Personality disorder and mental retardation

Lecture 10Lecture 10Psychopathies and pathological Psychopathies and pathological

development of personality. development of personality. Etiology and pathogenesis. Clinical Etiology and pathogenesis. Clinical forms of psychopathies. Diagnostic forms of psychopathies. Diagnostic

and differential diagnostics. and differential diagnostics. Treatment and rehabilitation. Treatment and rehabilitation.

Question of examination.Question of examination. Mental retardation.Mental retardation.

..

CHARACTERISTICSCHARACTERISTICS

All personality disorders are characterized All personality disorders are characterized by behavior that:by behavior that:

deviates from cultural standardsdeviates from cultural standards

is rigid and pervasiveis rigid and pervasive

is consistent over timeis consistent over time

causes distress or functional impairmentcauses distress or functional impairment

IDENTIFICATIONIDENTIFICATIONThere are 10 personality disorders that fall into 3 clusters:Cluster A (Odd/Eccentric)Cluster A (Odd/Eccentric)

ParanoidParanoidSchizoid .Schizoid .SchizotypalSchizotypal

Cluster B (Dramatic/Emotional)Cluster B (Dramatic/Emotional)AntisocialAntisocialBorderlineBorderlineHistrionicHistrionicNarcissisticNarcissistic

Cluster C (Anxious/Fearful)Cluster C (Anxious/Fearful)AvoidantAvoidantDependentDependentObsessive-compulsiveObsessive-compulsive

Cluster A (Odd/Eccentric)Cluster A (Odd/Eccentric)

Paranoid Personality DisorderParanoid Personality Disorder is is characterized by distrust and characterized by distrust and suspiciousness of other people.suspiciousness of other people.Schizoid Personality DisorderSchizoid Personality Disorder describes describes people with a pervasive detachment from people with a pervasive detachment from social interaction.social interaction.Schizotypal Personality DisorderSchizotypal Personality Disorder is is characterized by bizarre behavior and characterized by bizarre behavior and ideas and a reduced capacity for social ideas and a reduced capacity for social relationships.relationships.

Cluster B (Dramatic/Emotional)Cluster B (Dramatic/Emotional)Antisocial Personality DisorderAntisocial Personality Disorder is diagnosed in is diagnosed in people who show a consistent pattern of disregard people who show a consistent pattern of disregard for the rights of others. The pattern of behavior must for the rights of others. The pattern of behavior must have been present since the age of 15.have been present since the age of 15.Borderline Personality DisorderBorderline Personality Disorder describes people describes people who show a pervasive pattern of (1) unstable who show a pervasive pattern of (1) unstable relationships, (2) unstable affect, (3) unstable self-relationships, (2) unstable affect, (3) unstable self-image, and (4) unstable impulse control. image, and (4) unstable impulse control. Histrionic Personality DisorderHistrionic Personality Disorder describes people describes people who demonstrate excessive emotional expression who demonstrate excessive emotional expression and attention-seeking behavior.and attention-seeking behavior.Narcissistic Personality DisorderNarcissistic Personality Disorder is characterized is characterized by a heightened sense of entitlement, exaggerated by a heightened sense of entitlement, exaggerated feelings of self-importance, and fragile self-esteem.feelings of self-importance, and fragile self-esteem.

Cluster C (Anxious/Fearful)Cluster C (Anxious/Fearful)Avoidant Personality DisorderAvoidant Personality Disorder is diagnosed is diagnosed in people who are impaired in social in people who are impaired in social interactions because of feelings of interactions because of feelings of inadequacy and fear of rejection.inadequacy and fear of rejection.

Dependent Personality DisorderDependent Personality Disorder describes describes people who have an excessive need to be people who have an excessive need to be cared for and a fear of separa tion.cared for and a fear of separa tion.

Obsessive-Compulsive Personality Obsessive-Compulsive Personality DisorderDisorder is characterized by a preoccupation is characterized by a preoccupation with orderliness and control.with orderliness and control.

