personality disorders classification


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personality disorders classification

  1. 1. Dr.SRIRAM.R
  2. 2. Allport in 1937 defined personality as “the dynamic organization within the individual of those psychophysical systems that determine his unique adjustments to his environment” Mischel in 1976 told that it consists of “the distinctive patterns of behavior, including thoughts and emotions that characterzeeach individual’s adaptation to the situations of his or her life”
  3. 3. Traits are ENDURING patterns of thinking/perceiving/relating about environment and oneself which are exhibited in a wide range of social/personal contexts DSM IV-TR – “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 funtional impairment or subjective distress  DISORDER
  4. 4.  Categorical Classification - ICD-10 (F60 Specific PD)-WHO DSM-5-American Psychiatric Association Millon’s description  Additional classification – Severity, Social functioning and Attribution  Dimensional Classification - (ICD-11?) Thomas Widiger’s Five-factor model
  5. 5. a. Marked disharmonious attitude and behaviour involving several areas of functioning b. Enduring/long standing c. Pervasive and maladaptive d. Childhood to adulthood e. Personal distress f. Socio-occupational dysfunction
  6. 6. F60 Specific personality disorders F60.0 Paranoid personality disorder F60.1 Schizoid personality disorder F60.2 Dissocial personality disorder F60.3 Emotionally unstable personality disorder .30 Impulsive type .31 Borderline type F60.4 Histrionic personality disorder F60.5 Anankastic personality disorder F60.6 Anxious [avoidant] personality disorder F60.7 Dependent personality disorder F60.8 Other specific personality disorders F60.9 Personality disorder, unspecified F61 Mixed and other personality disorders F61.0 Mixed personality disorders F61.1 Troublesome personality changes
  7. 7. Cluster A (odd disorders) “MAD CLUSTER” Paranoid personality disorder (301.0): characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent Schizoid personality disorder (301.20): lack of interest and detachment from social relationships, and restricted emotional expression Schizotypal personality disorder (301.22/F21 SSD ICD- 10): a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions
  8. 8. Cluster B (dramatic, emotional or erratic disorders) “BAD CLUSTER” Antisocial personality disorder(301.7/DISSOCIAL PD IN ICD- 10): a pervasive pattern of disregard for and violation of the rights of others, lack of empathy Borderline personality disorder(301.83): pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity Histrionic personality disorder(301.50): pervasive pattern of attention-seeking behavior and excessive emotions Narcissistic personality disorder(301.81/F60.81 OTHER PD ICD- 10): a pervasive pattern of grandiosity, need for admiration, and a lack of empathy
  9. 9. Cluster C (anxious or fearful disorders) “SAD CLUSTER” Avoidant personality disorder (301.82): pervasive  feelings of social inhibition and inadequacy, extreme  sensitivity to negative evaluation Dependent personality disorder (301.6): pervasive  psychological need to be cared for by other people. Obsessive-compulsive personality disorder (301.4/ Anankastic PD in ICD-10): characterized by rigid  conformity to rules, perfectionism and control
  10. 10. the most common estimations range of all P.D. is about 10-23%. Paranoid 0.5-2.5% Schizoid ?% Schizotypal 3% Antisocial 3% Borderline 2% Histrionic 2-3% Narcissistic less than 1% Avoidant 0.5-1% Dependent >2.5%
  11. 11. Paranoid personality disorder (1) Excessive sensitivity to setbacks and rebuffs (2) Bear grudges persistently (3) Suspiciousness and misconstruing (4) Personal rights  (5) Sexual fidelity suspicions (6) Self-referential attitude (7) “Conspiratorial" explanations
  12. 12. Schizoid personality disorder (1) Few, if any, activities provide pleasure (2) emotional coldness (3) Inability to express feelings (4) indifference to praise/criticism (5) little sexual interest (6) solitary activities (7) preoccupation with fantasy /introspection (8) No confiding relationships (9) insensitivity to social norms /conventions
  13. 13. Dissocial personality disorder (1) unconcern for the feelings of others (2) irresponsibility and disregard for social norms,  rules, obligations (3) incapacity to maintain enduring relationships, no  difficulty in establishing them (4) low tolerance for frustration/aggression  (5) incapacity to experience guilt or to profit from  adverse experience  (6) blame others and rationalize their behaviour
  14. 14. Emotionally unstable personality disorder Impulsive type (1) tendency to act unexpectedly without  consideration of the consequences (2) quarrelsome behavior/conflicts with others (3) behavioral explosions and inability to control (4) difficulty in maintaining any course of action that  offers no immediate reward (5) unstable mood
  15. 15. Emotionally unstable personality disorder Borderline type     At least three of the symptoms mentioned in criterion for  impulsive type, and:  (1) disturbances in and uncertainty about self-image, aims, and internal preferences  (2) liability to become involved in intense and unstable relationships, often leading to emotional crises (3) excessive efforts to avoid abandonment (4) recurrent threats or acts of self-harm (5) chronic feelings of emptiness
  16. 16. Histrionic personality disorder (1) self-dramatization, theatricality, or exaggerated expression  of emotions (2) suggestibility (3) labile affectivity (4) continual seeking for excitement and activities in which is  the center of attention (5) seductiveness in appearance or behavior (6) overconcern with physical attractiveness       Egocentricity,  continuous  longing  for  appreciation,  lack  of  consideration  for  others,  and  persistent  manipulative  behavior complete the clinical picture, but are not required  for the diagnosis.
  17. 17. Anankastic personality disorder (1) feelings of excessive doubt and caution (2) preoccupation with details, rules, order, organization, or schedule (3) perfectionism that interferes with completion (4) conscientiousness and scrupulousness (5) preoccupation with productivity to the exclusion of pleasure and relationships (6) pedantry and adherence to conventions (7) rigidity/stubbornness/unwelcome thoughts and impulses (8) unreasonable insistence that others submit to exactly way of doing things, or unreasonable reluctance to way of doing of them
  18. 18. Anxious (avoidant) personality disorder (1) persistent feelings of tension and apprehension (2) Inferior to others attitude (3) Cannot stand criticism/rejection (4) unwillingness to become involved with people unless certain of being liked (5) restrictions in lifestyle because of need for physical security (6) avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval, or rejection.
  19. 19. Dependent personality disorder (1) encouraging or allowing others to make the most of one's important life decisions (2) subordination of own needs to others on whom is dependent, and compliance with their wishes (3) unwillingness to make reasonable demands on the people one depends on (4) feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself (5) preoccupation with fears of being left to care for oneself (6) limited capacity to make everyday decisions without an advice and reassurance from others
  20. 20. Theodore Millon was a psychologist, and he proposed a system of classification of personality disorders These included all the types of personality disorders previously discussed, plus there were in addition, 4 more These are Depressive, passive-aggressive (negativistic), sadistic and self defeating (masochistic)
  21. 21. [21] Tyrer, P. (2000) Personality Disorders: Diagnosis, Management and Course. Second Edition. London: Arnold Publishers Ltd., pp. 126–32.
  22. 22. There are several advantages to classifying personality disorder by severity: Addresses comorbidity Represents the influence of personality disorder on clinical outcome This system accommodates the new diagnosis of severe personality disorder, particularly "dangerous and severe personality disorder" (DSPD)
  23. 23. TYPE R - Do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders TYPE S - treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment Cluster C are mostly Type S, Cluster A personality disorders significantly more likely to be Type R
  24. 24. Source: Goldberg, L. R. (1990). An alternative “description of personality”: The big-five factor structure. Journal of Personality & Social Psychology, 59, 1216–1229. “MALADAPTIVE TRAITS/DIMENSIONS”