Personality Disoder

1. Personality Disorders
Mr. Jayesh Patidar (Assit.Professor)
Manikaka Topawala Institute of Nursing
CHARUSAT ,Changa

2. What is a Personality
• Greek word Persona.(Theatrical Mask worn by dramatic actor)
• Over the years ,it lost its connoation of pretense & illusion & come to
represent person behind the mask.-the real person
• (If the person does did, does that, what capacity, Has got this capacity
–No)
• Personality- Predictable response/Behavior of the individual to the
envt.(Other people & the world in general)
• So what the other people say ,what the other people feel. How you
behave with a other people & the world in general ,your
response,behavior,given to envt.in response to Envt.

3. What is personality Disorder
• It is a group of Psychiatric condition in which persons long term
behaviors, emotions & thought are very different from their culture
expectations & cause serious problem with relationship and work.
• It occur when personality traits become inflexible & maladaptive &
cause either significant functional impairment or subjective distress.
• Person with PD are fare more likely to refuse psychiatric help & deny
their problems .
• Personality disorder is not the same as mental illness, so to speak.
The symptoms of mental illness are not continuous, but mostly
episodic. The symptoms of personality disorders are continuous and
start from adolescence or even before.

4. Definition
• The DSM-IV-TR defines paranoid personality disorder as “a pervasive
distrust & suspiciousness of others such that their motives are
interpreted as malevolent, beginning by early adulthood & present in
a variety of contexts” (APA, 2000).
• PD. Happened when the features of the personality cause subjective
distress to the individual & or to those associated with the individual
or significant impairment in social or occupational function.

5. Epidemiology
• Common & Chronic
• Prevalence is estimated between 10 -20% in general population
• Approximately one half of all psychiatric patients have PD.
• The prevalence of paranoid personality disorders is estimated at 0.5%
to2.5% of the general population, it’s more common in males.

6. Characteristics of Personality disorders
• An enduring pattern of psychological disturbances
• Behavior differs prominently from cultural expectations
• Behavior pattern must appear inflexible & pervasive across a wide
range of situations.
• Behavior leads to significant important in important area of
functioning
• Maladaptive pattern must be stable & long lasting
• Problem start early during the stage of adolescence or early
adulthood.

7. Etiology
• Genetic Factor – Monozygotic twins
• Biological Factors- Person who exhibit impulsive traits also often
show high level of testosterone,17-estradiol.Low platelet MAO level
have also been noted in some patients with schizotypal.
• Neurotransmitters- fluoxetine produce dramatic changes
• Electrophysiology – Changes in EEG (Most commonly antisocial and
borderline)
• Psychoanalytical factors- oral character are passive & dependent
because of fixated at oral stage, when dependence on others for
food. Anal character are stubborn,Parisimonious& Highly
conscientious.

8. Classification
Whenever you learn psychology & try to look at D.S.M. criteria one of the
important criteria, always is there should be social functional and the
occupational function.
In DSM IV, personality disorder are coded on axis II and have been divided
into three clusters,
• 1. Cluster A (Odd and eccentric)
• 2. Cluster B (Dramatic, emotional, erratic)
• 3. Cluster C (Anxious and fearful)

9. Clusters of personality disorders
DSM-IV-TR
• Cluster A includes disorders of an odd or eccentric nature (paranoid,
schizoid, schizotypal),Absence of close relatives, can not make good
friends, Commonly seen in biologic relatives of schizophrenic.
• Cluster B includes disorders of an erratic, dramatic, or emotional
nature (antisocial, borderline,histrionic, narcissistic)Stormy relations
&Sudden outburst anger ,Alcholisum,Somatization disorder.
• Cluster C includes those of an anxious or fearful nature (avoidant,
dependent, obsessive-compulsive)Self doubt,Never sure about
himself,

10. Cluster A (odd and eccentric)
a. Paranoid personality disorder:
• Paranoid personality disorder is more prevalent in male then females.
• This disorder is marked by a distrust of other people and a constant
unwarranted suspicion that others have sinister motive.
• Person with this disorder search for hidden meanings and hostile
intention in everything others say or do.

11. SIGNS AND SYMPTOMS:
• Suspicious.
• Mistrustful.
• Argumentative.
• Stubborn.
• Self-importance.
• Hypersensitive.
• Jealous
• Irritable

12. Clinical Features
• The hallmarks of paranoid personality disorder are
• suspicion & distrust of others’ motives. Other features
• include:
• Refusal to confide in others
• Inability to collaborate with others
• Hypersensitivity
• Inability to relax (hypervigilance)
• Self-righteousness
• Detachment & social isolation
• Poor self – image
• Sullenness, hostility, coldness & detachment
• Humorlessness
• Anger, jealousy & envy
• Bad temper, hyperactivity & irritability
• Lack of social support systems.