REVIEWREVIEWPersonality disorders are diagnosed on Axis II. Personality disorders are diagnosed on Axis II. They are often referred to as "character disorders" They are often referred to as "character disorders" or "Axis II" in general. It is extremely important to or "Axis II" in general. It is extremely important to distinguish between personality disorders and distinguish between personality disorders and personality traits. Every person has traits that are personality traits. Every person has traits that are consistent with personality disorders. The consistent with personality disorders. The difference between personality disorders and difference between personality disorders and personality traits lies in symptom severity and the personality traits lies in symptom severity and the degree of functional impairment. In order to degree of functional impairment. In order to diagnose a personality disorder the characteristic diagnose a personality disorder the characteristic behavior must (1) deviate from cultural standards, behavior must (1) deviate from cultural standards, (2) be rigid and pervasive, (3) be con sistent over (2) be rigid and pervasive, (3) be con sistent over time, and (4) cause distress or functional time, and (4) cause distress or functional impairment. This section will review the essential impairment. This section will review the essential features of the personality disorders.features of the personality disorders.

ESSENTIAL FEATURES OF CLUSTER A ESSENTIAL FEATURES OF CLUSTER A (ODD/ECCENTRIC)(ODD/ECCENTRIC)

Paranoid Personality DisorderParanoid Personality DisorderThese people appear guarded and suspicious and are These people appear guarded and suspicious and are always afraid of being deceived.always afraid of being deceived.They tend to interpret other people's actions as They tend to interpret other people's actions as harmful or threatening.harmful or threatening.People with paranoid personality disorder are quick to People with paranoid personality disorder are quick to anger and persistently bear grudges.anger and persistently bear grudges.Their affect is usually constricted and they tend to lack Their affect is usually constricted and they tend to lack interpersonal warmth.interpersonal warmth.They use projection as their defense mechanism, They use projection as their defense mechanism, attributing their own unacceptable thoughts and attributing their own unacceptable thoughts and impulses to others.impulses to others.Denial is also frequently used, where they refuse to Denial is also frequently used, where they refuse to accept or acknowledge painful aspects of reality.accept or acknowledge painful aspects of reality.The differential diagnosis includes paranoid type The differential diagnosis includes paranoid type schizophrenia and delusional disorder.schizophrenia and delusional disorder.


Schizoid Personality DisorderSchizoid Personality DisorderThese people appear These people appear emotionally withdrawn emotionally withdrawn and and usually avoid eye contact.usually avoid eye contact.They may seem self-absorbed and cold, but they are They may seem self-absorbed and cold, but they are actually afraid of intimacy.actually afraid of intimacy.Unlike people with social phobia or avoidant personality Unlike people with social phobia or avoidant personality disorder, people with schizoid personality disorder are disorder, people with schizoid personality disorder are not interested in relationships and not interested in relationships and do not seek social do not seek social interaction.interaction.Their defense mechanism is Their defense mechanism is fantasy fantasy where imaginary where imaginary friends or lovers substitute for actual ones.friends or lovers substitute for actual ones.The fantasy mechanism serves to express underlying The fantasy mechanism serves to express underlying conflicts or to obtain gratification.conflicts or to obtain gratification.The differential diagnosis includes social phobia and The differential diagnosis includes social phobia and avoidant and schizotypal personality disorders.avoidant and schizotypal personality disorders.


Schizotypal Personality DisorderSchizotypal Personality DisorderPeople with schizotypal personality disorder are overtly People with schizotypal personality disorder are overtly strange strange and and bizarre.bizarre.Peculiar notions, Peculiar notions, magical thinking, magical thinking, and and ideas of reference ideas of reference are are characteristic of this disorder.characteristic of this disorder.Although thought disorder is absent, speech may be difficult to Although thought disorder is absent, speech may be difficult to interpret.interpret.Because of Because of inappropriate behavior inappropriate behavior these people are socially these people are socially isolated.isolated.Schizotypal personality disorder is sometimes considered along the Schizotypal personality disorder is sometimes considered along the schizophrenic spectrum.schizophrenic spectrum.People with schizotypal personality disorder are more likely to have a People with schizotypal personality disorder are more likely to have a family history of schizophrenia.family history of schizophrenia.A small percentage of these people may demonstrate A small percentage of these people may demonstrate brief brief psychotic psychotic symptoms.symptoms.The differential diagnosis includes schizophrenia and schizoid and The differential diagnosis includes schizophrenia and schizoid and avoidant personality disorders.avoidant personality disorders.

Course and PrognosisCourse and Prognosis

Symptoms of Cluster A disorders Symptoms of Cluster A disorders typically begin in childhood.typically begin in childhood.These disorders usually follow a These disorders usually follow a chronic course that may be lifelong.chronic course that may be lifelong.A small percentage of people with A small percentage of people with Cluster A disorders eventually Cluster A disorders eventually develop schizophrenia.develop schizophrenia.Schizotypal personality disorder in Schizotypal personality disorder in particular is associated with an particular is associated with an increased risk of suicide.increased risk of suicide.

