This document provides information on personality disorders, including definitions of personality and personality disorders. It describes several specific personality disorders (paranoid, schizoid, antisocial/dissocial, borderline, histrionic, obsessive-compulsive, avoidant) and discusses their diagnostic criteria, characteristics, prevalence, sex differences, treatments and prognosis. Personality disorders are grouped into clusters (A, B, C) based on common features and are diagnosed using systems like the DSM and ICD.

1. PERSONALITY DISORDERS
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2. Personality
 Is a set of deeply
ingrained (firmly
established),
enduring patterns of
thinking, acting, &
behaving
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3. Personality cont…
 Personality is often confused with two related
terms Temperament.
 Personality is the patterning of characteristics
across the entire matrix of the person.
 Rather than being limited to a single trait,
personality regards the total configuration of the
person’s characteristics: interpersonal, cognitive,
psychodynamic, and biological.
 Each trait reinforces the others in perpetuating the
stability and behavioral consistency of the total
personality structure05/18/18 3

4. A “healthy personality” means:
 Maintaining healthy relationships
 Experiencing intimacy while maintaining own
separate identity
 Maintaining a continuum of dependent and
independent behavior
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5. Personality Disorders
 Is an enduring subjective experiences and
behavior that deviate from cultural standards
(DSM-IV)
 The individual has few strategies for relating
and his or her approach to relationships and to
the environment is inflexible and maladaptive.
 Prevalence of personality disorders in the
general population is 10-18%
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6. Personality Disorders Cont…
 Have an onset in adolescence or early adulthood
 Are rigidly pervasive, and stable through time
 Lead to unhappiness and impairment
 When personality traits are rigid and maladaptive
and produce functional impairment or subjective
distress, a personality disorder may be diagnosed
 Lack insight into PD (seek treatment for Axis I
problem or relationship problems)
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7. Personality Disorders Cont…
 PD symptoms are ego syntonic = feels like a
normal part of oneself
 Most have interpersonal problems
 Can be difficult to diagnose in initial session
 Intractable, difficult to treat; can affect
treatment of other disorders
 Person must meet the general criteria before a
specific PD is diagnosed
 Coded on Axis II
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8. Personality Disorders Cont…
 Personality disorder is also a predisposing factor
for other psychiatric disorders (e.g., substance
use, suicide, affective disorders, impulse-control
disorders, eating disorders, and anxiety
disorders) in which it interferes with treatment
outcomes of Axis I syndromes and increases
personal incapacitation, morbidity, and
mortality of these patients
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9. Personality Disorders Cont…
 Many persons exhibit traits that are not limited to a
single personality disorder.
 When a patient meets the criteria for more than
one personality disorder, clinicians should diagnose
each
 Do certain personality disorders favor men and
others favor women?
 borderline, dependent, and histrionic-frequent in
females
 paranoid, schizoid, schizotypal, antisocial, narcissistic,
and obsessive-compulsive are more frequently
diagnosed in men05/18/18 9

10. Classifications
 ICD-10 (F60 Specific P.D.)- WHO
 DSM-IV (Diagnostical and statistical manual)
-American Psychiatric Association
both are similar with some differences
(e.g.schizotypal disorder- in ICD in ch. F2)

11. Clusters of personality disorders in DSM-IV-TR
PDs are classified within clusters defined by
common features
 Cluster A- includes disorders of an odd or
eccentric (unconventional and strange) nature
(paranoid, schizoid, schizotypal)
 Cluster B- includes disorders of an erratic,
dramatic, or emotional nature (antisocial,
borderline, histrionic, narcissistic)
 Cluster C- includes those of an anxious or fearful
nature (avoidant, dependent, obsessive-
compulsive)
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12. General diagnostic criteria-
ICD-10
G1. enduring patterns of inner experience and
behavior as a whole deviate markedly from the
culturally expected and accepted range. Deviation in
more than one of the following areas: (1) cognition,
(2) affectivity , (3) control over impulses and
gratification of needs;
(4) manner of relating to others and of handling
interpersonal situations.
G2. behavior is inflexible, maladaptive across a broad
range of personal and social situations

13. General diagnostic criteria-
ICD-10
G3. personal distress, or adverse impact on the
social environment, or both
G4. the deviation is stable and of long duration, onset
in late childhood or adolescence
G5. not as a manifestation or consequence of other
adult mental disorders
G6. organic cause must be excluded

14. Personality disorders
ICD-10:
F 60 -Specific personality disorders:
Paranoid P.D.
Schizoid P.D.
Dissocial P.D.
Emotionally unstable P.D.
Histrionic P.D.
Anancastic P.D.
Anxious (avoidant) P.D.
F 61 –Mixed and Other P.D.

