2. Definition
• Personality disorders are a class of
social disorders characterized by:
enduring maladaptive patterns of
behavior, cognition and inner
experience, exhibited across many
contexts and deviating markedly from
those accepted by the individual's
culture.
APA (2013). DSM (Fifth ed.).
3. Criteria for diagnosis DSM-
5
• Experience difficulties in (2 or more) of
cognition, affect, interpersonal functioning or
control of impulses.
• These patterns develop early, are inflexible
and are associated with significant distress or
disability.
• Involving several areas associated with
considerable personal and social disruption.
• Not for as a manifestation of another mental
disorder, or to the direct physiological effects
of a substance or a general medical condition.
4. • DSM-5 published in 2013 now lists
personality disorders in the same way as
other mental disorders, rather than on a
separate 'axis' as previously.
• Personality disorders are diagnosed in
40–60 percent of psychiatric patients,
making them the most frequent of all
psychiatric diagnoses.
5. DSM-5
Cluster A (odd or eccentric disorders)
• Paranoid personality disorder: a pattern of
irrational suspicion and mistrust of others,
interpreting motivations as malevolent
• Schizoid personality disorder: lack of interest
and detachment from social relationships, and
restricted emotional expression
• Schizotypal personality disorder: a pattern
extreme discomfort interacting socially,
distorted cognitions and perceptions
6. DSM-5
Cluster B (dramatic, emotional or erratic disorders)
• Antisocial personality disorder: a pervasive pattern
of disregard for and violation of the rights of others,
lack of empathy
• Borderline personality disorder: pervasive pattern of
instability in relationships, self-image, identity,
behavior and affects often leading to self-harm and
impulsivity
• Histrionic personality disorder: pervasive pattern of
attention-seeking behavior and excessive emotions
• Narcissistic personality disorder: a pervasive pattern
of grandiosity, need for admiration, and a lack of
empathy
7. DSM-5
Cluster C (anxious or fearful disorders)
• Avoidant personality disorder: pervasive
feelings of social inhibition and inadequacy,
extreme sensitivity to negative evaluation
• Dependent personality disorder: pervasive
psychological need to be cared for by other
people.
• Obsessive-compulsive personality disorder
(not the same as obsessive-compulsive
disorder): characterized by rigid conformity to
rules, perfectionism and control
8. DSM-5
Other personality disorders
•Personality change due to another medical
condition – is a personality disturbance due to
the direct effects of a medical condition
•Other specified personality disorder –
symptoms characteristic of a personality disorder
but fails to meet the criteria for a specific
disorder, with the reason given (e.g mixed
features)
•Unspecified personality disorder- without the
reason given
N.B. Depressive, passive aggressive were not
included
9. Clinical picture
Type of PD Description
Paranoid
Guarded, defensive, distrustful and suspiciousness.
Hypervigilant to the motives of others to undermine or
do harm. Always seeking confirmatory evidence of
hidden schemes. Feels righteous, but persecuted.
Schizoid
Apathetic, indifferent, remote, solitary, distant,
humorless. Neither desires nor needs human
attachments. Withdrawal from relationships and
prefer to be alone. Minimal awareness of feelings of
self or others. Few drives or ambitions, if any.
Schizotypal
Eccentric, self-estranged, bizarre, absent. Exhibits
peculiar mannerisms and behaviors. Thinks can read
thoughts of others. Preoccupied with odd daydreams
and beliefs. Blurs line between reality and fantasy.
Magical thinking and strange beliefs.
10. Clinical picture
Type of PD Description
Antisocial
Impulsive, irresponsible, deviant, unruly. Acts without
due consideration. Meets social obligations only when
self-serving. Disrespects societal customs, rules, and
standards. Sees self as free and independent.
Borderline
Unpredictable, manipulative, unstable. Frantically
fears abandonment and isolation. Experiences rapidly
fluctuating moods. Shifts rapidly between loving and
hating. Sees self and others alternatively as all-good
and all-bad. Unstable and frequently changing
moods.
Histrionic
Dramatic, seductive, shallow, stimulus-seeking, vain.
Overreacts to minor events. Exhibitionistic as a
means of securing attention and favors. Sees self as
attractive and charming. Constant seeking for others'
attention.
11. Clinical picture
Type of PD Description
Narcissistic
Egotistical, arrogant, grandiose, insouciant.
Preoccupied with fantasies of success, beauty, or
achievement. Sees self as admirable and superior,
and therefore entitled to special treatment.
