There are 10 personality disorders classified into 3 clusters: A) odd/eccentric behavior, B) dramatic/emotional behavior, and C) anxious/fearful behavior. Some disorders include paranoid personality disorder, characterized by distrust and suspiciousness, and avoidant personality disorder, characterized by social inhibition and feelings of inadequacy. Treatment may involve medication, psychotherapy, social skills training, and cognitive behavioral therapy.

1. Personality Disorders
M.S Sara Dawod

2. Personality Disorders
• A heterogeneous group of disorders defined
by longstanding, pervasive, inflexible pattern
of behavior and inner experiences that
deviate from the expectations of their culture,
manifested in two or more of the following
areas: cognition, emotion, relationship,
impulse control.
• There is 10 personality disorders which are
classified into 3 groups:

3. Personality Disorders
• Cluster A: odd or eccentric behavior or bizarre
thinking, including: paranoid, schizoid,
schizotypal personality disorders.
• Cluster B: dramatic or emotional behaviors,
including: antisocial, borderline, histrionic,
narcissistic personality disorders .
• Cluster C: anxious of fearful behaviors,
including: avoidant, dependant, obsessive
compulsive personality disorders.

4. Paranoid personality disorder
A. Pervasive distrust and suspiciousness of
others , beginning early adulthood, as indicated
by 4 or more of the following:
1. Suspects, without sufficient basis, that others
are exploiting, harming, or deceiving them.
2. Preoccupied with unjustified doubts about
the loyalty or trustworthiness of others.
3. Reluctant to confide others because of
unwarranted fear that the information will be
used against them.

5. Paranoid personality disorder
4. Reads hidden demeaning or threatening
meanings into benign remarks or events.
5. Persistently bears grudges, i.e., is unforgiving of
insults, injuries, or slights.
6. Perceives attacks on their character or reputation
that are not apparent to others and is quick to react
angrily or to counterattack.
7. Has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner

6. Paranoid personality disorder
B. Doesn't occur exclusively during the course of
schizophrenia, a mood disorder with psychotic
features, or another psychotic disorder and is
not due to the direct physiological effects of a
general medical condition.

7. Paranoid personality disorder
• Other features:
• Difficult to have close relation, fear love,
interest in electronics.
• They are rigid.
• Less impairment in social and occupational
functioning.
• Comorbid with schizotypal, borderline, and
avoidant personality disorders.

8. Paranoid personality disorder
• Etiology: fear of shame, homosexual
underlying conflict.
• Treatment: respect and trust, and set limit in
threatening situations.

9. Schizoid personality Disorder
A. Pervasive pattern of detachment from social
relationships and a restricted range of expression
of emotions in interpersonal settings, beginning by
early adulthood, as indicated by 4 or more of the
following:
1. Neither desires nor enjoys close relationships,
including being part of a family.
2. Almost always chooses solitary activities that don’t
include interaction with others (mechanical:
computer or abstract thinking: math games.

10. Schizoid personality Disorder
3. Has little, if any, interest in having sexual
experiences with another person (often don’t
marry).
4. Takes pleasure in few, if any, activities.
5. lacks close friends or confidants other than
first-degree relatives .
6. Appears indifferent to the praise or criticism
of others .
7. Shows emotional coldness, detachment, or
flattened activity (smile, nod, anger, joy).

11. Schizoid personality Disorder
B. Does not occur during the course of schizophrenia,
mood disorder with Psychotic Features, another
Psychotic Disorder and is not due to the direct
physiological effects of a general medical condition.
• Other information:
• M more than F
• Uncommon in clinical setting, long lasting disorders,
have successful work history.
• Etiology: culture, family interactive style, genetics.

12. Schizotypal personality disorder
Perception, thinking and communication are disturbed.
A. Pervasive pattern of social and interpersonal deficits
marked by acute discomfort with, and reduced capacity for,
close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, beginning by early
adulthood and, as indicated by 5 or more of the following:
1. ideas of reference: incorrect interpretation of events as
having unusual meaning (excluding delusions of reference).
2. odd beliefs or magical thinking that influences behavior and
is inconsistent with subcultural norms (special powers to
sense events before they happen or read others thoughts).

13. Schizotypal personality disorder
3. Unusual perceptual experiences, including bodily
illusions.
4. Odd thinking and speech.
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or
peculiar .
8. Lack of close friends or confidants other than
first-degree relatives .
9. Excessive social anxiety that does not diminish
with familiarity and tends to be associated with
paranoid fears.

