Ghn

1. PERSONALITY DISORDER
• Personality disorder – defined as enduring
subjective experience and behavior that
deviate from cultural standard
• Are rigidly pervasive
• Have an onset in adolescence or early
adulthood
• Are stable through time and
• Lead to unhappiness and impairment

2. CLUSTERS
• Gouped in 3 clusters
-cluster A
(a)Paranoid
(b)Schizoid
(c) Schizotypal
People with this personality disorder are often
perceived as odd and eccentric

3. CONT-
• CLUSTER B
(a) Antisocial
(b) borderline
(c) histrionic
(d)Narcissistic
People with this disorder often seem dramatic,
emotional and erratic

4. CONT-
• CLUSTER C
(a) Avoidant
(b) Dependent
(c) obsessive-compulsive
People with this disorder are often fearful and
tearful
Other category includes
Personality disorder not otherwise specified such as
(a)Passive-aggressive
(b) Depressive personality disorder

5. ETIOLOGY
• GENETIC FACTORS
- Concordance rate higher in monozygotic twins
than in dizygotic twins
- Cluster (A) personality disorder are more
common in biological relatives of pt with
schizophrenia(especially schizotypal)
- Antisocial (pd) is associated with alcohol use
disorder
- Borderline(pd) is associated with family history of
depression or other mood disorder

6. CONT-
• BIOLOGICAL FACTORS
(a)Hormones
-People who exhibit impulsive traits often has high level of
testosterone
-In non human primates adrogen increases likely hood of
aggression
(b)Platelet monoamine oxidase(pmo)
-Low level of pmo is associated with sociability in monkeys
-College students with low pmo report spending more time
insocial activities than do student with high level of pmo

7. CONT-
• SMOOTH PURSUIT EYE MOVEMENT(SPEM)
-SPEM are saccadic (that is jumpy)in people
Who are introverted
Who have low self esteem
Who tend to withdrawal from others
NEUROTRANSMITTERS
Treatment with serotenergic agent may produce
dramatic changes in some character traits of
personality

8. CONT-
• PSYCHOANALYTIC FACTORS
-Sigmoid Freud suggested that personality traits
are related to a fixation at one psychosocial
stage of development
-Oral characters are passive and dependent on
food or other substances
-Anal characters are stubborn , precise
parsimonious, and punctual

9. PARANOID PERSONALITY DISORDER
• Characterised by long standing suspiciouness and
mistrust of people in general
• They are often hostile, irritable and angry and often
interpret the actions of others as being deliberately
deaming or threatening
• They tend to be pathological jealous and augmentative
• They are usually unemotional and fail to maintain
friendly relationship
• In some cases may show stubbornness and feeling of
self importance
• They pay close attention to power and rank

10. EPIDEMIOLOGY
• Prevalence 0.5-2.5 in general population
• Relatives of pt with schizophrenia show high
incidence of ppd than do control
• More common in men than in women
• High incidence found in minority group ,
immigrants or people who are deaf than it is
in general population

11. CLINICAL FEATURES
• Interpretation of other people actions as
deliberately, deaming or threatening
• They frequently dispute without any justification
friends or associate loyalty or trustworthiness
• They are pathologically jealous and for no reason
question the fidelity of their spouses or sexual
partners
• They lack any warmth and are impressed with
and pay close attention to power and rank
• They express disdain for those who are seen as
weak,sickling ,impaired or in some way defective

12. CONT-
• COURSE AND PROGNOSIS
-Life long
-Occupational and marital problem are common
TREATMENT
-Psychotherapy
RX of choice
Therapist should be straight forward when dealing with this pt
An honest apology when in the wrong and not excuses is
required eg lateness for appointment
They do not fit in group therapy and individual psychotherapy
is indicated which requires a professional and not overly
warm style from therapist

13. CONT-
• PHARMACOTHERAPY
- Useful in dealing with agitation and anxiety
such as diazepam , but accasionally
antipsychotics eg haloperidal is indicated in
managing severe agitation and delusional
thinking
- Antipsychotic pimozide is useful in reducing
paranoid ideation in some patient

