Different types of personality disorder

1. Dr. Sushma Rathee
assistant clinical psychologist
PGIMER, Chandigarh
email: sushmaratheecp@gmail.com

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PERSONALITY DISORDERS:
Personality – relatively stable and enduring set of
characteristic behavioral and emotional traits.
Personality Disorders refer to long-standing, pervasive
and inflexible patterns of behavior
Depart from cultural expectations
Impair social and occupational functioning
Cause emotional distress
Personality disorders are coded on Axis II of the DSM-IV
TR
Personality disorders can be a co-morbid condition for an
Axis I disorder

3. What is personality disorder
Personality disorders, in which a person adopts
a persistent, rigid, and maladaptive pattern of
behavior that interferes with normal social
interactions.
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Personality Disorder
Enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individual’s culture.
 Pattern is inflexible and pervasive across a broad range of
personal and social situations.
 Pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
 Pattern is stable and of long duration and its beginning can be
traced back at least to adolescence or early adulthood.
 Pattern is not better accounted for as a manifestation or
consequence of another mental disorder
 Pattern is not due to the direct physiological effects of a
substance (drug of abuse or medication) or a general medical
condition (head trauma).

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PERSONALITY DISORDERS
Personality disorders are pervasive chronic psychological
disorders. Having a personality disorder can negatively
affect one's work, one's family, and one's social life.
During times of increased stress or external pressures
(work, family, a new relationship, etc.), the symptoms of
the personality disorder will gain strength and begin to
seriously interfere with their emotional and psychological
functioning.

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PERSONALITY DISORDERS
Those with a personality disorder possess
several distinct psychological features:
 disturbances in self-image
 ability to have successful interpersonal relationships
 appropriateness of range of emotion
 ways of perceiving themselves, others, and the world
 normative impulse control.

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Causes:
There are as many potential causes of personality disorders as
there are people who suffer from them.
Bio-psycho-social approach: Combination of parental
upbringing, one's personality and social development,
as well as genetic and biological factors. Research
has not narrowed down the cause to any factor at this
time. We do know:
These disorders will most often manifest themselves during
increased times of stress and interpersonal difficulties in one's
life.
Treatment most often focuses on increasing one's coping
mechanisms and interpersonal skills.

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General diagnostic criteria for a
Personality Disorder
A. An enduring pattern of inner experience and behavior
that deviates markedly from the expectations of the
individual's culture. This pattern is manifested in two (or
more) of the following areas:
(1) cognition (i.e., ways of perceiving and interpreting
self, other people, and events)
(2) affectivity (i.e., the range, intensity, lability, and
appropriateness of emotional response)
(3) interpersonal functioning
(4) impulse control

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General diagnostic criteria for a
Personality Disorder
B. The enduring pattern is inflexible and pervasive across a broad
range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or
impairment in social,, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be
traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation
or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., head trauma).

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Paranoid personality disorder:
involves suspicion of others, hostility, jealousy
 No hallucinations and no full-blown delusions are
present in paranoid PD
Paranoid PD occurs more frequently in men than
in women.
Lifetime prevalence is about 2%.
Ch 13.3

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Cont…
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, as indicated by four (or more) of the
following:

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Cont…
Suspects, without sufficient basis, that others are
exploiting, harming, or deceiving him or her
Preoccupied with unjustified doubts about the loyalty
or trustworthiness of friends or associates
Reluctant to confide in others because of unwarranted
fear that the information will be used maliciously
against him or her
Reads hidden demeaning or threatening meanings
into benign remarks or events
Cont

14. 14
Cont…
Persistently bears grudges, i.e., Is unforgiving of
insults, injuries, or slights
Perceives attacks on his or her character or reputation
that are not apparent to others and is quick to react
angrily or to counterattack
Has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner

15. 15
Cont…..
“SUSPECT”
 Spouse fidelity suspected
 Unforgiving (bears grudges)
 Suspicious of others
 Perceives attacks (and reacts quickly)
 “Enemy or friend” (suspects associated and
friends)
 Confiding in others feared
 Threats perceived in benign events

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involves
 Reduced social relations and few friends
 Reduced sexual desire and few pleasurable activities
 Indifference to praise or criticism
 Lonely life style
Prevalence of schizoid PD is less than 2% and
occurs more commonly in men than women.
Schizoid personality disorder:
Ch 13.4

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Cont…
Pervasive pattern of detachment from
social relationships
Restricted range of expression of
emotions in interpersonal settings,
beginning by early adulthood and present
in a variety of contexts
Indicated by four (or more) of the
following:

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Cont…
• Neither desires nor enjoys close relationships, including being
part of a family.
•Almost always chooses solitary activities.
•Has little, if any, interest in having sexual experiences with
another person.
•Takes pleasure in few, if any, activities.
•Lacks close friends or confidants other than first-degree
relatives.
•Appears indifferent to the praise or criticism of others.
•Shows emotional coldness, detachment, or flattened affectivity

