Personality Disorders

Personality DisordersPersonality Disorders

Types of Personality DisordersTypes of Personality DisordersParanoid personalityParanoid personalitySchizoid personality Schizoid personality Cluster ACluster ASchizotypal personality Schizotypal personality

Antisocial personalityAntisocial personalityBorderline personalityBorderline personalityHistrionic personalityHistrionic personality Cluster BCluster BNarcissistic personalityNarcissistic personality

Avoidant personalityAvoidant personalityDependent personalityDependent personality Cluster CCluster CObsessive-compulsive personalityObsessive-compulsive personality

Classification of P.DClassification of P.D ICD-10: ICD-10:

F 60 -Specific personality disorders:F 60 -Specific personality disorders: Paranoid P.D. Paranoid P.D. Schizoid P.D. Schizoid P.D. Dissocial P.D. Dissocial P.D. Emotionally unstable P.D. Emotionally unstable P.D. Histrionic P.D. Histrionic P.D. Anan Anankkastic P.D.astic P.D. Anxious (avoidant) P.D. Anxious (avoidant) P.D. Dependent P.D Dependent P.D

F 61 –Mixed and Other P.D.F 61 –Mixed and Other P.D.

General characteristics of P.DGeneral characteristics of P.D- Inflexible, maladaptive patterns of Inflexible, maladaptive patterns of

personality personality

- Begins early in adulthoodBegins early in adulthood

- Results in social, occupational problems or Results in social, occupational problems or distressdistress

Facts About Personality DisordersFacts About Personality DisordersOnset usually late childhood, early adolescenceOnset usually late childhood, early adolescence

Causes Causes othersothers distress distress

Affects behavior in many situationsAffects behavior in many situations

Poor insightPoor insight

Little behavior change Little behavior change

Coded on Axis IICoded on Axis II

EtiologyEtiologyHereditary factor : chromosomal Hereditary factor : chromosomal

abnormality or genetic predispositionabnormality or genetic predispositionRelation of personality disorder to mental Relation of personality disorder to mental

disorderdisorderP.D and upbringingP.D and upbringing

eg. Disturbed parent-child relationshipeg. Disturbed parent-child relationship

Cont…………..Cont…………..

Other causesOther causes maternal deprivation in antisocial P.Dmaternal deprivation in antisocial P.DPhysical & sexual abuse in childhood (borderline Physical & sexual abuse in childhood (borderline

P.D)P.D)Excessive use of repression (histrionic P.D)Excessive use of repression (histrionic P.D)Fixation in the oral stage of development Fixation in the oral stage of development

(dependent P.D)(dependent P.D)Lack of parental affection & persistent rejection Lack of parental affection & persistent rejection

(paranoid P.D)(paranoid P.D)

General Diagnostic Criteria for PD’sGeneral Diagnostic Criteria for PD’sEnduring pattern of inner experience or behavior Enduring pattern of inner experience or behavior

that deviates from expectations of culture, that deviates from expectations of culture, manifested in two or more of the following:manifested in two or more of the following:

- cognition (perception of self, others)- cognition (perception of self, others) affectivity (intensity, range of emotions)affectivity (intensity, range of emotions) interpersonal functioninginterpersonal functioning impulse controlimpulse control

Enduring pattern is inflexible, pervasive in many Enduring pattern is inflexible, pervasive in many situationssituations

General Diagnostic Criteria for PD’sGeneral Diagnostic Criteria for PD’sEnduring pattern leads to distress, impairment in Enduring pattern leads to distress, impairment in

important areas of functioningimportant areas of functioning

Pattern is stable and of long duration, can be Pattern is stable and of long duration, can be traced back to childhoodtraced back to childhood

Pattern not better explained by another disorderPattern not better explained by another disorder

Pattern not due to substance abuse or medical Pattern not due to substance abuse or medical conditioncondition

Cluster A Personality DisordersCluster A Personality DisordersParanoid, schizoid, and schizotypal Paranoid, schizoid, and schizotypal

personality disorderspersonality disorders

Marked by Marked by eccentricityeccentricity, , odd behaviorodd behavior, , not psychosisnot psychosis

Share a superficial similarity with Share a superficial similarity with schizophrenia (a milder version)schizophrenia (a milder version)

Cluster B Personality DisordersCluster B Personality Disorders

Antisocial, borderline, histrionic, and Antisocial, borderline, histrionic, and narcissistic personality disordersnarcissistic personality disorders

Being Being self-absorbed, prone to self-absorbed, prone to exaggerate importance of exaggerate importance of eventsevents

