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What should be done for psychological issues or personality problem?

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Psychiatrist
Practicing since : 2004
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My question is about my kids/wife

I am the father to the 4 boys, my problem is about the second boy (12 yearold) relation to his mother and brothers. This boy is very active, very alive and smart, tooo teasing for his brothers specially the elder one, excessively compares himself with his brother, excessively stands for his rights and defends him self in an annoying way, which makes him a trouble maker in our family. All this and more is normal. However, what is weird is his mother's perception, she does not accept him at all, she criticizes every single thing he does, always shouts at him, she sometimes tell him that he is the reason for her miserable life (our life is v.good and stable except for this problem), and that he might go to hill because his mother does not love him!. He believes that his mother hates him, he explicitly says this, even his brothers tell him this when they fight : "Even your mother hates you!!"

From my side, I am very supportive and understanding husband, but I am not able to accept her strange behavior against her son, I used to support him when he is right while trying to be objective and in a productive way, however I fail sometimes, specially when my son cries at me and assure that his mother hates him.

Now what should I do from my side ? is it normal that she does not accept her own son that way even if he is annoying ?

Notes:

- I consider my wife a perfectionist
- She is not sentimental at all to her kids, no hugging or kissing after age of 10
- she is not supportive to them, never encourages them because they never satisfy her expectations
- My subject son is excellent at school and the best amongst his brothers !!
- His elder brother is 13, and mother is 39

What can I do ??
Posted Thu, 8 Nov 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 2 hours later
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

From your query, your son behavior is age appropiate to me. There is chances of having some problem (stress, psychological issues or personality problem) in case of your wife, which need assessment for confirmation and management.

I want to give information related to personality disorders so that you can understand the complexity of its assessment and concurrent assessment of psychiatric disorder during examination. I strongly suspect Cluster C personality in your wife case.

Definition: Personality disorders as enduring subjective experiences and behavior that deviate from cultural standards, are rigidly pervasive, have an onset in adolescence or early adulthood, are stable through time, and lead to unhappiness and impairment. When personality traits are rigid and maladaptive and produce functional impairment or subjective distress, a personality disorder may be diagnosed

Personality disorder subtypes classified in DSM-IV-TR are: schizotypal, schizoid, and paranoid (Cluster A); narcissistic, borderline, antisocial, and histrionic (Cluster B); and obsessive-compulsive, dependent, and avoidant (Cluster C).

Cluster A includes three disorders with odd, aloof features, such as paranoid, schizoid, and schizotypal.

Cluster B includes four disorders with dramatic, impulsive, and erratic features, such as borderline, antisocial, narcissistic, and histrionic.

Cluster C includes three disorders sharing anxious and fearful features, such as avoidant, dependent, and obsessive-compulsive. Obsessive compulsive person used to have perfectionist attitude which interfere with their routine life.

Personality disorder is a common and chronic disorder. Its prevalence is estimated between 10 and 20 percent in the general population, and its duration is expressed in decades. Persons with personality disorder are frequently labeled as aggravating, demanding, or parasitic and are generally considered to have poor prognosis.

Personality disorder is also a predisposing factor for other psychiatric disorders (e.g., substance use, suicide, affective disorders, impulse-control disorders, eating disorders, depression and anxiety disorders) in which it interferes with treatment outcomes of other psychiatric disorder and increases personal incapacitation, morbidity, social complication (like interpersonal issues with son) and mortality of these patients.

Persons with personality disorders are far more likely to refuse psychiatric help and to deny their problems than persons with anxiety disorders, depressive disorders, or obsessive-compulsive disorder. Personality disorder symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment) and ego-syntonic (i.e., acceptable to the ego). Persons with personality disorders do not feel anxiety about their maladaptive behavior. Because they do not routinely acknowledge pain from what others perceive as their symptoms, they often seem disinterested in treatment and impervious to recovery.

Many persons exhibit traits that are not limited to a single personality disorder. When a patient meets the criteria for more than one personality disorder, clinicians should diagnose each. In your case during screening you give YES answer to questions related to all clusters of personality(A,B,C).