TreatmentTreatmentA combination of psychotherapy and A combination of psychotherapy and pharmacotherapy is used to manage personality pharmacotherapy is used to manage personality disorders.disorders.

Psychotherapeutic techniques include cognitive-Psychotherapeutic techniques include cognitive-behavioral therapy, psychoanalytic (insight-oriented) behavioral therapy, psychoanalytic (insight-oriented) therapy, and group therapy.therapy, and group therapy.

People with Cluster A disorders usually do not seek People with Cluster A disorders usually do not seek treatment.treatment.

People with schizoid or schizotypal personality People with schizoid or schizotypal personality disorders may do well in group settings.disorders may do well in group settings.

Antipsychotic medication is used to treat delusional Antipsychotic medication is used to treat delusional thinking and other psychotic symptoms.thinking and other psychotic symptoms.

ESSENTIAL FEATURES OF CLUSTER B ESSENTIAL FEATURES OF CLUSTER B (DRAMATIC/EMOTIONAL)(DRAMATIC/EMOTIONAL)

Antisocial Personality Disorder (ASP)Antisocial Personality Disorder (ASP)These people are consistently These people are consistently deceitful deceitful and and manipulative, manipulative, and without and without regard for other people.regard for other people.On the surface, they may appear intelligent or charming.On the surface, they may appear intelligent or charming.Probing will reveal a history of truancy from school, fighting, illegal activity, Probing will reveal a history of truancy from school, fighting, illegal activity, and and impulsive impulsive behavior.behavior.Antisocial behavior must have been present since the age of 15, and the Antisocial behavior must have been present since the age of 15, and the person needs to be at least 18 for diagnosis.person needs to be at least 18 for diagnosis.The diagnosis of ASP is only made if antisocial behavior is pervasive and The diagnosis of ASP is only made if antisocial behavior is pervasive and not not state-dependent, in other words, not exclusively associated with state-dependent, in other words, not exclusively associated with intoxication, mania, or psychosis.intoxication, mania, or psychosis.People with ASP make up a large percentage of the prison population.People with ASP make up a large percentage of the prison population.Substance abuse Substance abuse (particularly alcohol) is more common in these people (particularly alcohol) is more common in these people and their families.and their families.Multiple somatic complaints and somatization disorder are also associated Multiple somatic complaints and somatization disorder are also associated with ASP.with ASP.There is a characteristic There is a characteristic lack of remorse lack of remorse associated with their actions.associated with their actions.There may be soft neurological signs suggesting brain damage from There may be soft neurological signs suggesting brain damage from childhood.childhood.The differential diagnosis includes conduct disorder, substance abuse, and The differential diagnosis includes conduct disorder, substance abuse, and bipolar disorder (manic episode).bipolar disorder (manic episode).

Borderline Personality DisorderBorderline Personality Disorder

The term "borderline" refers to the border between neurosis and psychosis.The term "borderline" refers to the border between neurosis and psychosis.These people have These people have unstable relationships, unstable affect, unstable self-image, unstable relationships, unstable affect, unstable self-image, and and poor poor impulse control.impulse control.Interpersonal relationships are characterized by a Interpersonal relationships are characterized by a fear of abandonment fear of abandonment and dependency.and dependency.Affect is Affect is labile labile and patients may appear depressed, and then angry or euphoric a moment later.and patients may appear depressed, and then angry or euphoric a moment later.They complain of loneliness, feeling "empty," and lacking a sense of identity (identity diffusion).They complain of loneliness, feeling "empty," and lacking a sense of identity (identity diffusion).Their behavior is unpredictable and they may Their behavior is unpredictable and they may attempt suicide attempt suicide or perform self-mutilating acts.or perform self-mutilating acts.This disorder is often comorbid with substance abuse and major depression.This disorder is often comorbid with substance abuse and major depression.A history of being physically or sexually abused is common in women with borderline personality A history of being physically or sexually abused is common in women with borderline personality disorder.disorder.They use They use splitting splitting as their defense mechanism, viewing people or themselves as either "all as their defense mechanism, viewing people or themselves as either "all good" or "all bad."good" or "all bad."People with borderline personality disorder may also alternately idealize and devalue the same People with borderline personality disorder may also alternately idealize and devalue the same person.person.Other characteristic defense mechanisms are Other characteristic defense mechanisms are denial, denial, and and projective identification.projective identification.Projective identification occurs when people attribute their own unacknowledged feelings to Projective identification occurs when people attribute their own unacknowledged feelings to another person, and then identify with that person for feeling the way they themselves do.another person, and then identify with that person for feeling the way they themselves do.The differential diagnosis includes mood disorders and symptoms secondary to substance The differential diagnosis includes mood disorders and symptoms secondary to substance abuse.abuse.

