的普遍性和不灵活性。
特定的人格障碍
dsm - iv安排人格障碍分为三个集群的基础上相似性之间的障碍。
- 集群的一个:个人与这些疾病常常看上去很奇怪或偏心。这些疾病的症状有点类似精神分裂症的症状不太严重,特别是在它的前驱症状或残余阶段。这个集群包括偏执,精神分裂症患者和分裂型人格障碍。
- 集群B:个人与这些疾病通常描述为戏剧性的,冲动的,反复无常。这个集群包括演员、自恋、反社会和边缘型人格障碍。
- 集群C:个人与这些疾病常常出现焦虑和恐惧。很难区分这些人格障碍伴有焦虑轴我在一些个人障碍。这个集群包括逃避型、依赖和强迫性人格障碍。
Paranold人格障碍
偏执型人格障碍患者(产后抑郁症)怀疑他人,希望被别人虐待。他们希望伤害到自己和敏感的证据即将袭击,没有足够的基础或没有考虑其他解释。他们倾向于认为自己是清白的,而不是吹毛求疵的不幸,他们可能会寻找线索,验证他们的期望。他们专注于怀疑别人的忠诚和诚信,因此,不可能相信别人。他们在与他人的相互作用是高度敏感,往往赋予贬义的意图甚至良性的评论或事件。行为,他们常常被描述为“警惕”,和他们的人际关系的敌意。他们内部的焦虑与几乎恒定的害怕被别人伤害。他们通常记恨,不可能原谅觉察得到,经常与愤怒的反应。虽然有些人患有产后抑郁症表现出短暂的精神病症状(例如,被害妄想),他们通常接触现实,没有表现出明显的知觉障碍与认知和行为失序经常发现在精神病。一些研究表明,产后抑郁症可能比精神分裂症妄想障碍密切相关。 PPD occurs more frequently in men and is most likely comorbid with schizotypal, avoidant, and borderline personality disorders. Its prevalence rate in the general population is between 2% and 4%, and its prevalence in outpatient psychiatric settings is about 4%.
精神分裂型人格障碍
分裂性人格障碍的患者(SPD)通常表现出一种无力的社会关系,包括与家人的关系,以及缺乏兴趣。社民党的dsm - iv标准包括社会关系模式的分离和有限范围的影响在人际环境,就是明证至少四个以下特点:个人与社会民主党既不欲望也不喜欢亲密关系(包括他或她的家庭);几乎总是选择单独活动;有很少或没有性经验的兴趣;喜爱一些活动;缺乏朋友或知己(一级亲属除外);是对表扬和批评;展品距离感、冷淡或扁平的影响。尽管早些时候相信社民党是精神分裂症的前兆,之间没有很强的基因联系发现这两个障碍。研究已经表明,有基因联系社民党和阿斯伯格综合症,自闭症,和广泛性发育障碍,而不是另有规定。 Recent epidemiological studies suggest that the prevalence rate of SPD in the general population is between 1% and 3%, and the prevalence rate in outpatient psychiatric settings is about 1%. The preference for solitude and the lack of general distress in SPD may account for the low prevalence rates in psychiatric populations. Behaviorally, individuals with SPD are often described as “loners” or “lethargic,” and interpersonally they desire distance from others. They are likely to feel comfortable with the interpersonal emptiness of their lives.
分裂型人格障碍
分裂型人格障碍患者(STPD)通常有奇怪的或特殊的信仰或外观伴随着社会和人际关系赤字。他们往往有认知和知觉障碍和古怪的与他人沟通。分裂性人格障碍的患者,那些STPD社会孤立和撤回,但分裂型人格也包括古怪的想法,演讲,和感知。STPD dsm - iv诊断标准包括社会和人际关系赤字的普遍模式,急性不适与亲密关系以及怪癖的思想,观念,和行为,下面就是明证至少5:参考的想法(但不是妄想参考);奇怪或奇幻思维;不寻常的知觉体验;奇怪的思维和语言;疑心或偏执思维;不适当的或收缩的影响;奇怪的,古怪的行为或表现; lack of a close friend other than first-degree relatives; and excessive social anxiety that is associated with paranoid fears. Individuals with STPD may present with an erratic or bizarre manner, peculiar speech (vague or overelaborated), ruminative thinking, and atypical perceptual experiences that do not reach the level of psychosis (e.g., illusions). These individuals may report being clairvoyant or telepathic and are likely to be superstitious. Epidemiological studies place prevalence rates in the general population at less than 1% and prevalence rates in outpatient psychiatric settings at less than 1%. Research has suggested a genetic link between STPD and schizophrenic spectrum disorders. Oddities of speech and behavior have been found in children who later develop the disorder.
