پادکست زهینه [زندگی بهینه] - کارگاه اختلالات شخصیت👨‍🏫دکتر سرگلزایی

دکتر سَرگُلزاییPersonality Disordersاختلالات شخصیت عبارتند از مجموعه اختلال‌های روان شناختی که ویژگی اصلی آن‌ها رفتارهای خشک و غیرقابل انعطاف است. این رفتارها به اشخاص آسیب می‌رساند، چون مانع سازگاری آن‌ها با الزام‌های زندگی روزانه می‌شود و روابط آن‌ها را با دیگران مختل می‌سازد.اختلال شخصیتشخصیت، بیانگر آن دسته از ویژگی‌های فردی است که شامل الگوهای ثابت فکری، عاطفی و رفتاری است (پروین، جان، ۲۰۰۱، ص۳). این تعریف بیانگر آن دسته از ویژگی‌های فردی با ثبات چه در زمینهٔ فکری، رفتاری یا عاطفی است.اختلال یا نابهنجاری بر اساس چهار خصیصه تعریف شده‌است که عبارتند از:پریشانی: تجربه عذاب هیجانی یا جسمانی، در زندگی متداولاختلال: کاهش توانایی فرد در انجام امور روز مره به‌طوری‌که نتواند کارهایش را به نحو مطلوب انجام دهد.به مخاطره انداختن خود و دیگران با کارهایی که انجام می‌دهند.لحاظ اجتماعی و فرهنگی غیرقابل قبول باشد.اشخاصی که به اختلال‌های شخصیتی دچار هستند، صفات شخصیتی ناسازگارانه دارند و این صفت‌ها آن‌قدر ژرف و عمیق حکاکی شده‌اند که در برابر هرگونه تغییر و دگرگونی مقاومت می‌کنند. در بیشتر مواقع این اشخاص گمان می‌کنند دیگران باید تغییر کنند تا با آن‌ها مطابقت داشته باشند و نه بر عکس. اشخاص مبتلا به اختلال‌های شخصیت خود و دنیا را به گونه‌ای تفسیر می‌کنند که برایشان به شدت ناراحت‌کننده است یا توانایی آن‌ها را برای زندگی عادی از بین می‌برد. تجربه‌های ناسازگارانهٔ آن‌ها از خودشان و دنیا از کودکی و نوجوانی آغاز می‌شود و به‌تدریج و در همه جا بر زندگی‌شان تأثیر می‌گذارد. اختلال‌های شخصیت، انواع مختلف دارد و اندیشه، احساسات، و رفتارهای مورد تجربهٔ شخص بسته به نوع اختلال شخصیت می‌تواند متفاوت باشد. شخصیت می‌تواند سازگار یا ناسازگار باشد و این ارتباط نزدیکی با «انعطاف‌پذیری» دارد. اختلال شخصیت[۱] یعنی «رفتارهای ناسازگار و انعطاف‌ناپذیر در برخورد با محیط و موقعیت‌ها»آن‌ها ممکن است ناگهان حرف‌هایی بر اساس محیط فعلی خود بزنند که خود از آن حرف پشیمان شوند.ارتباط سازوکارهای دفاعی در اختلالات شخصیت با افسردگی و اضطرابدفاع‌ها در موثرترین حالتِ خود به ویژه در افراد مبتلا به اختلال شخصیت می‌توانند اضطراب و افسردگی را به کلی از بین ببرند. پس یکی از دلایل عمده افراد مبتلا به اختلالات شخصیت از تغییر ندادن رفتارشان همین است که دست کشیدن از هر دفاع یعنی بیشتر شدن اضطراب و افسردگی خودآگاهانه آن‌ها.[۲]طبقه‌بندی اختلالاتبر اساس DSM-IV-TR ده اختلال شخصیت در سه گروه طبقه‌بندی شده‌است.گروه A افراد عجیب و نامتعارفاختلال شخصیت پارانوئید[۳]اختلال شخصیت اسکیزوئید[۴]اختلال شخصیت اسکیزوتایپال[۵]گروه B افراد نمایشی-احساساتی و دمدمیضد اجتماعی[۶]اختلال شخصیتی مرزی[۷]اختلال شخصیت نمایشی[۸]اختلال شخصیت خودشیفته[۹]گروه C افراد مضطرب و هراساناختلال شخصیت دوری‌گزین[۱۰]اختلال شخصیت وابستهاختلال شخصیت وسواسی جبری[۱۱]سایر اختلالات شخصیتاختلال شخصیت افسرده[۱۲]منفعل - مهاجم[۱۳]ملاک‌های تشخیصی کلی برای اختلال شخصیتیک الگوی پایدار در گسترهٔ وسیعی از موقعیت‌های شخصی و اجتماعی، انعطاف‌ناپذیر و فراگیر است.این الگوی پایدار از لحاظ بالینی به پریشانی یا اختلال قابل ملاحظه در کارکرد اجتماعی، شغلی یا سایر زمینه‌های مهم کارکرد منجر می‌شود.این الگو، با ثبات و طولانی مدت است و آغاز آن را می‌توان دست کم در نوجوانی یا اوایل بزرگسالی جستجو کرد.این الگوی پایدار به نحو بهتری به عنوان جلوه یا پیامد اختلال روانی دیگر تبیین نمی‌شود.این الگوی پایدار ناشی از اثرات فیزیولوژیایی مستقیم یک ماده (مانند سوء مصرف یک دارو، دارو درمانی) یا یک بیماری جسمانی (مانند آسیب سر) نیست.این الگوی پایدار از رفتار و تجربهٔ درونی که به میزان قابل ملاحظه‌ای با انتظارات فرهنگی فرد مغایرت دارد. این الگو در دو (یا بیشتر از دو) مورد از موارد زیر آشکار می‌شود:شناخت (یعنی راه‌های ادراک و تفسر خویشتن، دیگران و رویدادها)هیجان پذیری (یعنی دامنه، شدت، نااستواری هیجانی و مناسب بودن پاسخ هیجانی)کارکرد میان فردیکنترل تکانهPersonality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions may vary somewhat, according to source, and remain a matter of controversy.[2][3][4] Official criteria for diagnosing personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the fifth chapter of the International Classification of Diseases (ICD).Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish individual humans. Hence, personality disorders are defined by experiences and behaviors that differ from social norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. In general, personality disorders are diagnosed in 40–60% of psychiatric patients, making them the most frequent of psychiatric diagnoses.