In last following measures will help you:

•     Personality assessment by clinical psychologist or trained psychiatrist. It may take several days to make final diagnosis. Following tests are used to assess personality which is administered by trained psychologist: Clinical interview, Sentence completion test, Rorschach Inkblot Test, Thematic Apperception Test (TAT), Minnesota-Multiphasic Personality Inventory (MMPI) and several other tests
•     Psychotherapeutic treatment after assessment in form of counseling, supportive therapy and cognitive behavior therapy +/- drug therapy.
•     Treatment of co morbid illness (if present) like: anxiety, depression or other problems.
•     Reduction of critical comments in family.
•     Improvement may take weeks or months depending on the case.

Wishing you good health.
Regards,
Above answer was peer-reviewed by
 
Follow-up: What should be done for psychological issues or personality problem? 13 hours later
Dear Dr XXXXXXX

Thanks for the thourough reply, I appreciate it, its too technical for me though :)

Please allow me to ask few questions, and elaborate more in this case :

1- Whats the thing I mentioned that makes you strongly suspects cluster C ?

2- Is it possible to have online sessions through Skype or so ?
3- What about start doing the required assessments and tests ? she will accept by the way because she admits that she needs help

Further notes :

- My wife has very stable and very good behavior when there is no conflict, and/or when we are outside with our big family or friends.

- She is not an avoidant, or dependent, she works very hard at home because she loves everything to be perfect, but she only complaints a lot.

- What my family believe about my wife is that she is very wise, very calm, very stable, and very loving & caring person ... she is very excellent in maintaining this image

- I love her, and she loves me very much and normally no conflicts except when the button is pushed

- Currently the situation is stable because I started not to criticize her about her behavior with the kid, I started to give her some credit and give her trust when dealing with him, and I started to release my self from interaction generally. The boy now is better and never says this "hating" thing and its completely banned that his brothers mentions it again !

- Yes, the situation is much better now, but explosions happen in any minute ! She is still unfair to him, he feels it, and I try to maintain myself to a higher limit. I am telling the kid that she is tired and exhausted blablabla


The remaining inquiries are :

- Shall I maintain doing this even if its unfair to the kid ? shall I defend him when it requires ?
- What to do with regards to her ignorance of, not "loving" them, no hugging, kissing, no supporting words, no encouraging or believing behavior ... which is very critical. The reason of this is, she is always not satisfied with whatever they achieve.
- How can we get an online consulting or help ?

Thanks
 
 
Answered by Dr. Ashish Mittal 9 hours later
Hello again,
Thanks for follow up.

1- Whats the thing I mentioned that makes you strongly suspects cluster C ?
Answer: It is from information provided by you in primary query like:
- I consider my wife a perfectionist
- She is not sentimental at all to her kids, no hugging or kissing after age of 10
- she is not supportive to them, never encourages them because they never satisfy her expectations
- My subject son is excellent at school and the best amongst his brothers !!

I suspect obsessive compulsive personality traits in her case. Thanks for further information about her good functioning in follow up query. Obsessive compulsive persons are one of successful person in society because of their perfection, but same these quality (when in excess) can create problem in social life due to perfection and rigidity. As I mentioned personality assessment is needed for final diagnosis, as premature diagnosis without assessment can offend a person.

2- Is it possible to have online sessions through Skype or so ?
Answer: I would prefer in person assessment and counseling for her. If there is limitation then, many websites provide these service.
Like:
WWW.WWWW.WW
3- What about start doing the required assessments and tests ? she will accept by the way because she admits that she needs help
Answer: In person assessment is needed for these testings. Each test may take 30-60 min and may cost 20-50 USD according to your area.


The remaining inquiries are :
- Shall I maintain doing this even if its unfair to the kid ? shall I defend him when it requires ?
Answer: You are doing behevior therapy at home. You should defend kid whenever he is right. You should also remind your wife (in alone) whenever her behavior is rude or unfair. Remain persistent for reminding it. It will take time, may be several months. But it will work as it is working already, as mentioned by you.

- What to do with regards to her ignorance of, not "loving" them, no hugging, kissing, no supporting words, no encouraging or believing behavior ... which is very critical. The reason of this is, she is always not satisfied with whatever they achieve.
Answer: Follow my all advice in current and previous reply for that.

- How can we get an online consulting or help ?
Answer: You can follow link above.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.
Above answer was peer-reviewed by
 
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