Personality Disorders & Impulse Control Disorder

INTRODUCTION
 Dynamic organization and configuration of trait within a
person.
 This trait determines the characteristics behavior and
thoughts of the person.
 The personality of a person allows other to predict how this
person would react, feel or think in a particular situation.
An extreme variant of a normal personality trait.
PERSONALITY
PERSONALITY DISORDERS

EPIDEMIOLOGY
 Overall prevalence of personality disorder in
community surveys : 5 – 10%
 Overall rates are higher in men than women and
decrease with age.
 Antisocial personality disorder (1 – 3% in
community surveys) – more common in men
 Histrionic personality disorder (2%) &
borderline personality disorder (1 – 2%) – more
common in women.

AETIOLOGY
1. GENETICS
2. CHILDHOOD EXPERIENCE
3. INJURY TO BRAIN AT BIRTH
4. ABNORMAL BRAIN DEVELOPMENT
5. ENVIRONMENTAL FACTORS
6. NEUROCHEMISTRY

AETIOLOGY
1. Children of parents with
antisocial personality
disorder have greater rates
of antisocial behavior than
children of parents who do
not have this personality.
2. Similar excess has been
reported also among
adopted children whose
biological parents have
disorder and whose
adoptive parents do not.
GENETICS CHILDHOOD EXPERIENCE
1. Separation from parents in
early childhood is more
frequent among people with
disorder than among
controls.
1. This association could be
due to:
A. Parental disharmony
preceding separation
B. The separation itself
C. A consequence of
separation such as
upbringing in care rather

AETIOLOGY
1. Sometimes
followed by
impulsive and
aggressive
behavior.
2. Such injury has
been suggested
as cause of
personality
1. The only evidence,
which is indirect, is that
some adults with
have non-specific
features in the
electroencephalogram
(EEG) of a kind found
normally in
adolescents, not
adults.
INJURY TO BRAIN AT BIRTH ABNORMAL BRAIN DEVELOPMENT

AETIOLOGY
 Low
socioeconomic
status
 Social isolation
 High levels of
testosterone, oestrone
– associated with
impulsivity in
borderline and
disorders.
 Low level of serotonin
metabolite 5-
hydroxyindoleacetic
acid (5-HIAA) –
ENVIRONMENTAL FACTORS NEUROCHEMISTRY

DIFFERENTIAL DIAGNOSIS
DIFFERENCES BETWEEN PERSONALITY DISORDER AND:
 SCHIZOPHRENIA: People with personality disorder may
present with psychotic features but have relatively intact
capacity for reality testing, expression of emotion, ability to
distinguish between thoughts of their own and others.
 BIPOLAR DISORDER: People with personality disorder may
complain of mood swings but these range from normal mood
to irritability and should not have hypomanic or manic
episodes.

CLASSIFICATION
Cluster A
 Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder
Cluster B
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
Cluster C
 Avoidant personality disorder
 Dependent personality disorder
Obsessive compulsive personality disorder

CLUSTER A
1. Paranoid Personality Disorder
1. Schizoid Personality Disorder
1. Schizotypal Personality Disorder

‘People with paranoid personality disorder are
suspicious and worry about conspiracy against
oneself’

PARANOID PERSONALITY
Prevalence - 0.5-2.5%
Gender – Male > Female
Heritability – 0.69
DISORDER
EPIDEMIOLOGY

AETIOLOGY
 More common among 1st degree relatives of schizophrenia patients
 Childhood experience : Lack of protective care and support in
childhood, humiliation
 Temperament : Non-adaptability, tendency of hyperactivity
 Defense Mechanism : Projection of negative internal feeling onto
other people
 Sensory impairment : Impaired vision, impaired hearing, victims of
traumatic brain injury

CLINICAL FEATURES
ICD-10 CRITERIA
• Met general criteria for personality disorder and ≥4 symptoms
Behavior :
Tendency to bear grudges persistently
Cognition :
• Excessive sensitivity to setbacks and rebuffs
• Suspiciousness and a pervasive tendency to distort experience
• Combative and tenacious sense of personal rights
• Recurrent suspicious without justification
• Persistent self-referential attitude, associated particularly with
excessive self-importance