14. SCHIZOID PERSONALITY DISORDER
• Patient display a life long pattern of social withdrawal
• They are often seen by others as eccentric , isolated or
lonely
EPIDEMIOLOGY
-Affect 7.5% of general population
- Sex ratio is unknown
-Some studies report a 2;1 m’.f ratio
-Affected person gravitate towards solitary jobs that
involve little or no contact with others
-May prefer night work to day work so that they need not
deal with many people

15. CLINICAL FEATURES
• They are cold and aloof
• They show no involvements with everyday events and the concerns
of others
• They appears queit , distant, seclusive and unsociable
• They may pursue their lives with little need or longing for
emotional ties
• They are the last to be aware of changes in popular fashion
• Have solitary interest and success at non competitive lonely jobs
that others find difficult to tolerate
• They sexual life may exist exclusively in fantasy
• They are often seen as aloof but such people can sometimes
conceive, develop and give to the world genuinely original creative
ideas

16. CONT-
• COURSE AND PROGNOSIS
-Start in early childhood
-It is long lasting but not necessarily life long
TREATMENT
Psychotherapy
Main stay of treatment
As trust develops they may reveal a ph ethora of fantancies and fear
even of merging with the therapist
They are reserved in group therapy and should be protected against
other aggressive patients
PHARMACOTHERAPY
Small dose of antipsychotics, antidepressant and psychostimulant may
be effective in some patients

17. SCHIZOTYPAL PERSONALITY DISORDER
• The pt are eccentric, suspicious and show poor
interpersonal relationship
• Magical thinking, peculiar notions, ideas of reference,
illusions and derealization are part of a schizotypal
person’s everyday world
• EPIDEMIOLOGY
-Prevalence rate 3% of the population
-Sex ratio unknown
-Greater association among relatives with schizophrenia
-Higher incidences among monozygotics twins

18. CONT-
• COURSE AND PROGNOSIS
-10% commit suicide
-Schizotypal according to the current clinical thinking is
premorbid personality of the pt with schizophrenia
TREATMENT
-Psychotherapy similar to schizoid pt
-Neuroleptics are used for psychotic pt in dealing with
ideas of reference, illusions etc
-Antidepressant are used when depressive component of
the personality is present

19. CLUSTER B
• ANTISOCIAL PERSONALITY DISORDER
- Inability to conform to the social norms that govern
many aspects of people’s adolescence and adult
behavior
EPIDEMIOLOGY
-Prevalence 3% in men 1% in women
-More common in poor urban areas
-In prison population prevalence may be as high as 75%
-Familial pattern is present the disorder is 5 times more
common in first degree relatives than among the
control

20. CONT-
• CLINICAL FEATURES
-Patient with APD may present as normal and even pleasant
- However they have a history of disregard for and violation
of the right of others
- They are often known to steal, fight and abuse substances
- The disorder begin in child hood with symptoms occuring
ealier in girls than in boys
- As adults they cannot and do not adhere to social norms
- They often fail to sustain relationship and have no concern
for the feelings of others
- They have a tendency to violence and may get involved in
repeated crimes

21. CONT-
• COURSE AND PROGNOSIS
- It runs in unmitting course the height of the
antisocial behaviour occuring in late
adolescence
- Symptoms may decrease as person grows
older
- Depressive disorder, alcohol use disorder and
other substance abuse are common

22. CONT-
• TREATMENT
-PSYCHOTHERAPY
When pt with APD are immobilized( placed in hospital)
they become amenable to psychotherapy
They may be engaged in gp therapy
Self help group have been more useful than have jails in
alleviating the disorder
PHARMACOTHERAPY
Used to deal with symptoms of anxiety, rage and
depression

23. BORDERLINE PERSONALITY
DISORDER(BPD)
• Patient with BPD stand on the border between
neurosis and psychosis
• They are characterised by extraordinary unstable
affect, mood, behavior object relation and self image
• EPIDEMIOLOGY
• Affect about 1-2% of population
• Sex ratio2.1 f.m
• 1st degree relatives have increased frequency of mood
disorder, alcohol use and other substance use

24. CONT-
• Patient with BPD always appear to be in a state of crisis
• Mood swings are common
• Pt can be auqumentative at one moment, depressed at the
next and later complains of having no feelings
• Many have short lived psychotic episodes(so called
micropsychotic) rather than full blown psychotic symptoms
• The painful nature of their lives is reflected in repetitive self
destrutive acts such as- pt may slash their wrist and
perform other self mutilation to elicit help from others or
to express anger
• They are unable to maintain a relationship