Avoidant
Hesitant, self-conscious, embarrassed, anxious.
Tense in social situations due to fear of rejection.
Plagued by constant performance anxiety. Sees self
as inept, inferior, or unappealing. Feels alone and
empty.
Dependent
Helpless, incompetent, submissive, immature.
Withdraws from adult responsibilities. Sees self as
weak or fragile. Seeks constant reassurance from
stronger figures.
12. Clinical picture
Type of PD Description
Obsessive–
compulsive
Restrained, conscientious, respectful, rigid. Maintains
a rule-bound lifestyle. Adheres closely to social
conventions. Sees the world in terms of regulations
and hierarchies. Sees self as devoted, reliable,
efficient, and productive.
Depressive
Somber, discouraged, pessimistic, brooding, fatalistic.
Presents self as vulnerable and abandoned. Feels
valueless, guilty, and impotent. Judges self as worthy
only of criticism and contempt.
Passive–
aggressive
(Negativistic)
Resentful, contrary, skeptical, discontented. Resists
fulfilling others’ expectations. Deliberately inefficient.
Vents anger indirectly by undermining others’ goals.
Alternately moody and irritable, then sullen and
withdrawn.
13. Prevalence
• The median rate of diagnosable PD
was estimated at 10.6%.
• The prevalence of individual
personality disorders ranges from
about 2% to 3% for the more common
varieties, such as schizotypal,
antisocial, borderline, and histrionic, to
0.5–1% for the least common, such as
narcissistic and avoidant
14. Sex difference
• All PDs are more prevalent in males
except:
Borderline, histrionic and dependent
personality disorder are more in
females.
Avoidant PD is equally prevalent in
both sexes.
15. Etiology
• Developmental & psychosocial: e.g
abuse, early family difficulties, incest
(antisocial, borderline PDs), parental
depreciation (avoidant), physical
illness, parental loss (dependent),
harsh disciplines (OCPD), failure of
maternal empathy (narcissistic).
16. Etiology
• Biological:
Genetic: in all cluster A, antisocial,
borderline, OCPD. (DA, SE genes)
Head trauma, perinatal injury in
antisocial, borderline PD.
Pathophysiology: Frontal, temporal,
parietal lobes affection.
17. Etiology
Neurotransmitters:
• Decrease SE: impulsivity, aggression.
• Dopamine: increased in schizotypal,
decreased in impulsivity, aggression.
• NE: affective instability.
Endocrinal:
• Abnormal DST in borderline
• Blunted prolactin response to
fenfluramine in impulsivity, aggression.
19. Etiology
Cluster Evidence for Brain Dysfunction
A
Evidence for relationship of schizotypal personality to
schizophrenia; otherwise none known
B
Evidence suggestive for antisocial and borderline
personalities; otherwise none known
C Unknown
20. Personality disorder subtypes and
other mental disorders
• Paranoid or schizotypal personality disorders
may be observed to be premorbid antecedents
of delusional disorders or schizophrenia.
• Borderline personality disorder is seen in
association with mood and anxiety disorders
and with impulse control disorders, eating
disorders, ADHD, or a substance use disorder.
• Avoidant personality disorder is seen with
social anxiety disorder.
21. Interventions
Specific approaches
• Individual psychotherapy has been a mainstay of
treatment.
• Family therapy.
• Group therapy for personality dysfunction is probably the
second most used.
• Psychological-education may be used as an addition.
• Self-help groups may provide resources for personality
disorders.
• Milieu therapy, a kind of group-based residential
approach, including therapeutic communities.
• Emphasize psychodynamic techniques, or cognitive or
behavioral techniques.
• Psychiatric medications for treating symptoms of
personality dysfunction or co-occurring conditions.
22. Intervention
Response of Patients with Personality Disorders to Biological and
Psychosocial Treatments
Cluster
Response to Biological
Treatments
Response to Psychosocial
Treatments
A
Schizotypal, paranoid?,
schizoid? patients may improve
on antipsychotic medication
Poor. Supportive psychotherapy
may help
B
Antidepressants,
antipsychotics, or mood
stabilizers may help for
borderline personality;
otherwise not indicated
Poor in antisocial personality.
Variable in borderline,
narcissistic, and histrionic
personalities
C
OCPD may improve on SSRIs?
Medications may help with
comorbid anxiety and
depression
Most common treatment for
these disorders. Response
variable