CLINICAL FEATURES
DSM-5 CRITERIA
Salient Features of DSM-5 :
• Must not occur (schizophrenia,mood disorder with psychotic features
or other psychotic disorder or a pervasive developmental disorder)
Additional affective symptom:
• Angry reaction to perceived attacks on his/her character or reputation
Additional cognitive symptoms includes:
• Unjustified doubts about loyalty or trustworthiness of friends
• Hidden demeaning or threatening meanings

MANAGEMENT
1. Psychotherapy
 Supportive Psychotherapy
 Problem Solving Therapy
 Cognitive Behaviour Therapy
2. Pharmacology
 Antidepressants : To treat mood symptoms
 Antipsychotics : To treat psychotic
symptoms

SCHIZOID PERSONALITY
 Prevalence - 0.5-1.5%
 Gender – Male > Female
 Heritability – 0.55
DISORDER
EPIDEMIOLOGY
AETIOLOGY
More common among 1st degree relatives of
schizophrenia patients

CLINICAL FEATURES
ICD-10 CRITERIA
Affect :
 Emotional coldness, detachment or flattened affectivity
 Limited capacity to express either warm, tender feelings or anger towards
others
Behavior :
 Few, if any, activities provide pleasure
 Little interest in having sexual experience with another person
 Consistent choice of solitary activities
 No desires for possession of any close friends
Cognition :
 Excessive preoccupation
 Marked insensitivity to prevailing social norms and conventions

CLINICAL FEATURES
DSM – 5 CRITERIA
 DSM-5 requires ≥ 5 symptoms
 Must not occur ( schizophrenia, mood disorder with psychotic
features , other psychotic disorder )
Affective Symptoms :
 Limited capacity to express either warm, tender feelings or anger
towards others
Additional Behavior Symptoms :
 Lack of close friends or confident
Cognitive symptoms :
 Marked insensitivity to prevailing social norms and conventions

‘People with schizoid personality disorder show
restricted affective expression, impoverished social
relationships and avoidance of social activities’

1. Other Personality Disorders :
 People with Schizotypal Personality Disorder
are more eccentric with disturbed and thought
form
 People with Paranoid Personality Disorder
are more easily engaged resentful
2. Pervasive development disorder
3. Schizophrenia

MANAGEMENT
1. Psychotherapy
 Supportive psychotherapy is useful to
establish therapeutic alliance , as trust
increases, the therapist may be able to
access patient’s fantasies
2. Pharmacotherapy
 Low dose Anti-Psychotics and Anti-
Depressants have been used with variable
outcomes

SCHIZOTYPAL
PERSONALITY
DISORDER

SCHIZOTYPAL PERSONALITY
 Prevalence - 3%
 Gender – Male > Female
 Heritability – 0.72
DISORDER
EPIDEMIOLOGY
AETIOLOGY
 More common among 1st degree relatives of
schizophrenia patients
 Link to dopamine dysregulation

CLINICAL FEATURES
Psychoticism :
• Eccentricity – odd, unusual or bizarre behaviour or appearance
• Cognitive and perceptual dysregulation – odd or unusual thought
process , odd sensations
• Unusual beliefs and experiences – unusual experiences of reality
Detachment :
• Restricted affectivity – constricted emotional experience and
indifference
• Social withdrawal – avoidance of social contacts and activity
Negative Affectivity :
• Suspiciousness – expectations of and heightened sensitivity to signs
of interpersonal ill-intent or harm, doubts about loyalty and fidelity of
others , feelings of persecutions

1. Delusional Disorder , Schizophrenia and
Severe Depressive Disorder with
psychotic features
2. Paranoid and Schizoid Personality
Disorder
3. Borderline Personality Disorder
4. Avoidant Personality Disorder
5. Pervasive Development Disorder

MANAGEMENT
1. Psychotherapy
 Supportive therapy
 Social skill training
2. Pharmacotherapy
 Antipsychotic drug : May lead to mild
to moderate improvement in psychotic
symptoms

CLUSTER B
1. Antisocial personality disorder
1. Borderline personality disorder
1. Histrionic personality disorder
1. Narcissistic personality disorder

