Jurnal terbitan berkala : Gangguan Personaliti di Kalangan Rakyat Malaysia | Personality Disorders in Malaysia

Gangguan Personaliti di Kalangan Rakyat Malaysia

Penerbit: Afiq Shahiri 7 June 2023 

Gangguan personaliti merupakan satu keadaan mental yang dicirikan oleh corak pemikiran, perasaan, dan tingkah laku yang berbeza daripada norma masyarakat dan kekal dalam jangka masa panjang. Ia boleh menjejaskan fungsi harian dan hubungan interpersonal seseorang individu. Di Malaysia, kesedaran tentang gangguan ini semakin meningkat, namun masih terdapat banyak stigma dan salah faham mengenainya.

Jenis-jenis Gangguan Personaliti

Menurut Manual Diagnostik dan Statistik Gangguan Mental (DSM-5), gangguan personaliti boleh diklasifikasikan kepada beberapa kategori utama:

1. Gangguan Personaliti Klasifikasi A (Eksentrik atau Aneh):

   • Paranoid: Mempunyai kepercayaan bahawa orang lain berniat jahat atau tidak boleh dipercayai.
   • Schizoid: Mengelakkan hubungan sosial dan tidak menunjukkan banyak emosi.
   • Schizotypal: Memiliki pemikiran atau kelakuan aneh dan percaya pada perkara yang luar biasa.

2. Gangguan Personaliti Klasifikasi B (Dramatik, Emosional atau Tidak Stabil):

   • Antisosial: Tidak mengambil kira hak atau perasaan orang lain.
   • Borderline: Emosi yang tidak stabil, imej diri yang kabur, dan hubungan yang tidak tetap.
   • Histrionik: Sentiasa mencari perhatian dan cenderung dramatik.
   • Narsistik: Mempunyai perasaan kepentingan diri yang berlebihan dan memerlukan penghargaan berterusan.

3. Gangguan Personaliti Klasifikasi C (Cemas atau Takut):

   • Avoidant: Mengelak daripada situasi sosial kerana rasa takut terhadap kritikan atau penolakan.
   • Dependent: Bergantung secara berlebihan kepada orang lain untuk membuat keputusan dan memenuhi keperluan diri.
   • Obsessive-Compulsive: Terlalu fokus kepada kesempurnaan, peraturan, dan kawalan.

Faktor Penyumbang di Malaysia

Terdapat pelbagai faktor yang boleh menyumbang kepada perkembangan gangguan personaliti di kalangan rakyat Malaysia:

1. Budaya dan Sosial:

   • Tekanan sosial dan harapan budaya yang tinggi, seperti kepentingan keluarga dan kejayaan akademik, boleh mencetuskan atau memperburuk gangguan personaliti.
   • Stigma sosial terhadap gangguan mental menyebabkan ramai individu tidak mendapatkan bantuan yang diperlukan.

2. Ekonomi:

   • Kesempitan hidup dan tekanan ekonomi boleh mempengaruhi kesejahteraan mental seseorang.
   • Perubahan pantas dalam ekonomi negara turut memberi kesan kepada kestabilan emosi dan psikologi rakyat.

3. Keluarga dan Persekitaran:

   • Pengalaman zaman kanak-kanak yang negatif, seperti penderaan atau pengabaian, boleh menyumbang kepada perkembangan gangguan personaliti.
   • Dinamika keluarga yang disfungsional juga boleh menjadi faktor risiko.

4. Genetik dan Biologi:

   • Faktor genetik mungkin memainkan peranan dalam perkembangan gangguan personaliti, di mana sejarah keluarga dengan gangguan mental boleh meningkatkan risiko.

Prevalensi dan Cabaran dalam Penjagaan

Kajian menunjukkan bahawa gangguan personaliti agak umum di kalangan rakyat Malaysia, namun prevalensinya sering diabaikan atau disalah tafsir sebagai masalah sosial atau moral. National Health and Morbidity Survey (NHMS) pada tahun 2015 mencatatkan bahawa sekitar 29.2% rakyat Malaysia mengalami masalah kesihatan mental, yang termasuk pelbagai jenis gangguan personaliti.