Having difficulty maintaining close Having difficulty maintaining close relationshipsrelationships

Cluster C Personality DisordersCluster C Personality DisordersAvoidant, obsessive-compulsive, dependent Avoidant, obsessive-compulsive, dependent

disordersdisorders

People are often People are often anxious, fearful, and anxious, fearful, and depresseddepressed

Cluster A Personality DisordersCluster A Personality Disorders

Paranoid Personality DisorderParanoid Personality Disorder

Lack of trust in othersLack of trust in others

Fear that friends may be disloyal, unfaithful Fear that friends may be disloyal, unfaithful

Being hypersensitive, overly suspicious, Being hypersensitive, overly suspicious,

perceived as hostileperceived as hostile

DSM-IVDSM-IV Criteria for Paranoid PD Criteria for Paranoid PD

Pervasive distrust, suspicion of others, Pervasive distrust, suspicion of others, and four or more of the following:and four or more of the following: suspects, without basis, that others are suspects, without basis, that others are

exploiting, harming, deceivingexploiting, harming, deceiving is preoccupied with unjustified doubts of is preoccupied with unjustified doubts of

loyalty or trustworthiness of peopleloyalty or trustworthiness of people is reluctant to confide in othersis reluctant to confide in others persistently bears grudgespersistently bears grudges perceives attacks on reputationperceives attacks on reputation has unjustified suspicions about fidelity of has unjustified suspicions about fidelity of

othersothers

Facts About Paranoid Facts About Paranoid Personality DisorderPersonality Disorder

Affects 0.5–2.5 percent of populationAffects 0.5–2.5 percent of population

Sometimes several individuals band Sometimes several individuals band together into groups that share paranoid together into groups that share paranoid beliefsbeliefs

More common in malesMore common in males

Schizoid Personality DisorderSchizoid Personality Disorder

Enduring pattern of thinking and behavior Enduring pattern of thinking and behavior characterized by characterized by pervasive pervasive indifference to othersindifference to othersdiminished range of emotional experiences, diminished range of emotional experiences,

expressionsexpressions

Socially isolated, Socially isolated, lacking in social lacking in social relationshipsrelationships

DSM-IVDSM-IV Criteria for Schizoid PD Criteria for Schizoid PD

Detachment from social relationships, Detachment from social relationships, restricted emotions, as indicated by four restricted emotions, as indicated by four or more of the following:or more of the following: neither desires nor enjoys social relationshipsneither desires nor enjoys social relationships prefers solitary activitiesprefers solitary activities has little interest in sexual experienceshas little interest in sexual experiences gets pleasure from few activitiesgets pleasure from few activities lacks close friendslacks close friends appears indifferent to praise or criticismappears indifferent to praise or criticism shows emotional coldness, detachment, flat affectshows emotional coldness, detachment, flat affect

Schizotypal Personality Schizotypal Personality DisorderDisorder

Enduring pattern of discomfort with others Enduring pattern of discomfort with others and odd, peculiar thinking and behaviorand odd, peculiar thinking and behavior

Shares symptoms with both paranoid and Shares symptoms with both paranoid and schizoid personality disordersschizoid personality disorders

Most closely linked to schizophreniaMost closely linked to schizophrenia

DSM-IVDSM-IV Criteria for Schizotypal PD Criteria for Schizotypal PD

Acute discomfort with social relationships, Acute discomfort with social relationships, eccentric behavior, and five or more of the eccentric behavior, and five or more of the following:following: ideas of referenceideas of reference odd beliefsodd beliefs unusual perceptual experiencesunusual perceptual experiences odd speechodd speech suspiciousnesssuspiciousness inappropriate or constricted affectinappropriate or constricted affect odd or eccentric appearance and behaviorodd or eccentric appearance and behavior lack of close friendslack of close friends excessive social anxietyexcessive social anxiety

Cluster B Personality DisordersCluster B Personality DisordersAntisocial, borderline, histrionic, and Antisocial, borderline, histrionic, and

narcissistic personality disordersnarcissistic personality disorders

Being self-absorbed, prone to exaggerate Being self-absorbed, prone to exaggerate importance of eventsimportance of events

Having difficulty maintaining close Having difficulty maintaining close relationshipsrelationships

Antisocial Personality DisorderAntisocial Personality Disorder

Pervasive, persistent disregard for or Pervasive, persistent disregard for or violation of rights of other peopleviolation of rights of other people

