This document provides an overview of personality disorders in adults. It defines personality disorders as deeply ingrained behavior patterns that differ significantly from social norms. The document discusses classifications of normal versus abnormal personalities and classifications of personality disorders in the ICD-10 and DSM-IV systems. It describes the clinical features and symptoms of several specific personality disorders. The document also discusses potential causes of personality disorders and approaches to prognosis and management, including biological, psychological, and social treatment methods.

1. DISORDERS OF ADULT
PERSONALITY
FAREED MINHAS
Professor of Psychiatry
HEAD, Institute of Psychiatry
Rawalpindi Medical College
Rawalpindi

2. Introduction
Clinically
significant conditions and behavior patterns
which tend to be persistent
Are the expression of an individual’s characteristic
lifestyle and mode of relating to self and others
Some of these conditions emerge early in the course
of an individual’s development
Result of both constitutional factors and social
experience
While others are acquired later in life

3. What is normal personality?



Many definitions given by psychiatrists and
psychologists
Simplest definition : “the characteristic patterns of
behavior and modes of thinking that determine a
person’s adjustment to the environment”
Important features:
- present since adolescence
- stable over time despite fluctuations in mood
- manifest in different environments
- recognizable to friends and acquaintances

4. Normal Personality (contd.)

Classification of normal personality
Type model
Interaction
Model
Trait model

Psychodynamic model
Situational model
Consistency of normal personality
More theory than proof in various longitudinal studies

5. Abnormal Personality

Deeply ingrained and enduring behavior patterns, manifesting
themselves as inflexible responses to a broad range of personal and
social situations

They represent either extreme or significant deviations from the
way the average individual in a given culture perceives, thinks, feels
and particularly relates to others

These behavior patterns are stable, encompass multiple domains of
behavior and psychological functioning and frequently associated with
subjective distress and problems in social functioning and
performance

Appear in childhood or adolescence and continue into adulthood and
are not secondary to mental disorder or brain damage

6. Important Contributions of
the Past…

Schneider’s Psychopathic Personalities(1950)
Abnormal personalities who either suffer personally
because of their own abnormality or make the community
suffer because of it. Various subtypes described were
of little clinical value. Inborn characteristics believed to
be the sole source of personality, no role of external
factors

Peter Tyrer and Nottingham group(1988)
Classified personality disorders into mature and
immature types. Mature type are evident in adolescence
and don’t change with age. Immature type change and
have late onset

7. Important Contributions of
the Past…
 Graham Foulds Models relating personality
disorder and psychiatric illness
PSYCHIATRIC PERSONALITY
ILLNESS
DISORDER
NORMALITY
MODEL 1
PERSONALITY DISORDER
PSYCHIATRIC
ILLNESS
NORMALITY
MODEL 2

8. PSYCHIATRIC ILLNESS
PERSONALITY DISORDER
=
PERSONALITY
PSYCHIATRIC ILLNESS
DISORDER
NORMALITY
NORMALITY
MODEL 3
PSYCHIATRIC
ILLNESS
PERSONALITY
MODEL 4
NORMAL
PERSONALITY
DISORDER
DISORDER
NORMALITY
MODEL 5
Alternative
MODEL 4
PSYCHIATRIC
ILLNESS

9. Classification of Personality
Disorders









ICD 10
Paranoid
Schizoid (schizotypal)
Dissocial
Emotionally unstable
(Impulsive/Borderline)
Histrionic
Anankastic (obsessive
compulsive)
Anxious (avoidant)
Dependent
Other









DSM IV
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Obsessive-compulsive
Avoidant
Dependent
Passive-aggressive

10. Clinical Features of abnormal
personalities

Paranoid Personality Disorder
- suspicious
- stubborn
- mistrustful

- argumentative
- sensitive
- self important
Schizoid Personality Disorder
- Emotionally cold
- Aloof
- Introspective
- Detached
- Humorless

11. Clinical Features of abnormal
personalities (contd.)

Schizotypal Personality Disorder
-

Social Anxiety
- Unable to form close relations
Eccentric behavior
– Oddities of speech
Inappropriate affect - Unusual perceptual experiences
Suspiciousness
- Ideas of reference/odd ideas
Dissocial (Antisocial) Personality Disorder
- Failure to sustain relationships
(Disregard for others’ feelings)
- Impulsive actions
(Low tolerance of frustration)
(Tendency to violence)
- Lack of guilt
- Failure to learn from
experience

12. Clinical Features(contd.)

Emotionally unstable personality disorder
Impulsive type
Borderline type
- Emotional instability
-Unstable relationships
- Lack of impulse control
-Impulsive behavior
- Outbursts of anger in the form of -Variable moods
words, physical violence etc
-Lack of control of anger
-Recurrent suicidal threats/behavior
-Uncertainty about personal identity
-Chronic feelings of emptiness
-Efforts to avoid abandonment
-Transient stress-related paranoid symptoms

13. Clinical Features(contd.)

Histrionic Personality Disorder
-
Self-dramatization; exaggerated expression of emotion
Suggestibility; easily influenced
Shallow and labile affect
Continual seeking for excitement and attention
- Over-concern with physical attractiveness

Narcissistic Personality Disorder
-
Grandiose sense of self-importance
Preoccupation with fantasies of unlimited success
Exploit others with no return
Crave attention

14. Clinical Features(contd.)

Anankastic personality disorder
-

Feelings of excessive doubt and caution
Preoccupation with details/rules/order/schedule
Perfectionism that interferes with task completion
rigidity and stubborness
Inflexible and judgemental
Anxious (avoidant) personality disorder
-
Persistent/pervasive feelings of apprehension
Belief that one is inferior/socially inept
Excessive preoccupation with criticism and rejection
Avoidance of interpersonal contact

15. Clinical Features(contd.)

Dependent Personality Disorder
-

Allowing others to make important life decisions
subordination of one’s needs to those of others
unwillingness to make even reasonable demands
feeling helpless when alone because of fears of
inabilty to take care of self
Passive-aggressive Personality Disorder
- When demands made for adequate performance,
response is of passive resistance eg.
Deliberate
inefficiency

16. Etiology of Personality Disorders

Genetic Causes

Relation to mental disorders

Personality disorder and
upbringing

17. Prognosis

Age factor – Anxious, Dependent and Passiveaggressive type decrease slightly with age

Few studies mostly on borderline and antisocial types
show poor prognosis

18. Management of Personality
Disorders

Thorough assessment

Three levels of management
(biological/psychological and social)

Biological methods- Anti-psychotics (short-term benefits for borderline)
- Monoamine oxidase inhibitors (also in borderline)
- Anti-epileptic drugs (control of anger outbursts)

19. Management of Personality
Disorders(contd.)


Psychological treatment
- Counselling
- Dynamic psychotherapy
- Cognitive therapy
- Individual or group therapy as appropriate
Social treatment
- Help the individual to change present life
circumstances to as less discordant with
personality as possible

20. THANKYOU
References :
-OXFORD TEXTBOOK OF PSYCHIATRY (Third
Edition)
-COMPANION TO PSYCHIATRIC STUDIES
(Fifth Edition)
-ICD 10 (Clinical and Diagnostic Guildlines)