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Is there a clinical definition for the psychological disorder/personality disorder for people who like to get under people's skin?

Is there a clinical definition for the psychological disorder/personality disorder for people who like to get under people's skin?


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I have noticed in my 50+ years of life that there are people who take joy (sometimes great joy) out of “getting under” another person's skin. Is there a clinical definition for this behavior? Perhaps it is a personality disorder.

(There is a non-clinical way to describe such a person but civility restrains me).

I have noticed that people who exhibit this behavior seem to be looking for a reaction. And by seeing a reaction to what they say, they see their control over another person. It may also be the only way the person knows how to impress others (possibly due to low self-esteem).

I have searched the internet and all I have found so far is information on how to deal with such a person.


Taking joy in irritating others is unlikely to be classifiable as a personality disorder, however, the Dark Triad describes individuals with disagreeable habits. In combination with other extremely adverse behaviours, it is perhaps classifiable as Conduct disorder or Narcissistic personality disorder.


Harmonic convergence

The next research question may seem obvious: If anyone can experience pain relief by inflicting pain on themselves, why don't more of us do it? To ask the question a different way, why do self-injurers harm themselves instead of opting for healthier or more pleasant ways of relieving emotional pain, such as watching a movie, meeting a friend or going to a yoga class?

As Franklin was pondering this question in light of possible benefits to the self-injurer, Hooley and her team wondered about psychological explanations. She already knew that self-injurers would endure physical pain for longer, but why? Was this increased pain endurance linked to some of the psychological factors that are commonly associated with self-injury — depression, hopelessness or dissociation, for instance?

Somewhat surprisingly, her team found no significant associations. So having interviewed all of her self-injuring research participants in detail, she returned to her notes in search of clues.

That's when one factor stood out: How often they spontaneously described themselves as being "bad," "defective" or "deserving of punishment."

"It was as if harming themselves or experiencing pain was somehow congruent with their highly negative self-image," she explains.

To test this possibility, her team developed a measure that specifically assesses self-beliefs about being "bad" and deserving criticism. This time, they found an answer: The higher a person's score on negative self-beliefs, the longer they were willing or able to endure pain.

Given his conversations with Hooley, Franklin was thinking along similar lines. When he asked himself why people would undertake this behavior, he looked at it in context of the fact that most people probably like themselves and therefore don't want to hurt themselves. In ongoing, still unpublished work, he asked participants to rate words like "me," "myself" and "I" on a 10-point scale ranging from most unpleasant to most pleasant. Most people rated themselves between a seven and eight, but self-injurers gave themselves only a two or a three.

Likewise, Franklin reasoned that most people would not be overly fond of stimuli that depict blood, wounds, knives or equivalent images. But he surmised that people who self-injure might feel differently, partly because his findings suggested they would associate such images with pain relief. A 2014 study in Clinical Psychological Science shows this is the case: People who had engaged in NSSI over the past year or who had 10 or more lifetime episodes of self-cutting were much less likely to report aversion to these kinds of stimuli than non-injuring controls.

Meanwhile, Hooley has recently completed a neuroimaging study looking at how people process such stimuli.

"We're predicting that images of self-injury will activate reward-processing areas in the brains of people who engage in NSSI," she says, "but not in non-self-injuring controls."


Examples of dramatic/erratic (Cluster B) personality disorders

Borderline personality disorder. People with this disorder are not stable in their perceptions of themselves. They have trouble keeping stable relationships. Moods may also be inconsistent, but never neutral. Their sense of reality is always seen in "black and white." People with borderline personality disorder often feel as though they lacked a certain level of nurturing while growing up. As a result, they constantly seek a higher level of caretaking from others as adults. This may be achieved through manipulation of others, leaving them often feeling empty, angry, and abandoned. This may lead to desperate and impulsive behavior.

Antisocial personality disorder. People with this disorder characteristically disregard the feelings, property, authority, and respect of others for their own personal gain. This may include violent or aggressive acts involving or targeting other individuals, without a sense of regret or guilt for any of their destructive actions.

Narcissistic personality disorder. People with this disorder present severely overly-inflated feelings of self-worth, grandness, and superiority over others. People with narcissistic personality disorder often exploit others who fail to admire them. They are overly sensitive to criticism, judgment, and defeat.