PERSONALITY
DISORDER
ANTISOCIAL

EPIDEMIOLOGY
Prevalence:
 In the community: 0.6-3.0%
 In prison: 75%
 More common in urban settings
 Gender: M:F = 3:1
 Comorbidity: people with onset of substance
misuse younger than 15 years are more likely to
develop
 ASPD; Substance abuse is also a comorbidity of
ASPD

AETIOLOGY
 Parental deprivation and antisocial behaviour: e.g. witnessed abuse
when patients were young, inconsistent or harsh parenting
 Frequent moves or migration, large family size and poverty
 Children who go on to develop antisocial personality disorder are
innately aggressive, have high reactivity levels and diminished
ability to be consoled
DEVELOPMENTAL CAUSES
PSYCHOLOGICAL CAUSES
 Temperament: high novelty seeking, low harm avoidance, low
reward dependence, uncooperativeness.

CLINICAL FEATURES
ICD 10
Affect:
 Very low tolerance to frustration and a low threshold for discharge of
aggression, including violence.
 Incapacity to experience guilt, or to profit from adverse experience,
particularly punishment.
Behavior:
 Incapacity to maintain enduring relationships, though no difficulty in
establishing them.
 Marked proneness to blame others, or to offer plausible rationalizations for
the behavior that has brought the individual into conflict with society.
Cognition:
 Callous unconcern for feelings of others
 Gross and persistent attitude of irresponsibility and disregard for social
norms, rules and obligations.

DIAGNOSTIC STATISTIC
MANUAL-5 CRITERIA
Antagonism:
 Manipulativeness: frequent use of subterfuge to influence or control others
 Deceitfulness: dishonesty and fraudulence or misrepresentation of self
 Callousness: lack of concern for feelings or problems of others; lack of guilt or
remorse
 Hostility: persistent or frequent angry feelings; anger or irritability in response
to minor insults
Disinhibition:
 Irresponsibility: Failure to honor obligations or commitments and lack of
follow through on agreements and promises.
 Impulsivity: Acting on the spur of the moment in response to immediate
stimuli; acting on a momentary basis without a plan or consideration of
outcomes; difficulty establishing and following plans.
 Risk taking: Engagement in dangerous, risky, and potentially self-damaging
activities, unnecessarily and without regard or consequences; boredom
proneness and thoughtless initiation of activities to counter boredom; lack of
concern for one‘s limitations and denial of the reality of personal danger.

1. Temporary antisocial behavior:
focal behavior (e.g. vandalism or riot),
not exploitive and with conscience
preserved
1. Mania/hypomania: antisocial
behavior (e.g. reckless driving or
violence) as a result of impaired
judgement and irritability

MANAGEMENT
Management (NICE Guidelines Recommendations)
 Psychotherapy:
– Cognitive and behavioral interventions: Address impulsivity,
interpersonal difficulties and antisocial behavior; for people with forensic
history, the CBT should focus on reducing offending and other antisocial
behavior
– Important to assess risk regularly and adjust the duration and intensity of
the program accordingly
 Pharmacotherapy:
– Should not be routinely used for the treatment of dissocial personality
disorder
– May be considered in the treatment of comorbid disorders such as
depression and anxiety (e.g. SSRIs) and aggression (e.g. low dose
antipsychotics or mood stabilizers)

COURSE AND PROGNOSIS
Positive prognostic factors include:
 Showing more concern and guilt with regard to
antisocial behavior
 Ability to form therapeutic alliance
 Positive occupational and relationship record

HISTRIONIC
PERSONALITY
DISORDER

INTRODUCTION
 Prevalence: 2-3%
 Gender: M = F
 Usually begins by late teens or early 20s (adolescent or
early adulthood)
 Comorbidity: Somatisation disorder, alcohol misuse
 The word histrionic means "dramatic or theatrical."