表演型人格障碍
表演型人格障碍(HPD),原名歇斯底里的性格,描述个人过于戏剧性,寻求关注和高度情绪化的。他们经常不舒服的情况下他们不是关注的焦点,他们可能会表现出性诱人或挑衅行为在他们与他人互动。他们一直使用他们的外表(即。奇异的服装,化妆,头发颜色)引人注意。他们表现出迅速变化,浅的情绪往往是戏剧和夸张。他们的演讲是印象派,但缺乏细节。他们经常误解比实际更亲密的关系,他们往往是值得高度关注的。他们通常以自我为中心,可以overconcerned关于别人的认可。行为,他们可能被视为诱人,和人际关系,他们往往有暴风雨的人际关系。他们经常被认为是情绪不稳定,反复无常,和情感肤浅。 HPD has a prevalence rate in the general population of about 2% and is more common among women. It remains unclear whether the differential rate of diagnosis is due to gender bias. Comorbidity with borderline personality disorder is relatively high. The prevalence rate in outpatient psychiatric settings is about 1%. The lower prevalence rate in psychiatric settings may be due to the culturally adaptive characteristics associated with the symptoms of the disorder.
自恋型人格障碍
自恋型人格障碍患者(NPD)有一个宏大的查看自己的独特性或价值,关注与欣赏,对成功的幻想,缺乏同情他人。他们经常自负,自负,他们以自我为中心,他们有权利,他们倾向于试图主导与他人对话。因此,他们经常疏远别人,他们缺乏同情心让有意义的关系的创建和维护困难。尽管他们对批评很敏感,他们现在一样傲慢和优越的保护自己的一种方式。他们常常羡慕别人或相信别人是羡慕他们。当他们对他人的期望没有得到满足,他们可能与愤怒反应,避免羞耻或烦躁不安。像患有边缘型人格,那些NPD理想化和贬低他人之间可能会动摇,取决于另一个人让他们对自己的感觉。最近的流行病学研究表明,NPD在一般人口的流行率小于1%,门诊精神病人群的患病率约为2%。一些研究表明,它可能是男性比女性更频繁地观察到。
反社会人格障碍
具有反社会人格障碍的个体(ASPD)持续违反和显示视法律为无物,或他人的权利。他们控制或操纵他人没有懊悔和羞愧。这种欺骗和操纵模式开始在儿童期或青春期早期和反映在至少三个以下dsm - iv诊断标准:未能符合社会规范的违法行为;不诚实;冲动、攻击性、易怒;漠视自己或他人的安全;不负责任的工作或财务事项;和缺乏悔恨。此外,诊断的先决条件是在15岁之前品行障碍的存在。因此,诊断ASPD,不仅应该有反社会行为,但这种行为模式应该在童年开始。 Historically, the diagnosis was synonymous with psychopathy, but this term has come to have a specific meaning (see below). Behaviorally, antisocial individuals may be described as aggressive and controlling, and interpersonally, they manipulate others through deceit or coercion. Antisocial individuals are likely to take risks, break laws, and seek excitement and sensation. They fail to plan ahead, as evidenced by impulsive and reckless behaviors. They seldom take responsibility for their behaviors, and they are motivated by their own selfish needs. They lack the responsibility and feelings for others that are required to maintain meaningful long-term relationships and are likely to be occupationally and financially irresponsible. They may be cunning, glib, and socially skilled, thereby hiding their selfish motives from others. They are likely to be easily bored and have a low tolerance for frustration or depression, acting out aggressively in response to negative emotions. Once they have acted out aggressively, they are unlikely to experience remorse for any harm to others. Any overt expression of shame or remorse is likely to be shallow, transient, or insincere. Antisocial individuals are unlikely to seek mental health treatment independently, instead presenting for treatment when coerced by others, especially legal authorities. Epidemiological research suggests that prevalence rates in the general population is about 1% to 4% and prevalence in outpatient psychiatric settings between 3% and 4%. The prevalence is thought to be three times higher in men than in women and much higher among young adults than older adults. Diagnosis is also more common among people of low socioeconomic status. It has been estimated that about 75% of convicted felons meet the diagnostic criteria for ASPD. ASPD is comorbid with a number of other diagnoses, especially substance abuse.