Histrionic Personality DisorderHistrionic Personality DisorderPeople with histrionic personality disorder always need to be People with histrionic personality disorder always need to be the the center of attention.center of attention.Their behavior is often Their behavior is often seductive seductive and and flirtatious.flirtatious.They tend to dress in colorful and dramatic clothing.They tend to dress in colorful and dramatic clothing.They express themselves in a theatrical fashion and have They express themselves in a theatrical fashion and have exaggerated exaggerated and and shallow emotional responses.shallow emotional responses.Relationships are usually viewed as more serious or intimate Relationships are usually viewed as more serious or intimate than they actually are.than they actually are.Somatization disorder Somatization disorder and mood disorders frequently co-and mood disorders frequently co-occur with histrionic personality disorder.occur with histrionic personality disorder.People with histrionic personality disorder use People with histrionic personality disorder use repression repression and and dissociation dissociation as defense mechanisms.as defense mechanisms.Repression is the unconscious forgetting or ignoring of Repression is the unconscious forgetting or ignoring of unpleasant feelings.unpleasant feelings.Dissociation is the temporary modification of personal identity to Dissociation is the temporary modification of personal identity to avoid emotional distress.avoid emotional distress.The differential diagnosis includes borderline personality The differential diagnosis includes borderline personality disorder.disorder.

Narcissistic Personality DisorderNarcissistic Personality DisorderPeople with narcissistic personality disorder appear People with narcissistic personality disorder appear arrogant with a heightened sense of self-importance.arrogant with a heightened sense of self-importance.They are actually extremely sensitive to criticism and They are actually extremely sensitive to criticism and suffer from low self-esteem.suffer from low self-esteem.Their feelings of self-entitlement lead them to ignore Their feelings of self-entitlement lead them to ignore conventional rules of behavior.conventional rules of behavior.These people are incapable of showing empathy and are These people are incapable of showing empathy and are only concerned with selfish pursuits.only concerned with selfish pursuits.Fragile self-esteem makes narcissistic people more Fragile self-esteem makes narcissistic people more susceptible to depression.susceptible to depression.They use denial and projection as their defense They use denial and projection as their defense mechanisms.mechanisms.In projection, people attribute their own unacceptable In projection, people attribute their own unacceptable feelings to others.feelings to others.The differential diagnosis includes all the Cluster B The differential diagnosis includes all the Cluster B personality disorders because they frequently co-exist with personality disorders because they frequently co-exist with narcissistic personality disorder.narcissistic personality disorder.


Cluster B disorders begin in adolescence.Cluster B disorders begin in adolescence.The course of symptoms is stable with a The course of symptoms is stable with a possibility of improvement over time.possibility of improvement over time.The prognosis depends on the patient's The prognosis depends on the patient's motivation for recovery and comorbid motivation for recovery and comorbid illness such as depression or sub stance illness such as depression or sub stance abuse.abuse.

TreatmentTreatmentManagement may be accomplished with Management may be accomplished with psychotherapy and pharmacotherapy.psychotherapy and pharmacotherapy.Insight-oriented psychoanalytic Insight-oriented psychoanalytic psychotherapy is often used.psychotherapy is often used.Cognitive-behavioral therapy may be effective Cognitive-behavioral therapy may be effective in borderline personality disorder for impulse in borderline personality disorder for impulse control and reduc ing hypersensitivity to control and reduc ing hypersensitivity to criticism.criticism.Mood stabilizers are effective in treating Mood stabilizers are effective in treating impulse control problems.impulse control problems.Antidepressants are used for depression and Antidepressants are used for depression and somatic complaintssomatic complaints