Cabaran utama dalam menangani gangguan personaliti di Malaysia termasuk:

1. Kekurangan Kesedaran dan Pendidikan:

   • Masih terdapat banyak salah faham dan kurang pengetahuan tentang gangguan ini.
   • Usaha pendidikan awam masih kurang, menyebabkan kesedaran masyarakat terhadap isu ini berada pada tahap yang rendah.

2. Akses kepada Rawatan:

   • Kekurangan sumber dan kemudahan perubatan untuk rawatan kesihatan mental di kawasan luar bandar.
   • Kurangnya pakar psikologi dan psikiatri yang terlatih dalam menangani gangguan personaliti.

3. Stigma dan Diskriminasi:

• Individu dengan gangguan personaliti sering berhadapan dengan stigma dan diskriminasi, yang menyukarkan mereka untuk mendapatkan bantuan atau rawatan.
• Tanggapan negatif masyarakat terhadap gangguan mental menghalang mereka daripada mendapatkan sokongan yang diperlukan.

Intervensi dan Sokongan

Untuk mengatasi masalah gangguan personaliti di kalangan rakyat Malaysia, beberapa langkah boleh diambil:

1. Meningkatkan Kesedaran dan Pendidikan:

   • Melalui kempen kesedaran awam dan program pendidikan di sekolah untuk mengurangkan stigma dan meningkatkan pemahaman mengenai gangguan personaliti.
   • Penglibatan media dalam menyebarkan maklumat yang betul dan mengurangkan stereotaip negatif tentang gangguan ini.

2. Memperbaiki Akses kepada Rawatan:

   • Meningkatkan bilangan pakar kesihatan mental dan kemudahan di seluruh negara, terutamanya di kawasan luar bandar.
   • Menyediakan latihan untuk profesional kesihatan agar mereka lebih bersedia untuk menangani kes gangguan personaliti.

3. Menyokong Keluarga dan Komuniti:

   • Menyediakan sokongan dan sumber untuk keluarga dan individu yang terjejas, seperti kumpulan sokongan dan perkhidmatan kaunseling.
   • Menggalakkan persekitaran yang inklusif dan penyayang dalam komuniti untuk membantu individu yang menghadapi gangguan personaliti.

4. Mengembangkan Polisi dan Sokongan Kerajaan:

   • Kerajaan perlu menggubal dasar yang menyokong penjagaan kesihatan mental yang komprehensif dan mudah diakses.
   • Meningkatkan pembiayaan dan sumber untuk program kesihatan mental di seluruh negara.

Gangguan personaliti adalah isu yang signifikan dan memerlukan perhatian serius di Malaysia. Dengan meningkatkan kesedaran, memperbaiki akses kepada rawatan, mengurangkan stigma, dan menyediakan sokongan yang berkesan, kita boleh membantu mereka yang terjejas oleh gangguan ini untuk menjalani kehidupan yang lebih baik dan lebih bermakna. 

Rujukan 

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
2. Institute for Public Health. (2015). National Health and Morbidity Survey (NHMS) 2015. Ministry of Health Malaysia.
3. Teoh, H. J., & Rose, P. (2001). Child mental health: An integrated approach to the planning and delivery of services with respect to culturally diverse communities. Asia Pacific Journal of Social Work and Development, 11(2), 80-91.

Personality Disorders

By Unitar International University : Abnormal course

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable overtime, and leads to distress or impairment. (DSM-5) ( formerly known as a “character disorder” )

A type of mental disorder in which you have rigid and unhealthy pattern of thinking, functioning and behaving.