心理变态
尽管精神病并不包括在dsm - iv中,这是一个被广泛接受的,明确的人格障碍得到越来越多的实证研究的支持。尽管大幅重叠反社会人格障碍的诊断标准,心理变态仍然是一个明显的障碍。而反社会人格障碍的诊断主要集中于公开的行为,精神病也包括情感和人际关系赤字。虽然大多数精神病患者会满足反社会人格障碍的诊断标准,只有少数反社会个体也将满足精神病的标准。描述的“病态人格”是1915年由埃米尔Kraepelin虽然指的是一群罪犯缺乏道德。1941年,Hervey Cleckley阐述了构建通过详细的案例研究在他开创性的书,理智的面具。Cleckley概念化的变态人格作为操纵,自私,冲动,缺乏同情心,悔恨,和焦虑已经或多或少仍然完好无损。精神病的特征包括两者的结合人际和情感赤字以及公开的反社会行为。这两个因素被称为初级和二级精神病,分别保持在现代评价的基础。
边缘型人格障碍
边缘型人格一词最初是指那些被认为是神经症和精神病之间的“边界”。目前的定义,然而,边缘型人格障碍(BPD)的不稳定影响,人际关系,和自我形象,以及明显冲动行为。BPD患者表现出严重的干扰基本身份。由于不稳定的自我形象,他们也有高度不稳定和强烈的人际关系,表现为交替的极端理想化和别人的贬值。他们绝望的努力来避免真实的还是想象的放弃。边缘型个人一般孤独的不宽容。他们的行为冲动可能领域的性别、赌博、购物狂欢,物质滥用,鲁莽驾驶,或者暴饮暴食。反复出现的自杀行为是常见的,包括自残或“切割”的行为。自杀企图或手势往往明显操纵,旨在引起别人的反应。他们报告慢性空虚的感觉,往往很难控制不恰当表达愤怒。 They may experience transient stress-related symptoms such as paranoid ideation or severe dissociative symptoms. BPD is one of the most lethal psychiatric disorders, with up to 10% of identified patients completing suicides. Those who successfully suicide are more likely to have comorbid major depressive disorder and/or a family history of substance abuse. Recent studies estimate that prevalence rates in the general population are at about 1% and about 9% in an outpatient psychiatric setting. Women are three times more likely than men to be diagnosed with the disorder. There is an ongoing debate regarding the possibility of gender bias and the power of applying the label of borderline to a female patient. BPD is associated with increased utilization of psychological services and psychopharmacological treatment. Recent research has suggested that the etiology of BPD can be explained by an interaction of genetic/biological and environmental factors. Comorbidity is found with substance abuse, PTSD, eating disorders, mood disorders, and personality disorders from Cluster A.
逃避型人格障碍
逃避型人格障碍患者(AVPD)模式的极端社会抑制和撤军由于害怕被拒绝,尴尬,或批评。他们经常报告不足的感觉。因为他们的过敏症批评和潜在的拒绝,他们避免其他人,但是,不像精神分裂症的人,他们渴望人际接触,往往寂寞或者无聊。dsm - iv诊断标准至少包括下列四个特点:避免涉及重要的人际接触的职业活动由于害怕批评,反对,或拒绝;不愿参与的关系,除非特定的喜欢;在亲密关系由于害怕被羞辱和嘲笑;对批评或拒绝在社交场合;抑制在新的人际关系情况下由于力不从心的感觉;把自我看作社会无能,没有吸引力,或差;不愿冒个人风险或从事新活动可能导致尴尬。 Behaviorally, individuals with AVPD are described as shy and guarded, and although they desire interpersonal relationships, they are unlikely to engage in them. They may present as aloof and apprehensive and are likely to make little eye contact. Epidemiological estimates place the prevalence of AVPD at between 2% and 5% in the general population and at about 15% in an outpatient psychiatric setting.
