PD < introduction to personality disorder >

性格違常 又稱為「人格疾患」 by署立八里療養院 李維庭 臨床心理師

性格違常 之

特性

在精神疾病的分類中，有一類的診斷相當特別，指的是一些特定的個性型態，這些特定的個性型態會造成這個人生活上的困難，損害其社會、職業方面的效能，在精神醫學上就把這些特定的個性型態標示出來，而擁有這樣個性的人，稱其為「人格疾患」或是「人格違常」。

具有「人格違常」特性的人往往在他的認知功能、情緒、社交人際及衝動控制上有偏差的狀況，舉例來說，媒體常報導重大刑案的罪案具有「反社會人格」，這樣的人通常可發現他的個性是不負責任的、殘忍好鬥、喜歡破壞及侵犯他人權利、容易衝動，且犯罪後絲亳沒有悔意與羞恥。這樣的人格特性使得他經常生活在人際衝突、被處罰及身體傷害之中。


形成期

人格違常既是一種特定型態的個性，讀者可以想見它幾乎會對此人的生活各方面造成廣泛的影響，因為我們所有的行為舉止，均可被視為個性的表達，就好像聆聽一首曲子，雖然曲子中會聽到不同的樂器在演奏，但它具有的基調（個性）都顯現在每一個音符、每一種樂器演奏中。

再者，人格違常因為是「個性」形式的一種，所以它發生時間就在生命前期，通常個性的定型期就是它形成的時間（青春期或成年早期）。因此只要我們對國中時期或高中初期的學生仔細觀察，就可能注意得到，正在發展出人格違常的人。


診斷

那麼到底人格違常的內容是什麼呢？在精神醫學上區分為三群，共十種的性格特性，也就是十種的人格違常診斷，簡介如下：

A群人格違常：這一群的人通常在人際的表現上是退縮的、自我中心的，情緒的反應是冷淡的、對外界的人事物常是多疑心的，而且在思考內容及一些想法上不容易被人所理解。又細分為三種。

1.1 妄想型：這類人的個性會讓你覺得他們時常在疑東疑西，不易信任別人，防衛心重，他們常會覺得事情的背後有隱藏的意義。比如說無証據就懷疑伴侶的忠誠度、認為別人心存惡意在欺負他‥等。

1.2 類分裂型：這類的人讓你感覺他能獨自一人活在世界上不需要人際關係，對別人給予的讚賞或批評都不會有情緒。

1.3 分裂病型：這類人會讓你覺得他們不會社交生活，也因此缺乏親密的朋友，而且你會覺得他們在行為舉止上，會有一些古怪的想法、奇特的說話方式，情感的表達也很侷限。


B群人格違常：這一群人的個性被描述為戲劇化的、情緒的起伏相當的大而且頻繁，一直會尋求被別人的關注，並經常陷入人際的衝突裏。此群下有四種：

2.1 反社會型：如同前述，這類的人通常令我們覺得做事不負責任、殘忍、喜歡破壞打架、缺乏道德感、以侵犯他人權利為樂。

2.2 邊緣型：這類人會讓我們感覺到他的情緒極度不穩定，衝動，常動不動就威脅要自殺，或是出現過度而不合適的生氣（旁人的你會不瞭解為什麼生這麼大的氣？﹗）。他們常會抱怨空虛、不知道自己是誰、極度的人際不安全、因此常擔憂被人拋棄。我們可以想見，這樣個性的人在人際上會帶給對方相當沉重的感受。

2.3 戲劇型：故名思義，戲劇型的人在情緒的表達及言談內容上相當誇張，好像在演戲一樣，他們在人際互動中總喜歡變成他人關注的焦點，也喜歡利用身體外觀來引人注意。

2.4 自戀型：此種人格特徵是過度的自大，不斷地尋求他人的誇讚，會陷溺在成功的想像、自己的獨特性及自我的重要感覺上，嫉妒他人的成功，也因此缺乏對他人的同理心。


C群人格違常：這一群人的特徵則是以焦慮緊張為主。其下有三種：

3.1 逃避型：這類個性的人會讓你覺得他在人際上相當脆弱、易受傷害、禁不起別人的批評。他們也因此在人際互動上焦慮，深怕行為舉止顯得愚蠢，並覺得自己樣樣都不如人。逃避人際接觸，也因此人際互動受限。

3.2 依賴型：此類人的性格特徵即是「依賴他人」，他們常感覺事事都無法自己決定，需要別人幫他決定給意見才會心安。害怕與別人分離，不切實際地擔心自己會孤苦一人。

3.3 強迫型：也可稱做完美主義者，但這類的人常會過度注重細節，而喪失重要的整體。容易被別人認為一絲不苟、過於固執，而顯得缺乏變通的彈性。


病因

為什麼會形成這些人格違常呢？可以簡略地歸因為先天生理上的與後天環境上的因素。先天的因素包括家族的遺傳、基因、腦部的發展‥等。通常在A群人格違常裏，先天因素的比例較重；而後天的因素，包括父母的管教方式及態度、早期的同儕經驗‥等。通常在C群的人格違常裏，後天的因素比例較重。


治療

那麼如何治療呢？由於個性是相當穩定而持久的一部份，所以治療上花費的時間較長。在精神醫學上，以藥物治療加上各式的心理治療為主，兩者比例視情況而定。

如果你發現自己或周遭的人受苦於人格違常，可以求助於專業的人員，如臨床心理師或精神科醫師，可以提供有效的建議。



Personality Disorders

--by Linda Lebelle



A personality disorder is identified

by a pervasive pattern of experience and behavior that is abnormal with respect to any two of the following:

thinking, mood, personal relations,

and the control of impulses.



