The document provides a comprehensive review of various personality disorders from the DSM-5, focusing on cluster B disorders such as antisocial, borderline, histrionic, and narcissistic personality disorders. It outlines diagnostic criteria, co-occurring disorders, contributing factors, assessment methods, and treatments including psychotherapies and medications for managing symptoms. The text emphasizes the challenges in treating these disorders due to patient denial of problems and manipulative behaviors, highlighting the importance of personalized therapeutic approaches.

1. Review of DSM5 Mental Disorders for NCMHCE Study

2. 1. Antisocial Personality
Disorder
2. Borderline Personality
Disorder
3. Histrionic Personality
Disorder
4. Narcissistic
Personality Disorder
 Cluster B disorders are
known as dramatic

3.  Pervasive patterns of thinking, moods and
actions
 Relative to self perception, distressing or
exciting circumstances, personal impulses
and urges, other people
 Begun in youth, consistent and inflexible in
many personal and social situations and
stable over time
 Causes problems

4. S2. Assess
Testing
 Personality Disorders
Questionnaire- 4
 MCMI3 (Millon)
 MMPI
 CATI (Coolidge )
 Dimensional
Assessment of
Personality Pathology—
Basic Questionnaire
 Structured Clinical
Interview
 International Personality
Disorder Examination
 NEO Five-Factor Inventory
 Thematic Apperception
Test
 Global Assessment of
Functioning scale
 Adult Attachment
Interview

5. S4.Treatment
Therapy
 PsychodynamicTherapy
 CBT
 CBT SchemaTherapy
 DBT
 MindfulnessTherapy
 Mentalization FocusedTherapy

7. Diagnosis I
Disregard for and violation of the rights of others,
lack of empathy, bloated self-image, manipulative
and impulsive behavior
 From age 15 and now at least 18 years old
 Evidence of conduct disorder and HDAD before
age 15

8. Diagnosis II
Requires 3 or more of the following:
 Failure to conform to social norms
and laws, repeatedly arrested;
 Deception, repeatedly lying, or
conning others
 Impulsivity or failure to plan ahead
 Irritability and aggressiveness, with
repeated physical fights or assaults
 Reckless disregard for
safety of self or others;
 Consistent
irresponsibility,
regarding work or
financial obligations
 Lack of remorse,
rationalizing having
mistreated

9. Diagnosis III
Co-occurring
1. Anxiety disorders
2. Depressive disorder
3. Impulse control disorders
4. Substance-related disorders
5. Somatization disorder
6. Attention deficit hyperactivity
disorder
7. Borderline personality disorder
8. Histrionic personality disorder
9. Narcissistic personality disorder
Contributing factors:
 Childhood ADHD
 Reading
problems
 Low IQ
 Brain injury
Rule out:
 Not only during
psychotic or
manic episodes

10. S1. Find Out S2. Assess & Refer
 MCMI3 (Millon)
 MMPI
 Structured Clinical
Interview

11. S4.Treatments
1.Very challenging
 Clients deny having a
problem and see no costs
of their actions
 Usually brought to
treatment by authorities
 May simulate remorse to
manipulate staff
 Non-critical, non-
judgmental stance
 Focus on practical benefits
of prosocial behavior
2.Therapy
 Schema therapy
 Multisystemic therapy
 Individual therapy, with
a structured and active
approach
 Reality Based Approach
forAnger Management,
substance use recovery,
and Social SkillsTraining

13. Diagnosis I
 Marked impulsivity and instability of affects,
interpersonal relationships and self image
 Highly sensitive to rejection
 Present by early adulthood

14. Diagnosis I
Requires at least 5 of following:
1. Frantic efforts to avoid real or
imagined abandonment
2. Unstable, intense
relationships with extreme
idealization and devaluation
3. Identity disturbance: unstable
self-image or sense of self
4. Impulsivity in at least 2 self-
damaging ways (substances,
eating, driving)
5. Recurrent suicidal or self-
mutilating threats or behavior
6. Emotional instability and
reactivity of mood
 intense episodic dysphoria,
irritability, or anxiety
 Lasting hours or day3445
7. Chronic emptiness
8. Inappropriate, intense anger
9.Transient, stress-related
paranoid ideation or severe
dissociative symptoms