14. Schizotypal personality disorder
B. Does not occur during the course
of schizophrenia, mood disorders with psychotic
features, another Psychotic Disorder, or
a pervasive developmental disorder.

15. Schizotypal personality disorder
• Other information:
• Seek treatment for depression, anxiety and
another symptoms rather than for personality
disorder.
• Causes for cluster A: genetics.
• Patients with schizophrenia are at increased
risk for these personality disorders especially
schizotypal.

16. Antisocial personality disorder
A. Pervasive pattern of disregard for and
violation of the rights of others occurring since
age 15 years, as indicated by 3or more of the
following:
1. Failure to conform to social norms with
respect to lawful behaviors.
2. Deceitfulness (repeated lying) .
3. Impulsivity or failure to plan ahead (take
decisions without thinking about
consequences).

17. Antisocial personality disorder
4. Irritability and aggressiveness, as indicated by
repeated physical fights or assaults.
5. Reckless disregard for safety of self or others
(driving, accidents).
6. Consistent irresponsibility (repeated failure to
sustain consistent work behavior or honor
financial obligations).
7. Lack of remorse (being indifferent to or
rationalizing having hurt, mistreated, or stolen
from another).

18. Antisocial personality disorder
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with
onset before age 15 years.
D. The occurrence of antisocial behavior is not
during the course of schizophrenia or a manic
episode.

19. Antisocial personality disorder
• Other information:
• It occurs in low socioeconomic class and urban
settings.
• M>F
• It is chronic disorder and becomes less evident
as individual grows older.

20. Etiology
• Genetic factors.
• Social factors: especially in first 5 years of life.
Family environment: high negativity, low warmth,
poverty, exposure to violence, parenting pattern,
child parent relationship (trust versus autonomy).
• Emotion: they do not experience negative
emotions such as fear or anxiety when they
encounter antisocial situation. Also punishment
doesn’t arouse strong emotion or inhibit
antisocial behaviors.

21. Borderline personality disorder
• pervasive pattern of instability of interpersonal
relationships, self-image, affects, and marked
impulsivity beginning by early adulthood as
indicated by 5 or more of the following:
1. frantic efforts to avoid real or imagined
abandonment (panic if somebody important come
late or cancel an apointment) because it implies
they are bad or intolerance of being alone.
2.unstable and intense interpersonal relationships
(extremes of idealization and devaluation).

22. Borderline personality disorder
3. identity disturbance, unstable self-image or
sense of self .
4. impulsivity in at least two areas that are
potentially self-damaging (e.g., spending,
sex, Substance Abuse, reckless driving, binge
eating).
5. recurrent suicidal behavior, gestures, or threats,
or self-mutilating behavior
6. affective instability .
7. chronic feelings of emptiness .

23. Borderline personality disorder
8. inappropriate, intense anger or difficulty
controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical
fights)
9. transient, stress-related paranoid ideation or
severe dissociative symptoms
(depersonalization) which last for minutes or
hours (remission occurs as the caregivers return
their nurturance).

24. Borderline personality disorder
• Other information:
• Undermining themselves at the moment his
goal is about to be realized (drop out of school
just before graduation, destroying relation
when it is clear it could last).
• Develop psychotic symptoms (hallucination,
ideas of reference) during stress.
• Common, very hard to treat and associated
with suicide.

25. Etiology
• Neurobiological factors: genetics, decrease
function of serotonin system.
• Social factors: physical and sexual abuse, neglect,
hostile conflict, and parental loss or separation.
• Object-relation theory: adverse childhood
experiences when child fail to integrate loving
and unloving aspects of the people who are close
to them because of their parents provide love
and support inconsistently so they develop
insecure ego and BPD . Common in their personal
history.

26. Etiology
• During their 30s-40s, the majority of the
individual attain greater stability in their
relationship.
• By age 40, most people seem no longer meet
the diagnostic criteria comorbid AXIS I anxiety
disorder (esp. PTSD), mood disorder.

27. Histrionic personality disorder
(hysterical personality)
• pervasive pattern of excessive emotionality and
attention seeking, beginning by early adulthood
as indicated by 5 or more of the following:
1. uncomfortable in situations in which he or she is
not the center of attention, so they may create
stores or scene, gift, providing new symptoms
each visit to attract attention.
2. interaction with others by inappropriate
sexually seductive or provocative behavior .

28. Histrionic personality disorder
(hysterical personality)
3. displays rapidly shifting and shallow expression of
emotions.
4. uses physical appearance to draw attention to
self (spend money on cloths, hair color, and grooming
or complains about photos).
5. style of speech that is excessively impressionistic
and lacking in detail (this person is good without ability
to mention the reason).
6. shows self-dramatization, theatricality, and
exaggerated expression of emotion (excessive public
display of emotions).

