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Ones set of stable, predictable emotional and behavioral traits

Sigmund Freud
Father of Psychosexual Theory of Development

1856 - 1939

Psychoanalytic theory
Behavior and personality derives from the constant

and unique interaction of conflicting psychological forces that operate at three different levels of awareness: the preconscious, the conscious, and the unconscious
Mind divided into 2 parts
The conscious the part of which we are aware The unconscious the part of which we are not aware

* The unconscious mind has more influence than the conscious has on our personality development & behaviour

Super Ego is part of the Preconscious mind


Id is part of the Unconscious mind

* Ego is floating is all 3 states

The unconscious mind is further divided into 3 parts: the id encourages us to seek physical satisfaction (sexual, nutritional) the superego prompts us to do the moral thing, not the one that feels the best the ego referees between the id and superego, and deals with external reality (our conscious self)

*our early childhood experiences, usually involving our relationships with our parents & family, are stored in our unconscious mind

According to Freud, the key to a healthy personality is a balance between the id, the ego, and the superego.

Deeply ingrained, inflexible patterns in interpersonal relationships (maladaptive)
Deviates from cultural norms

Prevalence: 10-20% in the general population

PD is a predisposing factor for other psychiatric

disorders; e.g. substance use, suicide, affective disorders, impulse-control disorders, eating disorders and anxiety disorders

A pattern of behavior/inner experience that deviates from culture in 2 ways:
-Cognition -Affect -Personal relations -Impulse control


inflexible & pervasive pattern significant distress/ impairment in functioning stable & long duration w onset no later than adolescence or early adulthood not accounted by other mental illness not d/t other GMC/substance abuse




Example of case
A 35 year-old computer programmer , has always had difficulty forming close friendships, not because of a lack of desire but because of an intense fear of rejection and disapproval. He looked for work that would minimize social interaction and opportunities to be judged by others. He describes himself as being painfully shy since childhood.

DSM IV Avoidant PD
A pattern of social inhibition, hypersensitivity, and feeling of inadequacy since early adulthood, with at least 4 of the following 1. Avoid occupation that involves interpersonal contact due to fear of criticism and rejection 2. Unwilling to interact unless certain of being liked 3. Cautious of intrapersonal relationships 4. Preoccupied with being criticized or rejected in social situation 5. Inhibited in new social situations because he/she feels inadequate 6. Believes he/she is socially inept and inferior 7. Reluctant to engage in new activities for fear of embarrassment.

Assertiveness training
For people who are abnormally shy or socially awkward

Socially acceptable expression of thoughts and feelings

is encourage as follow : 1. Analyze the problem in terms of facial expression, eye contact, posture and tone of voice 2. Exchange of roles to help pt understand the viewpoint of the other person in the situation 3. Demonstrate appropriate social behaviour 4. Practice appropriate behavior within the session 5. Practice appropriate social behavior in everyday life 6. Record the outcome of this practice

1. Realize where changes are needed and believe in

your rights. 2. Figure out appropriate ways of asserting yourself in each specific situation that concerns you 3. Practice giving assertive responses 4. Try being assertive in real life situations

Example of case
A 55 year-old lady has trouble deciding on choosing which dress to wear to attend a wedding ceremony. She calls her mother and her best friends several times to ask the opinion.

DSM IV Dependent PD
A pattern of submissive and clinging behaviour due to excessive need to be taken care of. At least 5 of the following must be present:
2. 3.

5. 6.


has difficulty making everyday decisions without an excessive amount of advice and reassurance from others needs others to assume responsibility for most major areas of his or her life has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: does not include realistic fears of retribution. has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself urgently seeks another relationship as a source of care and support when a close relationship ends is unrealistically preoccupied with fears of being left to take care of himself or herself



Perfectionism, inflexibity & extreme orderliness stiff, serious and formal with constricted affect ~1% (males>; oldest child)

Shy/ timid Dependent and submissive Avoiding social inhibition d/t Poor self-confident intense fear of rejection Others decide for them 1 to 10% ~1% (females>)

Chronic course
associated anxiety and depressive disorders DD Schizoid PD Social phobia/ anxiety d/s associated depression DD Avoidant PD Borderline & histrionic PD Comorbid- MDD, schizophrenia, anorexia nervosa, bulimia DD OCD Narcissistic PD

Psychotherapy Behavior therapy (Assertive training & desensitization) Group therapy (understanding) Good rapport & reassurance Pharmacotherapy Anxiolytic (B-blocker) SSRI (depression)

Psychotherapy Family/couple therapy Assertive training- autonomy/ decision making Pharmacotherapy Anxiolytic (B-blocker during crisis) SSRI (depression)

Psychotherapy Behavior therapy Group therapy Pharmacotherapy Anxiolytic SSRI

*Anti-psychotics (severe case)???

Example of case
30 year-old gentlemen tells you that his 6th roommate has just moved out because he makes unreasonable rules and schedules concerning the care of the apartment

Pattern of pre-ocupation with orderliness, control and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts. At least 4 of the following must present:
1. Preoccupation with details, rules, lists, and organization such that the major point of the activity is lost 2. Perfectionism that is detrimental to completion of task 3. Excessive devotion to work 4. Excessive conscientiousness and scrupulousness about morals and ethics 5. Will not delegrate tasks 6. Unable to discard worthless objects 7. Miserly 8. Rigid and stubborn