[5][clarification needed]Personality disorders are characterized by an enduring collection of behavioral patterns often associated with considerable personal, social, and occupational disruption. Personality disorders are also inflexible and pervasive across many situations, largely due to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are therefore perceived to be appropriate by that individual. In addition, people with personality disorders often lack insight into their condition and so refrain from seeking treatment. This behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression and result in impaired psychosocial functioning. These behavior patterns are typically recognized by adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life.[2][6][7]While emerging treatments, such as dialectical behavior therapy, have demonstrated efficacy in treating personality disorders, such as borderline personality disorder,[8] personality disorders are associated with considerable stigma in popular and clinical discourse alike. Despite various methodological schemas designed to categorize personality disorders, many issues occur with classifying a personality disorder because the theory and diagnosis of such disorders occur within prevailing cultural expectations; thus, their validity is contested by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.[9]ClassificationThe two relevant major systems of classification arethe International Classification of Diseases (11th revision, ICD-11) published by the World Health Organizationthe Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, DSM-5) by the American Psychiatric Association.The ICD system is a collection of numerical codes that have been assigned to all known clinical disease states, which provides uniform terminology for medical records, billing, and research purposes. The DSM defines psychiatric diagnoses based on research and expert consensus, and its content informs the ICD-10 classifications. Both have deliberately merged their diagnoses to some extent, but some differences remain. For example, ICD-10 does not include narcissistic personality disorder as a distinct category, while DSM-5 does not include enduring personality change after catastrophic experience or after psychiatric illness. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other.[10]General criteriaBoth diagnostic systems provide a definition and six criteria for a general personality disorder. These criteria should be met by all personality disorder cases before a more specific diagnosis can be made.The ICD-10 lists these general guideline criteria:[11]Markedly disharmonious attitudes and behavior, generally involving several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;The above manifestations always appear during childhood or adolescence and continue into adulthood;The disorder leads to considerable personal distress but this may only become apparent late in its course;The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."[11]In DSM-5, any personality disorder diagnosis must meet the following criteria:[12]An enduring pattern of inner 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 (i.e., ways of perceiving and interpreting self, other people, and events).Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).Interpersonal functioning.Impulse control.The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).In ICD-10Chapter V in the ICD-10 contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.[13]The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[14]Besides the ten specific PD, there are the following categories:Other specific personality disorders (involves PD characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic.)Personality disorder, unspecified (includes "character neurosis" and "pathological personality").Mixed and other personality disorders (defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).Enduring personality changes, not attributable to brain damage and disease (this is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).In ICD-11In the proposed revision of ICD-11, all discrete personality disorder diagnoses will be removed and replaced by the single diagnosis "personality disorder". Instead, there will be specifiers called "prominent personality traits" and the possibility to classify degrees of severity ranging from "mild", "moderate", and "severe" based on the dysfunction in interpersonal relationships and everyday life of the patient.