This document provides an overview of personality disorders, including their definition, classification, causes, and treatment. It discusses the main personality disorder clusters (A, B, and C), describing the key features of disorders within each cluster such as paranoid, schizoid, borderline, narcissistic, and obsessive-compulsive personality disorders. The document also covers the genetic and environmental factors involved in the development of these conditions, their prevalence rates, and challenges with treatment, which typically involves supportive psychotherapy rather than a focus on past issues. Pharmacological interventions may help specific symptoms but are generally not effective as a standalone treatment.

1. 1

2. 
The understanding of personality and its
disorders distinguishes psychiatry
fundamentally from all other branches of
medicine.
A person is a self-aware human being not “a
machine-like object that lacks self-awareness.”
(C. Robert Cloninger)
2
Introduction

3. 
Personality
 Is the dynamic organization of the psychobiological
systems by which a person shapes and adapts in a
unique way to changing internal and external
environments.
 personality develops through the interaction of hereditary
dispositions and environmental influences.
 Basic functions of personality are to feel, think, and
perceive and to incorporate these into purposeful 3
Introduction

4. 
 The totality of somebody's attitudes, interests,
behavioral patterns, emotional responses, social roles,
and other individual traits that endure over long
periods of time.
 Are enduring patterns of perceiving and thinking about
the environment and oneself that are exhibited in a
wide range of social and personal contexts 4
Introduction

5. 
 DSM 5 defines personality disorders as
 Enduring pattern of behaviour and inner experience
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.
5
Personality disorder

6. 
• It manifests in at least two of the following four
areas: cognition, affectivity, interpersonal function,
or impulse control.
• When personality traits are rigid and maladaptive
and produce functional impairment or subjective
distress, a personality disorder may be diagnosed.
6

7. 
Personality disorder
 Common and chronic disorder.
 Occur in 10 to 20 % of the general population and in
about half of psychiatric patients.
 Generally considered to have poor prognosis.
 It is a predisposing factor for other psychiatric disorders.
7
Cont’d…

8. 
 Persons with personality disorders are far more likely to
refuse psychiatric help and to deny their problems .
 Personality disorder symptoms are alloplastic (i.e., able
to adapt to, and alter, the external environment) and ego-
syntonic (i.e., acceptable to the ego).
8
Cont’d…

9. 
Personality disorder subtypes are:
 Cluster A - Schizotypal, Schizoid, and Paranoid.
 Odd, aloof features.
 Cluster B- Narcissistic, Borderline, Antisocial, and Histrionic
 Dramatic, impulsive, and erratic features.
 Cluster C- Obsessive-compulsive, Dependent, and
Avoidant
 Anxious and fearful features.
 Many persons exhibit traits that are not limited to a single 9
Classification

10. 
Genetic Factors
 Among monozygotic twins, the concordance for personality
disorders was several times that among dizygotic twins.
 Cluster A personality disorders
 Are more common in the biological relatives of patients with
schizophrenia .
 Cluster B personality disorders.
 Antisocial personality disorder is associated with alcohol use
disorders.
 Depression is common in the family of patients with borderline
personality disorder.
10
Etiology

11. 
A strong association is found between histrionic
personality disorder and somatization disorder.
Cluster C personality
Patients with avoidant personality disorder often
have high anxiety levels.
Patients with obsessive-compulsive personality
disorder show some signs associated with
depression.
11
Cont’d…

12. 
Biological Factors
 Persons who exhibit impulsive traits also often show high
levels of testosterone, 17-estradiol, and estrone.
 Low platelet MAO levels have been associated with
activity and sociability.
 High endogenous endorphin levels may be associated
with persons who are phlegmatic.
12
Cont’d…

13. 
Psychoanalytic factor
 Sigmund Freud suggested that personality traits are
related to a fixation at one psychosexual stage of
development. For example,
 Those who fixated at the oral stage are passive and
dependent.
 Those with an anal character are stubborn,
parsimonious, and highly conscientious because of
struggles over toilet training during the anal period.
13
Cont’d…

14. 
 Individuals with these disorders often appear odd or
eccentric /aloof
 Paranoid PD
 Schizoid PD
 Schizotypal Personality Disorders
14
Cluster A includes