Histrionic personality disorder. People with this disorder are overly conscious of their appearance and are constantly seeking attention. They also often behave dramatically in situations that don't warrant this type of reaction. The emotional expressions of people with histrionic personality disorder are often judged as superficial and exaggerated.


A Word From Verywell

It is important to remember that from time to time, many people may experience some of the symptoms described above. However, people with BPD experience several of these symptoms daily or almost every day for years. Also, people with BPD experience these symptoms across different contexts. For example, they will experience instability in many relationships, not just one or two or even three.

If you think you may have BPD, it is important to see a licensed mental health professional who can listen to your concerns and make an accurate diagnosis. Treatment with a good mental health professional can help both people living with BPD and their family and friends manage the symptoms and the underlying basis of the condition.


Treatment

Support for people with gender dysphoria may include open-ended exploration of their feelings and experiences of gender identity and expression, without the therapist having any pre-defined gender identity or expression outcome defined as preferable to another. 2 Psychological attempts to force a transgender person to be cisgender (sometimes referred to as gender identity conversion efforts or so-called &ldquogender identity conversion therapy&rdquo) are considered unethical. 2,3

Support may also include affirmation in various domains. Social affirmation may include an individual adopting pronouns, names, and various aspects of gender expression that match their gender identity. 4,5 Legal affirmation may involve changing name and gender markers on various forms of government identification. 6 Medical affirmation may include pubertal suppression for adolescents with gender dysphoria and gender-affirming hormones like estrogen and testosterone for older adolescents and adults. 7, 8 Medical affirmation is not recommended for prepubertal children. 7, 8 Some adults (and less often adolescents) may undergo various aspects of surgical affirmation. 7, 8

Family and societal rejection of gender identity are some of the strongest predictors of mental health difficulties among people who are transgender. 9 Family and couples&rsquo therapy can be important for creating a supportive environment that will allow a person&rsquos mental health to thrive. Parents of children and adolescents who are transgender may benefit from support groups. Peer support groups for transgender people themselves are often helpful for validating and sharing experiences.


Symptoms

BPD can often interfere with your ability to enjoy life or achieve fulfillment in relationships, work, or school. It's associated with specific and significant problems in interpersonal relationships, self-image, emotions, behaviors, and thinking, including:  

  • Behaviors: BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous or risky sex, or binge eating. Also, people with BPD are more prone to engage in self-harming behaviors, such as cutting or burning and attempting suicide.
  • Emotions: Emotional instability is a key feature of BPD. Individuals feel like they're on an emotional roller coaster with quick mood shifts (i.e., going from feeling OK to feeling extremely down or blue within a few minutes). Mood changes can last from minutes to days and are often intense. Anger, anxiety, and overwhelming emptiness are common as well.
  • Relationships: People with BPD tend to have intense relationships with loved ones characterized by frequent conflicts, arguments, and break-ups. BPD is associated with an intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment. This usually leads to difficulty trusting others, putting a strain on relationships.
  • Self-image: Individuals with BPD have difficulties related to the stability of their sense of self. They report many ups and downs in how they feel about themselves. One moment they may feel good about themselves, but the next they may feel they are bad or even evil.
  • Stress-related changes in thinking: Under conditions of stress, people with BPD may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm), or dissociation (feeling spaced out, numb, or like they're not really in their body).

Not everyone with BPD experiences every symptom. Some people may have a few, while others experience most of these symptoms.  


To receive a diagnosis of antisocial personality disorder according to the DSM-4, a person must meet four criteria:

  1. Showing “a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years”
  2. Age 18 or older
  3. Showing evidence of conduct disorder before age 15
  4. Displaying antisocial behavior that is is not directly related to schizophrenia or bipolar disorder

The pattern of disregarding others’ rights is met by fulfilling at least three of the following seven behaviors:

  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
  3. Impulsivity or failure to plan ahead
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
  5. Reckless disregard for safety of self or others
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  7. Lack of remorse, as indicated by being indifferent or rationalizing

The second and third criteria, regarding age, go hand in hand: A person who shows characteristics of antisocial personality disorder before age 18 should be diagnosed with conduct disorder. A child or adolescent with conduct disorder has emotional and behavioral problems, including defiant and impulsive behavior and a willingness to break rules and laws, according to the National Institutes of Health. (2)

A clinician may diagnose a person with antisocial personality disorder even if they did not receive an official diagnosis of conduct disorder, as long as their behavior before age 15 met the criteria for conduct disorder.

