Self-defeating Personality Disorder is a pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following:

Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available.

Rejects or renders ineffective the attempts of others to help him of her.

Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain ( e.g., an accident).

Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated).

Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure).

Fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, (e.g., helps fellow students write papers , but is unable to write his or her own).

Is uninterested in or rejects people who consistently treat him or her well, (e.g., is not attracted to caring sexual partners).

Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice;
The behaviors do not occur exclusively in response to, or in anticipation of , being physically, sexually, or psychologically abused.

The behaviors do not occur only when the person is depressed.

The behaviors do not occur exclusively in response to, or in anticipation of , being physically, sexually, or psychologically abused.

Associated Features:

Dysthymia.
Major Depressive Episode.
Suicidal Behavior.
Depressed Mood.

Differential Diagnosis:

Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.People with self-defeating personalities are drawn to situations and relationships in which they are subject to failure, humiliation, suffering, and distress. Although sexual masochism may be present, it has no necessary connection with this disorder.

Social Phobia, Generalized Type
Dependent Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Paranoid Personality Disorder
Personality Change Due to a General Medical Condition
Symptoms that may develop in association with chronic substance use.

Cause:

There is no clear cause for sadistic personality disorder; some theories suggest that it is a function of how one is brought up, but biological factors are likely as well. This disorder is fairly uncommon and there is little information about occurrence by gender or about family pattern.

Treatment:

Treating a personality disorder takes a long time. Personality traits such as coping mechanisms, beliefs, and behavior patterns take many years to develop, and they change slowly. Changes usually occur in a predictable sequence, and different treatment modalities are needed to facilitate them. Reducing environmental stress can quickly relieve symptoms such as anxiety or depression. Behaviors, such as recklessness, social isolation, lack of assertiveness, or temper outbursts, can be changed in months. Group therapy and behavior modification, sometimes within day care or designed residential settings, are effective. Participation in self-help groups or family therapy can also help change socially undesirable behaviors.

Counseling and Psychotherapy [ See Therapy Section ]:

Although treatment differs according to the type of personality disorder, some general principles apply to all. Family members can act in ways that either reinforce or diminish the patient's problematic behavior or thoughts, so their involvement is helpful and often essential.

Pharmacotherapy [ See Psychopharmacology Section ] :

Drugs have limited effects. They can be misused or used in suicide attempts. When anxiety and depression result from a personality disorder, drugs are only moderately effective. For persons with personality disorders, anxiety and depression may have positive significance, ie, that the person is experiencing unwanted consequences of his disorder or is undertaking some needed self-examination.

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