The character of a person is shown through his or her personality -- by the way an individual thinks, feels, and behaves. When the behavior is inflexible, maladaptive, and antisocial, then that individual is diagnosed with a personality disorder.


Most personality disorders begin as problems in personal development and character which peak during adolescence and then are defined as personality disorders.


Personality disorders are not illnesses in a strict sense as they do not disrupt emotional, intellectual, or perceptual functioning. However, those with personality disorders suffer a life that is not positive, proactive, or fulfilling. Not surprisingly, personality disorders are also associated with failures to reach potential.


The DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, defines a personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.



Currently, there are 10 distinct personality disorders identified in the DSM-IV:

· Antisocial Personality Disorder: Lack of regard for the moral or legal standards in the local culture, marked inability to get along with others or abide by societal rules. Sometimes called psychopaths or sociopaths.

· Avoidant Personality Disorder: Marked social inhibition, feelings of inadequacy, and extremely sensitive to criticism.

· Borderline Personality Disorder: Lack of one's own identity, with rapid changes in mood, intense unstable interpersonal relationships, marked impulsively, instability in affect and in self image.

· Dependent Personality Disorder: Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on his or her own. Fear of separation and submissive behavior. Marked lack of decisiveness and self-confidence.

· Histrionic Personality Disorder: Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.

· Narcissistic Personality Disorder: Behavior or a fantasy of grandiosity, a lack of empathy, a need to be admired by others, an inability to see the viewpoints of others, and hypersensitive to the opinions of others.

· Obsessive-Compulsive Personality Disorder: Characterized by perfectionism and inflexibility; preoccupation with uncontrollable patterns of thought and action.

· Paranoid Personality Disorder: Marked distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive him or her; lack of trust; belief of others' betrayal; belief in hidden meanings; unforgiving and grudge holding.

· Schizoid Personality Disorder: Primarily characterized by a very limited range of emotion, both in expression of and experiencing; indifferent to social relationships.

· Schizotypal Personality Disorder: Peculiarities of thinking, odd beliefs, and eccentricities of appearance, behavior, interpersonal style, and thought (e.g., belief in psychic phenomena and having magical powers).


According to Dr. Sam Vaknin, author of Malignant Self-Love: Narcissism Revisited, individuals with personality disorders have many things in common (see The Interrelationship Between Personality Disorders):

· Self-centeredness that manifests itself through a me-first, self-preoccupied attitude

· Lack of individual accountability that results in a victim mentality and blaming others, society and the universe for their problems

· Lack of perspective-taking and empathy

· Manipulative and exploitative behavior

· Unhappiness, suffering from depression and other mood and anxiety disorders

· Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks

· Distorted or superficial understanding of self and others' perceptions, being unable to see his or her objectionable, unacceptable, disagreeable, or self-destructive behaviors or the issues that may have contributed to the personality disorder

· Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs

· No hallucinations, delusions or thought disorders (except for the brief psychotic episodes of Borderline Personality Disorder)


Vaknin does not propose a unified theory of psychopathology as there is still much to learn about the workings of the world and our place in it. Each personality disorder shows its own unique manifestations through a story or narrative (see Metaphors of the Mind), but we do not have enough information or verifying capability to determine whether they spring from a common psychodynamic source.



It is important to note that some people diagnosed with borderline, antisocial, schizoid, and obsessive-compulsive personality disorders may be suffering from an underlying biological disturbance (anatomical, electrical, or neurochemical). A strong genetic link has been found in antisocial and borderline personality disorders (see Genetics and Mental Disorders, The Chemistry of Personality and The Biology of Borderline Personality Disorder).



Treatment of Personality Disorders


Dr. David B. Adams of Atlanta Medical Psychology says that therapists have the most difficulties with those suffering from personality disorders. They are difficult to please, block effective communication, avoid development of a trusting relationship, [and] cannot be relied upon for accurate history regarding problems or how problems arose (The Psychological Letter, February 2000).


According to the Surgeon General, mental disorders are treatable. An armamentarium of efficacious treatments is available to ameliorate symptoms . . . Most treatments fall under two general categories, psychosocial and pharmacological. Moreover, the combination of the two ?known as multimodal therapy ?can sometimes be even more effective than each individually. (See Mental Health: A Report of the Surgeon General)



By reading the DSM-IV's definition of personality disorders, it seems that these conditions are not treatable. However, when individuals choose to be in control of their lives and are committed to changing their lives, healing is possible. Therapy and medications can help, but it is the individual's decision to take accountability for his or her own life that makes the difference.



To heal, individuals must first have the desire to change in order to break through that enduring pattern of a personality disorder. Individuals need to want to gain insight into and face their inner experience and behavior. (These issues may concern severe or repeated trauma during childhood, such as abuse.)



This involves changing their thinking--about themselves, their relationships, and the world. This also involves changing their behavior, for that which is not acted upon is not learned.


Then, with a support system (e.g., therapy, self-help groups, friends, family, medication), they can free themselves from their imprisoned life.



This article may be reproduced wholly or in part without written permission but must cite the author, Linda Lebelle, and provide a link to Focus Adolescent Services