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Cont…
“DISTANT”
 Detached (or flattened affect)
 Indifferent to criticism and praise
 Sexual experiences of little interest
 Tasks (activities) done solitarily
 Absence of close friends
 Neither desires nor enjoys close relations
 Takes pleasure in few activities

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Involves:
 An attenuated form of schizophrenia
Odd beliefs and magical thinking
Recurrent illusions (things not present)
Ideas of reference (hidden meaning)
Behavior and appearance is eccentric
Prevalence of schizotypal PD is less than 1
percent.
Schizotypal personality disorder:
Ch 13.5

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Cont…
A pervasive pattern of social and
interpersonal deficits marked by
 acute discomfort with, and reduced
capacity for, close relationships
 cognitive or perceptual distortions and
eccentricities of behavior, beginning by
early adulthood and present in a variety of
contexts, as indicated by five (or more) of
the following:

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Cont…
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behavior
and is inconsistent with subcultural norms (e.g.,
superstitiousness, belief in clairvoyance, telepathy, or
"sixth sense"; in children and adolescents, bizarre
fantasies or preoccupations)
unusual perceptual experiences, including bodily
illusions
odd thinking and speech (e.g., vague, circumstantial,
metaphorical, overelaborate, or stereotyped)
Cont.

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Cont…
suspiciousness or paranoid ideation
inappropriate or constricted affect
behavior or appearance that is odd, eccentric, or peculiar
lack of close friends or confidants other than first-degree
relatives
excessive social anxiety that does not diminish with
familiarity and tends to be associated with paranoid fears
rather than negative judgments about self

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Etiology of the Odd/Eccentric
Cluster
These PDs are linked to Axis I: schizophrenia
 Schizophrenia has clear genetic determinants
 Family studies reveal that relatives of schizophrenic
patients are at increased risk for developing
schizotypal PD as well as paranoid PD
No clear pattern for schizoid PD
Additional similarities for Schizotypal PD
 Have cognitive and neuropsychological problems
similar to those found in individuals with
schizophrenia.
 Have enlarged ventricles and less temporal lobe gray
matter.
Ch 13.6

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Narcissistic PD:
Mnemonic SPECIAL (5 criteria).
S: Special (believes he or she is special and
unique)
P: Preoccupied with fantasies (of unlimited
success, power, brilliance, beauty, or ideal love)
E: Entitlement
C: Conceited (grandiose sense of self-
importance)
I: Interpersonal exploitation
A: Arrogant (haughty)
L: Lacks empathy

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Cont…
Mnemonic PRAISE ME (5 criteria).
P: Provocative (or sexually seductive) behavior
R: Relationships (considered more intimate than they
are)
A: Attention (uncomfortable when not the center of
attention)
I: Influenced easily
S: Style of speech (impressionistic, lacks detail)
E: Emotions (rapidly shifting and shallow)
M: Made up (physical appearance used to draw attention
to self)
E: Emotions exaggerated (theatrical)

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Borderline PD
Mnemonic AM SUICIDE (5 criteria).
A: Abandonment
M: Mood instability (marked reactivity of mood)
S: Suicidal (or self-mutilating) behavior
U: Unstable and intense relationships
I: Impulsivity (in two potentially self-damaging areas)
C: Control of anger
I: Identity disturbance
D: Dissociative (or paranoid) symptoms that are transient
and stress-related
E: Emptiness (chronic feelings of)

30. Cont…
Maladaptive personality pattern in which the person
is moody, unstable, lacks a clear sense of identity,
and often clings to others.
The frequency of this disorder in women is nearly
two to three times greater than in men. Periods of
depression are not unusual, and some may engage in
excessive spending, drug abuse, or suicidal behavior.
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Antisocial PD
Mnemonic CORRUPT (3 criteria)
C: Conformity to law lacking
O: Obligations ignored
R: Reckless disregard for safety of self or others
R: Remorse lacking
U: Underhanded (deceitful, lies, cons others)
P: Planning insufficient (impulsive)
T: Temper (irritable and aggressive)

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Cont…
Professional psychiatry generally compares APD to socio-
pathy and psychopathic disorders (not to be confused with
psychosis). Approximately 3% of men and 1% of women are
thought to have some form of antisocial personality disorder
according to DSM-IV TR.
Sociopath is the serial killer, a person who kills others for the
excitement and thrill of killing without feeling any guilt. There
is a definite gender difference in antisocial personality disorder
with nearly three times to six times as many males diagnosed
with this disorder as females

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Cont…
The manual lists the following additional necessary
criteria:
The individual is at least age 18 years.
There is evidence of conduct disorder with onset
before age 15 years.
The occurrence of antisocial behavior is not
exclusively during the course of Schizophrenia or a
Manic Episode