15. Diagnosis II
Co-occurring: Rule out:
 Thyroid conditions
 Substance abuse
 Dissociative Identity
Disorder

16. S1. Find Out S2. Assess & Refer
 MCMI3 (Millon)
 MMPI
 Structured Clinical
Interview

17. 4.Treatments
Helpful for clients to
understand their
condition and direct
their care plan
 Expect problems
in relation to
therapist
 Long term care is
needed
 Family support
important
Psychotherapy
 Dialectical BehaviorTherapy is best
 Mentalization-based treatment (MBT)
 Transference-focused psychotherapy
 Schema-focused CBT may help
 STEPP group therapy
Medications for symptoms
 Depakote for impulsivity
 Naltrexone for self-injury
 Antipsychotics for disorganized
thinking

18. S5. Monitoring
 Improved social functioning
 More consistency in
relations with therapist
S6.Termination
 Monitor medications (may
be many)

20. Diagnosis 1
Onset in early adulthood
Exaggerates interpersonal problems and blames others
Requires:
1. Discomfort if one is not the center of attention
2. Inappropriate flirtatious and provocative behavior
3. Display of shallow and labile emotions
4. Dressing in a manner to draw attention to themselves
5. Speech is overly impressionistic and shallow
6. Theatrical and excessively emotional personal presentation
7. Suggestible by others and the situation, easily follows fads
8. Overestimates the level of intimacy in a relationship

21. Diagnosis II
Co-occurring:
 Borderline Personality
Disorder
 Substance abuse disorders
 Antisocial, Dependent, and
Narcissistic personality
disorders
 Depression
 Anxiety disorders
 Panic disorder
 Somatic disorders
 Anorexia nervosa
 Attachment disorders
Rule out:
 Bipolar, hypomanic
phase
 Borderline Personality
Disorder
 Narcissistic Personality
Disorder
 PTSD

22. S1. Find Out S2. Assess & Refer
 MCMI3 (Millon)
 MMPI
 Structured Clinical
Interview

23. S4.Treatments
Very challenging since clients deny
that they have a problem and
blame others
 May act suicidal or depressed
to gain attention
 Non-critical, non-judgemental
stance is essential
Possible treatments:
1. CBT
2. Long term
psychotherapy
3. GroupTherapy
4. Functional Analytic
Therapy (behavioral
therapy)

24. S5. Monitoring
 Social functioning
S6.Termination
 Monitor for suicide

26. Diagnosis I
Key:
 Excessively preoccupied
with adequacy, power and
prestige
 Unable to see the
destructive damage they
are causing to themselves
and to others in the process

27. Diagnosis I
Requires at least 5:
 Grandiose sense of self-
importance
 Preoccupied with
fantasies of success,
power, brilliance, or love
 Belief that they are
exceptional and can only
be understood by others
who are important
 Needs admiration
 Sense of entitlement
 Exploitative and
oppressive behavior
 No empathy
 Envious and resentful of
others or believes others
envy them
 Egotistical

28. Diagnosis III
Co-occurring:
 Depression
 Anxiety
 Substance abuse
Rule out:
 Substance abuse
 Antisocial personality
disorder
 Borderline personality
disorder
 Histrionic personality
disorder

29. S1. Find Out S2. Assess & Refer
 MCMI3 (Millon)
 MMPI
 Structured Clinical
Interview

30. S4.Treatments
 Very challenging since clients
deny symptoms
 Usually seeks treatment when
illness or other crisis shatters
illusions of perfection
 Will demand high status
clinician; derisive towards
lesser staff
 Initial approach of support
followed by step-by-step
confrontation of the patient’s
vulnerabilities
Therapy
 CBT as SchemaTherapy
 Psychoanalytic for anger,
envy, self-sufficiency
 Expressive, conflict-solving
psychotherapy
 Residential may be needed
Medications
 Depression
 Anxiety

31. S5. Monitoring
 Improved social
functioning
S6.Termination
 Monitor for suicide