Mental health professionals must also be sure that conduct disorder is not a misdiagnosis of another mental health or developmental condition. A child with ADHD, for example, may be misdiagnosed as having conduct disorder. The same symptoms that lead to a conduct disorder diagnosis may also be early symptoms of bipolar disorder, schizophrenia, or major depressive disorder. (2)

A recent study, published in January 2017 in the Journal of Clinical Psychiatry, found that up to 20 percent of Americans show strong characteristics of antisocial behavior in adulthood but without having a diagnosis of conduct disorder before age 15. (3)


Multiple personality disorder

multiple myeloma a malignant neoplasm of plasma cells in which the plasma cells proliferate and invade the bone marrow, causing destruction of the bone and resulting in pathologic fracture and bone pain. It is the most common type of monoclonal gammopathy , characterized by presence of a monoclonal immunoglobulin (immunoglobulin recognized as a single protein), Bence Jones proteins in the urine, anemia, and lowered resistance to infection. Called also plasma cell myeloma.

Diagnostic procedures to confirm suspected multiple myeloma include blood analyses, quantitative immunologic assays of serum and urine, urinalysis, bone marrow aspiration and biopsy, and skeletal x-rays. Findings indicative of the disease are an increased number of plasma cells in the bone marrow (usually over 10 per cent of the total), anemia , hypercalcemia due to release of calcium from deteriorating bone tissue, and elevated blood urea nitrogen , Bence Jones protein in the urine, and osteolytic lesions that give the bone a honeycomb appearance on x-ray and lead to vertebral collapse.

Patient Care . Major problems presented by the patient with multiple myeloma are related to anemia, hypercalcemia, bone pain and pathologic fractures, and emotional distress created by trying to cope with the day-to-day physiologic and emotional aspects associated with the diagnosis of a malignant disease. The more common complications to be avoided are infection, renal failure , and the sequelae of spinal cord compression.

Transfusions with packed red blood cells can help alleviate and minimize some of the more severe symptoms of anemia. It is important that the patient be adequately hydrated to improve viscosity of the blood and circulation, to help avoid hypercalcemia, and to maintain kidney function for excretion of the products of protein metabolism. Continued ambulation and moderate exercise help slow down the loss of minerals, especially calcium, from the bones. Other problems are related to the administration of highly toxic antineoplastic drugs.

multiple sclerosis (MS) a chronic neurologic disease in which there are patches of demyelination scattered throughout the white matter of the central nervous system, sometimes extending into the gray matter . The disease primarily affects the myelin and not the nerve cells themselves any damage to the neurons is secondary to destruction of the myelin covering the axon. The symptoms caused by these lesions are typically weakness, incoordination, paresthesias, speech disturbances, and visual disturbances, particularly diplopia. More specific signs and symptoms depend on the location of the lesions and the severity and destructiveness of the inflammatory and sclerotic processes.

The course of the disease is usually prolonged, with remissions and relapses over many years. Brief exacerbations, even with acute and severe symptoms, are thought to be the result of a transient inflammatory depression of neural transmission. Recovery occurs when there has been no permanent damage to the myelin sheath during the attack. Repeated attacks can, however, eventually permanently denude the axons and leave the yellow sclerotic plaques that are characteristic of the disease. Once the disease process reaches the stage of sclerosis the affected axons cannot recover and there is permanent damage.

The prevalence of MS is not certain because the disease is not one that is reported, and mild cases can be either misdiagnosed or never brought to the attention of a health care provider. It is far more common in the temperate zones of the world than in tropical and subtropical climates. The onset of symptoms most often occurs between the ages of 20 and 40 years, and the disease affects both sexes about equally.

The cause of multiple sclerosis is unknown. It is likely that an inherited immune response is somehow responsible for the production of autoantibodies that attack the myelin sheath. Some authorities believe that infection by one of the slow viruses occurs during childhood and after some years of latency the virus triggers an autoimmune response. Others believe there is an antigen or environmental trigger for the disease.

