Personality disorders

What we mean by the word PERSONALITY?
 refers to the collection of characteristics
or traits that we have developed as we
have grown up and which make each of
us an individual.
 These include the ways that we:
 think
 feel
 behave

What is Personality Disorder?
- an enduring pattern of inner experience
and behavior that deviates markedly
from cultural expectations, is inflexible
and pervasive, has its onset
in adolescence or early adulthood, is
stable over time, and leads to distress or
impairment.

What is Personality Disorder?
Personality Disorder common features include:
 being overwhelmed by negative feelings such as distress,
anxiety, worthlessness or anger
 avoiding other people and feeling empty and emotionally
disconnected
 difficulty managing negative feelings without self-harming or,
in rare cases, threatening other people
 odd behaviour
 difficulty maintaining stable and close
relationships, especially with partners, children and
professional carers
 sometimes, periods of losing contact with reality

Different kinds of personality
disorders
Personality disorders tend to fall into three
groups, according to their emotional
'flavour':
 Cluster A: 'Odd or Eccentric
 Cluster B: 'Dramatic, Emotional, or
Erratic'
 Cluster C: 'Anxious and Fearful'

Cluster A: 'Odd and Eccentric'
Paranoid PD
- is a mental
disorder characterized by
paranoia and a
pervasive, long-standing
suspiciousness and
generalized mistrust of
others.
PPD Symptoms:
 may be hypersensitive, easily feel
slighted, and habitually relate to the
world by vigilant scanning of the
environment for clues or suggestions
that may validate their fears or
biases.
 They think they are in danger and
look for signs and threats of that
danger.
 tend to be guarded and suspicious
and have quite constricted emotional
lives.
 They may or may not have a
tendency to bear grudges,
suspiciousness, tendency to interpret

Cluster A: 'Odd and
Eccentric'
PPD Causes:
- A genetic contribution to
paranoid traits and a possible
genetic link between this
personality disorder and
schizophrenia exist.
Psychosocial theories
implicate projection of
negative internal feelings and
parental modeling. Cognitive
theorists believe the disorder
to be a result of an underlying
belief that other people are
deceptive/malevolent in
combination with a lack in self-
confidence.
PPD Treatment:
Because of reduced levels of
trust, there can be challenges
in treating PPD.
However, psychotherapy, antidep
ressants,
antipsychotics and anti-
anxiety medications can play a
role when an individual is
receptive to intervention

Schizoid PD
- is a personality
disorder characterized by
a lack of interest in social
relationships, a tendency
towards a solitary
lifestyle, secretiveness,
emotional coldness,
and apathy.
SPD Symtoms:
 often aloof, cold and indifferent
 have trouble establishing
personal relationships
 may remain passive in the face
of unfavorable situations.
 When the individual's personal
space is violated, they feel
suffocated and feel the need to
free themselves
 It is not people as such that they
want to avoid, but emotions both
negative and positive, emotional
intimacy, and self disclosure

SPD Causes:
There is some evidence to suggest that there is an
increased prevalence of schizoid personality disorder in
relatives of people with schizophrenia or schizotypal
personality disorder. To Sula Wolff, who did extensive
research and clinical work with children and teenagers
with schizoid symptoms, "schizoid personality has a
constitutional, probably genetic, basis. Other
researchers had hypothesized that unloving,
neglectful, or excessively perfectionist parenting could
play a role.Twin studies with schizoid personality
disorder traits, low sociability and low warmth, suggest
these traits are inherited. Because of this, there is
indirect evidence linking the heritability of schizoid
personality disorder

Cluster A: 'Odd and
Eccentric'
SPD Treatment:
 Medication
 Psychotherapy
 Modalifinil
 Socializations Groups