AETIOLOGY
PSYCHOLOGICAL
CAUSE
DEFENCE
MECHANISM
DEVELOPMENTAL CAUSE
 Significant separations in the 1st 4
years of life
 Assoc. with authoritarian or seductive
paternal attitudes during childhood
 Favouritism towards male gender in a
family (if patient is a woman) causing
power imbalance
 Childhood: traumatic, deprivation,
chronic physical illness
 Absence of meaningful relationship
 May have families high in control,
intellectual orientation, low in cohesion
 Extreme variant of
temperamental disposition
 Emotionality, extraversion
& reward dependence
 Tendency towards overly
generalized cognitive
processing
 Dissociation
 Denial

CLINICAL FEATURES
I Inappropriate behaviour – seductive or
provocative
C Centre of attention
R Relationship are seen as closer than
they really are
A Appearance is most important
V Vulnerable to others’ suggestions
E Emotional expression is exaggerated
S Shifting emotions, Shallow
I Impressionistic manner of speaking
(lacks detail)
N Novelty is craved
“I CRAVE SIN”

CLINICAL FEATURES
ICD-10 DSM-5
Affect
 Self-dramatization, theatricality or exaggerated
expression of emotions
 Shallow and labile affectivity
Salient features
DSM-5 requires a fulfilment of  5 symptoms
Additional affective symptoms
 Discomfort in situations in which he/she is not
the centre of attention
Behaviour
 Suggestibility (he/she is easily influenced by
others or circumstances)
 Continual seeking for excitement & activities in
which the individual is the centre of attention
 Inappropriate seductiveness in appearance or
behaviour
Additional behaviour symptoms
 Consistent use of physical appearance to draw
attention to self
 Excessively impressionistic style of speech
Cognition
 Over concern with physical attractiveness
 People with histrionic personality disorder feel
comfortable in situations where they are the
centre of attention
Additional behaviour symptoms
 Consideration of relationships to be more
intimate than they actually are

‘People with histrionic personality disorder feel
comfortable in situations where they are the center of
attention’

AXIS I DISORDERS AXIS II DISORDERS
Hypomania/mania
 Characterized by episodic mood
disturbances with grandiosity and
elated mood
Borderline Personality Disorder
 More self-harm, chaotic relations
& identity confuse
Somatisation/conversion disorder
 People with histrionic personality
are more dramatic and attention
seeking
Dependent Personality Disorder
 More impairment in making
important decisions
Substance misused Narcissistic Personality Disorder
 Need attention by being praised
 They are very sensitive to
humiliation when they are the
centre of attention

MANAGEMENT
Psychotherapy
Patient may see power and strength as a male attribute based
on their childhood experience & feel inferior about own gender
and need to seek attention.
 Dynamic Psychotherapy – May be useful to help patients
analyse their deep seated views & understand how childhood
experiences affect perception & personality development;
therapist should help patient to build self-esteem
 Cognitive Psychotherapy – Challenge cognitive distortions,
reduce emotional reasoning
Pharmacotherapy
SSRIs target depressive symptoms

BORDERLINE
PERSONALITY
DISORDER

INTRODUCTION
Borderline personality disorder (BPD) is a
serious mental disorder marked by a pattern of
ongoing instability in moods, behaviour,
self-image, and functioning. These
experiences often result in impulsive actions
and unstable relationships.
A person with BPD may experience intense
episodes of anger, depression, and anxiety that
may last from only a few hours to days.

EPIDEMIOLOGY
 Prevalence : 1-2%
 Gender : 1:2
 Age of onset : Adolescence
or early adulthood
 Suicide rate : 9%
 Comorbidity : Depression,
PTSD, Substance misuse,
bulimia nervosa
http://www.newhealthguide.org/Famous-
People-With-Borderline-Personality-
Disorder.html

AETIOLOGY
EARLY
DEVELOPMENT ATTACHMENT
PAST TRAUMA
& ABUSE
DEFENCE
MECHANISM
BIOLOGICAL
FACTORS

EARLY DEVELOPMENT
 Early Separation/loss : early insecure attachment results in fear of
abandonment
 Family Environment : high conflict, unpredictability, dysfunction, divorce
 Parental Factors : Alcohol/drugs misuse, forensic history, mother not
emotionally available
 Emotionally vulnerable temperament interacts with an invalidating
environment
PAST TRAUMA AND ABUSE
 Childhood trauma
 Physical/sexual abuse, neglect
ATTACHMENT
 All infants possess a basic instinct towards attachment; if attachment is not
formed, the child’s ability to develop a stable and realistic concept of self is
impaired; the child will have limited mentalisation (capacity) to depict
feelings & thought in self & other people.
AETIOLOGY