The diagnosis of multiple sclerosis is difficult because of the wide variety of possible clinical manifestations and the resemblance they bear to other neurological disorders. There is no definitive diagnostic test for the condition, but persons with objectively measured abnormalities of the central nervous system, a history of exacerbation and remission of symptoms, and demonstrable delayed blink reflex and evoked visual response are diagnosed as having either possible or probable multiple sclerosis. With time and progressive worsening of symptoms the diagnosis can become definite.

Treatment . A multidisciplinary approach is required to diagnose the condition and help patients and their families cope with the attendant problems. Multiple sclerosis has an impact on physical activity and life style, role, and interpersonal relationships therefore, vocational guidance, counseling, and group therapy are helpful. It is important that the patient with severe disability maintain a positive attitude, focusing on functional abilities rather than disabilities. Regeneration of the damaged neural tissue is not possible but retraining and adaptation are. Stress due to trauma, infection, overexertion, surgery, or emotional upset can aggravate the condition and precipitate a flare-up of symptoms.

Supportive measures include a regimen of rest and exercise, a well-balanced diet, avoidance of extremes of heat and cold, avoidance of known sources of infection, and adaptation of a life style that is relatively unstressful while still being as productive as possible.

Therapeutic measures include medications to diminish muscle spasticity measures to overcome urinary retention (such as credé's method or intermittent catheterization ) speech therapy and physical therapy to maintain muscle tone and avoid orthopedic deformities. Management of MS has been greatly enhanced by the availability of interferons beta-1a and beta-1b . Research support is strong that these medications reduce the frequency and severity of relapses.


How Is Histrionic Personality Disorder Diagnosed?

If signs of this personality disorder are present, the doctor will begin an evaluation by performing a complete medical and psychiatric history. If physical symptoms are present, a physical exam and laboratory tests (such as neuroimaging studies or blood tests) may also be recommended to assure that a physical illness is not causing any symptoms that may be present.

If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist, psychologist, or other licensed behavioral health professional who may use specially designed interview and assessment tools to evaluate a person for a personality disorder.


Types of Personality Disorders

Personality disorders are a type of mental illness in which a person’s thought patterns and behaviors cause them distress. Often, people with a personality disorder experience inflexible thoughts that impair their ability to adapt to stress, problem-solve, or engage in healthy relationships with others.

There are many types of personality disorders, and only a skilled mental health professional, such as a psychiatrist, psychologist or social worker, can diagnose a personality disorder. The signs and symptoms of many personality disorders can overlap each other, though each specific type usually involves a defining feature.


Treatment

Support for people with gender dysphoria may include open-ended exploration of their feelings and experiences of gender identity and expression, without the therapist having any pre-defined gender identity or expression outcome defined as preferable to another. 2 Psychological attempts to force a transgender person to be cisgender (sometimes referred to as gender identity conversion efforts or so-called &ldquogender identity conversion therapy&rdquo) are considered unethical. 2,3

Support may also include affirmation in various domains. Social affirmation may include an individual adopting pronouns, names, and various aspects of gender expression that match their gender identity. 4,5 Legal affirmation may involve changing name and gender markers on various forms of government identification. 6 Medical affirmation may include pubertal suppression for adolescents with gender dysphoria and gender-affirming hormones like estrogen and testosterone for older adolescents and adults. 7, 8 Medical affirmation is not recommended for prepubertal children. 7, 8 Some adults (and less often adolescents) may undergo various aspects of surgical affirmation. 7, 8

Family and societal rejection of gender identity are some of the strongest predictors of mental health difficulties among people who are transgender. 9 Family and couples&rsquo therapy can be important for creating a supportive environment that will allow a person&rsquos mental health to thrive. Parents of children and adolescents who are transgender may benefit from support groups. Peer support groups for transgender people themselves are often helpful for validating and sharing experiences.


Types of Personality Disorders

Personality disorders are a type of mental illness in which a person’s thought patterns and behaviors cause them distress. Often, people with a personality disorder experience inflexible thoughts that impair their ability to adapt to stress, problem-solve, or engage in healthy relationships with others.

There are many types of personality disorders, and only a skilled mental health professional, such as a psychiatrist, psychologist or social worker, can diagnose a personality disorder. The signs and symptoms of many personality disorders can overlap each other, though each specific type usually involves a defining feature.


How Is Histrionic Personality Disorder Diagnosed?

If signs of this personality disorder are present, the doctor will begin an evaluation by performing a complete medical and psychiatric history. If physical symptoms are present, a physical exam and laboratory tests (such as neuroimaging studies or blood tests) may also be recommended to assure that a physical illness is not causing any symptoms that may be present.

