The document provides a comprehensive overview of personality disorders, including definitions, types, prevalence, and treatment options. It categorizes personality disorders into three clusters (A, B, and C) and discusses the characteristics and implications of various disorders such as paranoid, borderline, and narcissistic personality disorders. The document emphasizes the complexity of assessing and managing these conditions due to their ingrained nature and associated comorbidities.

1. Personality
Disorders
Sankalpa Gunathilaka
MBBS(Sri Lanka)
Dip.in Psychology and Counselling

2. Content
• What is ‘Personality’ an introduction
• Personality changes
• Personality disorders
• Aetiology
• Classification
• Cluster A –B- C
• Assessment
• Management
• Complication
• References

3. What is ‘Personality’ ?
 Enduring patterns of thoughts, attitudes, mood and behaviors which help to define us as
individuals.
 Every personality is unique.
 But every personality has common features.
 Upon these common features; different aspects of personality can be identified
=Personality Traits

4. Personality changes
 Personality is enduring and stable
 But small changes often may take place gradually over a period of many years. These gradual
changes are not termed as ‘personality changes’
 Rather Personality changes can be termed as modifications in one’s personality that occurs
more abruptly or in a step-wise manner.
 Personality changes may occur due to :
 Injury to or organic disease of the brain.
 Residual effect of severe mental disorder (eg –Schizophrenia)
 Exceptionally severe stressful experiences.
The curious case of Phineas Gage

5. Personality disorder
What is personality disorder ?
Deeply ingrained, enduring and inflexible patterns of behavior to broad range of personal and
social situations.
 They show either extreme or significant deviation from the way of an average individual in
a given culture.
 Deviations in:
o Cognition(perceive, feel, think)
o Affectivity
o Control over impulses and gratification of needs
o Manner of relating to others
o Manner of handling stress
o Handling interpersonal situations
 These behavior patterns are stable and can be seen in multiple domains of behavior and
psychological functioning
 And frequently associated with subjective distress and problems in social functioning

6.  Cause harm to person and to others.
 Development conditions
 Onset: Childhood or Adolescent – continue into adult life
 But no clear point of onset (differ from mental illness).
 Making a diagnosis is unusual before adulthood
 Prevalence : 5% of adult population & 40% of psychiatry inpatients
 Personality disorders differ from personality changes in timing and mode of emergence
Personality disorder Personality changes
Development condition Acquired condition
Onset : Childhood/ Adolescent Onset: usually in Adult life
Not secondary to brain damage/disorder
(But can coexist)
Following a brain damage/ disorder /
exceptionally stressful conditions

7. Aetiology
• Causes for personality disorders are uncertain.
• Linked with Genetic factors and Various kind of early
life experiences
• Only minority of those who experience adverse life
events develop personality disorders
• Some personality disorders are linked with the
etiology of psychiatric illness.

8. Classification of
personality disorders in
ICD-10 is compared with
that in DMS-5

9. Classification of Personality disorders
Personality disorders are classified into three ‘clusters’
Cluster A
(odd/eccentric)
Cluster B
(dramatic/emotional)
Cluster C
(fearful/anxious)
• Paranoid
• Schizoid
• Schizotypal*
*(in DSM-5.Not in ICD-10)
• Avoidant
• Dependent
• Anankastic(Obsessive-
compulsion in DSM-5)
• Histrionic
• Dissocial(Antisocial in DSM-5)
• Borderline
• Narcissistic

10.  Suspicious
• Look upon others as they are about to deceive or exploit the person
• So difficult to make friends
• Avoid involvement in group activities
• Resentful
 Mistrustful and Jealous.
 Sensitive
 Marked sense of self importance – but easily feel shame and humiliation
 Take offense easily – see criticism where non was intended
 First degree relatives of Schizophrenic patients > normal populations.
Paranoid Personality Disorder
 Suspicious ideas can be more intense
• mistaken as Persecutory delusions.