DEFENCE MECHANISM
 Splitting: Adopting a polarised or extreme view of the world where people
are either all good or bad and failing to see that each person has good and
bad aspects
 Projective Identifications: The patient unconsciously projects a bad figure
onto the male doctor (projection) and accuses the doctor to be a non-caring
individual; due to counter-transference, the male doctor tries to avoid the
patient as if he does not care about the patient (identification)
AETIOLOGY
BIOLOGICAL FACTORS
 Risk of relatives of borderline personality disorder to develop such disorder is 5x
higher as compared to general population (More common in 1st degree relatives of
patients with depression)
 Abnormal dexamethasone suppression test results,  REM latency, thyrotrophic
response, abnormal sensitivity to amphetamine in BPD patients
 Specific marker for impulsivity : CSF 5HIAA (metabolic serotonin)
 Chronic Trauma: leads to decreased hippocampal volume, decrease hemispheric
integration & hyperactive HPA axis
 Increased bilateral activity in amygdala with emotionally aversive stimuli
 Orbitofrontal cortex abnormalities

Negative affectivity
1. Emotional liability:
• Unstable emotional and frequent mood changes
2. Anxiousness:
• Intense feelings
• Panic in reaction
• Fears of losing control
3. Separation insecurity:
• Fears of rejection
4. Depression:
• Feeling down, miserable and hopelessness
MANUAL-5 CRITERIA

Disinhibition
1. Impulsivity:
• Acting on momentary basis w/o plan or consideration
• Difficulty following the plans
• Self harming under emotional distress
2. Risk taking:
• Engagement in dangerous, risky and self damaging
activities
Antagonism
1. Hotility:
• Frequent angry feelings
• Anger or irritability
MANUAL-5 CRITERIA

‘People with borderline personality disorder present
with recurrent acts of self-harm usually in the form of
self-laceration. They often report chronic feelings of
emptiness and unstable emotion’

NARCISSISTIC
PERSONALITY
DISORDER
(NPD)

WHAT IS NPD?
 Narcissistic personality
disorder is a condition
characterized by an inflated
sense of self-importance,
need for admiration, extreme
self-involvement, and lack of
empathy for others.
 Individuals with this disorder
are usually arrogantly self-
assured and confident.

WHAT IS NARCISSISM?
The word “narcissism” meaning self-love or
admiration for ones self, is derived from the story
of Narcissus in Greek Mythology. Narcissus was
a handsome young man who loved no one but
his own reflection.

EPIDEMIOLOGY
 Prevalence: 0.4 – 0.8%
 Gender: M>F
 Comorbidity: hypomania , depression,
substance misuse, anorexia nervosa

PARENTAL
• Pampering and spoiling
• Parental disdain for fears and needs expressed during childhood
• Lack of affection and praise during childhood
• Neglect and emotional abuse in childhood
• Excessive praise and over- indulgence
• Unpredictable or unreliable care giving from parents
• Learning manipulative behaviours from parents
TEMPERAMENT
• High novelty seeking and reward dependence
DEFENCE MECHANISM
• Low self-esteem
AETIOLOGY

CLINICAL FEATURES
 Exaggerated sense of self-importance
 Expecting to be recognized as superior even without achievements that
warrant it
 Exaggerating your achievements and talents
 Being preoccupied with fantasies about success, power, brilliance, beauty
or the perfect mate
 Believing that you are superior and can only be understood by or associate
with equally special people
 Requiring constant admiration
 Having a sense of entitlement
 Expecting special favours and unquestioning compliance with your
expectations
 Taking advantage of others to get what you want
 Having an inability or unwillingness to recognize the needs and feelings of
others
 Being envious of others and believing others envy you
 Behaving in an arrogant or haughty manner