If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist, psychologist, or other licensed behavioral health professional who may use specially designed interview and assessment tools to evaluate a person for a personality disorder.


Symptoms

BPD can often interfere with your ability to enjoy life or achieve fulfillment in relationships, work, or school. It's associated with specific and significant problems in interpersonal relationships, self-image, emotions, behaviors, and thinking, including:  

  • Behaviors: BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous or risky sex, or binge eating. Also, people with BPD are more prone to engage in self-harming behaviors, such as cutting or burning and attempting suicide.
  • Emotions: Emotional instability is a key feature of BPD. Individuals feel like they're on an emotional roller coaster with quick mood shifts (i.e., going from feeling OK to feeling extremely down or blue within a few minutes). Mood changes can last from minutes to days and are often intense. Anger, anxiety, and overwhelming emptiness are common as well.
  • Relationships: People with BPD tend to have intense relationships with loved ones characterized by frequent conflicts, arguments, and break-ups. BPD is associated with an intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment. This usually leads to difficulty trusting others, putting a strain on relationships.
  • Self-image: Individuals with BPD have difficulties related to the stability of their sense of self. They report many ups and downs in how they feel about themselves. One moment they may feel good about themselves, but the next they may feel they are bad or even evil.
  • Stress-related changes in thinking: Under conditions of stress, people with BPD may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm), or dissociation (feeling spaced out, numb, or like they're not really in their body).

Not everyone with BPD experiences every symptom. Some people may have a few, while others experience most of these symptoms.  


Examples of dramatic/erratic (Cluster B) personality disorders

Borderline personality disorder. People with this disorder are not stable in their perceptions of themselves. They have trouble keeping stable relationships. Moods may also be inconsistent, but never neutral. Their sense of reality is always seen in "black and white." People with borderline personality disorder often feel as though they lacked a certain level of nurturing while growing up. As a result, they constantly seek a higher level of caretaking from others as adults. This may be achieved through manipulation of others, leaving them often feeling empty, angry, and abandoned. This may lead to desperate and impulsive behavior.

Antisocial personality disorder. People with this disorder characteristically disregard the feelings, property, authority, and respect of others for their own personal gain. This may include violent or aggressive acts involving or targeting other individuals, without a sense of regret or guilt for any of their destructive actions.

Narcissistic personality disorder. People with this disorder present severely overly-inflated feelings of self-worth, grandness, and superiority over others. People with narcissistic personality disorder often exploit others who fail to admire them. They are overly sensitive to criticism, judgment, and defeat.

Histrionic personality disorder. People with this disorder are overly conscious of their appearance and are constantly seeking attention. They also often behave dramatically in situations that don't warrant this type of reaction. The emotional expressions of people with histrionic personality disorder are often judged as superficial and exaggerated.


A Word From Verywell

It is important to remember that from time to time, many people may experience some of the symptoms described above. However, people with BPD experience several of these symptoms daily or almost every day for years. Also, people with BPD experience these symptoms across different contexts. For example, they will experience instability in many relationships, not just one or two or even three.

If you think you may have BPD, it is important to see a licensed mental health professional who can listen to your concerns and make an accurate diagnosis. Treatment with a good mental health professional can help both people living with BPD and their family and friends manage the symptoms and the underlying basis of the condition.


Harmonic convergence

The next research question may seem obvious: If anyone can experience pain relief by inflicting pain on themselves, why don't more of us do it? To ask the question a different way, why do self-injurers harm themselves instead of opting for healthier or more pleasant ways of relieving emotional pain, such as watching a movie, meeting a friend or going to a yoga class?

As Franklin was pondering this question in light of possible benefits to the self-injurer, Hooley and her team wondered about psychological explanations. She already knew that self-injurers would endure physical pain for longer, but why? Was this increased pain endurance linked to some of the psychological factors that are commonly associated with self-injury — depression, hopelessness or dissociation, for instance?

Somewhat surprisingly, her team found no significant associations. So having interviewed all of her self-injuring research participants in detail, she returned to her notes in search of clues.

That's when one factor stood out: How often they spontaneously described themselves as being "bad," "defective" or "deserving of punishment."