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Avoidant PD:
Mnemonic CRINGES (4 criteria).
C: Certainty (of being liked required before willing to get
involved with others).
R: Rejection (or criticism) preoccupies one's thoughts in social
situations
I: Intimate relationships (restraint in intimate relationships due
to fear of being shamed)
N: New interpersonal relationships (is inhibited in)
G: Gets around occupational activity (involving significant
interpersonal contact)
E: Embarrassment (potential) prevents new activity or taking
personal risks
S: Self viewed as unappealing, inept, or inferior

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Dependent PD:
Mnemonic RELIANCE (5 criteria).
R: Reassurance required for decisions
E: Expressing disagreement difficult (due to fear of loss of
support or approval)
L: Life responsibilities (needs to have these assumed by others)
I: Initiating projects difficult (due to lack of self-confidence)
A: Alone (feels helpless and discomfort when alone)
N: Nurturance (goes to excessive lengths to obtain nurturance
and support)
C: Companionship (another relationship) sought urgently when
close relationship ends
E: Exaggerated fears of being left to care for self

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Obsessive Compulsive PD
Mnemonic LAW FIRMS (4 criteria).
L: Loses point of activity (due to preoccupation with detail)
A: Ability to complete tasks (compromised by perfectionism)
W: Worthless objects (unable to discard)
F: Friendships (and leisure activities) excluded (due to a
preoccupation with work)
I: Inflexible, scrupulous, overconscientious (on ethics, values,
or morality, not accounted for by religion or culture)
R: Reluctant to delegate (unless others submit to exact
guidelines)
M: Miserly (toward self and others)
S: Stubbornness (and rigidity)

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Conduct Disorder:
The diagnostic criteria for Conduct Disorder as listed in the DSM-IV-TR are as
follows.
A. A repetitive and persistent pattern of behavior in which the basic rights of
others or major age-appropriate societal norms or rules are violated, as
manifested by the presence of three (or more) of the following criteria in the past
12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals
 1. often bullies people, threatens, or intimidates others
 2. often initiates physical fights
 3. has used a weapon that can cause serious physical harm to others (e.g., a
bat, brick, broken bottle, knife, gun)
 4. has been physically cruel to people
 5. has been physically cruel to animals
 6. has stolen while confronting a victim (e.g., mugging, purse snatching,
extortion, armed robbery)
 7. has forced someone into sexual activity

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Cont…
Destruction of property
 8. has deliberately engaged in fire setting with the intention of
causing serious damage.
 9. has deliberately destroyed others' property (other than by fire).
Deceitfulness or theft
 10. has broken into someone else's house, building, or car
 11. often lies to obtain goods or favors or to avoid obligations
(i.e., "cons" others)
 12. has stolen items of nontrivial value without confronting a
victim (e.g., shoplifting, but without breaking and entering;
forgery)

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Cont…
Serious violations of rules
 13. often stays out at night despite parental prohibitions,
beginning before age 13 years
 14. has run away from home overnight at least twice while living
in parental or parental surrogate home (or once without returning
for a lengthy period)
 15. is often truant from school, beginning before age 13 years
B. The disturbance in behavior causes clinically significant
impairment in social, academic, or occupational functioning.
C. If the individual is age 18 years or older, criteria are not met for
Antisocial Personality Disorder.

40. What causes personality disorders?
1. Genetics. Researchers are beginning to identify some possible genetic
factors behind personality disorders.
1. One team, for instance, has identified a malfunctioning gene that may
be a factor in obsessive-compulsive disorder.
2. Other researchers are exploring genetic links to aggression, anxiety and
fear — traits that can play a role in personality disorders.
2. Childhood trauma. Findings from one of the largest studies of personality
disorders, the Collaborative Longitudinal Personality Disorders Study, offer
clues about the role of childhood experiences.
3. Verbal abuse. Even verbal abuse can have an impact. In a study of 793
mothers and children, researchers asked mothers if they had screamed at
their children, told them they didn’t love them or threatened to send them
away. Children who had experienced such verbal abuse were three times as
likely as other children to have borderline, narcissistic, obsessive-
compulsive or paranoid personality disorders in adulthood. 40

41. Cont…
4. High reactivity. Sensitivity to light, noise, texture and other stimuli may also
play a role.
 Overly sensitive children, who have what researchers call “high reactivity,” are
more likely to develop shy, timid or anxious personalities.
 However, high reactivity’s role is still far from clear-cut. Twenty percent of infants
are highly reactive, but less than 10 percent go on to develop social phobias.
5. Peers. Certain factors can help prevent children from developing personality
disorders.
 Even a single strong relationship with a relative, teacher or friend can offset
negative influences, say psychologists.
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42. Cont….
6. Environment and social circumstances: The environment
and social circumstances we grow up in and the quality of care
we receive can affect the way our personality develops.
7. Early life experiences: Our experiences growing up can affect
our personality in later life. If you had a difficult childhood, you
might have developed certain beliefs about the way people think
or act and how relationships work. This can lead to developing
certain strategies for coping which may have been necessary
when you were a child, but which aren't always helpful in your
adult life.
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