15. Paranoid personality disorder
 (1) excessive sensitivity to setbacks and rebuffs
 (2) tendency to bear grudges persistently
 (3) suspiciousness, tendency to distort experience by
misconstruing the neutral or friendly actions as hostile
 (4) situation inadeqate sense of personal rights
 (5) recurrent suspicions regarding sexual fidelity of sexual
partner
 (6) self-referential attitude, associated particularly with
excessive self-importance
 (7) "conspiratorial" explanations

16. Paranoid Personality Disorder
 The DSM-IV-TR defines paranoid personality
disorder as “a pervasive distrust and
suspiciousness of others such that their
motives are interpreted as malevolent,
beginning by early adulthood and present in
a variety of contexts” (APA, 2000)
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17. COMPLICATIONS
 Brief reactive psychosis in response to stress.
COMORBIDITY
Major depression
OCD
Agoraphobia
Substance abuse or dependence
Cooccuring with schizotypal
Schizoid
Narcissistic
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18. IMPAIRMENT:
Frequently only mild and typically occupational and
Social difficulties
SEX RATIO
More in males
FAMILIAL PATTERNS
Among relatives of chronic schizophrenia and
delusional disorder and paranoid type
DIFFERENTIAL DIAGNOSIS :
Schizotypal
OCD, Schizoid, borderline and histrionic , Avoidant
Antisocial and Narcissitic05/18/18 18

19. Treatment of Paranoid Personality
 Establish a therapeutic relationship
 Pharmacotherapy-is useful in dealing with
agitation and anxiety
 Antianxiety agent such as diazepam- used most of the time
 Antipsychotic meds may be useful- low dose haloperidol
 Empathetic response to patient’s anxiety
 Psychotherapy-is the treatment of choice for
paranoid personality disorder- CBT
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20. Schizoid personality disorder
 (1) few, if any, activities provide pleasure
 (2) emotional coldness or flattened affectivity
 (3) limited capacity to express feelings
 (4) an appearance of indifference to valuation
 (5) little sexual interest with another person
 (6) consistent choice of solitary activities
 (7) preoccupation with fantasy and introspection
 (8) low or no need of any confiding relationships
 (9) insensitivity to social norms and conventions

21. Schizoid Personality Disorder
Schizoid personality disorder is
characterized primarily by a profound defect
in the ability to form personal relationships
or to respond to others in any meaningful,
emotional way (Phillips, Yen, & Gunderson,
2003).
 These individuals display a lifelong pattern of
social withdrawal, and their discomfort with
human interaction is apparent
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22. Complications
 Very brief reactive psychosis
Co morbidity:
 Premorbid antecedent of delusional disorders,
schizophrenia major depression
Co-occurring personality disorder:
 Paranoid, schizotypal and avoidant
Impairment:
 Severe problems in social relations
 Occupational problems
 Solitary work
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23. Sex:
 More in males
Familial pattern and genetics:
 Relatives of schizophrenia or schizotypal
personality disorder
Differential diagnosis:
 Other personality Disorder
 PDD ( AUTISUM & ASPERGERS SYNDROME)
 Schizophrenia
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24. MANAGEMENT
 Seek treatment due to low insight into
associated problems and low capacity with
relationship and motivation
 Psychotherapy : supportive psychotherapy to
establish therapeutic alliance.
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25. Dissocial personality disorder
 (1) callous unconcern for the feelings of others
 (2) attitude of irresponsibility and disregard for social
norms, rules, obligations
 (3) incapacity to maintain enduring relationships, no
difficulty in establishing them
 (4) very low tolerance to frustration and a low threshold
for aggression
 (5) incapacity to experience guilt or to profit from
adverse experience
 (6) proneness to blame others or to plausible
rationalizations for the conflict behavior