"It was as if harming themselves or experiencing pain was somehow congruent with their highly negative self-image," she explains.

To test this possibility, her team developed a measure that specifically assesses self-beliefs about being "bad" and deserving criticism. This time, they found an answer: The higher a person's score on negative self-beliefs, the longer they were willing or able to endure pain.

Given his conversations with Hooley, Franklin was thinking along similar lines. When he asked himself why people would undertake this behavior, he looked at it in context of the fact that most people probably like themselves and therefore don't want to hurt themselves. In ongoing, still unpublished work, he asked participants to rate words like "me," "myself" and "I" on a 10-point scale ranging from most unpleasant to most pleasant. Most people rated themselves between a seven and eight, but self-injurers gave themselves only a two or a three.

Likewise, Franklin reasoned that most people would not be overly fond of stimuli that depict blood, wounds, knives or equivalent images. But he surmised that people who self-injure might feel differently, partly because his findings suggested they would associate such images with pain relief. A 2014 study in Clinical Psychological Science shows this is the case: People who had engaged in NSSI over the past year or who had 10 or more lifetime episodes of self-cutting were much less likely to report aversion to these kinds of stimuli than non-injuring controls.

Meanwhile, Hooley has recently completed a neuroimaging study looking at how people process such stimuli.

"We're predicting that images of self-injury will activate reward-processing areas in the brains of people who engage in NSSI," she says, "but not in non-self-injuring controls."


To receive a diagnosis of antisocial personality disorder according to the DSM-4, a person must meet four criteria:

  1. Showing “a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years”
  2. Age 18 or older
  3. Showing evidence of conduct disorder before age 15
  4. Displaying antisocial behavior that is is not directly related to schizophrenia or bipolar disorder

The pattern of disregarding others’ rights is met by fulfilling at least three of the following seven behaviors:

  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
  3. Impulsivity or failure to plan ahead
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
  5. Reckless disregard for safety of self or others
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  7. Lack of remorse, as indicated by being indifferent or rationalizing

The second and third criteria, regarding age, go hand in hand: A person who shows characteristics of antisocial personality disorder before age 18 should be diagnosed with conduct disorder. A child or adolescent with conduct disorder has emotional and behavioral problems, including defiant and impulsive behavior and a willingness to break rules and laws, according to the National Institutes of Health. (2)

A clinician may diagnose a person with antisocial personality disorder even if they did not receive an official diagnosis of conduct disorder, as long as their behavior before age 15 met the criteria for conduct disorder.

Mental health professionals must also be sure that conduct disorder is not a misdiagnosis of another mental health or developmental condition. A child with ADHD, for example, may be misdiagnosed as having conduct disorder. The same symptoms that lead to a conduct disorder diagnosis may also be early symptoms of bipolar disorder, schizophrenia, or major depressive disorder. (2)

A recent study, published in January 2017 in the Journal of Clinical Psychiatry, found that up to 20 percent of Americans show strong characteristics of antisocial behavior in adulthood but without having a diagnosis of conduct disorder before age 15. (3)


Multiple personality disorder

multiple myeloma a malignant neoplasm of plasma cells in which the plasma cells proliferate and invade the bone marrow, causing destruction of the bone and resulting in pathologic fracture and bone pain. It is the most common type of monoclonal gammopathy , characterized by presence of a monoclonal immunoglobulin (immunoglobulin recognized as a single protein), Bence Jones proteins in the urine, anemia, and lowered resistance to infection. Called also plasma cell myeloma.

Diagnostic procedures to confirm suspected multiple myeloma include blood analyses, quantitative immunologic assays of serum and urine, urinalysis, bone marrow aspiration and biopsy, and skeletal x-rays. Findings indicative of the disease are an increased number of plasma cells in the bone marrow (usually over 10 per cent of the total), anemia , hypercalcemia due to release of calcium from deteriorating bone tissue, and elevated blood urea nitrogen , Bence Jones protein in the urine, and osteolytic lesions that give the bone a honeycomb appearance on x-ray and lead to vertebral collapse.

Patient Care . Major problems presented by the patient with multiple myeloma are related to anemia, hypercalcemia, bone pain and pathologic fractures, and emotional distress created by trying to cope with the day-to-day physiologic and emotional aspects associated with the diagnosis of a malignant disease. The more common complications to be avoided are infection, renal failure , and the sequelae of spinal cord compression.

