Active avoidance, escape
Passive avoidance, extinction
Behavioral maintenance (reward dependence)
Norepinephrine
Resistance to extinction
Cloninger’s Seven-Factor Model
Cluster B Histrionic Antisocial Borderline Narcissistic Cluster C Obsessive-compulsive Avoidant Dependent
Sociopathic Personality Disturbance Antisocial Dyssocial
Torgersen, Krinபைடு நூலகம்len, Cramer; 2001
轴I和轴II
轴I和轴II障碍的共同点
Dimension Axis I Disorder Axis II Disorder Biological Indexes Characteristic Traits Defenses and Coping Strategies
CSF 5-HIAA*, responses to serotonergic challenge, galvanic skin response*, continuous performance task REM latency, responses to cholinergic challenges*, responses to catecholamingeric challenges* Heart rate variability*, orienting responses, responses to lactate and yohimbine
Hysterical
Passive-aggressive Obsessive-compulsive
Cluster B Histrionic Antisocial Borderline Narcissistic Cluster C Compulsive Avoidant Dependent Passive-aggressive
人格障碍的诊断及治疗策略
孙启武 博士
华中师范大学心理学院 讲师 武汉华中子和心理咨询中心
课程提纲
• DSM-IV和DSM-V系统人格障碍诊断的变化 • 精神动力学取向的诊断 • SWAP-200
– 简介 – 用SWAP-200做诊断 – 不同的人格障碍和治疗策略
• 案例研究（边缘、自恋和表演）
人格障碍的诊断及治疗策略
Disorganization, psychotic-like symptoms
Social isolation, detachment, guardedness
Impulsivity/ Aggression
Impulse disorders
Dramatic cluster (borderline & antisocial PDs)
Cognitive/ Perceptual Organization
Schizophrenia
Odd cluster (schizotypal PD)
Eye movement dysfunction*, continuous performance task, backward masking test*, plasma HVA*, CSF HVA*, evoked potential response, VBR
D. Personality Disorder Not Otherwise Specified
人格和人格障碍连续谱
DSM-IV 人格障碍的定义
A.明显偏离了患者所在文化所应有的持久的内心体 验和行为类型，表现为下列二方面以上： （l）认知（即对自我、他人、和事件的感知 和解释方式）； （2）情感（即：情绪反应的范围、强度、脆 弱性、和适合性）； （3）人际关系； （4）冲动控制。
Environmentally responsive, transient affective shifts
A. Cluster A (odd/eccentric) 1. Paranoid 2. Schizoid 3. Schizotypal B. Cluster B (dramatic/emotional/impulsive) 1. Antisocial 2. Borderline 3. Histrionic 4. Narcissistic C. Cluster C (anxious/fearful) 1. Avoidant 2. Dependent 3. Obsessive-Compulsive
人格维度
开放性（Openness）
子因素
思想、幻想、审美、行动、情感、价值观
尽责性（Conscientiousness） 能力、秩序、责任感、上进心、自律、深思熟虑 外向性（Extraversion） 乐群、自信、活跃、兴奋寻求、积极情绪、热心
随和性（Agreeableness） 神经质（Neuroticism）
Readiness to action, irritability/ aggression
Externalization, dissociation, enactment, repression
Affective Instability
Major affective disorders
Dramatic cluster (borderline & possibly histrionic PDs)
DSM-III-R Appendix* Self-defeating Sadistic
Figure 1. Ontogeny of Personality Disorder Classification
indicates that category was discontinued.
DSM-IV Personality Disorders
Air
Blood
Sanguine
Earth
Fire
Black Bile
Yellow Bile
Melancholic
Choleric
Sad
Irascible Irritable Apathetic Slow
Water
Phlegm
Phlegmatic
维度 类别
人格的维度系统
• • • • • Interpersonal Circumplex - Leary, Wiggins, Kiesler Three factors - Eysenck & Eysenck Four factors - Livesley et al., Clark et al. Five factors - Costa & McCrae Seven factors - Cloninger et al.
Prevalence of PDs in a Community Sample (N=2053) Overall – 13.4%
Torgersen, Kringlen, Cramer, 2001
Prevalence of PDs in a Community Sample (N=2053)
Personality Disorder Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive Passive-Aggressive Self-Defeating Present Prevalence 2.4 1.7 0.6 0.7 0.7 2.0 0.8 5.0 1.5 2.0 1.7 0.8
DSM 类别系统
DSM-I (1952)
Personality Pattern Disturbance Inadequate Paranoid Cyclothymic Schizoid
DSM-II (1968)
DSM-III (1980)
Axis I cyclothymic disorder
DSM-IV (1994)
Axis I cyclothymic disorder Cluster A Paranoid Schizoid Schizotypal
Inadequate Paranoid Cyclothymic Schizoid
Cluster A Paranoid Schizoid Schizotypal
Personality Trait Disturbance Emotionally unstable Passive-aggressive dependent type aggressive type Compulsive
DSM-IV和DSM-V人格障碍诊断及 变化
人格？
韦 小 宝
看电影迟到了， 拿着票却被看门 老头拦在门口， 说必须等到下一 场才让进。
迈克 · 泰森 林 黛 玉
许三多
Hippocrates Classification
Element Humor Type Style
Hopeful Enthusiastic Optimistic
DSM-IV 人格障碍的定义
B.这种持久的类型是不可变的，并且涉及个人和社交 场合的很多方面。 C.这种持久的类型导致临床上明显的痛苦烦恼，或 在社交、职业、或其他重要方面的功能缺损。 D.这种类型在长时间内是相当稳定不变的，至少可 以追溯到青少年或早期成年时。 E.这种行为类型不可能归于其他精神障碍的表现或 后果。 F.这种行为类型并非由于某种物质（例如某种滥用 药物，治疗药品），或一般躯体情况（例如颅脑外 伤）所致之直接生理性效应。