This document provides information on personality disorders including definitions, characteristics, prevalence, etiology, and treatment. It defines personality and personality disorders. Personality disorders are diagnosed when personality traits become inflexible and maladaptive. Common personality disorders discussed include paranoid, schizotypal, schizoid, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorders. Etiology may include genetic and biological factors as well as psychoanalytical factors. Treatment involves pharmacotherapy such as antidepressants, antipsychotics, and mood stabilizers as well as psychotherapy including CBT and DBT. Examples of characters from television exhibiting personality disorders are also provided.

1. PERSONALITY DISORDERS
– Dr. Ranjan Bhattacharya
– Associate Professor and HOD
– Dept of Psychiatry
– Msd MCH
– Dr. Aratrika Sen
– Senior Resident
– Dept of Psychiatry
– Msd MCH

2. PERSONALITY
Definition:
“Personality is the dynamic organization within the individual of those
psychophysical systems that determine his or her unique adjustment
with his or her environment" (Allport, 1961)
“The characteristics or blend of characteristics that make a person
unique" (Weinberg & Gould, 1999)
The totality of emotional and behavioral characteristics that are
particular to a specific person and that remain somewhat stable and
predictable over time.

3. PERSONALITY DISORDERS
 Are diagnosed when personality traits become inflexible and maladaptive and
significantly interferes with how a person functions in society or cause the
person emotional distress.
 Common and chronic disorder.
 Prevalence: 10-20% in general population.
 Approximately one half of all psychiatric patients have personality disorders.
 Personality Disorder is predisposing factor for other psychiatric disorders (eg:
substance abuse, suicide, affective disorders, impulse control disorders.)
 They are far more likely to refuse psychiatric help. They do not routinely feel
anxious or pain from their mal-adaptive behavior.

4. ETIOLOGY
GENETIC FACTORS
BIOLOGICAL
FACTORS
PSYCHOANALYTICAL
FACTORS

5. GENETIC
FACTORS
CLUSTER A
Paranoid
Schizophrenia
in biological
relatives
CLUSTER B
Alcohol use
disorders,
depression in
biological
relatives
CLUSTER C
Anxiety
disorder, OCD
in biological
relatives

6. BIOLOGICAL
FACTORS
HORMONES
High levels of
testosterone, estrone in
impulsive traits.
DST results are
abnormal in BPD.
PLATELET MAO
Low platelet MAO
noted in some patients
of Schizotypal
personality disorder.
NEUROTRANSMITT
ERS
Low Serotonin level in
Impulsive and
Aggressive patients.

7. PSYCHOANALYTICAL FACTORS:

10. ORGANIC
PERSONALITY
DISORDER:
 Personality change due to
structural brain damage
 Causes:
1. Head Trauma: commonest
2. CVA
3. Intracranial Neoplasms
4. Epilepsy
5. Neurosyphilis
6. Multiple Sclerosis
7. Heavy Metal Poisoning

11. PHINEAS GAGE
 Phineas P. Gage (1823–1860) was an
American railroad construction foreman
remembered for his improbable survival of
an accident in which a large iron rod was
driven completely through his head,
destroying much of his brain's left frontal
lobe, and for that injury's reported effects on
his personality and behavior over the
remaining 12 years of his life - effects
sufficiently profound (for a time at least)
that friends saw him as "no longer Gage’.
 It was perhaps the first case to suggest the
brain's role in determining personality, and
that damage to specific parts of the brain
might induce specific mental changes.

15. SCHIZOTYPAL PERSONALITY DISORDER:
 Prevalence: 3%
 M > F
 Ideas of Reference
 Odd beliefs,
magical thinking,
superstitious
 Suspiciousness
 Lack of close
friends
 Micropsychotic
episodes

16. SCHIZOID PERSONALITY DISORDER:
 Prevalence: 5%
 M > F
 More in solitary jobs.
 Onset: Early Childhood
 Do not enjoy close relation,
prefer solitary
 Indifference to praise/ criticism
 Lack of pleasure in any
activities.
 Do not enjoy sexual/ conjugal
life.
 Cannot express anger directly.
 Interest in mathematics,
astronomy
 Fantasy thinking.

17. PARANOID PERSONALITY DISORDER:
 2-4% of population
 M > F, Higher in Minority,
Immigrants
 Pre-occupied with unjustified
doubts
 Suspects people without
basis that they are
exploiting/harming.
 Reluctant to confide in others
 Bear grudge on others.
 Reads hidden demeaning
threat in trivial incident.
 Should not be diagnosed in a
course of Schizophrenia,
BPAD or other psychiatric
disorders.

19. ANTISOCIAL PERSONALITY DISORDER:
 Onset < 15yrs
 M > F
 Failure to stick to societal norms
 Unlawful behavior
 Lying, Deceitfulness
 Impulsivity, disregard for safety
for self / others.
 Aggressiveness, Assaultive
behaviour
 Lack of remorse
 H/O conduct disorder in
childhood

20. TED BUNDYJOHN WAYNE GACY LUIS GARAVITO

21. BORDERLINE PERSONALITY DISORDER:
 Pervasive instability of IPR, self-image and mood
 Fear of abandonment
 Unstable IPR, attending between extreme idealization and
devaluation.
 Identity disturbance
 Impulsivity that is self-damaging (excessive spending, substance
abuse, unprotected sex, reckless driving)
 Deliberate self-harm
 Chronic feeling of emptiness
 Affective instability
 Micro psychotic episode.