26. Antisocial Personality Disorder
 Antisocial personality disorder is a pattern of
socially irresponsible, exploitative, and
guiltless behavior that reflects a disregard for
the rights of others (Phillips, Yen, &
Gunderson, 2003). These individuals exploit
and manipulate others for personal gain and
have a general disregard for the law
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27. Complications
 Dysphoria, tension, low tolerance for boredom,
depressed mood
Co morbidity:
 Impulse control disorders, Major depression,
substance abuse or dependence pathological
gambling, Anxiety disorders , somatization
disorder
Co-occurring personality disorder:
Narcissistic, Histrionic, Borderline
Impairment:
 Typical Social difficulties
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28. Sex:
 More in Males
Familial pattern and genetics:
 First degree Biological relatives
 Familial transmission of antisocial PD, Substance
use and somatization
Differential diagnosis:
 Paranoid PD
 Borderline PD
 Histrionic PD
 Adult antisocial behaviour
 Narcisstic05/18/18 28

29. MANAGEMENT
 Cognitive and behavioral interventions
 Pharmacological interventions for the
treatment of PD and for the comorbd
disorders such as depression and anxiety
( SSRI) And aggression ( low dose
antipsychotics or mood stablisers)
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30. COURSE & PROGNOSIS
 Show more concerns and guilt of antisocial
behavior
 Ability to form therapeutic alliance
 Positive occupational and relationship record
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31. Emotionally unstable personality
disorder
Impulsive type
 (1) tendency to act unexpectedly without consideration
of the consequences
 (2) marked tendency to quarrelsome behavior and to
conflicts with others
 (3) liability to outbursts of anger or violence, with inability
to control the behavioral explosions
 (4) difficulty in maintaining any course of action that
offers no immediate reward
 (5) unstable and capricious mood

32. 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

33. Borderline Personality
 A pervasive pattern of instability of
interpersonal relationships.
 Impulsivity in at least two pontentially self
damaging areas ( spending, sex, subtance
abuse, reckless driving)
 Main defense mechanisms:
 Splitting: inability to integrate the good and bad
aspects of oneself.
 Projection: projects parts of oneself onto others.
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34. Complications
 Psychotic like symptoms in response to stress,
physical handicaps from suicide and suicidal
gestures, failed suicide and self injurious behaviour,
Co morbidity:
 Impulse control disorders, Major depression,
substance abuse or dependence, PTSD, Eating
disorder ( bulimia) , ADHD
Co-occurring personality disorder:
any other PD
Impairment:
 sEVERE and frequent job losses, interrupted
education, Broken marriages05/18/18 34

35. Sex:
 More in Females (75%)
Familial pattern and genetics:
 Childhood physical and sexual abuse., neglect,
hostile conflict, early parental loss or seperation.
 Increases with familial risk of antisocial PD,
substance abuse & mood disorder
Differential diagnosis:
 Mood D/o
 Dysthymis or cyclothymic disorder
 Identity confusion
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36. Treatments for BD
 DBT: Dialectic Behavioral Therapy
 Partial hospitalization involving group and
individual psychotherapy for 18 months
reduces the number of suicide attempts and
acts of self-harm. Also increases the quality of
social and interpersonal functioning.
 Medications
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37. COURSE & PROGNOSIS
Poor prognosis associated with childhood sexual
abuse, Chornicity of the symptoms, high
affective instability aggression and substance
use
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38. Histrionic Personality Disorder
 Histrionic personality disorder is
characterized by colorful, dramatic, and
extroverted behavior in excitable, emotional
people. They have difficulty maintaining
long-lasting relationships, although they
require constant affirmation of approval and
acceptance from others.
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39. Complications
 Frquesnt suicidal gestures, unstable interpersonal
relationships, shallow and generally ungratifing,
frequent marital problems,
Co morbidity:
 Major depression, substance abuse or
dependence, Somatization and conversion D/O
Co-occurring personality disorder:
Borderline , Antisocial, dependent & Narcisstic
Impairment:
 Loss of mild romatic relationships
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40. Sex:
 More in Females / Men =women
Familial pattern and genetics:
 Genetic link between histrionic, antisocial and
alcoholism is suggested.
Differential diagnosis:
 Borderline PD
 antisocial PD
 Narcisstic PD
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41. MANAGEMENT
 Dynamic psychotherapy-to build self esteem
 Pharmacological interventions for the
treatment of PD and for the comorbd
disorders such as depression and anxiety
( SSRI) And aggression ( low dose
antipsychotics or mood stablisers)
 CBT
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42. COURSE & PROGNOSIS
 Have less functional impairment
 Improve as age and maturity improves
 Sensational seeking may lead to substance use
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43. Anancastic 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) undue preoccupation with productivity to the exclusion
of pleasure and relationships
 (6) pedantry and adherence to conventions
 (7) rigidity
 (8) unreasonable insistence that others submit to exactly
way of doing things, or unreasonable reluctance to way of
doing of them

44. Anxious (avoidant) personality disorder
 (1) persistent feelings of tension and apprehension
 (2) belief that one is socially inept, personally
unappealing, or inferior to others
 (3) excessive preoccupation with being criticized or
rejected in social situations
 (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.

