Definition DEFINITION An abnormal personality is one in which there are “ deeply ingrained maladaptive pattern’s behavior recognizable by the time of adolescence or earlier and confining through most of adult life because of this ,the patient suffer or others have to suffer and there is an adverse affect on the individual or on society. Classification or clusters Cluster A Cluster B Cluster C Causes Diagnosis Treatment

1. MRS A.V.SUMIRTHI
ASST PROFESSOR
GANGA COLLEGE OF NURSING
COIMBATORE

2. Characteristic ways of thinking, feeling,
and behaving that are stable across time
and across situations
Considered to be a disorder when
 Traits are inflexible and maladaptive
Cause significant functional impairment
and/or distress

3. The totality of emotional and
behavioral characteristics that are
particular to a specific person and
that remain somewhat stable and
predictable over time.

4. DEFINITION
An abnormal personality is one in which
there are “ deeply ingrained
maladaptive pattern’s behavior
recognizable by the time of
adolescence or earlier and confining
through most of adult life because of
this ,the patient suffer or others have
to suffer and there is an adverse affect
on the individual or on society.

5. 0.5 - 2.5% of the general
population
2 - 10% of outpatients
10 - 30% of inpatients

6. Thought to originate in childhood
and continue into adulthood
Believed to be relatively stable,
difficult to treat

7. Considerable overlap among
categories
About 50% of people diagnosed with
one personality disorder also meet
criteria for another.

8. Clusters A: Odd/Eccentric
Clusters B: Dramatic/Erratic
Clusters C: Anxious/Fearful

10. Paranoid
Schizoid
Schizotypal

12. Pervasive pattern of distrust and
suspiciousness of others such
that their motives are
interpreted as malevolent (having or
showing a wish to do evil to others)

13. Suspects others are exploiting, harming,
or deceiving him
Preoccupied with doubts about
loyalty/trustworthiness of friends,
associates
Reluctant to confide in others (fears info
will be used against him)

14. Reads hidden threatening meanings into
benign events
Bears grudges, is unforgiving
Perceives attacks on character or
reputation and is quick to counterattack
Suspicious of fidelity of sexual partner

15. Biological
 slightly more common among relatives of
people with schizophrenia
Psychological
 theory: certain basic mistaken assumptions
about others
 “people are malevolent and deceptive” and
“they’ll attack you if they get the chance”
 result of upbringing? taught by parents?

16. Suspiciousness
Mistrust
Sensitive
Argumentative
Stubborn
Self –important
Jealous and irritable

17. Difficulty that brings them in is a crisis
Cognitive therapy - Changing person’s
mistaken beliefs about others
Psychotherapy
An Antianxiety agent such as Diazepam
(Valium) & antipsychotic such as
haloperidol (Haldol) & Pimozide (Orap) has
successfully reduced paranoid ideation in
some patients.

19. Pervasive pattern of detachment
from social relationships and
restricted range of expression of
emotion in interpersonal settings

20. Neither desires nor enjoys close
relationships
Chooses solitary activities
Little, if any, interest in sexual
experiences with another person
Lacks close friends
Appears indifferent to praise/criticism
Shows emotional coldness, detachment
Takes pleasure in few, if any, activities

21. Emotionally cold
Aloof (unfriendliness)
Detached
Humorless
Introspective
Inability to experience pleasure

22.  Causes
 No research
 preference for social isolation resembles aspects of
autism
 Treatment
 point out value of social relationships
 learn empathy
 Social skills training
 Psychotherapy
 small dosages of antipsychotics, antidepressants, and
psychostimulants has benefitted some patients.
Benzodiazepines may help diminish interpersonal

24.  Pervasive pattern of social and interpersonal
deficits marked by acute discomfort with, and
reduced capacity for, close relationships and
cognitive or perceptual distortions and
eccentricities of behavior

25.  Ideas of reference
 Odd beliefs or magical thinking
 Unusual perceptual experiences
 Odd thinking and speech
 Suspiciousness/Paranoia