25. CONT-
• COURSE AND PROGNOSIS
- A stable diagnosis with little change over time
- Patient may change to schizophrenia and
others have high incidence of mood disorder
- Diagnosis is made before the age of 40 when
the pt are attempting to make occupational,
marital and other choices and are unable to
deal with normal stages of the life cycle

26. CONT-
• TREATMENT
-PSYCHOTHERAPY
-Is the treament of choice but usually difficuilt for both the patient and
the therapist alike
-Because can regress easily and show –ve or +ve transference which
are difficuilt to analyze
-Pattient do well in hospital settings in which they receive intensive
individual and group therapies
-Hospital settings also limit patient who are excessively impulsive, self
destructive or self mutilating tendencies
-Under ideal circumstances patient should stay in hospital until they
show marked improvement (ie up to a period of one year)
-Patient can then be discharged to special support systems such as day
hospital,night hospital and half way houses

27. CONT-
• PHARMACOTHERAPY
-Antipsychotics used to control anger and brief
psychotic episode
-Antdepressant to control depressed mood
-Benzodiazepines help to control anxiety and
depression

28. HISTRIONIC PERSONALITY DISORDER
• Characterised by excessive display of emotions
and behave in a colourful, dramatic and
extoverted fashion
• The individual has attention seeking behavior
and are over-concerned with physical
attractiveness
• Their relationship is superficial and don’t last long
• They tend to be dependent on others , they are
demanding and have endless need for
reassurance

29. EPIDEMIOLOGY
• Prevalence 1-3% of general population
• More common in women than in men
• Has an association with somatization disorder
and alcohol use disorders

30. CLINICAL FEATURES
• Show high degree of attention seeking
behavior
• They tend to exaggerate their thoughts and
feelings and make everything sound more
important than it really is
• They display temper tantrums ,tears and
accusations when they are not the center of
attention or are not receiving praise and
approval

31. CONT-
- Sexual fantasies about important or famous
people with whom they are involved are common
- But most histrionic pt may have psychosexual
dysfunction eg women may be anorgasmic and
men may be impotent
- In interviews they may be cooperative and earger
to give details, make frequent slips of the tongue
and generally use very colourful language

32. COURSE AND PROGNOSIS
• Symptoms decrease with age
• People with this disorder are sensation seeker
and may get into trouble with the law, abuse
substance and act promiscuously

33. TREATMENT
• PSYCHOTHERAPY
-Pt are usually unaware of their own real feeling
clarification of the same is important in psychotherapy
Psychoanalytically oriented psychotherapy whether gp or
individual is the treatment of choice
PHARMACOTHERAPY
- Useful in the treatment of depression or anxiety
(antidepression and antianxiety drugs)
- Antipsychotic are used for derealization and illusion

34. NARCISSISTIC PERSONALITY DISORDER
• Characterised by heightened sense of self
importance and entittlement and grandiose
feeling of uniqueness
• EPIDEMIOLOGY
-Prevalence less than 1-6% in general population
-People with the disorder may impart to their
children an unrealistic sense of omnipotence,
grandiosity, beauty and talents thus offsprings of
such parents may have a higher than usual risk of
developing the disorder

35. CONT-
• CLINICAL FEATURES
- Person with NPD have a grandiose sense of self importance
- They consider themselves special and expect special treatment
- They believe they are unique in some way and behave accordingly
- They are envious of others, arrogant and expect favous from others
but do not reciprocate these favours
- They are unable to show empathy and feign sympathy only to
achieve their selfish ends
- Interpersonal difficulties,occupational problems,rejection and loss
are among the stresss nacissistic commonly produce by their
behavior– stress they are least able to handle
- They are prone to depression

36. COURSE AND PROGNOSIS
• Nacissistic personality disorder
-It is chronic and difficult to treat
-These pt handle aging poorly as they
inappropriately cling to youthful attributes
and values( for example beauty and strength)
-They are therefore more vulnerable to mid life
crisis