29. Histrionic personality disorder
(hysterical personality)
7. is suggestible, (easily influenced by others or
circumstances).
8. considers relationships to be more intimate than they
actually are (calling the doctor by his/her name or use my
dear, dear friend).
• Other information:
• Over reaction to minor events, egocentric, demanding.
• They have impaired relation with the same sex.
• Initiate job with great enthusiasm but their interest lag
quickly.
• Ignore long relation and start new relation.
• Don’t exhibit feeling of emptiness, or identity diffusion.

30. Histrionic personality disorder
(hysterical personality)
• F > M
• Etiology: childhood traumatic experiences.
• Psychoanalytic theory: it occurs as a result of
parental seductiveness especially fathers
seductive behavior toward his daughter. also
the patients were raised in a family in which
parents talk about sex as dirty yet behaved as
though it was existing and desirable which
create conflict.

31. Narcissistic personality disorder
• pervasive pattern of grandiosity, need for
admiration, and lack of empathy, beginning by
early adulthood as indicated by 5 or more of
the following:
1. has grandiose sense of self-importance (e.g.,
exaggerates achievements and talents).
2. preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal
love .

32. Narcissistic personality disorder
3. believes that they are special and unique .
4. requires excessive admiration .
5. has a sense of entitlement.
6. interpersonally exploitative.
7. lacks empathy.
8. often envious of others or believes that others
are envious of him or her.
9. shows arrogant, haughty behaviors or
attitudes.

33. Etiology
• Self psychology model:
• When the parent respond to the child with
respect, warmth and empathy, they endow
their child with normal sense of self worth.
When they don’t do that, low self esteem will
develop and the child will have a problem in
accepting their own shortcoming so they try
to bolster their sense of self worth through
unending quests for love and approval from
others.

34. Etiology
• Social cognitive model:
• Patient has fragile self esteem and
interpersonal interaction is important for
bolstering self esteem rather than closeness
or warmth. They show cognitive bias to
maintain grandiose self beliefs (brag a lot
when success or denigrate the other person
when fail).

35. Avoidant personality disorder
• pervasive pattern of social inhibition, feelings
of inadequacy, and hypersensitivity to
negative evaluation, beginning by early
adulthood as indicated by 4 or more of the
following:
1. avoid occupational activities that involve
significant interpersonal contact, because of
fears of criticism, disapproval, or rejection.

36. Avoidant personality disorder
2. unwilling to get involved with people unless
certain of being liked.
3. shows restraint within intimate relationships
because of the fear of being shamed.
4. preoccupied with being criticized or rejected
in social situations.
5. inhibited in new interpersonal situations
because of feelings of inadequacy.

37. Avoidant personality disorder
6. views self as socially inept, personally
unappealing, or inferior to others.
7. reluctant to take personal risks or to engage in
any new activities because they may prove
embarrassing (cancel job interview for fear of
being embarrassed by not dressing
appropriately).

38. Avoidant personality disorder
• Other notes:
• It is often diagnosed with dependent
personality disorders or borderline personality
disorder.
• M=F
• Etiology: genetics or influence of environment
in which the child is taught to fear situation or
people who are harmful or stranger.

39. Dependent personality disorder
• pervasive and excessive need to be taken care
of that leads to submissive and clinging
behavior and fears of separation, beginning by
early adulthood and as indicated by 5 or more
of the following:
1. has difficulty making everyday decisions
without an excessive amount of advice and
reassurance from others.

40. Dependent personality disorder
2. needs others to assume responsibility for
most major areas of his or her life.
3. has difficulty expressing disagreement with
others because of fear of loss of support .
4. has difficulty initiating projects or doing
things on their own .
5. goes to excessive lengths to obtain nurturance
and support from others (volunteering to do
things that are unpleasant).

41. Dependent personality disorder
6. feels uncomfortable or helpless when alone
because of exaggerated fears of being unable to
care for theirselves.
7. urgently seeks another relationship as a
source of care and support when a close
relationship ends.
8. unrealistically preoccupied with fears of being
left to take care of himself or herself.

42. Dependent personality disorder
• F>M
• Chronic course.
• Etiology:
• Genetic, overprotective and authoritarian parenting
style that prevent the development of feeling of self
efficiency.
• Attachment problem: child's separation from adult
lead to anger and stress and feel secure in the
presence of figure of security, failed in this process
lead to this disorders.
• Psychoanalysis: oral stage and satisfaction from
dependency and sucking.