[15][16]In DSM-5The most recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders stresses that a personality disorder is an enduring and inflexible pattern of long duration leading to significant distress or impairment and is not due to use of substances or another medical condition. The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.[17]DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive personality disorder.The DSM-5 also contains three diagnoses for personality patterns not matching these ten disorders, but nevertheless exhibit characteristics of a personality disorder:[12]Personality change due to another medical condition – personality disturbance due to the direct effects of a medical condition.Other specified personality disorder – general criteria for a personality disorder are met but fails to meet the criteria for a specific disorder, with the reason given.Unspecified personality disorder – general criteria for a personality disorder are met but the personality disorder is not included in the DSM-5 classification.Personality clustersThe specific personality disorders are grouped into the following three clusters based on descriptive similarities:Cluster A (odd or eccentric disorders)Cluster A personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorder shares some of its hallmark symptoms, e.g., acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior, with schizophrenia. However, people diagnosed with odd-eccentric personality disorders tend to have a greater grasp on reality than those diagnosed with schizophrenia. Patients suffering from these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships. Though their perceptions may be unusual, these anomalies are distinguished from delusions or hallucinations as people suffering from these would be diagnosed with other conditions. Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.[18]Paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.Schizoid personality disorder: lack of interest and detachment from social relationships, apathy, and restricted emotional expression.Schizotypal personality disorder: pattern of extreme discomfort interacting socially, and distorted cognition and perceptions.Cluster B (dramatic, emotional or erratic disorders)Main article: Cluster B personality disordersAntisocial personality disorder: pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behavior.Borderline personality disorder: pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behavior and affect, often leading to self-harm and impulsivity.Histrionic personality disorder: pervasive pattern of attention-seeking behavior and excessive emotions.Narcissistic personality disorder: pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy. In a more severe expression, narcissistic personality disorder may show evidence of paranoia, aggression, psychopathy, and sadistic personality disorder, which is known as malignant narcissism.[19]Cluster C (anxious or fearful disorders)Avoidant personality disorder: pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation.Dependent personality disorder: pervasive psychological need to be cared for by other people.Obsessive-compulsive personality disorder: characterized by rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships (distinct from obsessive-compulsive disorder).Other personality typesSome types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterized by behavior consequently undermining the person's pleasure and goals). They were listed in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria.[20] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[21]ناهنجاری‌های شخصیت