23. HISTRIONIC
PERSONALITY
DISORDER:
 F > M
 Frantic effort to be Centre
of attraction
 Overtly seductive,
Sexually provocative
 Shallow expression of
emotion
 Over-dramatisation

24. NARCISSISTIC PERSONALITY DISORDER:
 Grandiose sense of self-
importance and achievement
 Fantasies of unlimited success,
brilliance, beauty
 Craving for admiration and self-
entitlement
 Interpersonally exploitative,
envious, jealous
 Lacks empathy, Overtly arrogant,
Haughty

27. AVOIDANT
PERSONALITY
DISORDER:
 1-10% of general population
 Extreme sensitivity to rejection
 Although shy, but not asocial
 Show a great desire for
companionship
 Inferiority complex, lack of
self-confidence
 Afraid to speak in public

28. DEPENDENT PERSONALITY DISORDER:
 F > M
 2.5% of general population
 Persons with chronic physical
illness in childhood may be more
susceptible
 Pervasive pattern of dependence
and submissive nature
 Cannot take decisions without
excessive amount of advice and
reassurance
 Avoid positions of responsibility,
becomes anxious if asked to
assume a leadership role
 Seek out on others
 Relationships are distorted by their
need to be attached to another
person

29. OBSESSIVE COMPULSIVE PERSONALITY
DISORDER:  Also called anankastic personality disorder
 1-2% of general population
 M : F = 2:1
 More common in biological relatives of the
OCD patients
 Background of harsh discipline in
childhood
 Preoccupation with perfection,
organization, structure and control
 Excessive devotion to work
 Rule-conscious behavior
 Self-conscious and inability to forgive own
errors

31. TREATMENT
PHARMACOTHERAPY PSYCHOTHERAPY

32. PHARMACOTHERAPY:
1. ANTI- DEPRESSANT
 SSRI: Mostly in depressive symptoms
associated with BPD, ASPD, Avoidant,
Dependent & OCPD.
OCPD: High dose of SSRI [Fluoxetine,
Fluvoxamine, Sertraline, Escitalopram]
 TCA: Clomipramine, adjunctive therapy in
OCPD
Imipramine: In Nocturnal enuresis,
common in BPD
 NDRI: Bupropion, in smoking cessation in
BPD, ASPD, decreases performance anxiety in
cluster C
 MAOI: Decreases aggression in Schizotypal,
ASPD

33. PHARMACOTHERAPY:
2. ANTIPSYCHOTICS:
 Second generation antipsychotics
used to treat the psychotic
episodes in Cluster A & B
 Aripiprazole: to decrease the
aggression in BPD
 Pimozide: Decrease delusional
component of Cluster A
 Clozapine: decrease suicidality,
DSH in BPD
 As an add-on therapy in Cluster
C

34. PHARMACOTHERAPY:
3. MOOD STABILISER
 LiCO3, Na Valproate,
Divalproex Na, Lamotrigine,
Carbamazepine
 Decrease the impulsivity,
affective instability in Cluster B
 LiCO3: Anti-suicidal, decrease
DSH in BPD
 Valproate: used in chronic
dysphoria of BPD

35. PHARMACOTHERAPY:
4. BENZODIAZEPINES:
 In anxiety, insomnia, Predominantly in Cluster
C, also used in Cluster A & B
 To be used for short duration.
 To be used judiciously in BPD, may develop
dependence to BZDs
5. OTHERS:
 CLONIDINE: decrease aggression
 NALTREXONE: decrease agitation
 PROPRANOLOL: decrease anxiety symptoms
 METHYL PHENIDATE / ATOMOXETINE:
Used in associated ADHD symptoms in BPD

36. PSYCHOTHERAPY:
 Treatment of choice for any PD
 Building rapport, therapeutic
alliance is pre-requisite for
favorable outcome.

37. PSYCHOTHERAPY:
1. INDIVIDUAL
PSYCHOTHERAPY:
 Mostly in Cluster A
 In patients who face difficulty
in interacting with others
 Also helpful in Cluster C
 Supportive
2. GROUP THERAPY:
 Mostly in Cluster B & C
 In Cluster A, it is to be
preceded by Individual
Psychotherapy

38. PSYCHOTHERAPY:
3. CBT:
Treatment of choice in Cluster B & C
4. INSIGHT ORIENTED
PSYCHOTHERAPY:
Cluster C
5. MENTALIZATION BASED
THERAPY:
In BPD
6. DIALECTICAL BEHAVIOR
THERAPY:
In BPD

39. TELEVISION
AND
PERSONALITY
DIOSRDERS

40. PHEOBE [FRIENDS]
SCHIZOTYPAL
HEAD BUTLER
[REMAINS OF THE
DAY]
SCHIZOID
JERRY
[CONSPIRACY
THEORY]
PARANOID

41. Dr. HANNIBAL LECTER
[HANNIBAL] ASPD
RON [ANCHORMAN]
NARCISSISTIC
SUSANNA [GIRL,
INTERRUPTED] BPD
SCARLETT [GONE WITH
THE WIND]
HISTRIONIC

42. SHELDON COOPER [BIG BANG THEORY]
OCPD
ROSS [FRIENDS] DEPENDENT