PERSONALITY

DISORDERS
Dr. Sami Mahmoud
Assistant Professor, KSAU
Consultant Psychiatrist, KASCH
Mental Health
 OBJECTIVES
 Define and differentiate between personality styles, traits, and disorders.
 Identify the essential features of the following personality disorders:
o (cluster A) Paranoid, schizoid, schizotypal
o (cluster B) Antisocial, borderline, histrionic, narcissistic
o (cluster C) Avoidant, dependent, obsessive-compulsive
Apply this information to clinical situations.
 Distinguish between some commonly confused terms, such as:
- schizoid versus schizotypal versus schizophrenic
- obsessive-compulsive personality disorder versus OCD

• Overview the general principles for management of personality disorders.

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 PERSONALITY TRAIT
CHARACTER
- Perceiving = by the 5 sensations
- Relate to (based on the previous experiences)
- Thinking about
- React Emotionally or Behaviorally

• Personality trait: An enduring pattern of

(perceiving, relating to, and thinking about)
the environment and others.

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 PERSONALITY DISORDERS

• Personality disorders:
Ingrained patterns of relating to other people,
situations, and events with
A rigid and maladaptive pattern of
inner experience, behavior and interpersonal
relationship
causing distress to the self or others or both

• Dating back to adolescence or early adulthood =

the diagnosis should be at the age 18+ years

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 BIOPSYCHOSOCIAL PERSPECTIVE

• Personality Disorders represent:

• Mix of long-standing personal dispositions (physical

appearance, temper& characters) and behavior patterns

• Disturbances in identity and interpersonal relationships

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 THE NATURE OF PERSONALITY
DISORDERS
• Personality Disorders must manifest themselves
in at least (two) of the following (four) areas:

1. Cognition
2. Identity
3. Affectivity (Emotion)
4. Impulse control (Behavior)
5. Interpersonal functioning

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GENERAL CRITERIA FOR A PERSONALITY DISORDER

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 DSM-5 MULTIAXIAL CLASSIFICATION

• Personality disorder is Axis II diagnosis within the

Multiaxial classification of the DSM-5.

Axis 1 : Clinical Disorders

Axis II : Personality Disorders OR Mental Retardation
Axis III : Medical Conditions related to Axis1
Axis IV: Psychosocial Stressors
Axis V : Global Assessment of Functioning (0:50:100)

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 DSM-V PERSONALITY DISORDER
CLUSTERS
• The DSM-V groups the 11 diagnoses into three
clusters based on shared characteristics:
• Cluster A - The odd and eccentric behaviors
• Cluster B - The dramatic and emotional behaviors
• Cluster C - The anxious and fearful behaviors

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CLUSTER A PERSONALITY DISORDERS

• Cluster A of the personality disorders in DSM-V

include those disorders characterized by
eccentric behavior.

• In other words, individuals with these disorders show

characteristics that might lead others to view them
as slightly odd, unusual, or peculiar.

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 PARANOID PERSONALITY
DISORDER
• A personality disorder whose outstanding feature is
that the individual is unduly suspicious of others and
is always on guard against potential danger or
harm.

• Impossible to trust people

• Project blame onto others

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SCHIZOID PERSONALITY DISORDER

• Prefer to be alone
• Cold, reserved, withdrawn
• Insensitive to feelings of others
• No desire to love or be loved
• Indifference to social and sexual relationships
• Unfashioned (unrefined) in his dress

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SCHIZOTYPAL PERSONALITY DISORDER

• A personality disorder that primarily involves odd

appearance, beliefs, communication, behavior
and interpersonal style.

• Such individuals :
lack a clear sense of direction or motivation
do not have a clear set of standards against which
to measure their behavior

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SCHIZOTYPAL PERSONALITY DISORDER

• Eccentricity
• Peculiar communication
• Poor social adaptation
• Social isolation
• Micro psychosis

• Treatment
• Parallels interventions commonly used in treating
schizophrenia

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CLUSTER B PERSONALITY DISORDERS

These disorders include :

- An inflated sense of self
- A tendency to seek stimulation
- Dramatic
- Impulsivity

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 ANTISOCIAL PERSONALITY DISORDER

• A personality disorder characterized by :

- Lack of regard for society’s moral or legal standards
- Impulsive
- Risky lifestyle.
• The diagnostic criteria in the DSM-5 require that an
individual show a pervasive pattern of three out of
seven possible behaviors:
1. Failure to conform to social norms
2. Deceitfulness
3. Lack of remorse (Lack of deep or lasting emotion)
4. Impulsivity
5. Aggressiveness
6. Disregard for safety of self or others
7. Irresponsibility
 IMPORTANT DISTINCTIONS

• There is a difference between antisocial personality

disorder and antisocial behavior.