依赖型人格障碍
依赖型人格障碍患者(DPD),由于缺乏自信和自主权,有一种强烈的需要照顾。他们认为自己的软弱和无能和其他人一样强烈,导致顺从和执着行为由于一个极端害怕分离。他们培养提供保护和支持的关系,他们往往过于听从别人。他们经常无法表达愤怒或与他人的分歧,因为担心失去他们的支持和爱,并且他们很容易参与心理上或身体上的虐待关系。他们经常有困难的日常决策没有过度的建议和安慰他人,和他们寻找其他人负责他们的生活的主要区域。他们很难启动项目由于缺乏自信在他们的判断或能力。他们经常会自愿做不愉快的事情为了获得别人的养成。他们独自一人时报告感觉不舒服或无助由于夸张害怕无法照顾自己。一个密切的关系结束时,他们通常将立即寻求另一个关系的支持。据估计,目前市面上的流行率障碍是总人口的0.5%和1.5%左右的人口门诊精神病。 These data conflict with the DSM-IV assertion that DPD is one of the most frequently reported personality disorders encountered in outpatient clinics. Studies on inpatient rates suggest a higher prevalence rate, between 15% and 25%. DPD frequently co-occurs with other personality disorders as well as mood, anxiety, and eating disorders.
强迫性人格障碍
强迫症患者(想重复)表现出一个普遍的模式的完美主义,整齐,和控制干扰的灵活性、效率、任务完成、和社会互动。这些人往往被迫保持精神和人际控制通过专注于细节,列表,时间表,和规则。他们的完美主义干扰他们完成任务的能力,因为他们相信,他们不能满足他们过于严格的标准。尽管他们过分专注于工作的休闲活动和友谊,他们经常在工作效率不高,因为他们忙于琐碎的细节。他们往往是僵化的道德问题,道德或价值观。行为,他们常常被描述为固执和完美主义者,他们可能有困难,人际关系由于缺乏灵活性。虽然以前认为想重复反射轴我强迫症的倾向,最近的研究表明,想重复更高度与回避性人格障碍共病。一般人群的患病率约为2%至8%,8%至9%的门诊精神设置。
分类与空间的方法
最具争议的话题之一,精神病理学在过去的几十年里一直是人格障碍的分类。分类模型(例如,DSM)假定人格障碍可以定义为一个相对较少的“障碍”或“类型”,本质上是正交的。每个障碍都有一组特定的症状和体征,以及个人在每个诊断类别是假定一个组别。维的方法将取代现在的分类分类与识别使用精神障碍躺在一个连续的温和和正常行为而不是定性截然不同。人格障碍,因此,可以认为是极端的共同性格特征的变异,和人格障碍的症状可以被描述的相对站在特征的数量。人格障碍首次被放置在一个单独的轴在DSM 1980年,主要基于DSM工作小组成员的专家意见,没有强大的经验证据,这些疾病存在离散和独特的临床特征。之后,研究人员认为,DSM的类别分类的方法是不够的。例如,他们指出,高水平的疾病;许多人满足多个人格障碍的诊断标准或人格障碍和轴我障碍。工作继续发展的维度模型(例如,五因素模型)。 Nonetheless, until a unified system of classification is developed and agreed on, the categorical system employed by the DSM will be the mostly widely-used by clinicians.
引用:
- 兔子,r D。哈特,s D。& Harpur t . j . (1991)。精神病和反社会人格障碍的诊断标准。变态心理学杂志》,100年,391 - 398。
- McCrae, R R。&科斯塔,p . T。小(1990)。在成年后的性格。纽约:吉尔福德出版社。Wirth-Cauchon, j . (2001)。妇女和边缘型人格障碍。新泽西州新不伦瑞克:罗格斯大学出版社。
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