Dr. Sujit Kumar Kar discusses the assessment and diagnosis of personality disorders. He notes that personality disorders involve enduring and inflexible patterns of inner experiences and behaviors that deviate from cultural expectations. These patterns manifest in at least two of four domains - cognition, affectivity, interpersonal functioning, and impulse control. Assessment involves collecting information from the individual, family, friends, and other sources to evaluate functioning in these domains. The enduring patterns must cause clinically significant distress or impairment and be stable over time to meet the criteria for a personality disorder diagnosis.

1. Dr.Sujit Kumar Kar
Assistant Professor in Psychiatry
King George’s Medical University, Lucknow, UP

2. What?
Why?
How?
When?
Whom?
Where?

3. An enduring
pattern of inner
experience and
behaviour as per
the expectations
of the individual’s
culture

4. How we behave?
How we respond/react?
How we interpret things?
How we cope?
How adaptable we are?
How flexible we are?

6. Deviation from the
expected norms
Pattern is manifested in two (or more) of the following areas
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control

7. Domains of assessment
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control
What is normal
personality?
Cognition
Affect
Impulse

8. How one behaves?
How one responds/reacts?
How one interprets things?
How one copes?
How adaptable one is?
How flexible one is?
• Clues
• Erratic behaviour / self-harm
• Exaggerated response/ no to poor
response / turmoil / impulsiveness
• Misinterpretations / biases /
blames
• Difficulties in coping /
maladjustments / easily frustrated
• Frequent changes in job /
relationship
• Stubbornness / rigidness
• Impairments in relationship/
workplace/ school / social
situations
• Unacceptable by others
• Complaints from others /
complaining
• Risk taking / novelty seeking

9. Collection of Information
• History
• Self
• Family members
• Friends
• Workmates
• Structured interviews
• Projective assessments
• Observation of behaviour in multiple settings

10. Domains of assessment
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control
Cognition
Styles
Attitude
Attributes
Biases

11. Style
- Learned behaviour
Vs
- Inherited behaviour

12. Attitude
• Derived from Latin word –
aptus……. Means FITNESS
• A state of readiness for mental and
physical activity
• Types
• Positive Vs Negative
• Inherited Vs Acquired
• Judgemental Vs Non-judgemental

14. Personality Vs Attitude
• Personality
• Static
• Kind of emotions, thoughts, and qualities a person holds
• Predictable
• Attitude
• Dynamic
• How a person behaves at a certain point of time
• Contextual

16. Possible attributes ….
• A patient is admitted in my unit. I am not able to write the case sheet in
time.
• Today morning, I reached late in my office.
WHY? .. WHY?

17. Attribution gives us a convincing reason
• How “attribution” helps us?
• How “attribution” is operated?

27. Domains of assessment
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control
Affect (Emotion)
Range
Intensity
Appropriateness
Stability

28. Domains of assessment
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control
Interpersonal functioning
Evaluate all the Interfaces of the relationships (relationship
with spouse, parents, friends, siblings, children)

29. Domains of assessment
• Cognition [Ways of perceiving and interpreting self, people and events]
• Affectivity [Range, intensity, lability and appropriateness of emotional response]
• Interpersonal functioning
• Impulse control
Impulse
Antecedent
Behaviour
Consequence

30. Suicidal behavior in personality disorder
Why?
• Poor impulse control
• More maladjustments  more stress
• High level of depression & hopelessness
• Misperception & underestimation of the lethality of suicide
• Seeking pain ?
H/o recurrent suicidal behaviour and h/o multiple suicidal attempts are
sensitive markers of suicidal attempt in future

31. Development of personality disorder: Risk factors
Why me?
• Genetic make up
• Parental psychopathology
• Family break down
• Traumatic events (parental loss, abuse, isolation, abandonment)
• Nature of parenting, Peer relation
Bio-psycho-social model of personality disorder

32. • Enduring pattern is inflexible and pervasive
across various domains of life
• Enduring pattern leads to clinically
significant distress or impairment
• Pattern is stable and of long duration
• Onset – Adolescence to young adulthood
• The pattern of behaviour is unexplainable
by any other psychiatric disorder or
substance use disorder

37. Summary
Evaluation of
Personality
disorder
Job
Relationship
Handling
stress
Adaptability
FlexibilitySelf harm
Sexuality
Co-
morbidities
Social
support

38. Thank
You