Avoidant Personality DisorderAvoidant Personality Disorder

During interviews, people with avoidant personality During interviews, people with avoidant personality disorder appear shy and anxious.disorder appear shy and anxious.They avoid social contact because they are afraid of They avoid social contact because they are afraid of rejection.rejection.These people differ from schizoid personality disorder These people differ from schizoid personality disorder because they because they do do desire friendship.desire friendship.People with avoidant personality disorder become socially People with avoidant personality disorder become socially isolated as a result of hypersensitivity to criticism and isolated as a result of hypersensitivity to criticism and feelings of inadequacy.feelings of inadequacy.These people may commonly be described as having an These people may commonly be described as having an inferiority complex.inferiority complex.Anxiety and depression are common comorbid psychiatric Anxiety and depression are common comorbid psychiatric symptoms.symptoms.The differential diagnosis includes schizoid personality The differential diagnosis includes schizoid personality disorder and social phobia.disorder and social phobia.

Dependent Personality DisorderDependent Personality DisorderPeople with dependent personality disorder are People with dependent personality disorder are passive and require others to care for them.passive and require others to care for them.They have difficulty making decisions or assuming They have difficulty making decisions or assuming responsibility for themselves.responsibility for themselves.They have an urgent need to be cared for in a They have an urgent need to be cared for in a relationship and fear being alone.relationship and fear being alone.These people tend to exhibit clinging and submissive These people tend to exhibit clinging and submissive behavior.behavior.Regression Regression is their defense mechanism, where they is their defense mechanism, where they return to previous stages of development to avoid return to previous stages of development to avoid current conflict.current conflict.In shared psychotic disorder, the person diagnosed In shared psychotic disorder, the person diagnosed usually has dependent personality disorder.usually has dependent personality disorder.The differential diagnosis includes borderline The differential diagnosis includes borderline personality disorder because of the fear of personality disorder because of the fear of abandonment.abandonment.

Obsessive-Compulsive Personality DisorderObsessive-Compulsive Personality DisorderPeople with obsessive-compulsive personality disorder are typically People with obsessive-compulsive personality disorder are typically inflexible perfectionists.inflexible perfectionists.They require order and control in all aspects of their lives.They require order and control in all aspects of their lives.They may be unable to complete tasks due to compulsive attention to detail.They may be unable to complete tasks due to compulsive attention to detail.Their relationships are often cold and rigid and they have trouble with Their relationships are often cold and rigid and they have trouble with intimacy.intimacy.Anxiety is associated with anything that upsets the normal routine of their Anxiety is associated with anything that upsets the normal routine of their lives.lives.Unlike most people with personality disorders, these obsessive-compulsive Unlike most people with personality disorders, these obsessive-compulsive people recognize their symptoms and acknowledge the distress it causes people recognize their symptoms and acknowledge the distress it causes them.them.The defense mechanisms these people use are The defense mechanisms these people use are reaction formation, reaction formation, isolation, isolation, and and undoing.undoing.In reaction formation, people deny unacceptable feelings by adopting the In reaction formation, people deny unacceptable feelings by adopting the opposite attitude.opposite attitude.Isolation is the intrapsychic separation of an unacceptable feeling from the Isolation is the intrapsychic separation of an unacceptable feeling from the affect that accompanies it and the subsequent repression of the feeling.affect that accompanies it and the subsequent repression of the feeling.Undoing is where people use specific behaviors to symbolically negate Undoing is where people use specific behaviors to symbolically negate unacceptable thoughts, feelings, or actions.unacceptable thoughts, feelings, or actions.The differential diagnosis includes obsessive-compulsive disorder and can The differential diagnosis includes obsessive-compulsive disorder and can be distinguished by increased symp tom severity in OCDbe distinguished by increased symp tom severity in OCD

PERSONALITY DISORDER NOT OTHERWISE SPECIFIED

This diagnostic category is reserved for This diagnostic category is reserved for disorders that fall short of specific criteria but disorders that fall short of specific criteria but still demonstrate behavior that is consistent still demonstrate behavior that is consistent with personality disorders in general (i.e., with personality disorders in general (i.e., behavior deviates from cultural standards, is behavior deviates from cultural standards, is rigid and pervasive, is consistent over time, rigid and pervasive, is consistent over time, and causes distress or functional impairment). and causes distress or functional impairment). Passive-aggressive Passive-aggressive personality disorder and personality disorder and depressive depressive personality disorder both fall into personality disorder both fall into the NOS category.the NOS category.

