1、Personality DisorderHistoric Overview?Psychopathic personality(病态人格):Kraepelin，1909?Psychopathy?Personality Disorder Definition?DSM-Diagnostic Criteria?A.An enduring patternof inner experience and behavior that deviates markedly from the expectations of the individuals culture.This pattern is manife
2、sted in two(or more)of the following areas:?1.Cognition(ie,ways of perceiving and interpreting self,other people,and events)?2.Affectivity(ie,the range,intensity,lability,and appropriateness of emotional response)?3.Interpersonal functioning?4.Impulse controlDefinition?B.The enduring pattern is infl
3、exible and pervasive across a broad range of personal and social situation?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 ands its onset can be traced backat le
4、ast to adolescence or early adulthood.The individual is at least age 18.There is evidence of conduct disorder with onset before age 15.?E.The enduring pattern is not better accounted foras a manifestation of another mental disorder?F.The enduring pattern is not due tothe direct physiological effects
5、 of a substance(eg,a drug of abuse,a medication)or a general medical condition(eg,head trauma)Definition?CCMD-R Diagnostic Criteria?症状标准：个人的内心体验与行为特征在整体上与其文化所期望和所接受的范围明显偏离，这种偏离是广泛的、稳定的和长期的，并至少有下列1项?（1）认知（感知及解释人和事物，由此形成对自我及他人的态度和形象的方式）的异常偏离?（2）情感（范围、强度及适切的情感唤起和反应）的异常偏离?（3）控制冲动及满足个人需要的异常偏离?（4）人际关系的异常偏
6、离Definition?严重程度标准：特殊行为模式的异常偏离，使病人或其他人（如家属）感到痛苦或社会适应不良?病程标准：开始于童年、青少年期，现年18岁以上，至少已持续两年?排除标准：人格特征的异常偏离并非躯体疾病或精神障碍的表现或后果。Major Etiological Theory?Genetic Factor：Shield（1962）：同卵双生子研究Major Etiological Theory?Biological Factor?反社会人格障碍皮层抑制功能和警觉能力降低，脑电图有较多慢波，交感神经反应减弱?冲动型或边缘型人格5-HT能神经元功能降低Major Etiological
7、Theory?Psychosocial Factor?家庭环境问题?1.童年期遭受虐待（Abuse）?2.家庭关系不良?父母教育方式Categories of Personality disorder?DSM-?Cluster A:(paranoid,schizoid,schizotypal),which includes individuals who are odd and eccentric?Cluster B:(antisocial,borderline,histrionic,narcissistic),which includes individuals with dramatic,
8、acting-out behaviors and who have problems with empathy?Cluster C:(avoidant,dependent,obsessive-compulsive),which includes personality styles marked by prominent anxiety and novelty avoidanceClassification?Antisocial Personality Disorder(反社会型人格障碍)?Paranoid Personality Disorder（偏执型人格障碍）?Schizoid Pers
9、onality Disorder（分裂样型人格障碍）?Histrionic Personality Disorder（表演型人格障碍）?Dependent Personality Disorder（依赖型人格障碍）?Obsessive-compulsive Personality Disorder（强迫型人格障碍）CCMD-RAntisocial Personality Disorder(反社会型人格障碍)?又称无情型人格障碍（Affectionless personality disorder），是对社会影响最严重的类型特点?男性多见?高度攻击性?无羞惭感?行为无计划性?社会适应不良反社会型
10、人格障碍患者违法与一般犯罪的区别反社会型人格障碍患者违法与一般犯罪的区别反社会型人格障碍患者违法一般犯罪无计划性，常常是情绪冲突或本能愿望驱使有计划、有预谋犯罪动机模糊违法目的明显缺乏掩饰作案手法隐蔽狡诈严重影响心理活动的各个方面，持续和长期的行为障碍人格缺陷，但未达到人格障碍的程度完全形式责任能力完全形式责任能力特点?男性多见,又名狂信型人格（Fanatic personality），诡辩型人格（Querulant personality）?固执、敏感多疑、好妒?自我评价过高，拒绝接受他人批评?心理活动经常处于紧张状态，高度警惕Paranoid Personality Disorder（偏执
11、型人格障碍）特点?男性多见?孤独、退缩、不与人交往?情感淡漠，爱好不多?对人缺乏热情，缺乏知心朋友?活动能力差，缺乏进取性Schizoid Personality Disorder（分裂样型人格障碍）分裂样型人格障碍）Histrionic Personality Disorder（表演型人格障碍）（表演型人格障碍）特点?女性多见?情感过程的不成熟性?情感带有戏剧化色彩，过分做作和夸张的行为?暗示性很强?自我中心Dependent Personality Disorder（依赖型人格障碍）（依赖型人格障碍）特点?女性多见?缺乏自信，无助感?被遗弃感?缺乏独立性?为了获得别人的帮助，随时需要有人在
12、场，独处时便感到极大的不适Obsessive-compulsive Personality Disorder（强迫型人格障碍）（强迫型人格障碍）?特点?男性多见?刻板性、秩序性、拘谨性?过分自我克制、追求完美?责任感过强Course and Prognosis病程与预后病程与预后?慢性病程预后?年龄：随年龄增长，症状趋向缓和?有无治疗干预?既往人格特征Treatment治疗（1）?Medical Approach?小剂量抗精神兵药物情绪不稳定者?抗癫痫药脑电图有改变者?抗焦虑药有焦虑情绪表现者Treatment治疗（2）Psychological Approach?Cognitive therapy（认知治疗）?Family therapy（家庭治疗）?Couples therapy（婚姻治疗）Social Approach?治疗性社区（治疗性团体）?教育、训练和安排