Transfusions with packed red blood cells can help alleviate and minimize some of the more severe symptoms of anemia. It is important that the patient be adequately hydrated to improve viscosity of the blood and circulation, to help avoid hypercalcemia, and to maintain kidney function for excretion of the products of protein metabolism. Continued ambulation and moderate exercise help slow down the loss of minerals, especially calcium, from the bones. Other problems are related to the administration of highly toxic antineoplastic drugs.

multiple sclerosis (MS) a chronic neurologic disease in which there are patches of demyelination scattered throughout the white matter of the central nervous system, sometimes extending into the gray matter . The disease primarily affects the myelin and not the nerve cells themselves any damage to the neurons is secondary to destruction of the myelin covering the axon. The symptoms caused by these lesions are typically weakness, incoordination, paresthesias, speech disturbances, and visual disturbances, particularly diplopia. More specific signs and symptoms depend on the location of the lesions and the severity and destructiveness of the inflammatory and sclerotic processes.

The course of the disease is usually prolonged, with remissions and relapses over many years. Brief exacerbations, even with acute and severe symptoms, are thought to be the result of a transient inflammatory depression of neural transmission. Recovery occurs when there has been no permanent damage to the myelin sheath during the attack. Repeated attacks can, however, eventually permanently denude the axons and leave the yellow sclerotic plaques that are characteristic of the disease. Once the disease process reaches the stage of sclerosis the affected axons cannot recover and there is permanent damage.

The prevalence of MS is not certain because the disease is not one that is reported, and mild cases can be either misdiagnosed or never brought to the attention of a health care provider. It is far more common in the temperate zones of the world than in tropical and subtropical climates. The onset of symptoms most often occurs between the ages of 20 and 40 years, and the disease affects both sexes about equally.

The cause of multiple sclerosis is unknown. It is likely that an inherited immune response is somehow responsible for the production of autoantibodies that attack the myelin sheath. Some authorities believe that infection by one of the slow viruses occurs during childhood and after some years of latency the virus triggers an autoimmune response. Others believe there is an antigen or environmental trigger for the disease.

The diagnosis of multiple sclerosis is difficult because of the wide variety of possible clinical manifestations and the resemblance they bear to other neurological disorders. There is no definitive diagnostic test for the condition, but persons with objectively measured abnormalities of the central nervous system, a history of exacerbation and remission of symptoms, and demonstrable delayed blink reflex and evoked visual response are diagnosed as having either possible or probable multiple sclerosis. With time and progressive worsening of symptoms the diagnosis can become definite.

Treatment . A multidisciplinary approach is required to diagnose the condition and help patients and their families cope with the attendant problems. Multiple sclerosis has an impact on physical activity and life style, role, and interpersonal relationships therefore, vocational guidance, counseling, and group therapy are helpful. It is important that the patient with severe disability maintain a positive attitude, focusing on functional abilities rather than disabilities. Regeneration of the damaged neural tissue is not possible but retraining and adaptation are. Stress due to trauma, infection, overexertion, surgery, or emotional upset can aggravate the condition and precipitate a flare-up of symptoms.

Supportive measures include a regimen of rest and exercise, a well-balanced diet, avoidance of extremes of heat and cold, avoidance of known sources of infection, and adaptation of a life style that is relatively unstressful while still being as productive as possible.

Therapeutic measures include medications to diminish muscle spasticity measures to overcome urinary retention (such as credé's method or intermittent catheterization ) speech therapy and physical therapy to maintain muscle tone and avoid orthopedic deformities. Management of MS has been greatly enhanced by the availability of interferons beta-1a and beta-1b . Research support is strong that these medications reduce the frequency and severity of relapses.


Watch the video: Kαταγραφή ενός καταθλιπτικού επεισοδίου - Οριακή Διαταραχή Προσωπικότητας (June 2022).


Comments:

  1. Jeshurun

    What a fun topic

  2. Eachthighearn

    I'm sorry, but I think you are wrong. Email me at PM, we'll talk.

  3. Verrill

    I apologize, it doesn't quite come close to me. Who else can say what?

  4. Voodoogore

    As for me, the meaning is revealed further nowhere, the afftor has done the maximum, for which I respect him!

  5. Achates

    What words...

  6. Cenehard

    the exception))))



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