37. TREATMENT
• Psychotherapy is difficult as the patient are
unwilling to renounce nacissistic for progress
to be made
• Psychoanalysis may be attempted
• Pt with mood swings and depression may
benefit from mood stabilizer and
antidepressant

38. CLUSTER C
• AVOIDANT PERSONALITY DISORDER
-Pt show an extreme sentivity to rejection and
may lead a socially withdrawn life
-They are shy and show a great desire for
companionship
-But they need unusually strong guarantees of
uncritical acceptance
-Such people are commonly described as having
an inferiority complex

39. CONT-
• EPIDEMIOLOGY
-APD is common
-Prevalence is 2-3% of the general population
-No information available on sex ratio or familial pattern
COURSE AND PROGNOSIS
-Pt are able to function in a protected environment
-Some marry,have childen and live their lives surrounded
only by family members
-If support systems fail they are subject to depression
anxiety and anger
-They also present with social phobia

40. CLINICAL FEATURES
• Hypersentivity to rejection by others is the
central clinical feature of avoidant personality
disorder and their main personality traits is
timidity
• They desire the warmth and security of human
companionship but avoid relationship due to fear
of rejection
• When taking to someone they express
uncertainty , show lack of self confidence and
may speak in a self effacing manner

41. CONT-
• Because they are hypervigilant about
rejection they are afraid to speak up in public
or to make request from others
• They avoid occupation requiring close
interpersonal contact only become involved if
they are certain to be liked

42. TREATMENT
PSYCHOTHERAPY
• Assertiveness training a form of behavioh therapy may
teach pt to express their needs openly and to enlarge
their self esteem
• Gp therapy may help pt understand the effect of their
sensitivity to rejection on themselves and others
• PHARMACOTHERAPY
• Drugs used to manage anxiety or depression
• Beta adrenergic receptor antagonist such as Atenolol
may be used to control nervous system hyperactivity
especially when they approach a feared objects

43. DEPENDENT PERSONALITY
DISORDER(DPD)
• Pt with DPD suordinate their own needs to
those of others,
• Get other to assume responsibility for major
areas of their lives,
• Lack self confidence and
• May experince intense discomfort when alone
for more than a brief period

44. EPIDEMIOLOGY
• More common in women
• Account for 2-5% of all personality disorder
• More common in young children than older
ones
• People with chronic physical illness in
childhood may be most prone to the disorder

45. CLINICAL FEATURES
• Characterised by pervasive patterns of
dependent and submissive behavior related to an
excessive need to be taken care of
• They are indecisive, lack initiative and avoid
position of responsibility and become anxious if
asked to assume a leadership role
• They fear being alone and usually seek others on
who they can depend
• They are often pessimistic, passive and cannot
express agressive feelings

46. CONT-
• They cling to others for fear of abandonment and
often persevere maltreatment for long periods
• In shared psychotic disorder one member of the
pair usually suffers from DPD.The submissive
partner takes on the more aggressive assertive
partner on whom he or she is dependent
• An abusive unfaithful or alcoholic spouse may be
tolerated for long periods in order not to disturb
the sense of attachment

47. COURSE AND PROGNOSIS
• Course unknown
• Have impaired occupational functioning because
of their inability to act independently and
without close supervision
• Social relationship are limited to those on whom
they can depend and may suffers physical or
mental abuse because they cannot assert
themseselves
• May suffer from depression if they loss the
person they depend on

48. TREATMENT
• PSYCHOTHERAPY
-Insight orientated psychotherapy which enables
pt to understands the antecedents of their
behavior and through the support of
therapist become more independent,
assertive and self reliant
Behavioral therapy, assertiveness training,
family therapy and group therapy can also be
used

49. CONT-
• A problem may arise when a therapist
encourages a pt to change the dynamics of a
pathological relationship (eg support a
physically abused wife in seeking help from
the police)
• Therefore the therapist must show great
respect for these pt feelings of attachment no
matter how pathological these feeling may
seem

50. CONT-
• PHARMACOTHERAPY
Drugs are used to deal with specific symptoms
such as anxiety and depression
Pt with panic attacks and high level of
separation anxiety may be helped by
imipramine
Benzodizepines and setonergic agent are also
effective