45. DSM-IV-TR Diagnostic Criteria for
Avoidant Personality Disorder
The individual with avoidant personality disorder
is extremely sensitive to rejection and because of
this may lead a very socially withdrawn life. It is
not that he or she is asocial; in fact, there may be
a strong desire for companionship. The extreme
shyness and fear of rejection, however, create
needs for unusually strong guarantees of
uncritical acceptance (Sadock & Sadock, 2003).
05/18/18 45

46. Complications
 Social phobia
Co morbidity:
 Increased risk for mood and anxiety disoders
( social phobia and generalized type)
Co-occurring personality disorder:
 Paranoid, schizoid, Borderline, Schizotypal and
dependent PD
Impairment:
 Severe Occupational & Social difficulties
05/18/18 46

47. Sex:
 Males = Females
Differential diagnosis:
 Social phobia
 Schizotypal and schiozid PD
 Paranoid PD
 Dependent PD
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48. MANAGEMENT
 CBT
 Assertiveness and distress tolerance skill.
 Social skill Training
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49. COURSE & PROGNOSIS
 People with avoidanat personality disorder
may do well in familiar environment with
known people
 Shyness tends to decrease when they get
older
 Ppl with avoidant and co morbid depressive
disorder may have high drop out rate in
treatment
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50. 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

51. Dependent Personality Disorder
Dependent personality disorder is characterized
by “a pervasive and excessive need to be taken
care of that leads to submissive and clinging
behavior and fears of separation
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52. Complications
 Mood disorder, anxiety and adjustment disorder,
 Social phobia, low socioeconomic status, poor
family and marital functioning
Co morbidity:
 Risk for major depression, Anxiety and
adjustment disorder
Co-occurring personality disorder:
 HIstrionic, Borderline and avoidant PD
Impairment:
 Mild Occupational & Interpersonal relationship
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53. Sex:
 Males = Females
Familial pattern and genetics:
 Chronic illness or separation anxiety d/o
Differential diagnosis:
 Mood disorder, panic disorder, agrophobia
 Histrionic PD
 Borderline PD
 Avoidant PD
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54. MANAGEMENT
 Therapy targeting at self esteem, self
confidence, sense of efficacy and
assertiveness
 Psychotherapy :Family or couples therapy.
 CBT & Social skill Training
 Symptomatic pharmacotherapy
05/18/18 54

55. Mixed and other personality
disorders(F61)
Features of several of the specific personality
disorders are present
but
not to the extent that the criteria for any
of the specified personality disorders in that
category are met.

56. Schizotypal Personality Disorder
Individuals with schizotypal personality
disorder were once described as “latent
schizophrenics.” Their behavior is odd and
eccentric but does not decompensate to the
level of schizophrenia. Schizotypal personality
is a graver form of the pathologically less
severe schizoid personality pattern
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57. Complications
 Transient psychotic episodes
Co morbidity:
 One episode of major depression ( 30-50)
Co-occurring personality disorder:
 Paranoid, schizoid, Borderline and avoidant PD
Impairment:
 Occupational & Social difficulties
05/18/18 57

58. Sex:
 More in Females
Familial pattern and genetics:
 First degree Relatives of schizophrenia or
schizotypal personality disorder
Differential diagnosis:
 Delusional disorder, schizophernia and sever dep
d/o with psychotic features
 Paranoid and schiozid PD
 Borderline PD
 Avoidant PD
 PDD
05/18/18 58

59. MANAGEMENT
 ANTIPSYCHOTICS
 Psychotherapy : supportive psychotherapy to
establish therapeutic alliance.
 Social skill Training
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60. COURSE & PROGNOSIS
 10-20% wil develop schizophrenia
 Magical thinking , paranoid ideation and
social isolation are associated with risk of
schizophrenia
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61. Narcissistic Personality Disorder
 Persons with narcissistic personality disorder
have an exaggerated sense of self-worth. They
lack empathy, and are hypersensitive to the
evaluation of others. They believe that they
have the inalienable right to receive special
consideration and that their desire is sufficient
justification for possessing whatever they seek.
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62. Complications
 Social withdrawal, depressed mood, dysthymic or
major depressive disorder in reaction to criticism
or failure
Co morbidity:
 Major depression, substance abuse or
dependence ( c0caine use)
Co-occurring personality disorder:
Antisocial, Histrionic, Borderline and paranoid PD
Impairment:
 Severe marital and interpersonal relationship.
05/18/18 62

