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.
DSM-IV Code: Not Specified
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.