Schizotypal PD
- is a personality disorder
characterized by a
need for social
isolation, anxiety in
social situations, odd
behavior and thinking,
and often
unconventional
beliefs.
STPD Symptoms:
 feel extreme discomfort with
maintaining close relationships
with people, so they avoid
forming them.
 Peculiar speech mannerisms
and odd modes of dress
 may react oddly in
conversations, not respond, or
talk to themselves
 frequently misinterpret
situations as being strange or
having unusual meaning for
them

Cluster A: 'Odd and
Eccentric'
STPD Causes:
 Biological/Genetics
 Social and Environmental
Factors
STPD Treatment:
 Pharmacological
In order to decide which type of
medication should be used,
Paul Markovitz distinguishes
two basic groups of
schizotypal patients:
o Schizotypal patients who appear
to be almost schizophrenic in their
beliefs and behaviors (aberrant
perceptions and cognitions) - they
are usually treated with low doses
of antipsychotic medications,
e.g. thiothixene. However, it must
be mentioned that long-term
efficacy of neuroleptics is doubtful.
o Schizotypal patients who are
more obsessive-compulsive in
their beliefs and behaviors - in this
case SSRIs, e.g.Sertraline,
appear to be more effective.

‘Dramatic, Emotional and Erratic’

Cluster B: 'Dramatic,
Emotional and
Erratic'
Antisocial, or Dissocial
- is characterized by a long-
standing pattern of a
disregard for other people’s
rights, often crossing the line
and violating those rights.
- “Charming Psychopath”
ASPD Symptoms:
 don't care much about the feelings
of others
 easily get frustrated
 tend to be aggressive
 commit crimes
 find it difficult to make close
relationships
 impulsive - do things on the spur
of the moment without thinking
about them
 don’t feel guilty about things
you've done
 don’t learn from unpleasant
experiences

Emotional and
Erratic'
ASPD Causes:
 Biological Factors
 Genetic Factors
 Environment Factors
ASPD Treatment:
 Medications
 Long-term structured
residential settings
 Psychotherapy along with
Behaviour modification
techniques
 Self-help groups or pro-
social reform
organizations.

Emotional and
Erratic'
Borderline, or
Emotionally Unstable
- is a pervasive pattern of
instability in interpersonal
relationships, self-image
and emotions.
- Lack of sense of self
Borderline Symptoms:
 impulsive - do things on the spur
of the moment
 find it hard to control your
emotions
 feel bad about yourself
 often self-harm,
 feel 'empty’
 make relationships quickly, but
easily lose them
 can feel paranoid or depressed
 when stressed, may hear noises
or voices

Emotional and
Erratic'
BPD Causes:
 Biological
 Social Stressors
 Ways of thinking
BPD Treatment:
 Counseling and
Therapy
 Medicines
 Healthy habits
 Partial Hospitalization

Emotional and
Erratic'
Histrionic PD
- exhibit excessive
emotionalism--a tendency
to regard things in an
emotional manner--and
are attention seekers.
- lack a sense of self-worth
HPD Symptoms:
 over-dramatise events
 self-centered
 have strong emotions which
change quickly and don't last
long
 can be suggestible
 worry a lot about your
appearance
 crave new things and
excitement
 can be seductive

Emotional and
Erratic'
HPD Causes:
 Genetic Factors
 Neurochemical/physiologic
al causes
 Developmental causes
 Biosocial learning causes
 Sociocultural causes
 Personal variables
HPD Treatment:
 Psychodynamic therapy
 Cognitive-behavioral
therapy
 Group therapy
 Family therapy
 Medications

Emotional and
Erratic'
Narcissistic PD
- is a personality
disorder in which a
person is excessively
preoccupied with
personal
adequacy, power,
prestige and vanity,
mentally unable to
see the destructive
damage they are
causing to themselves
and others
NPD Symptoms:
 Exaggerated feelings
of self-importance
 They have a sense of
entitlement and
demonstrate
grandiosity in their
beliefs and behavior
 Strong need for
admiration, but lack
feelings of empathy