63. Sex:
 More in Males (50-75%)
Predisposing features:
 Imparting unrealistic sense of grandiosity and
these features serve as a nucleus around which
sense of specialness is organized
Differential diagnosis:
 Paranoid & Schizotypal PD
 Borderline PD
 Histrionic PD
 Antisocial PD
 Narcisstic & OCD
05/18/18 63

64. MANAGEMENT
 Psychotherapy
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65. COURSE & PROGNOSIS
Depression due to continuous frustration and
disappointment
 Unsatisfied life achievements ,difficulty in
aging as a result of high valued on self image
and unrealistic strength
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66. Personality Disorders NOS
 PASSIVE-AGGRESSIVE PD
 Resists fulfilling routine social and occupational tasks
 Stubborn, argumentative
 Unresonably criticizes and scorns authority
 Complains of being misunderstood and
unappreciated by others
 Inefficiency
05/18/18 66

67. Personality Disorders NOS- CONT
 DEPRESSIVE PD- Pessimistic, anhedonic, duty-
bound, Self bounding and chornically unhappy
 SADISTIC PD- cruel and demeaning behaviour
 SELF-DEFEATING PD- directed towards bad
outcomes, rejects good outcomes or help
05/18/18 67

68. Complications
-secondary mental illnesses (depression,
medicament, drug or alcohole abuse or addiction,
eating disorders, impulse-control disorders,
anxiety disorders, short psychosis)
-suicidal behavior
-acts of self-harm
-violence and crime behaviour
-risk behaviour (sexualy transmitted infections, drug
application...)

69. Treatment
Motivation to the therapy, compliance and
efficiency is different from case to case.
- Psychoterapy - basis
- Pharmacotherapy -in some cases,
symptomatic
- few controled studies of efficiency
- difficult but helpful

70. Psychoterapy
- the choise of the type of psychoterapy depends
on specific type of P.D. and other factors as
motivation to therapy, intelectual state, ego-
syntonicity or –dystonicity, age and another.
- basic psychoterapeutic support
- psychoanalytic: individual or group
- cognitive-behavioral therapy

71. Pharmacotherapy
- symptomatic, follows symptoms
- target: permanent symptoms (long-term) or
actual state (acute anxiety, disquiet, suicidal
beh., agitation, emotional crises...)

72. Pharmacotherapy for symptoms
depression- SRI, IMAO, atyp.AP
acute anxiety and agitation- BZD, AP
anxiety- (S)SRI, buspiron, IMAO, low dose AP
em. instability- VAL, CBZ, Li, low dose AP
em. flateness- atyp.AP, SSRI, IMAO
dysforia- SSRI, low dose atyp.AP
aggression- Li, antikonv., AP
impulsivity- SSRI, anticonv., Li, low dose AP
psychotic- AP

73. MAJOR STAGES IN THE TREATMENT OF
PD
 Crisis management and stabilization
 Awakening of a positive perspective and personal
values in life
 Other centered awareness
 Integrated intelligence
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74. SIGNS AND SYMPTOMS NURSING DIAGNOSIS
Crisis, High levels of anxiety Ineffective coping
Anxiety, self mutilation
Anger and aggression Risk for other directed violence
Ineffective coping
Impaired parenting
Disabled Family coping
Withdrawal Social isolation
Paranoia Fear
Disturbed sensory, thought,
Defensive Coping
Depression Hopelessness
Risk For suicide, Self mutilation.
Difficluty in relationships Ineffective coping, Impaired Social Interaction,
Defensive Coping, Interrupted Family process
Fail to followup Non Compliance , ineffective therapeutic regimen
Primary Nursing Diagnoses
05/18/18 74

75. Outcome Identification
 The patient will obtain maximum interpersonal
satisfaction by establishing and maintaining self
enhancing relationships with others.
 Social interaction Skills
 Motivation
 Aggression Self control
 Impulse Self Control
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76. Planning & Interventions
 Focus on helping pt. Change the thinking and
the behavior that result from the personality
disorder
 Set mutual goals
 Protection from self-harm
 Family and staff consistency
 Set limits and structure environment
 Focus on patient’s strengths
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