DSM-IVDSM-IV Criteria for Antisocial PD Criteria for Antisocial PD

Pattern of disregard for rights of others Pattern of disregard for rights of others since age 15, as indicated by three or since age 15, as indicated by three or more of the following:more of the following: failure to conform to social norms, respect failure to conform to social norms, respect

lawful behaviorlawful behavior deceitfulness, lying, conning others for deceitfulness, lying, conning others for

profit or pleasureprofit or pleasure impulsivity, failure to plan aheadimpulsivity, failure to plan ahead irritability, aggressiveness, repeated fightsirritability, aggressiveness, repeated fights

DSM-IVDSM-IV Criteria for Antisocial PD Criteria for Antisocial PD

disregard for safety of othersdisregard for safety of othersconsistent irresponsibility, failure to honor consistent irresponsibility, failure to honor

obligationsobligations lack of remorselack of remorse

Facts About Antisocial PDFacts About Antisocial PD

Affects 2.5–3.5 percent of populationAffects 2.5–3.5 percent of population

More common in menMore common in men

Highest prevalence among men 25–44 yr oldHighest prevalence among men 25–44 yr old

40 percent of affected men and 24 percent of 40 percent of affected men and 24 percent of affected women were diagnosed with conduct affected women were diagnosed with conduct disorder as childrendisorder as children

Causes of Antisocial PDCauses of Antisocial PDGeneticsGenetics

Birth traumaBirth trauma

Sensation-seekingSensation-seeking

Family dynamicsFamily dynamics

Modeling and mediaModeling and media

Borderline Personality Borderline Personality DisorderDisorder

Enduring pattern of thinking, behavior that Enduring pattern of thinking, behavior that involvesinvolves instability of moodinstability of mood, self-image, , self-image,

interpersonal relationships interpersonal relationships efforts to avoid real or imagined efforts to avoid real or imagined

abandonmentabandonment unrealistically positive or negative unrealistically positive or negative

opinions about others (intense opinions about others (intense relationships or nonexistance)relationships or nonexistance)

Facts About Borderline Facts About Borderline Personality DisorderPersonality Disorder

Affects 2 percent of populationAffects 2 percent of population

More common in womenMore common in women

Threats/actions of self-harm are commonThreats/actions of self-harm are common

Attributed to parental loss or abuse in Attributed to parental loss or abuse in childhoodchildhood

Treatment mostly unsuccessful – often use Treatment mostly unsuccessful – often use behavior therapybehavior therapy

DSM-IVDSM-IV Criteria for Borderline PD Criteria for Borderline PD

Instability in relationships, self-image, Instability in relationships, self-image, marked impulsivity, and five or more of marked impulsivity, and five or more of the following:the following: efforts to avoid real or imagined efforts to avoid real or imagined

abandonmentabandonment pattern of unstable, intense relationshipspattern of unstable, intense relationships identity disturbanceidentity disturbance impulsivity in two or more areas that are self-impulsivity in two or more areas that are self-

damagingdamaging

DSM-IVDSM-IV Criteria for Borderline PD Criteria for Borderline PD

recurrent suicidal behavior, gestures, threatsrecurrent suicidal behavior, gestures, threatsaffective instabilityaffective instabilitychronic feelings of emptinesschronic feelings of emptiness inappropriate intense angerinappropriate intense anger transient, stress-related paranoid ideastransient, stress-related paranoid ideas

Histrionic Personality DisorderHistrionic Personality Disorder

Enduring pattern of thinking, behavior Enduring pattern of thinking, behavior characterized by characterized by excessive excessive emotionality and attention-seeking emotionality and attention-seeking behaviorbehavior

Person is typically self-centered, demandingPerson is typically self-centered, demandingAppears in 2–3 percent of the populationAppears in 2–3 percent of the populationMainly diagnosed in womenMainly diagnosed in womenPerson dresses eccentrically, seductivelyPerson dresses eccentrically, seductively

DSM-IVDSM-IV Criteria for Histrionic PD Criteria for Histrionic PD

Excessive emotionality, attention-seeking, Excessive emotionality, attention-seeking, and five or more of the following:and five or more of the following: being uncomfortable when not center of attentionbeing uncomfortable when not center of attention rapidly shifting moodsrapidly shifting moods uses physical appearance to draw attentionuses physical appearance to draw attention interactions characterized by provocativeinteractions characterized by provocative exaggerates in dramatic mannerexaggerates in dramatic manner is suggestible, easily influencedis suggestible, easily influenced considers relationships more intimate than they considers relationships more intimate than they

areare

Narcissistic Personality DisorderNarcissistic Personality Disorder

Enduring pattern of thinking, behavior Enduring pattern of thinking, behavior characterized by characterized by grandiosity, grandiosity, preoccupation with own preoccupation with own achievementsachievements and abilities and abilities