26.  Inappropriate or constricted affect
 Behavior or appearance that is odd,
eccentric, or peculiar
 Lack of close friends
 Excessive social anxiety: associated with
paranoid fears

27.  Inappropriate affect
 Odd belief or magical thinking
 Social withdrawal
 Lack of close relationship
 Social isolation
 Not fitting easy with others

28.  Biological
 More common among relatives of people with
schizophrenia
 Treatment
 Psychological: social skills to help reduce
isolation or help person adjust to solitary
lifestyle
 Psychotherapy
 Anti-schizophrenia & Anti - depressants

29.  Avoidant
 Low on extraversion
 High on neuroticism
 Schizoid
 Low on extraversion
 High on neuroticism (not at high as avoidant)

30.  Borderline
 High on neuroticism
 Low on agreeableness(kindness)
 Paranoid
 Low on agreeableness
 Antisocial
 Low on agreeableness

31.  Histrionic
 High on extraversion
 High on neuroticism
 Dependent
 High on agreeableness
 High on neuroticism

33.  Antisocial
 Borderline
 Histrionic
 Narcissistic

34. Pervasive pattern of disregard for and violation of the rights
of others since age 15

35.  At least 3 sx
 Failure to conform to social norms with respect to
lawful behavior (repeated arrests)
 Deceitfulness (repeated lying, use of aliases, cunning)
 Impulsivity, failure to plan ahead
 Irritability and aggressiveness (repeated fights)
 Reckless disregard for safety of others
 Consistent irresponsibility (no steady employment,
doesn’t honor financial obligations)
 Lack of remorse (indifferent to or rationalizes having
hurt, mistreated, or stolen from others)

36.  Evidence of conduct disorder prior to age
15
 Violation of basic rights of others and major
social rules
 Aggression toward people and/or animals
 Destruction of property
 Deceitfulness or theft
 Serious violation of rules (stays out all night,
truant)

37.  Antisocial personality disorder overlaps
with personality trait called
“psychopathy”
 Glib or superficial charm (magic)
 Grandiose sense of self-worth
 Proneness to boredom/need for stimulation
 Pathological lying
 Conning/manipulative
 Lack of remorse(guilt)
 Not all psychopaths display aggressiveness
that is a DSM-IV-TR criterion for antisocial
personality

38.  Genetics
 Family, adoption, and twin studies show evidence
of a genetic link
 Examples:
 Offspring of felons raised by adoptive families show
higher rates of arrests and antisocial personality
disorder than controls
 Concordance rates for criminality are 55% for MZ twins
and 13% for DZ twins

39.  Underarousal hypothesis
 Psychopaths have abnormally low levels of
cortical arousal
 Engage in antisocial and risk-taking behaviors to
increase level of arousal
 Evidence
 Longitudinal study found that future criminals had
lower skin conductance activity, lower heart rate, and
more slow-frequency brain wave activity

40.  Fearlessness hypothesis
 psychopaths have a higher threshold for
experiencing fear than most people
 evidence
 psychopaths are less likely to develop a classically
conditioned fear response

41.  Oversensitivity to reward
 will persist in efforts to achieve goal, even
when goal is no longer attainable
 Inconsistent parental discipline
 giving in to problem behavior and poor
monitoring
 Other environmental influences
 low SES, stress, and degree of mutual trust and
solidarity in neighborhood linked to antisocial
behaviors

42.  Failure to sustain relationship
 Disregard for the feeling of others
 Impulsive action
 Low tolerance of frustration
 Tendency to cause violence
 Lack of guilt
 Failure to learn from experience
 Manipulative behavior

43.  Prognosis for adults is poor
 Best strategy is to intervene with “high risk” children
 Teach parents to use behavioral management
principles to reduce problem behavior and increase
prosocial behavior
 Psychotherapy
 Psychostimulants such as methylphenidate (Ritalin)
 antiepileptic drugs, for example, carbamazepine or
valproate.
 α-Adrenergic receptor antagonists have been used to
reduce aggression.