13. • Paranoid – Attributing responsibility of own problems/motives to others
,Suspicious ,Untrusting ,Grudges, hidden meaning in comments or events(No
delusion or Hallucination) Projection (M)
• Schizoid – Isolation, no longing for others , ‘’Longer ‘’Social withdrawal
,restricted, restricted emotional expression ,no Psychosis.
• Schizotypal – Eccentric, weired,odd behavior, thought speech, Magical
thinking, Lack of close friends ,Mismatched behavior.

14. Predisposing Factor
• The specific cause of paranoid personality disorder is unknown. Its
higher incidence in families with a schizophrenic member suggests a
possible genetic influence.
• Some expert believe that the disorder result (at least partly) from
negative childhood experiences & a threatening domestic
atmosphere
• – for example, extreme unfounded rage or condescension by the
parents, which can produce profound insecurity in the child.

15. Schizoid personality disorder:
• Schizoid personality disorder is characteristic by detachment and
social withdrawal. People with this disorder are commonly described
as loners, with solitary interest and occupations and no close friends.
• Typically they maintain a social distance even from family members
and seem unconcerned about others

16. SIGNS AND SYMPTOMS:
• Emotionally cold.
• Humourless.
• Aloof.
• Introspective.
• No desire for enjoyment of close relationship.
• Inability to experience pleasure.

17. Definition
• 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 individual displays a lifelong pattern of social
withdrawal & their discomfort with human interaction is very
apparent.

18. Epidemiological Statistics:-
• The prevalence of schizoid personality disorder within general
population has been estimated at between 3 & 7.5%. it is diagnosed
more frequently in men.

19. Clinical Features
• Emotional detachment
• Inability to experience pleasure
• Lack of strong emotions & little observable change in mood
• Avoidance of activities that involve significant interpersonal contact
• Little desire for or enjoyment of close relationships
• No desire to be part of a family
• Strong preference for solitary activities
• Little or no interest in sexual experiences with another person
• Lack of close friends or confidants other than immediate family members
• Shyness, distrust & discomfort with intimacy
• feeling of superiority
• loneliness
• self-consciousness
• Oversensitivity to slights.

20. Predisposing Factors
• As with the other personality disorders, the exact cause of schizoid
personality disorder isn’t known. Some researchers think it may be
inherited. Other possible causes may include:
• A sustained history of isolation during infancy & childhood
• Cold or grossly deficient early parenting
• Parental modeling of interpersonal withdrawal, indifference, &
detachment.

21. Schizotypal disorder:
• This disorder is marked by odd thinking and behavior, a pervasive
pattern of social and interpersonal deficits and acute discomfort with
others

22. SIGN AND SYMPTOMS
• Inappropriate affect.
• Odd believes or magical thinking.
• Social withdrawal.
• Odd, eccentric or peculiar behavior.
• Lack of close relationship.
• Social isolation.
• Not fitting easily with others.

23. Cluster B (dramatic, emotional,erratic)
a. Antisocial personality disorder.
• Antisocial personality disorder is characterized by chronic antisocial
behavior that violates other rights or social norms which predisposes
the affected person to the criminal behavior
• The person is unable to maintain the consistent, responsible
functioning at work, school or as a parent.

24. SIGN AND SYMPTOMS
• Failure to sustain the relationship.
• Impulsive actions.
• Low tolerance to frustration.
• Tendency to cause violence.
• Lack of guilt
• Inability to maintain close personal or sexual
• relationship

25. b. Histrionic personality disorder
• Patient with this disorder is characteristically have a pervasive pattern
of excessive emotionality and attention seeking behavior and are
drawn to momentary excitement and fleeting adventure.
• This disorder is most common in female. People with this disorder
need to be the center of attention at all time

26. SIGN AND SYMPTOMS
• Dramatic emotionality (emotional blackmail,angry scenes,
demonstrative suicide attempts.)
• Attention seeking behavior.
• Lack of considerations for other
• Self-dramatization

27. c. Narcissistic personality disorder.
• Patient with Narcissistic personality disorder is self-centered, self-
absorbed and lacking in empathy for others.
• He typically takes advantages of people to achieve his own ends, and
uses them without regards to their feelings.

28. SIGN AND SYMPTOMS
• Attention seeking
• Dramatic behavior
• Unable to face criticism.
• Lack of empathy.
• Arrogances.
• Exploitative behavior

29. d. Borderline personality disorder
• Borderline personality disorder is marked by a pattern of instability in
interpersonal relationship, mood, behavior, and self-image.