11. Schizoid Personality disorder
 Emotionally cold
• Detached and aloof
 Introspective.
 Lack of enjoyment in activities most people enjoy
• Leads to the separation from others
 Show little interest in sexual activities
 Do not form intimate relationships
 Show little family feeling – remain unmarried
 Follow a solitary course through life(seclusive)
 Interested in intellectual matters
 Have a complex inner world of excessive fantasy

12.  Socially anxious
• Lack of friends
• They feel different from others and do not fit in (differ from
Schizoid individuals)
 Behave eccentrically
• Unusual choices of clothes
• Odd mannerisms
 Experience cognitive and perceptual distortions (NOT delusions)
• Ideas of reference
• Magical thinking
• Suspicious beliefs
Schizotypal Personality disorder
This appears to be related to Schizophrenia. So not
classified as a personality disorder in ICD-10

13. CLUSTER B

14. Histrionic Personality Disorder
• warm and nice dressing
• Shallow and labile affect ( rapid changing of mood)
• outwardly confident
• Self dramatisation ( blackmail) and acting
• Suggestibility
• seeks excitement and wants to be centre of attention
• inappropriate seductiveness
• very concerned with physical attractiveness
• Self centred and vain
•marked capacity for self deception

15. Borderline personality disorder
• act impulsiveness without thinking the consequences
• inability to control anger
• conflict with others
• labile mood
• feelings of emptiness
• efforts to avoid abundance
• intense and unstable relationships
• uncertainty about self image
• Self harm – common
• Alcohol /substance abuse Also common
• Confused by strength and unpredictability of their needs
• Strong and fluctuating emotions
• Transient stress reaction /paranoid /dissociative symptoms

16. Narcissistic personality disorder
• Grandiose Sense of self importance
• Fantasies of success , power , Beauty and ideal love
• Need for excessive admiration
• Lacks empathy
• Arrogant
• Envious

17. Dissocial Personality Disorder
( Antisocial)
• Blames others
• Unconcern for others
• Gross and persistent irresponsibility
• Failure to have sustained relationships
• Incapacity to experience guilt and remorse
• Low threshold for violence
• Low tolerance for frustration
• Impulsive and irritable
• Fail to learn from adverse experiences
• Recklessness
• Risk of alcohol/ substance use

18. CLUSTER C

19. Anankastic personality Disorder
• Preoccupation with detail and rules
• Perfectionism interferes with completing the tasks
• Feeling of excessive doubts
• Rigid and stubborn
• Overemphasis on the work And productivity in the expense
of leisure
• Common among professionals

20. Dependent personality disorder
• Allows others to make important decisions
• Unwillingness to make reasonable demands on others
• Feels helpless when alone
• Fear of being abandoned
• Shifts quickly to a new relationship when the older one ends
• Lacks initiative

21. Avoidant personality disorder
• Feeling of tension and apprehension
• Preoccupation with being criticised
• Believe that they are socially inept and inferior to others
• Restrictions in Lifestyle because of the need for security
• Avoid risk and social involvement
• Feeling of inadequacy in New interpersonal situations

22. Assessment
• History
• MSE
• MRI if organic causes suspected ( frontal lobe tumors)
• Collateral history
• Psychometric assessments
• Comorbidities – depression; Anxiety disorder ; substance
abuse ; somatisation; Eating disorders

23. Mx
• Treatment of comorbid Disorders ( Anxiety; depression)
• Psychotherapy ( individual or group or Therapeutic community)
• Supportive – help to develop insight
• Analytical- Analyse and enlighten them
• Behavioural-
• Low dose antipsychotics If needed
• Antidepressants – may used in BPD ( SSRI)
• Lithium / antiepileptics – may used in episodic behavioural issues and
aggression
• Dialectical behavioural therapy for BPD

24. Complications
• Adverse effects On relationships/ Society
• Depressive illnesses
• Alcohol and substance abuse
• Deliberate self harm and suicide
• Violence towards others and other criminal activities
• Subjective distress
• Poor response to treatment of Psychiatric disorders

25. • Paranoid: Continue to have marital, Social and occupational
difficulties
• Schizoid : Relationship problems
• Dissocial : abuse of alcohol/ drugs , forensic hx
• Histrionic : improve with age,abuse of alcohol/drugs results
in bad outcome
• BPD : may improve with age, abuse of substance may result
in poor outcome , increased risk of Depression and suicide
• Anankastic : may develop OCD
• Dependant : If they lose dependant person ,can go into poor
prognosis

26. References
 Shorter oxford text book of psychiatry 7th
edition
 The ICD-10 classification of mental and behavioral
disorders: Clinical descriptions and diagnostic
guidelines
(www.who.int/docs/default-source/classification/other-classifications/
bluebook.pdf?sfvrsn=374758f7_2)

27. Thank
you !