43. Obsessive-Compulsive
personality disorder
• pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency, beginning
by early adulthood as indicated by 4 or more
of the following:
1. preoccupied with details, rules, lists, order,
organization so that the major point of the
activity is lost and repeatedly checking for
mistakes.

44. Obsessive-Compulsive
personality disorder
2. shows perfectionism that interferes with task
completion (restrict standard so the project doesn't
finished).
3. excessively devoted to work and productivity to
the exclusion of leisure activities and friendships.
4. inflexible about matters of morality, ethics, or
values.
5. unable to discard worn-out or worthless object.

45. Obsessive-Compulsive
personality disorder
6. reluctant to delegate tasks or to work with
others unless they submit to exactly his or her
way of doing things.
7. adopts a miserly spending style toward both
self and others.
8. shows rigidity and stubbornness.

46. Obsessive-Compulsive
personality disorder
• Other notes:
• Time is poorly managed and leave most important task to
last moment, deadline is missed.
• Etiology: genetics. Freud: fixation at anal stage (2-4 years)
and fear loss of control which is handled by
overcompensation.
• Ericson theory: autonomy verses shame (expression of
direct anger may be bring about shame or criticism so
attention to details is done to avoid parents, criticism and
get affection so the child learn to distant self from unmet
affection need by obsessive defense and displacing anger
to more neutral object.

47. Treatment
• Medication.
• Avoidant: antidepressant, antianxiety to reduce
social anxiety (phobia), group therapy to reduce
sensitivity to rejection, social skills training.
• Schizotypal: antipsychotic drugs (for
schizophrenia), psychotherapy, group and
individual therapy, psychodynamic (alter pts view
of childhood problem).

48. Treatment
• CBT: break personality disorders into set of
problems (e.g paranoid or avoidant disorder:
sensitive to criticism: so treated by social skills
training, systematic desensitization, identify and
challenge negative thought.
• Hysterical: psychoanalysis.
• Naracisstic: psychoanalysis and view grandiosity
as defense mechanism so support and show
empathy with the patients.

49. Treatment
• Antisocial: self help group than jails or
psychiatric unit or one to one therapy, firm
limit, halfway house, treat addiction, provide
alternative method to express anxiety (not only
to stop action).
• Dependent personality: behavior therapy
(assertiveness training).
• Obsessive-compulsive: patients know they have
a problem and seek treatment, group and
individual therapy.

50. Treatment of borderline
personality disorder
• The most difficult problem to deal with as the pts
tend to show their interpersonal problem toward
the therapists (distrust him so it affects the
therapeutic relation) or demanding special
attention from the therapists, refuse to keep
appointment next, beg the therapist for
understanding and support.
• Suicide is a serious risk but is difficult to therapist to
judge pt behavior (call at 2 am, seek attention or
suicide) so hospitalization may be nedded.

51. Treatment of borderline
personality disorder
• Drugs: antidepressant (fluoxetine, Prozac).
Antipsychotic (olanzapine), lithium reduce
anger, irritability and suicidility. Antiseizure
that is use to treat bipolar disorder.
• Object relation psychotherapy: to strength pts
weak ego so that he/she stop splitting (seeing
every thing to a simple good or bad).

52. Treatment of borderline
personality disorder
• Dialectical behavior therapy include either:
• Therapists accept pts and help them to
change.
• The pts realize that splitting the world into
good (antithesis) and bad (thesis) isn't
necessary and develop synthesis of both.

53. Treatment of borderline
personality disorder
• Provide group and individual therapy, involving 4
stages:
• Identify dangerous impulsive behavior.
• Learning to control extreme emotionality and
tolerate distress.
• Improving self-esteem and relations.
• Promote connectedness and happiness.

54. General Rules
• For diagnosis: out organic causation, get objective
records from school, employment, hospitals,
investigate the repetition of the behaviors in the
past.
• Defence mechanism: which are healthy for these
patients to help them to reduce anxiety and
depression including fantasy (schizoid and
therapist should be quiet and reassuring without
criticism), dissociation (histrionic: deny to
ventilate their anxiety), isolation (compulsive:
request for control which annoying the therapist).

55. General Rules
• Projection (attribute their feelings to others so
maintain formal distance, strict honesty are
helpful, dot agree with the patient but ask if
they can agree to disagree, use counter
projection techniques: give the patients full
credit for their feeling and perceptions, but do
not dispute their complains, nor reinforce
them.