45.  Pervasive pattern of instability of interpersonal
relationships, self-image, and affects marked by
impulsivity

46.  Frantic efforts to avoid real or imagined
abandonment (Neglect)
 Intense and unstable interpersonal relationships
 alternate between extremes of idealization and
devaluation
 Unstable self-image or sense of self
 Impulsivity in at least 2 areas that are
potentially self-damaging (sex, money)

47.  Recurrent suicidal behavior or self-mutilation
 Emotional instability due to marked reactivity of
mood
 Chronic feelings of emptiness
 Inappropriate, intense anger
 Transient, stress-related paranoid thoughts or
dissociative symptoms

48.  Family studies
 suggest genetic link
 suggest that BPD is linked to mood disorders
 Early trauma
 91% report h/o childhood sexual or physical abuse
 One theory
 child who has biological vulnerability to emotional
dysregulation and is raised by invalidating family

49.  Unstable relationship
 Unstable self image
 Unstable emotion
 Impulsivity

50.  Antipsychotics
Antidepressants
MAO inhibitors (MAOIs)
Benzodiazepines
Anticonvulsants,
Serotonergic agents such as selective
serotonin reuptake inhibitors (SSRIs)
have been helpful in some cases.

51.  Psychological
 Dialectical behavior therapy
 help people cope with stressors that trigger
suicidal behaviors
 teach patients how to identify and regulate
their emotions
 teach problem solving
 re-exposure to prior traumatic events to
extinguish fear
 trust own responses, rather than depend on
others for validation
 Reduces suicide attempts, dropouts from
treatment, and hospitalizations

53.  Pervasive pattern of excessive emotionality
and attention seeking

54.  Uncomfortable when not the center of
attention
 Inappropriate sexually seductive or
provocative behavior
 Rapidly shifting and shallow expression of
emotions
 Consistently uses physical appearance to
draw attention to self

55.  Speech is excessively impressionistic and
lacking in detail
 Shows self-dramatization, theatricality,
and exaggerated expression of emotion
 Highly suggestible
 Considers relationships to be more
intimate

56.  Dramatic emotionality
 Craving for novelty and excitement
 Shallow and labile activity
 Attention seeking behavior
 Over concern with physical attractiveness
 Vague (unclear)speech
 Suggestibility

57. Impulsivity
Ego centricity
Self-indulging , lack of
consideration for others

58.  Psychotherapy
Group therapy
Cognitive behavioral therapy
Family therapy
Medications
Alternative therapies

60. Pervasive pattern of grandiosity,
need for admiration, and lack of
empathy

61.  Grandiose sense of self-importance
 example: exaggerates achievements and
talents
 Preoccupied with fantasies of unlimited success,
power, beauty, etc.
 Believes he/she is special and unique
 can only be understood by or associate with
other special high status people
 Requests excessive admiration
 Sense of entitlement
 unreasonable expectations for favorable
treatment

62. Interpersonally exploitative
Lacks empathy
Often envious of others, or believes
others are envious of him/her
Arrogant, haughty (arrogantly superior)
behaviors or attitudes

63. Little research
One theory:
grandiosity is a defense against very
fragile self-esteem
develops because parents do not
respond with approval to child’s
displays of competency

64. Inflated sense of self important
Attention seeking, dramatic behavior
Unable face criticism
Exploitative behavior
Arrogance
Preoccupation with fantasies of success,
power, beauty.

65. Little research
Therapy focuses on grandiosity,
sensitivity to evaluation, and lack of
empathy
 psychodynamic, cognitive,
behavioral Therapy etc.)