51. OBSESSIVE- COMPULSIVE
PERSONALITY DISORDER(OCPD)
• Charscterised by emotional constriction,
orderliness, perseverance ,stubbornness and
indeciveness
• The essential features of the disorder is
pervasive pattern of perfetionism and
inflexibility

52. CLINICAL FEATURES
• Person with OCPD are preoccupied with rules
regulations neatness order and achievement of
perfection
• the individual are mostly formal serious and
generally lack a sense of humor
• They marginalise or alienate other people and are
often uncompromising
• Their fear of mistake render’s them indecisive
• They can tolerate prolonged routine work and
any distubance or change of their routine cause
them considerable anxiety

53. CONT-
• They alienate people; are unable to
compromise and insist that others submit to
their needs
• They are however eager to please those
whom they see as more powerful than
themselves and they carry out these people’s
wishes in an authoritarian manner

54. COURSE AND PROGNOSIS
• Course is variable and unpreditable
• From time to time people may develop
obsessions or compulsions in the course of
their disorder
• Some adolescence with OCPD evolve into
warm and loving adults others may develop
schizophrenia or decade later major
depressive disorder

55. TREATMENT
• PSYCHOTHERAPY
• Unlike pt with other personality disorder those with
OCPD are aware of their suffering and they seek
treatment on their own
• Free association and non directive therapy are the
treatment of choice
• Group therapy and behavior therapy are also useful
• PHARMACOTHERAPY
• Benzodiazepines reduces symptoms of OCPD
• SSRI are also useful

56. PERSONALITY DISORDER NOT
OTHERWISE SPECIFIED
• Given to personality disorder which do not fit
in any of the above categories
• This includes
• (a) passive- aggresive personality disorder
• (b) depressive personality disorder

57. PASSIVE PERSONALITY
DISORDER(NEGATIVISTIC PD)
• Person with this disorder have cocealed
obstructionism, stubbornness, procrastination
and inefficiency
• They lack a clear vision about their lives, lack
confidence and are typically pessimistic about
the future
• Suicide attempt are common though only 1%
succeed in it

58. TREATMENT
• Includes supportive psychotherapy and
confrontation which may be more helpful in
changing the pt behavior
• Antidepressant should be prescribed if and
when clinical condition dictates

59. DEPRESSIVE PERSONALITY DISORDER
Characterised by lifelong traits that fall along the
depressive spectrum
They are pessimistic, anhedonia,duty bound,
self doubting and chronically unhapppy
TREATMENT
PSYCHOTHERAPY –Insight orientated
psychotherapy is helpful
PHARMACOTHERAPY- includes use of
antdepressant especially SSRI

60. SADO-MASOCHISTIC PERSONALITY
DISORDER
• Characterised by element of sadism or masochism or a
combination of both
• SADISM is the desire to cause others pains by being either
sexually abusive, physically or psychologically abusive
• It is named after the Marqui’s de-sade in 18th century
writer of erotic and he described people who experience
sexual pleasure while inflicting pain on others
• Freud believed that sadist ward off castration anxiety and
they are able to achieve sexual pleasure only when they
can do to others what they fear will be done to them

61. CONT-
• MASOCHISM-Named after Leopold von Sacher-Masoch a
19th century German novelist- where they is achievement
of sexual gratification by inflicting pain in the self
• They are also so called moral masochists who generally
seek humilition and failure rather than physical pains
• Freud believed that masochists ability to achieve orgasm is
disturbed by anxiety and guilt feelings about sex -which are
alleviated by inflicting suffering and punishment
• TREATMENT-Insight- orientated psychotherapy including
psychoanalysis has been effective in some cases

62. SADISTIC PERSONALITY DISORDER
• Begin in early adulthood
• They have pervasive pattern of cruel deamining and
agressive behavior that is directed towards others
• Physical cruelity or violence is used to inflict pain on
others and not to achieve another goal eg mugging in
order to steal
• People with this disorder like to humiliate or demean
people infront of others and have usuallly treated or
disciplined people uncommonly harshly especially
children
• They are fascinated by ,weapons, injury or torture

63. Personality change due to a general
medical condtion
• Characterised by change in personality style
and traits from a previous level of functioning
• Usually result from structural damage to the
brain eg head trauma, cerebral neoplasms and
vascular accidents particuarly of the temporal
and frontal lobes

64. THE END
• THANKS