30. SIGN AND SYMPTOMS
• Unstable relationship.
• Unstable self-image
• Unstable emotions
• Impulsivity

31. Other S/S includes
• Lack of control of anger.
• Recurrent suicidal threats or behavior.
• Uncertainty about personal identity.
• Chronic feeling of emptiness

32. Cluster B(Dramatic & Emotional)
• Histrionic – Excess emotion, attention-seeking ,colurfull,dramatic,extrovert,no
long lasting relationship ,wanting spotlight, seductive –
Regression,somatization,Conversion,Dissociation(f)
• Narcissistic – Grandiose ,overconcerned with self ,self imp,fantasies of
unlimited wealth ,Power ,love, fragile ,prone to depression
,Criticism(Indifference or rage)
• Borderline – Unstable mood ,self image ,relationship in or chaos,self
detrimental, Promiscuity ,gamble,overeating,substance abuse ,unstable with
inferse personal relationship.
• Antisocial – Not recognizing the right of others,lifelongs criminal (theft,
running away, jobs)non-endurance,young age onset,conduct disoder

33. 3. Cluster C (anxious and fearful)
a. Avoidant personality disorder
• People with this disorder have low self-esteem, and poor self-
confident, they will be negative and have a difficulty in viewing
situation and interactions objectives

34. SIGNS AND SYMPTOMS
• Fear of disapproval or rejection.
• Unwillingness to become involved with people.
• Shyness.
• Insecurity

35. • The persons having this disorder also have other psychiatric disorder
like – social phobia, anxiety disorder, OCD, depressive disorder,
somatoform disorder, etc.

36. b. Dependent personality disorder
• This disorder is characterized by an extreme need to be taken care of,
which leads to submissive and fear of separation or rejection. People
with this disorder, let other make important discussion for them and
have a strong need for constant reassurance and support

37. SIGN AND SYMPTOMS:
• Feeling uncomfortable and helplessness.
• Inability to make decisions.
• Low self-esteem and lack of self-confidence.
• Hypersensitivity.

38. c. Obsessive compulsive personality disorder
• The individual places a great deal of pressure on himself and other
not to make a mistake.
• Believes his way of doing something is the only correct way, may force
himself and others to follow right moral principles.

39. SIGN AND SYMPTOMS
• Feeling of excessive doubt and caution.
• Perfectionism.
• High standards

40. Cluster A- Odd or Eccentric Disorders:
• Paranoid- suspicious, distrustful, hostile attributions
• Schizoid- interpersonally and emotionally cut-off, constricted, unresponsive
(the loner)
• Schizotypal- odd thoughts, feelings, behaviors, experiences, poor
interpersonal functioning
Cluster B-Dramatic, Emotional or Erratic Disorders:
• Histrionic- dramatic, attention-seeking, emotionally shallow
• Narcissistic- inflated sense of self-importance, entitled, low empathy, hidden
vulnerability
• Antisocial- pattern of behaviors that disregard laws and norms and rights of
others
• Borderline- instability in thoughts, feelings, behavior and sense of self
Cluster C- Anxious or Fearful Disorders:
• Obsessive-Compulsive- rigid, controlled, perfectionistic
• Avoidant- fear of negative evaluation and abandonment
• Dependent- submissive, dependent on others for self-esteem, fear of
abandonment

41. • Histrionic (Silent features)- Dressing ,flirting, mirror-make up, Crying –
Laughing,Strange,Draw attention.
• Antisocial- Making stories,Malingering,
-Faking-lying Addiction,No sense of Guilt,
Incarcerations,Punishment,Suspensions,expulsion,Murder,rape,beating,theft.
• Dependent – Getting other to assume responsibility
Indecisive (Can not take decision)
Leaving it for other to do
If you ask something ‘ Decide what you want ,I am afraid,I will take your help,I
am not good at all,Please do it for me,I am sure you would do it for me.

42. Avoidant –
Shy
Not mixing
Trying to avoid
‘’ Not me’’
I am afraid
I don’t want to be in it.
Well let me see, but I don’t think I can
Is it really necessary

43. Paranoid
Belief about others
‘’ Everybody is after me”
“Everyone dislike me”
“ Everyone hurt me”
“ They do not do my work deliberately.

44. TREATMENT
1.ANXIOLYTIC DRUGS:
• To treat severe stress,
• Alprazolam
• Ativan
• Librium
• Diazepam, etc

45. 2. NEUROLEPTIC DRUGS:
ANTIPSYCHOTIC
It can be useful in case of paranoid and schizotypal personality
disorder.
• - Olanzapine
• - Haloperidol
• - Droperidol

46. 3. PSYCHODYNAMIC TREATMENT:
• It’s also known as the insight oriented therapy, focuses on
unconscious processes as they are manifested in a person’s present
behavior.

47. • The goal of psychodynamic therapy is a client’s self-awareness and
understanding of the influence of the past on present behavior

48. 4. COGNITIVE AND BEHAVIOUR TEHRAPY
• Most cognitive behavioral approaches address specific aspects of
thought, feelings, behavior, or attitude and do not claim to treat the
entire personality disorder of the person.

49. CONCLUSION:
• abnormal personality can be defined as "deeply ingrained maladaptive
pattern of behavior, continuing throughout the most of adult life,
although often becoming less obvious in middle or old age