67. Avoidant
Dependent
Obsessive-compulsive

69. Pervasive pattern of social
inhibition, feelings of inadequacy,
and hypersensitivity to negative
evaluation

70. Avoids occupational activities that involve
significant interpersonal contact, because
of fears of criticism, disapproval, or
rejection
Unwilling to get involved with people
unless certain of being liked
Shows restraint in interpersonal
relationships because of fears of being
shamed or ridiculed

71. Preoccupied with being criticized or
rejected in social situations
Inhibited in new interpersonal situations
Views self as socially inept, unappealing,
or inferior
Reluctant to take risks or engage in new
activities (due to fears of embarrassment)

72. One theory
Person born with difficult
temperament or personality
characteristics
Parents reject them or don’t
provide enough early, uncritical love
Rejection results in low self-esteem
and social alienation

73. Persistent feeling of tension
Inferiority complex
Fear of criticism, disapproval, or
rejection
Unwillingness to become involved with
people
Excessive preoccupation with being
criticized

74. Controlled studies show evidence for
effectiveness of behavioral
intervention techniques for anxiety
and social skills
systematic desensitization
behavioral rehearsal

76. Pervasive and excessive need to be
taken care of that leads to
submissive, clinging behavior and
fears of separation

77. Difficulty making everyday decisions
Needs others to assume responsibility
Difficulty expressing disagreement
 due to fears of loss or support or
approval
Difficulty initiating projects or doing
things on his/her own
 due to lack of self-confidence in own
judgment or abilities

78. Goes to excessive lengths to obtain
nurturance and support
 volunteers to do unpleasant things
Feels uncomfortable or helpless when
alone
 because of fears of being unable to take
care of self
Urgently seeks another relationship as a
source of care/support when one ends
Preoccupied with fears of being left to
take care of him/herself

79. Subordinations of ones own needs
Unwillingness to make even reasonable
demand on the other people
Inability to take decision
Feeling of uncomfortable or helpless
when alone
Low self esteem , lack of confident
Hypersensitivity to criticism

80. Causes
one theory is that early death of
parent or neglect/rejection by
caregiver cause person to grow up
fearing abandonment
Treatment
little research

82. Pervasive pattern of preoccupation
with orderliness, perfectionism, and
mental and interpersonal control, at
the expense of flexibility, openness,
and efficiency

83. Preoccupied with details, rules, lists,
order, organization, or schedules to the
extent that the major point of the
activity is lost
Perfectionism that interferes with task
completion
Excessively devoted to work and
productivity to the exclusion of leisure
activities and friendships
Over conscientious(careful) and inflexible
about morality, ethics, or values

84. Unable to discard worn-out or worthless
objects
 even when they have no sentimental
value
Reluctant to delegate tasks
 unless others submit to person’s exact
way of doing things
Has miserly spending attitude
 money to be hoarded for future
catastrophes
Rigidity and stubbornness

85. Feeling of excessive doubt and
caution(watchfulness)
Preoccupation with details, rules,
lists, order, schedule.
Perfectionism
Rigidity and stubbornness
High standards

86. Causes
 weak genetic contribution
 possible parental reinforcement of
conformity and neatness
Treatment
 little research
 therapy addresses fears that underlie
need for orderliness
 relaxation techniques

87.  Impaired social interaction related to aggressive
behaviour as evidenced by anger outbursts
 Low self esteem related to maladaptive social
behaviour as evidenced by lack of initiation,
pessimistic thinking, fealadaptive social behaviour
related to lack of trust as evidenced by unsuccessful
relationship disinhibited behaviour
 Risk for self mutilation related to aggressiveness as
evidenced by keeping sharp objects and threatening
to harm himself and low self esteem
 Anxiety related to low self esteem as evidenced by
anxious facial expression

88.  Impaired decision making related to maladaptive
coping as evidenced by frequent fights
 Disturbed thought processes related to alteration in
perceptions as evidenced by impaired judgement
 defensive coping related to low self esteem as
evidenced by lack of trust, fear
 Ineffective therapeutic regimen management
related to reluctance as evidenced by inability to
carry out daily activities
 Impaired adjustment related to lack of desire for
social interaction as evidenced by flat, silly and
inappropriate affect
 Powerlessness related to low self esteem as
evidenced by feeling of inadequacy