15. 
 characterized by long-standing suspiciousness and
mistrust of persons in general.
 They are often hostile, irritable, and angry.
 such persons often are pathologically jealous
 This tendency begins by early adulthood and appears in
a variety of contexts.
 Almost invariably, those with the disorder expect to be
exploited or harmed by others in some way.
15
Paranoid Personality Disorder

16. 
 The prevalence is 2 to 4 percent in general population.
 More common in men and does not appear to have a
familial pattern.
 Higher among minority groups, immigrants, and persons who
are deaf than it is in the general population.
16
Cont’d….

17. 
 A pervasive pattern of detachment from social
relationships
 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
17
Schizoid Personality Disorder

18. 
The prevalence is not clearly established, but the disorder
may affect 7.5% of the general population.
The sex ratio of the disorder is unknown; some studies
report a 2:1 male-to-female ratio.
The onset ,usually occurs in early childhood.
The disorder is long lasting, but not necessarily lifelong.
18
Cont’d…

19. 
 Are strikingly odd or strange, even to laypersons.
 Magical thinking, peculiar notions, ideas of reference,
illusions, and derealization are part of a schizotypal
person's everyday world.
 They exhibit disturbed thinking and communicating.
19
Schizotypal Personality Disorder

20. 
 Are sensitive to, and aware of, the feelings of others,
especially negative affects such as anger.
 Their inner world may be filled with vivid imaginary
relationships and child-like fears and fantasies.
 Have poor interpersonal relationships and may act
inappropriately.
20
Cont’d…

21. 
 Occurs in about 3% of the population.
 The sex ratio is unknown.
 Patients may show features of borderline personality
disorder, and indeed, both diagnoses can be made.
 Patients with severe cases of the disorder may exhibit
anhedonia and severe depression.
21
Cont’d…

22. 
 Antisocial
 Borderline
 Histrionic
 Narcissistic Personality Disorders.
 Individuals with these disorders often appear dramatic,
emotional, or erratic/inconsistent
22
Cluster B PD includes

23. 
 Is an inability to conform to the social norms that
ordinarily govern many aspects of a person's adolescent
and adult behavior.
 Lying, truancy, running away from home, thefts, fights,
substance abuse, and illegal activities are typical
experiences.
 Promiscuity, spousal abuse, child abuse, and drunk
driving are common events in their lives.
 A notable finding is a lack of remorse for these actions. 23
Antisocial Personality Disorder

24. 
 Prevalence - 3 % in men and 1% in women.
In prison populations, may be as high as 75 %.
 It is most common in poor urban areas and among mobile residents of
these areas.
 Boys with the disorder come from larger families.
 Onset of the disorder is before the age of 15.
 A familial pattern is present;
 5x more common among first-degree relatives of
men with the disorder than among controls. 24
Cont’d…

25. 
 They are characterized by extraordinarily unstable affect,
mood, behavior, object relations, and self-image.
 Patients can be argumentative at one moment,
depressed the next, and later complain of having no
feelings
 unstable and intense interpersonal relationships
 Almost always appear to be in a state of crisis.
25
Borderline Personality Disorder

26. 
26
Cont’d…
 The painful nature of their
lives is reflected in repetitive
self-destructive acts.
 Slash their wrists and perform
other self-mutilations to elicit
help from others
 To express anger, or to
numb themselves to
overwhelming affect.

27. 
 It is thought to be present in about 1 to 2% of the
population
 Common in women(2x).
 An increased prevalence of
 Major depressive disorder, alcohol use disorders, and
substance abuse is found in first-degree relatives.
27
Cont…

28. 
 Characterized by excitable and emotional and behave in a
colorful, dramatic, extroverted fashion.
 Show a high degree of attention-seeking behavior
 They tend to exaggerate their thoughts and feelings and
make everything sound more important than it really is.
28
Histrionic Personality Disorder

29. 
 They display temper tantrums, tears, and accusations
when they are not the center of attention or are not
receiving praise or approval.
 Prevalence - 2 to 3% in general population
 Common in female
29
Cont’d…