Emotional and
Erratic'NPD Causes:
The cause of this disorder is unknown, however listed below the following
factors to be identified possibilities:
 An oversensitive temperament (personality traits) at birth.
 Excessive admiration that is never balanced with realistic feedback.
 Excessive praise for good behaviors or excessive criticism for bad
behaviors in childhood.
 Overindulgence and overvaluation by parents, other family members, or
peers.
 Being praised for perceived exceptional looks or abilities by adults.
 Severe emotional abuse in childhood.
 Severe emotional abuse in childhood.
 Learning manipulative behaviors from parents or peers.
 Valued by parents as a means to regulate their own self-esteem.

Emotional and
Erratic'
NPD Treatment:
 Psychotherapy is used to treat NPD.
 a form of therapy developed by Jeffrey Young that integrates
several therapeutic approaches (psychodynamic, cognitive,
behavioral etc.), also offers an approach for the treatment of
NPD
 Pattern change strategies, over a long period of time, are for
narcissists to work on increasing their ability to become more
empathetic in everyday relationships.
 psychoanalytic psychotherapy has a higher success rate.
Therapists must recognize the patient’s traits and use caution
in tearing down narcissistic defenses too quickly.

Cluster C: 'Anxious and
Fearful'
Obsessive-Compulsive Personality Disorder:
- is a pervasive, enduring, and inflexible pattern of maladaptive
inner experiences and pathological behavior. The essential
features include a pattern of impulsivity and instability
of behaviors, interpersonal relationships, and self-image. The
pattern is present by early adulthood and occurs across a
variety of situations and contexts.
 intense fears of abandonment
 intense anger
 irritability
 often engage in idealization and devaluation of others,
alternating between high positive regard and great
disappointment.

Fearful'
OCPD Symptoms:
 Splitting
 Chaos in relationships
 Markedly disturbed sense of identity
 Intense or uncontrollable emotional triggers
 Unstable interpersonal relationships and self-esteem
 Concerns about abandonment
 Self-damaging behavior
 Impulsivity
 Frequently accompanied by depression, anxiety, anger,
substance abuse or rage

Fearful'
OCPD Cause:
 childhood trauma can be a contributing factor,but less
attention has historically been paid to investigating the
causal roles played by congenital brain abnormalities,
genetics, neurobiological factors, and environmental
factors other than trauma.
 Social factors include how people interact in their early
development with their family, friends, and other
children.
 Psychological factors include the individual's personality
and temperament, shaped by his or her environment
and learned coping skills that deal with stress.
OCPD Treatment:
 Therapy

Fearful'
Avoidant PD
- characterized by marked
avoidance of both social
situations and close
interpersonal
relationships due to an
excessive fear of
rejection by others.
- Anxious Personality
Disorder
Avoidant PD Symptoms:
 very anxious and tense
 worry a lot
 feel insecure and inferior
 have to be liked and accepted
 extremely sensitive to criticism

Fearful'
APD Causes:
 Biological Factors
 Genetic Factors
 Social Factors
 Painful experiences
 Rejections
APD Treatment:
 Psychodynamically
oriented therapies
therapy
 Group therapy
 Family and Marital
therapy
 Medications

Fearful'
Dependent PD
- is characterized by an
excessive need to be
taken care of or depend
upon others. Persons
with this disorder are
typically submissive and
display clinging behavior
toward those from whom
they fear being
separated.
DPD Symptoms:
 passive
 rely on others to
make decisions for you
 do what other people want you
to do
 find it hard to cope with daily
chores
 feel hopeless and incompetent
 easily feel abandoned by
others

Fearful'
DPD Causes:
 Over-involvement and
intrusive behavior
 Socially humiliated by
others in their
developmental years
 Biopsychosocial Model
of Causation
DPD Treatment:
 Psychodynamically
oriented therapies
therapy
 Interpersonal therapy
 Group therapy
 Family and marital
therapy
 Medications

Personality disorders

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