Personality Disorders’ causes:

• Genetic 
• Childhood Trauma 
• Verbal Abuse 
• High Reactivity Peers 

(source: www.apa.org – American Psychological Association )

Clinical Features of Personality Disorder

chronic interpersonal difficulties 

problems with one’s identity ( sense of self ) (Livesly, 2001)

Diagnosing Personality Disorder

• Must be pervasive and inflexible 
• Stable and of long duration 
• Causes clinically significant distress or impairment (cognition, affect, interpersonal, functioning, impulse control)

Difficulties Doing Research on Personality Disorders

• Difficulties in diagnosing 
• Difficulties in studying the causes

3 Clusters of Personality Disorder

Cluster A 

- People with these disorders often seem odd or eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment.

Paranoid 

• Paranoid Personality Disorder – have pervasive suspiciousness and distrust of others. 
• other characteristics include: tendency to see self as blameless; on guard for perceived attacks by others. 
• Prevalence: National Comorbidity Survey Replication - 2.3% National Epidemiologic Survey on Alcohol and Related Conditions – 4.4%
• Causes: Little is known (maybe genetic/heritability) 
•  Treatment: People diagnosed with PPD are hard to treat. If sought: Psychotherapy
• Example

1. A 40-year-old construction worker believes that his co-workers do not like him and fears that someone might let his scaffolding slip in order to cause him injury on the job. This concern followed a recent disagreement on the lunch line when the patient felt that a coworker was sneaking ahead and complained to him. He began noticing his new “enemy” laughing with other men and often wondered if he were the butt of their mockery….
2. The patient offers little spontaneous information, sits tensely in the chair, is wide-eyed, and carefully tracks all movements in the room. He reads between the lines of the interviewer is siding his coworkers… He was a loner boy and felt that other children would form cliques and be mean to him. He did poorly in school but blamed his teachers – he claimed that they preferred girls or boys who were “sissies”. He dropped out of school and has since been a hard and effective worker, but he feels he never gets the breaks. He believes that he has been discriminated against because of Catholicism but can offer little convincing evidence. He gets on poorly with bosses and coworkers, is unable to appreciate joking around, and does best in situations where he can work and have lunch alone. He has switched jobs many times because he felt he was being mistreated. The patient is distant and demanding with his family. His children call him “Sir” and know that it is wise to be “seen but not heard” when he is around… He prefers not to have people visit his house and becomes restless when his wife is away visiting others.

 

Schizoid 

• Schizoid Personality Disorder – are usually unable to form social relationships and usually lack much interest in doing so. 
• other characteristics include: unable to express their feelings, seen by others as distant and cold. Don’t take pleasure in many activities like sexual activity. Rarely marry.
• Prevalence: National Comorbidity Survey Replication – 4.9% National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002) – 3.1% 
• Cause/s: Little is known 
• Treatment: People diagnosed with Schizoid don’t really come for treatment

Schizotypal 

• Schizotypal Personality Disorder – are excessively introverted and have pervasive social and interpersonal deficits (like those that occur in schizoid personality disorder), but in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior
• other characteristics include: highly personalized and superstitious thinking, experience transient psychotic symptoms. Often believe they have magical powers and may engage in magical rituals. Odd speech, and paranoid beliefs. 
• Prevalence: National Epidemiologic Survey on Alcohol and Related Conditions – 3.9% 
• Prevalence: National Epidemiologic Survey on Alcohol and Related Conditions – 3.9% 
• Cause/s: Little is known/linked (genetic/heritability) 
• Treatment: Psychotherapy with Schizophrenia Possible Medications (no specific drugs) 
• Example case