Passive AggressivePassive Aggressive Personality Disorder Personality Disorder

These people procrastinate, do not perform tasks These people procrastinate, do not perform tasks adequately, and make excuses for their behavior.adequately, and make excuses for their behavior.They manipulate themselves into dependent They manipulate themselves into dependent positions and force others to become responsible for positions and force others to become responsible for them.them.Passive-aggressive people are pessimistic and Passive-aggressive people are pessimistic and generally lack self-confidence.generally lack self-confidence.Friends become angry and frustrated with these Friends become angry and frustrated with these people and often feel manipulated.people and often feel manipulated.Reaction formation Reaction formation is their defense mechanism is their defense mechanism (denial of unacceptable feelings by adopting the (denial of unacceptable feelings by adopting the opposite atti tude).opposite atti tude).

Depressive Personality DisorderDepressive Personality Disorder

These people are chronically unhappy, These people are chronically unhappy, anhedonic, and generally pessimistic.anhedonic, and generally pessimistic.

Their personality traits are consistent with Their personality traits are consistent with depressive symptoms but they do not fully meet depressive symptoms but they do not fully meet diagnostic criteria for MDD or dysthymia.diagnostic criteria for MDD or dysthymia.

Their lives are usually described as lonely and Their lives are usually described as lonely and sad.sad.

They tend to feel hopeless and inadequate with They tend to feel hopeless and inadequate with frequent self-doubting.frequent self-doubting.


Cluster C disorders are chronic and may be Cluster C disorders are chronic and may be lifelong.lifelong.Obsessive-compulsive personality disorder Obsessive-compulsive personality disorder may follow a waxing and waning disease may follow a waxing and waning disease course.course.General functioning is usually impaired unless General functioning is usually impaired unless these people remain in protected these people remain in protected environments.environments.Depression and anxiety tend to complicate Depression and anxiety tend to complicate these disorders over time.these disorders over time.The prognosis is variable but these patients The prognosis is variable but these patients are typically motivated to change.are typically motivated to change.

TreatmentTreatment

Treatment is a combination of Treatment is a combination of psychotherapy and pharmacotherapy.psychotherapy and pharmacotherapy.

Psychotherapeutic methods include Psychotherapeutic methods include cognitive-behavioral therapy, cognitive-behavioral therapy, psychoanalytic (insight-oriented) therapy, psychoanalytic (insight-oriented) therapy, and group therapy.and group therapy.

Benzodiazepines are used for anxiety.Benzodiazepines are used for anxiety.

Antidepressants are used for depression.Antidepressants are used for depression.

Mental retardationMental retardation

Mental retardationMental retardation – innate – innate intelligence deficiency. After the intelligence deficiency. After the degree of psychical retardation and degree of psychical retardation and clinical picture select such forms: clinical picture select such forms:

a) mild (IQ 50-70)

b) moderate (IQ 35-49)

c) severe (IQ 20-34)

d) profound (IQ below 20)

Mental retardationGeneral signs:General signs:

An abnormal psychology structure An abnormal psychology structure with totality of psychical retardation with totality of psychical retardation and predominance of weakness of and predominance of weakness of abstract thought.abstract thought.

Stable state of intellectual Stable state of intellectual insufficiency.insufficiency.

The rate of psychical development The rate of psychical development of individual is slow.of individual is slow.

Causes of mental retardation Alterations in embryonic development, such as those Alterations in embryonic development, such as those caused by chromosomal abnormalities or fetal caused by chromosomal abnormalities or fetal exposure to drugs or toxins. exposure to drugs or toxins. Environmental deprivation and other mental disorders, Environmental deprivation and other mental disorders, such as autism. such as autism. Problems of pregnancy and the perinatal period, such Problems of pregnancy and the perinatal period, such as fetal malnutrition, hypoxia, infection, trauma.as fetal malnutrition, hypoxia, infection, trauma.Hereditary abnormalities, such as inborn errors of Hereditary abnormalities, such as inborn errors of metabolism or chromosomal aberrations. metabolism or chromosomal aberrations. Medical conditions of infancy or childhood, such as Medical conditions of infancy or childhood, such as central nervous system (CNS) infection or trauma.central nervous system (CNS) infection or trauma.Physical causes are evident in the majority of cases of Physical causes are evident in the majority of cases of moderate-to-profound retardation. A disadvantaged moderate-to-profound retardation. A disadvantaged environment is more likely in mild retardation. environment is more likely in mild retardation.

Documents

Personality disorder and mental retardation