• Antisocial behavior
• Illegal or immoral behavior such as stealing, lying, or
cheating

• Criminal behavior
• A legal term, not a psychological concept

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 PERSPECTIVES ON
ANTISOCIAL PERSONALITY
• Biological
• Possible genetic causes
• Various brain abnormalities

• Psychological
• Neuropsychological deficits
• Passive avoidance
• Response modulation hypothesis

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 TREATMENT OF ANTISOCIAL
PERSONALITY DISORDER
• Problems of working with these individuals
• Seeming lack of motivation to change
• Tendency toward deception and manipulation
• Lack of deep or lasting emotion

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 BORDERLINE PERSONALITY DISORDER

• Pervasive pattern of
- instability in
(mood, self-image “identity” and interpersonal relationships)
- Feeling Empty = No body love me = being rejected
- poor impulse control
BPD’s central feature is that of instability
• The way that people with BPD relate to others is termed
“splitting” = All or Non = Good or Bad
• Chronic suicidality

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 PERSPECTIVES ON BORDERLINE
PERSONALITY
• Biological
• High heritability
• Abnormalities in:
• Amygdala and prefrontal cortex – these are areas related to
emotion
• Neurotransmitters and hormones
• Psychological
• Emotional dysregulation
• Distress intolerance
• Experiential avoidance
• Childhood neglect or traumatic experiences
• Marital or psychiatric difficulties

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 TREATMENT OF BORDERLINE
PERSONALITY
• Dialectical behavioral therapy
• Core mindfulness
• Transference-focused psychotherapy
Need for clinicians to:
• Take an active role in treatment
• Take over a primary role in treatment
• Provide a therapeutic structure
• Support the client
• Involve the client in the therapeutic process
• Deal with the client’s suicidal threats or self-harming acts
• Be self-aware and ready to consult with colleagues

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 HISTRIONIC PERSONALITY DISORDER

• Show extreme pleasure as the center of attention,

• Behave in whatever way necessary to ensure that this
happens.

• Exaggerated emotional reactions,

• Approaching theatricality, in everyday behavior.

• Attention Seeking Behavior = they are excessively

concerned with their physical appearance, often trying to
draw attention to themselves in such extreme ways that
their behavior seems ludicrous (seems over)
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 HISTRIONIC PERSONALITY DISORDER

• Seductive
• Need for immediate gratification
• Demand reassurance, praise, approval of others
• Easily influenced by others
• Lack analytical ability = the ability to work with data
(problem-solving skills)

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NARCISSISTIC PERSONALITY DISORDER

• Unrealistic, inflated sense of self-importance

• Lack of sensitivity to other people’s needs

Pseudo grandiosity

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 THEORIES OF NARCISSISTIC
PERSONALITY
• Freudian
• Stuck in early psychosexual stages
• Psychodynamic
• Empathy – lack of empathy
• Cognitive behavioral
• Maladaptive ideas
• Grandiose ideas clash with their experiences of failure

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 TREATMENT OF NARCISSISTIC
PERSONALITY
• Most effective approach
• Provide reassurance
• Develop a more realistic view of themselves and other
people

• People with NPD are difficult to treat

• Tend not to have insight into their disorder
• Extreme perfectionism can obstruct treatment

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 CLUSTER C
PERSONALITY DISORDERS
These disorders involve people who appear :
- Anxious
- Fearful
- May seems highly restricted

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DEPENDENT PERSONALITY DISORDER

• The individual is extremely passive

• Tends to cling to other people to the point

of being unable to make any decisions

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AVOIDANT PERSONALITY DISORDER

The individual who

- Fearful of any involvement with other
people, although he desires the involvement.
- Terrified at the prospect of being publicly
embarrassed

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 AVOIDANT - THEORIES

• Cognitive-behavioral
• Hypersensitive due to parental criticism
• Distorted perceptions of experiences with
others
• Expect not to be liked
• Feel unworthy of other people’s regard
• Avoid getting close to avoid expected
rejection

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 TREATMENT OF AVOIDANT
PERSONALITY

• Cognitive-behavioral
• Confront and correct dysfunctional
attitudes and thoughts
• Break negative cycle of avoidance
• Graduated exposure to social situations
• Learn skills to improve chance of intimacy

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 OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
A personality disorder involving intense perfectionism
and inflexibility manifested in:
worrying, indecisiveness, and behavioral rigidity.

OCPD is a disturbance of personality, not a disturbance in

thoughts, involving anxiety or even out-of-control behaviors

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 OCPD DO NOT EXPERIENCE
OBSESSIONS AND COMPULSIONS.

- OCPD refers to this rigidly compulsive personality

tendency and also obsessive concern with
perfectionism.
- OCD refers to disturbance in the thought content
(obsessive thought) reflected by ritual behavior
(compulsion).
- OCPD person is ego-syntonic to their ideas and
behaviors ,
while OCD person is ego-dystonic to them.

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 THEORIES OF
OBSESSIVE-COMPULSIVE
• Freudian
• Fixation at anal psychosexual stage

• Cognitive-behavioral
• Unrealistic standard of perfection
• Ruminative tendency

• Metacognitive interpersonal therapy

• Think about their thinking

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 THANK YOU

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