DSM-IVDSM-IV Criteria for Narcissistic PD Criteria for Narcissistic PD

Grandiosity in fantasy and behavior, need Grandiosity in fantasy and behavior, need for admiration, lack of empathy, and five for admiration, lack of empathy, and five or more of the following:or more of the following:has grandiose sense of self-importancehas grandiose sense of self-importance is preoccupied with fantasies of power, is preoccupied with fantasies of power,

success, lovesuccess, lovebelieves he or she is special or uniquebelieves he or she is special or unique

DSM-IVDSM-IV Criteria for Narcissistic PD Criteria for Narcissistic PD

requires excessive admirationrequires excessive admirationhas sense of entitlementhas sense of entitlement takes advantage of others to achieve own takes advantage of others to achieve own

needsneeds lacks empathylacks empathy is often envious of othersis often envious of others is arrogantis arrogant

Cluster C Personality DisordersCluster C Personality DisordersAvoidant, obsessive-compulsive, dependent Avoidant, obsessive-compulsive, dependent

disordersdisorders

People are often People are often anxious, fearful, and anxious, fearful, and depresseddepressed

Avoidant Personality DisorderAvoidant Personality Disorder

Enduring pattern of thinking, behavior Enduring pattern of thinking, behavior characterized by characterized by pervasive social discomfort pervasive social discomfort fear of negative evaluation fear of negative evaluation social isolation social isolation being easily hurt being easily hurt fear of disapproval fear of disapproval

Shy and socially uncomfortable but desire social contact

Avoid it because of fear of embarrassment or criticism

Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality Disorder

Enduring pattern of thinking, behavior Enduring pattern of thinking, behavior characterized by perfectionism, inflexibilitycharacterized by perfectionism, inflexibility

Preoccupied with rules, excessively Preoccupied with rules, excessively moralistic, judgmentalmoralistic, judgmental

Dependent Personality DisorderDependent Personality DisorderEnduring pattern of submissive, dependent Enduring pattern of submissive, dependent

behaviorbehavior

Exceedingly dependent on others for advice, Exceedingly dependent on others for advice, reassurancereassurance

Feelings of anxiety and helplessness when Feelings of anxiety and helplessness when alonealone

TreatmentTreatment

Motivation to the therapy, compliance and Motivation to the therapy, compliance and efficiency is different from case to case.efficiency is different from case to case.

- - Psychoterapy - Psychoterapy - basisbasis

- - Pharmacotherapy -Pharmacotherapy -in some cases, in some cases, symptomaticsymptomatic

- few controled studies of efficiency- few controled studies of efficiency

- difficult but helpful- difficult but helpful

PsychotPsychothherapyerapy

- the choi- the choicce of the type of psychoterapy e of the type of psychoterapy depends depends

on specific type of P.D. and other factors on specific type of P.D. and other factors as motivation to therapy, intelectual state, as motivation to therapy, intelectual state, age and another.age and another.

- basic psychoterapeutic support- basic psychoterapeutic support- psychoanalytic: individual or group- psychoanalytic: individual or group- cognitive-behavioral therapy- cognitive-behavioral therapy

PharmacotherapyPharmacotherapy

- symptomatic, follows symptoms- symptomatic, follows symptoms- target: permanent symptoms (long-term) target: permanent symptoms (long-term)

or actual state (acute anxiety, disquiet, or actual state (acute anxiety, disquiet, suicidal beh., agitation, emotional crises...)suicidal beh., agitation, emotional crises...)

Pharmacotherapy for symptomsPharmacotherapy for symptoms

depression- SRI, MAOdepression- SRI, MAOII, atyp.AP , atyp.AP

acute anxiety and agitation- BZD, APacute anxiety and agitation- BZD, AP

anxiety- (S)SRI, buspiron, MAOanxiety- (S)SRI, buspiron, MAOII, low dose AP , low dose AP

em. instability- VAL, CBZ, Li, low dose APem. instability- VAL, CBZ, Li, low dose AP

em. flateness- atyp.AP, SSRI, IMAOem. flateness- atyp.AP, SSRI, IMAO

aggression- Li, APaggression- Li, AP

impulsivity- SSRI, anticonv., Li, low dose APimpulsivity- SSRI, anticonv., Li, low dose AP

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