MANUAL-5 CRITERIA
1. GRANDIOSITY
– Feelings of entitlement
– Overt or covert
– Self-centeredness
– Strongly beliefs that, One is better than others
– Condescending toward others
2. ATTENTION SEEKING
– Excessive attempts to attract and be the focus of the attention
– Admiration seeking

CLUSTER B
1. Avoidant personality disorder
1. Dependent personality disorder
1. Obsessive compulsive personality
disorder

AVOIDANT PERSONALITY
 Prevalence: 0.8-5.0% in the community
 Gender: M = F
 Heritability: 0.28 (estimated)
 Comorbidity: Social phobia
DISORDER
EPIDEMIOLOGY
AETIOLOGY
TEMPERAMENT
Neuroticism and introversion are vulnerabilities which seem to be shared with
social phobia.
PARENTING
 Inconsistent, absent, less demonstration of parental love
 Discouraging, rarely show pride in children
 Higher rates of rejection and isolation
 Maladaptive avoidance develops as a defence against shame, embarrassment,
failure

CLINICAL FEATURES
ICD-10
Affect:
1. Persistent, pervasive tension and apprehension
Behaviour:
1. Unwilling to be involved with people unless certain of being liked
2. Restricted lifestyle due to need for physical security
3. Avoidance of social oroccupational activities involving significant
interpersonal contact because of fear of criticism, disapproval or rejection
Cognition
1. Belief that one is socially inept, personally unappealing or inferior to others
2. Excessive preoccupation with being criticised or rejected in social situations
People with anxious (avoidant) personality disorder exhibit persistent,
pervasive tension and apprehension, characterised by avoidance of
interpersonal contact due to fear of criticism or rejection.

Additional behavioural symptoms:
1. Showing restraint in intimate relationships
because of the fear of being ashamed,
ridiculed, or rejected due to severe low
self-worth
2. Inhibition in new interpersonal situations
because of feelings of inadequacy
MANUAL-5 CRITERIA

‘People with anxious (avoidant) personality disorder
exhibit persistent, pervasive tension and apprehension,
characterized by avoidance of interpersonal contact due
to fear of criticism or rejection’

AXIS I DISORDERS AXIS II DISORDERS
1 Social phobia: People with social
phobia show more impairment and
distress in social situations; their
selfesteem is lower compared to
people with avoidant personality
disorder.
2 Agoraphobia: People with
agoraphobia may have more
frequent panic attacks.
3 Depressive disorder: Negative self
evaluation is related to low mood.
1. Dependent personality disorder:
People with avoidant personality
disorder avoid contact while people
with dependent personality disorder
focus on being cared for
1. Schizoid personality disorder:
Isolated but emotionally cold
2. Paranoid personality disorder:
People with paranoid personality
disorder are isolated due to lack of
trust in other people

MANAGEMENT
Cognitive Behaviour Therapy: May be more
useful and effective compared to brief dynamic
psychotherapy to overcome avoidance.
Assertiveness and social skill training: Useful
To help patients make and refuse requests.
Distress tolerance skill: Important to help
patients to handle anticipatory anxiety in social
situations.

PROGNOSIS
 May do well in familiar environments
with known people.
 Shyness tends to decrease as people
get older.
 High drop-out rates in treatment.

DEPENDENT
PERSONALITY
DISORDER

DEPENDENT PERSONALITY
 Prevalence : 1.0 – 1.7%
DISORDER
EPIDEMIOLOGY
AETIOLOGY
1. Indulgent parents who prohibit
independent activity
1. Insecure attachment

CLINICAL FEATURES
ICD -10
1. AFFECT
 Uncomfortable or helpless when alone due to exaggerated fear of inability
to self care
2. BEHAVIOR
 Encourage or allow others to make most of one’s important life decision
 Subordination of own needs to those of others on whom one is
dependent
 Unwilling to make reasonable demands on the people one depends on.
3. COGNITION
 Preoccupation with fears of being left to care for oneself
 Limited capacity to take everyday decisions without an excessive
amount of advice and reassurance from others.

MANUAL-5 CRITERIA
DSM-5
1. Additional criteria of disorder beginning in
adulthood
2. Require a fulfillment of >5 symptoms
3. Additional behavioral symptoms:
 Difficulty in initiating projects or doing things
on his /her own goes to excessive length to
obtain nurturance and support from others.
 Urgently seeks another relationship for care
and
 Support when close relationship ends.