1. The Introverted Computer Analyst : Bill, a highly intelligent but quiet introverted and withdrawn 33- year old computer analyst, was referred for psychological evaluation by his physician, who was concerned that Bill might be depressed and unhappy. Bill had virtually no contact with other people. He lived alone in his apartment, worked in a small office by himself, and usually saw no one at work except his supervisor, who occasionally visited to give him new work and pick up completed projects. He ate lunch by himself, and about once a week, on nice days, went to the zoo for lunch break. Bill was a lifelong loner; as a child he had few friends and had always preferred solitary activities over family outings (he was the oldest of five children). In high school he had never dated and in college had gone out with a woman only once – and that was with a group of students after a game. He had been active in sports, however, and had played varsity football in both high school and college. In college he had spent a lot of time with one relatively close friend – mostly drinking. However, this friend now lived in another city. Bill reported rather matter-of-factly that he ahd a hard time making friends; he never knew what to say in a conversation. On a number of occasions he had thought of becoming friends with other people but simply couldn’t think of the right words, so “the conversation just died”. He reported that he had given some thought lately to changing his life in an attempt to be more “positive", but it had never seemed worth the trouble. It was easier for him not to make effort because he became embarrassed when someone tried to talk to talk with him. He was happiest when he was alone…  

 

Cluster B 

- People with these disorders have a tendency to be dramatic, emotional, and erratic.

Histrionic 

• includes excessive attention-seeking behavior and emotionality. 
• other characteristics include: have lively, dramatic, and excessively extraverted styles of relationship, appearance and behavior are often theatrical and emotional. Speech is often vague and impressionistic. 
• Prevalence: National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002)– 1.84% 
• Cause/s: Little is known/Genetic and Environmental 
•  Treatment: Psychptherapy 
• Example case 

1. A Histrionic Wife Lulu : a 24-year-old housewife, was seen in an impatient unit several days after she had been picked up for “vagrancy” after her husband had left her at the bus station to return her to her own family because he was tired of her behavior and of taking care of her. Lulu showed up for the interview all made-up and in a very feminine robe, with her hair done in a very special way. Throughout the interview with a male psychiatrist, she showed flirtatious and somewhat childlike seductive gestures and talked in a rather vague way about her problems and her life. Her chief complaints were that her husband had deserted her and that she couldn’t return to her family because two of her brothers had abused her. Moreover, she had no friends to turn to and wasn’t sure how she was going to get along. Indeed, she complained that she had never had female friends, whom she felt just didn’t like her, although she wasn’t quite sure why, assuring the interviewer that she was a very nice and kind person.Recently, she and her husband had been out driving with a couple who were friends of her husband’s. The wife had accused Lulu of being overly seductive toward the wife’s husband, and Lulu had been hurt, thinking her behavior was perfectly innocent and not out of line. This incident led to a big argument with her own husband, one in a long series over the past six months in which he complained about her inappropriate behavior around other men and about how vain and needing of attention she was. These arguments and her failure to change her behavior had ultimately led her husband to desert her.

Narcissistic 

• Narcissistic Personality Disorder – shows an exaggerated sense of self-importance, a preoccupation with being admired, and a lack of empathy for the feelings of others (Pincus & Lukowitsky, 2010; Rnningstam, 2005, 2009, 2012)
• 2 subtypes of narcissism: Grandiose and Vulnerable Narcissism. 
• Grandiose Narcissism – is manifested by traits related to grandiosity, aggression, and dominance. 
• Vulnerable Narcissism – have fragile and unstable sense of self-esteem. Arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection.  
• Prevalence: 0% - 6.2% in community samples 
• Cause/s: Parental overvaluation or Emotional/Physical/Sexual Abuse 
• Treatment: Psychotherapy, Medications
• Sample case

1. A Narcissistic Student : A 25-year-old, single graduate student complains to his psychoanalyst of difficulty completing his Ph.D. in English literature and expresses concerns about his relationships with women. He believes that his thesis topic may profoundly increase the level of understanding in his discipline and make him famous, but so far he has not been able to get past the third chapter. His mentor does not seem sufficiently impressed with his ideas, and the patient is furious at him but also self-doubting and ashamed. He blames his mentor for his lack of progress and thinks that he deserves more help with his grand idea, and that his mentor should help him with some of the research. The patient brags about his creativity and complains that other people are “jealous” of his insight. He is very envious of students who were moving along faster than he and regards them as “dull drones and ass-kissers.” He prides himself on the brilliance of his class participation and imagines someday becoming a great professor. He becomes rapidly infatuated with women and has powerful and persistent fantasies about each new woman he meets, but after several sexual experiences feels disappointed and finds them dumb, clinging, and physically repugnant. He has many “friends”, but they turn over quickly, and no one relationship lasts very long.  People get tired of his continual self-promotion and lack of consideration of them. For example, he was lonely at Christmas and insisted that his best friend stay in town rather than visit his family. The friend refused, criticizing the patient’s selfcenteredness; and the patient, enraged, decided never to see his friend again. 