30. 
30
 Is uncomfortable in situations in
which he or she is not the center of
attention
 Displays rapidly shifting and
shallow expression of emotions
 Consistently uses physical
appearance to draw attention to self
 Has a style of speech that is
excessively impressionistic and
lacking in detail

31. 
 Characterized by a heightened sense of self-importance and
grandiose feelings of uniqueness.
 They consider themselves special and expect special
treatment.
 Their sense of entitlement is striking.
31
Narcissistic Personality Disorder

32. 
 They handle criticism poorly, or they may appear completely
indifferent to criticism.
 Frequently ambitious to achieve fame and fortune.
 Prevalence - 2 -16 % in the clinical population, < 1 % in the
general population.
 Offspring of such parents may have a higher than usual risk for
developing the disorder themselves.
32
Cont’d…

33. 
 Avoidant
 Dependent
 Obsessive-Compulsive Personality Disorders.
 Individuals with these disorders often appear anxious
or fearful.
33
Cluster C PD includes

34. 
 Avoidant personality disorder is common.
 Are extremely sensitivity to rejection and may lead a
socially withdrawn life.
 Such persons are commonly described as having an
inferiority complex.
34
Avoidant Personality Disorder

35. 
 Hypersensitivity to rejection by others is the central
clinical feature, and patients' main personality trait is
timidity(fear)
 They often have no close friends or confidants.
 The prevalence - 1 to 10% the general population.
 No information is available on sex ratio or familial
pattern.
35
Cont’d…

36. 
36
 A pervasive pattern of
social inhibition,
feelings of inadequacy,
and hypersensitivity to
negative evaluation

37. 
 Has been called passive-dependent personality.
 Characterized by a pervasive pattern of dependent and
submissive behavior.
 They cannot make decisions without an excessive amount
of advice and reassurance from others.
 They avoid positions of responsibility and become
anxious if asked to assume a leadership role.
 Pessimism, self-doubt, passivity, and fears of expressing
sexual and aggressive feelings. 37
Dependent Personality Disorder

38. 
 An abusive, unfaithful, or alcoholic spouse may be
tolerated for long periods to avoid disturbing the sense of
attachment.
 More common in women
 Prevalence- 2.5%
 Persons with chronic physical illness in childhood may be
most susceptible to the disorder.
38
Cont’d…

39. 
 Characterized by emotional constriction, orderliness,
perseverance, stubbornness, and indecisiveness.
 The essential feature of the disorder is a pervasive pattern of
perfectionism and inflexibility
 They are preoccupied with rules, regulations, orderliness,
neatness, details, and the achievement of perfection.
 Have limited interpersonal skills.
 They are capable of prolonged work, provided it is routinized
and does not require changes to which they cannot adapt.
39
Obsessive-Compulsive Personality Disorder

40. 
The prevalence disorder is unknown.
It is more common in men and is diagnosed most often
in oldest children.
 Occurs more frequently in first-degree biological
relatives of persons with the disorder than in the
general population.
 Patients often have backgrounds characterized by
harsh discipline.
40
Cont’d…

41. 
Pharmacotherapy
 In general, no single pharmacologic treatment is effective in the
treatment of a particular personality disorder.
 Medications may be of use in reducing certain features of the
disorders, but they are generally limited and are typically ineffective
in alleviating other symptoms.
• Because of the enduring nature of the problems
associated with these disorders, symptoms that
have responded to pharmacologic treatment often
return when the medication is stopped.
41
Treatment

42. 
 The effect of somatic treatments may be limited as a
result of the large psychosocial component.
Psychotherapy
 Patients with personality disorders tend to be challenging
to therapists.
 The fixedness and duration of their problems makes these
problems difficult to alter in a brief treatment.
42
Cont’d…

43. 
Alliance between therapist and patient is critical.
• Giving direct advice on personal and social problems
should be avoided .
Many of these patients appear to benefit from
supportive and cognitive therapy that is focused
more on current life issues than on past concerns
43
Cont’d…

44. 
Management of personality change disorder
involves treatment of the underlying organic
condition when possible.
Psychopharmacological treatment of specific
symptoms.
44

45. 
45