"Personality Disorders: An Overview" was an overview presentation I first gave in September 2014 to a group of medical doctors (mostly psychiatrists).

1. Personality Disorders
Dr Ayomide ADEBAYO
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2. 4-12%
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3. Diagnosable PD in ~10% (2008 study)
Clinically severe in ~4%
35% psychiatric inpatients
Prisoners: female 50%; male 60-80%
Nearly all marked by impaired impulse
control à ↑risk of addictive behaviour
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4. Qu’est que c’est?
An enduring pattern of inner experience
& behaviour that differs markedly from the
expectations of the individual’s culture, is
pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable
over time, and leads to distress or
impairment.
DSM-IV-TR
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5. Qu’est que c’est?
A severe disturbance in the
characterological condition and
behavioural tendencies of the individual,
usually involving several areas of the
personality, and nearly always associated
with considerable personal and social
disruption.
WHO
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6. Simple English
Deeply ingrained maladapative patterns
of behaviour
Extreme deviation from average cultural
norms of perceiving, thinking, feeling &
relating à problems for the person
“Weird” or “different”
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7. What’s Really Going On…
Internally
Disturbed ways
of thinking
Difficulties with
mood &
impulse control
Externally
Disturbed ways
of relating
Disturbed
behaviour
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8. 5-Factor Model of Personality
Openness to Experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
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9. DSM Clusters
Cluster A
(odd, eccentric)
Cluster B
(dramatic, emotional)
Cluster C
(anxious, fearful)
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcisstic
Avoidant
Dependent
Obsessive-
compulsive
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10. Psychopathy
Extreme form of antisocial/dissocial PD
Narrower group – often also fulfil criteria
for antisocial, narcissistic, histrionic &
paranoid
Strongly correlated with risk of future
violence
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11. PCL-R
Glibness, superficial charm
Promiscuous sexually
Grandiose sense of self-
worth
Early behaviour problems
Pathological lying
Impulsivity
Cunning/manipulative
No realistic long term goals
Need stimulation/prone to
boredom
Irresponsibility
Lack of remorse/ guilt
Failure to accept
responsibility
Shallow affect
Callous/lack of empathy
Juvenile delinquency
Parasitic lifestyle
Criminal versatility
Poor behavioural control
Multiple short-term marital
relationshipsDocAyomide.com

12. Psychodynamic Model
Theory of unconscious motivations: not all
“manipulative” behaviour is consciously
under the person’s control
Developmental view & focus on defence
mechanisms
Attempts to understand the internal processes
Problem: not easily generalisable to provide
simple plan of action
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13. Psychiatric Model
Reconsidered for ICD-11 & DSM-V
People often fit more than one category
Same diagnoses with different symptoms
Types shown to alter & change
Imprecise, too much overlap, despite
efforts to pin categories
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14. Relationships
Paranoid/schizotypal PD ≡ delusional disorders
or schizophrenia
Borderline PD ≡ disorders of mood & anxiety,
impulse control, eating, substance use or
ADHD
Avoidant PD ≡ social anxiety disorder
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15. DSM-5
Single axis
Hybrid method (further study)
Borderline Obsessive-Compulsive
Avoidant Schizotypal
Antisocial Narcissistic
PD-TS
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16. Management
Psychotherapy core
Basis: symptoms ß poor/limited coping skills
Aim: ↑perception of & response to social
stressors
Inpatient care rare – occasional short stay
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17. Management Principles*
Consistency
Reliability
Encouraging autonomy
Sensitive management of change
*BMJ 2013;347:f5276
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18. Medication
Minimal role
Adjunct to psychotherapy
For symptom clusters
cognitive-perceptual symptoms
affective dysregulation
impulsive-behavioural dyscontrol
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19. Issues in PD
Under-diagnosis
Stigma
Treatment options
Prognosis
Research
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20. DocAyomide.com