Antisocial 

• Antisocial Personality Disorder – are individuals who continually violate and show disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically without remorse or loyalty to anyone.
• other characteristics include: being impulsive, irritable and aggressive and to show pattern of generally irresponsible behavior
• Prevalence: 70% higher in affected adverse socioeconomic or sociocultural. 0.2% - 3.3% in criteria of previous DSMs 
• Cause/s: Genetic, Temperament/Deficiencies in fear and anxiety, Emotional Deficits (e.g., rejection, parental loss) 
• Treatment: Only if sought - Psychotherapy 
• Case sample :

1. A Thief with Antisocial Personality Disorder : Mark, a 22-year-old, was awaiting trial for car theft and armed robbery. His case records included a long history of arrests beginning at age 9, when he had been picked up for vandalism. He had been expelled from high school for truancy and disruptive behavior. On a number of occasions he had run away from home for days or weeks at a time – always returning in a disheveled and “rundown” condition. To date he had not held a job for more than a few days at a time even though his generally charming manner enabled him to obtain work readily. He was described as a loner with few friends. Although initially charming, Mark usually soon antagonized those he met with his aggressive, self-oriented behavior. Shortly after his first therapy session, he skipped bail and presumably left town to avoid his trial. 

 

Borderline

• Borderline Personality Disorder – show a pattern of behavior characterized by impulsivity and instability in interpersonal relationships, self-image, and moods. 
• other characteristics include: affective instability, highly unstable self image, impulsivity, self mutilation. 
• Prevalence: 6% in primary care settings. 10% among individuals seen in outpatient mental health clinics. 20% among psychiatric inpatients. May decrease in older age group. 
• Cause/s: Malfunctioned gene/Abnormalities in brain 
•  Treatment: Biological and Psychological Treatments 
• Sample Case:

1. Self-Mutilation in Borderline Personality Disorder : A 26-year-old unemployed woman was referred for admission to a hospital by her therapist because of intense suicidal preoccupation and urges to mutilate herself with a razor. The patient was apparently well until her junior year in high school, when she became preoccupied with religion and philosophy, avoided friends, and was filled with doubt about who she was. Academically she did well, but later, during college, her performance declined. In college she began to use variety of drugs, abandoned the religion of her family, and seemed to be searching for a charismatic religious figure with whom to identify. At times, massive anxiety swept over her, and she found it would suddenly vanish if she cut her forearm with a razor blade. 3 years ago she began psychotherapy and initially rapidly idealized her therapist as being incredibly intuitive and empathetic. Later she became hostile and demanding of him, requiring more and more sessions, sometimes twice in 1 day. Her life centered therapist, by this time to the exclusion of everyone else.

Cluster C 

- People with these disorders often show anxiety and fearfulness.

Avoidant 

• show extreme social inhibition and introversion, leading to lifelong patterns of limited social relationships and reluctance to enter into social interactions. 
• other characteristics include: do not enjoy their aloneness, feeling inept and socially inadequate.
• Prevalence: National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002)– 2.4% 
• Cause/s: Inhibited temperament/genetic 
•  Treatment: Psychotherapy 
• Sample Case:

1. The Avoidant Librarian: Sally, a 35-year-old librarian, lived a relatively isolated life and had few acquaintances and no close personal friends. From childhood on, she had been very shy and had withdrawn from close ties with others to keep from being hurt or criticized. Two years before she entered therapy, she had had a date to go to a party with an acquaintance she had met at the library. The moment they had arrived at the party, Sally had felt extremely uncomfortable because she had not been “dressed properly”. She left in a hurry and refused to see her acquaintance again. In the early treatment sessions, she sat silently much of the time, finding it too difficult to talk about herself. After several sessions, she grew to trust the therapist and she related numerous incidents in her early years in which she had been “devastated” by her alcoholic father’s obnoxious behavior in public. Although she had tried to keep her school friends from knowing about her family problems, when this had become impossible, she instead had limited her friendships, thus protecting herself fro possible embarrassment or criticism. When Sally first began therapy, she avoided meeting people unless she could be assured that they would “like her”. With therapy that focused on enhancing her assertiveness and social skills, she made some progress in her ability to approach people and talk with them.

Dependent 

• Dependent Personality Disorder : extreme need to be taken care of, which leads to clinging and submissive behavior. 
• other characteristics include: lack of self confidence and feeling helpless without great deal of advice and reassurance. 
• Prevalence: National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002) – 0.49% National Comorbidity Survey Replication – 0.6% 
• Cause/s: Possible biological/genetic or developmental 
•  Treatment: Psychotherapy Medications may be used. 
• Sample Case:

1. The Dependent Wife : Sarah, a 32-year-old mother of two and part-time tax accountant, came to a crisis center late one evening after Michael, her husband of a year and a half, had abused her physically and then left home. Although he never physically harmed the children, he frequently threatened to do so when he was drunk. Sarah appeared acutely anxious and worried about the future and “needed to be told what to do”. She wanted her husband to come back and seemed rather unconcerned about his regular pattern of physical abuse. At the time, Michael was an unemployed resident in a day treatment program at a halfway house for paroled drug abusers. He was almost always in a surly mood and “ready to explode”. Although Sarah had a well-paying job, she voiced great concern about being able to make it on her own. She realized that it was foolish to be “dependent” on her husband, whom she referred to as a “real loser”. (She had had a similar relationship with her first husband who had left her and her oldest child when she was 18.) . Several times in the past few months, Sarah had made up her mind to get out of the marriage but couldn’t bring herself to break away. She would threaten to leave, but when the time came to do so, she would “freeze in the door” with a numbness in her body and a sinking feeling in her stomach at the thought of “not being with Michael”. 

 

Obsessive-compulsive 

• Obsessive Compulsive Personality Disorder (OCPD) – perfectionism and a excessive concern with maintaining order and control. 
• other characteristics include: excessively devoted to work, inflexible about moral and ethical issues, have difficulty delegating tasks to others. Ungenerous
• Prevalence: 2.1% - 7.9% in general population. 
• Cause/s: Genetic/High level of conscientiousness/assertiveness 
•  Treatment: CBT, Medication, Relaxation Training 
• Sample case

1. The Perfectionist Train Dispatcher : Allan appeared to be well suited to his work as a train dispatcher. He was entious, perfectionistic, and attended to minute details. However, he was not close to his coworkers, and they reportedly thought him “off”. He would get quiet upset if even minor variations to his daily routine occurred. For example, he would become tense and irritable if coworkers did not follow exactly his elaborately constructed schedules and plans. In short, Alan got little pleasure out of life and worried constantly about minor problems. His rigid routines were impossible to maintain, and he often developed tension headaches or stomachaches when he couldn’t keep his complicated plans in order. His physician, noting the frequency of his physical complaints and his generally perfectionistic approach to life, referred him for a psychological evaluation. Psychotherapy was recommended, but he did not follow on the treatment recommendations because he felt that he could not afford the time away from work.  

Treatment of Borderline Personality Disorder

• Biological Treatments 
• Antidepressant medication (most often from the SSRI category) 
• Antipsychotic medication 
• Mood-stabilizing medications (e.g., carbazemine)

• Psychological Treatments 
• Dialectal Behavior Therapy 
• Variants of psychodynamic psychotherapy 
• Mentalization