‘People with dependent personality disorder may have self-effacing
diffidence, eagerness to please and importuning. They may adopt a
helpless or ingratiating posture, escalating demands for medication,
distress on separation and difficulty in termination of psychotherapy’

1. Depressive disorder
2. Agoraphobia
3. Social phobia

MANAGEMENT
1. Cognitive behavior therapy and social skills
training
1. Therapy targeted at including self esteem,
self confidence, sense of efficacy,
assertiveness and exploring fear of
autonomy

OBSESSIVE
PERSONALITY
DISORDER
COMPULSIVE

OBSESSIVE COMPULSIVE
 Prevalence : 1.7 – 2-2 %
 Gender: M > F
PERSONALITYDISORDER
EPIDEMIOLOGY
AETIOLOGY
1. Early development
Excessive parental control and criticism result in
perfectionism, orderliness and control.
2. Hereditary trait
1st degree relative with OCPD

CLINICAL FEATURES
ICD -10
1. Affect :
 Feeling of excessive doubt and caution
2. Behavior :
 Perfectionism that interfere with task completion
 Excessive conscientiousness and scrupulousness (
extremely careful)
 Excessive pedantry (rules) & adherence to social
convention
3. Cognition:
 Rigidity & stubbornness
 Undue preoccupation with productivity to the exclusion of
pleasure and interpersonal relationship

MANUAL-5 CRITERIA
DSM-5
1. COMPULSIVITY
 Rigid perfectionism on everything being flawless, perfect,
without errors or faults including one’s own and other’s
 Sacrificing of timeliness to ensure correctness in every
detail
 Believing that there is only one right way to do things
 Difficulty in changing ideas
 Preoccupation with details, organization, & order
2. NEGATIVE AFFECTIVITY
 Perseveration at task
 Continuation of same behavior despite repeated failures

‘People with anankastic personality disorder may have
excessive adherence to rules and are rigid with routine. For
example, they may park in the same parking lot every day
and become distress if it’s taken by others”

1. Obsessive compulsive disorder
2. Generalized anxiety disorder
3. Schizoid personality disorder

MANAGEMENT
1. Psychodynamic psychotherapy
1. Cognitive behavior therapy

IMPULSE CONTROL
These disorders are characterized by an impulse
(e.g. Gambling or fire-setting) which the person finds
difficult to resist. Prior to the act, there is a build-up of
tension and the person seeks pleasure, gratification,
or relief at the time of performing the act.
CLASSIFICATION
1. Pyromania
2. Kleptomania
DISORDER

IMPULSE CONTROL
DISORDER
DISORDER ICD-10 DIAGNOSTIC CRITERIA DSM-5 DIAGNOSTIC CRITERIA
Pyromania
(pathological fire-
setting)
1. There are two or more acts of
fire-setting without apparent
motive.
2. The I visual describes an
intense urge to set fire to
objects,neither a feeling of
tension before the act and
subsequent relief
3. The in ideal is preoccupied with
thoughts, mental images and
related matters such as an
abnormal interest in fire-
engines, fire station and the fire
service.
Similar to ICD-10 diagnostic criteria
Emphasis: fire setting is not done for monetary
gain,expression of political views or anger,riot,to conceal
criminal activity, false insurance of delusion or hallucination
or as a result of impaired judgement (e.g. In dementia or
intellectual disability.
Exclusion: fire setting is not in the context of conduct
disorder, manic episode or antisocial personality disorder
Kleptomania
(pathological stealing)
1. There are 2 or more thefts in
which the individual steals
without any apparent motive of
personal gain or gain for
another person
1. The individual describes an
intense urge to steal, with a
feeling of tension before the act
and subsequent relief.
Similar to the ICD-10 diagnostic criteria
Emphasis: stealing is not committed to express anger and
the theft is not a response to a delusion or a hallucination.
Exclusion:theft is not in the context of conduct disorder,
manic episodes or antisocial personality disorder.

Personality Disorders & Impulse Control Disorder

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Personality Disorders & Impulse Control Disorder