Personality Disorder ↑minority group, immigrants, deaf

Childhood trauma
Personality SUSPECT
→ totality of the person’s emotional and behavioural S – spouse fidelity suspected
traits that characterize their day-to-day living. U – Unforgiving (bear grudges)
S – Suspicious of others
1) Myers Briggs Type Indicator (MBTI) P – Perceives attacks (and react quickly)
Preferences : EISNTFJP E – Enemy / friend (suspect associates and friends)
C – Confiding (thrust) in other feared
Extraversion Introversion T – Threats perceived in benign event
Sensing Intuition A Pervasive distrust & suspiciousness of others
Thinking Feeling such that their motives are interpreted as
Judging Perceiving malevolent, beginning by early adulthood and
2) Big Five Model present in a variety of contexts, as by ≥ 4 of
1. Openness 1. Suspect, without sufficient basis, that others
2. Conscientiousness are exploiting, harming, or deceiving him
3. Extraversion 2. Is preoccupied with unjustified doubts about
4. Agreeableness the loyalty/ trustworthiness of friends
5. Neuroticism 3. Reluctant to confide (trust) in others because
of unwarranted fear that the information will
Personality be used maliciously against him
Disorder
4. Reads hidden demeaning/ threatening
Cluster A Cluster B Cluster C meanings into benign remarks/ events
5. Persistently bear grudges (unforgiving of
Paranoid Antisocial Avoidant insults, injuries or slights)
6. Perceive attacks on his character/ reputation
Schizoid Histrionic Dependant that are not apparent to others and is quick
to react angrily/ to counterattack
Obsessive
Schizotypal Narcissistic
Compulsive
7. Recurrent suspicious, without justification,
regarding fidelity of spouse/ sexual partner
Borderline B Does not occur exclusively during the course of
schizophrenia/ BPAD/ depressive disorder with
Aetiology 1. Genetics (40-60%) psychotic features or another psychotic disorder
- Cluster A common in 1st degree or medical disorder
relatives of pt with schizophrenia Schizoid
2. Neurochemistry A pattern of detachment from social relationships
- ↑ testosterone, oestrogen, 17- and a restricted range of emotional expression
oestradiol a/w impulsivity in Epidemiology
borderline & antisocial personality ds Men>Women
- ↓ serotonin 5-hydroxyindoleactic ↑in relative +ve schizophrenia/ schizotypal
acid (5-HIAA) a/w low mood, self- PD
harm, suicidal behaviour and Solitary jobs that involve little contact
borderline personality ds. Emotionally cold, neglectful, detached
3. Environment parents during childhood
- ↓ socioeconomic status and social DISTANT
isolation D – Detached (or flattened affect)
4. Parenting style I – Indifferent to criticism/ praise
- lack of care → borderline & S – Sexual experiences of little interest
dependent personality disorder T – Tasks done solitary
5. Childhood abuse A – Absence of close friend
- maltreatment & trauma N – Neither desires nor enjoy close relation
Cluster A T – Takes pleasure in few activities
“ Odd, eccentric (pelik)”, “weird personalities” A Detach from social relationship and restricted
- Genetic associated with Schizophrenia range of expression of emotions in interpersonal
- Familial a/w psychotic disorder settings, ≥ 4 of
Paranoid 1. No desires/ enjoys close relationships,
A pattern of distrust and suspiciousness such that including being part of a family
others’ motives are interpreted as malevolent (wish 2. Always choose solitary activities
to do evil) 3. Has little, if any, interest in having sexual
Epidemiology experiences with another person
Men>Women 4. Takes pleasure in few, if any, activities
↑in relative +ve schizophrenia 5. Lacks of close friends
6. Appears indifferent to the praise/ criticism
 7. Emotional coldness, detachment or flattened
affectivity
B Does not occur exclusively during the course of
schizophrenia/ BPAD/ depressive disorder with
psychotic features or another psychotic disorder
or medical disorder
Schizotypal
A pattern of acute discomfort in close relationships,
cognitive or perceptual distortion and eccentricities
of behaviour
Epidemiology
Men>Women
↑in relative +ve schizophrenia
Thought to be primarily biological
ME PECULIAR
M – magical thinking/ odd belief
E – experiences unusual perception
P – paranoid ideation
E – eccentric behaviour/ appearance
C – constricted/ inappropriate affect
U – unusual/odd thinking and speech
L – lacks close friends
I – ideas of reference
A – anxiety in social situations
R – rule out psychiatric disorders & pervasive
developmental disorder
A Social & interpersonal deficits marked by acute
discomfort with, and reduced capacity for, close
relationships + cognitive/ perceptual distortion +
eccentric behaviour, begin by early adulthood
with ≥ 5 of the following:
1. Ideas of reference (NOT DELUSION)
2. Odd beliefs/ magical thinking that influence
behaviour and is inconsistent with
subcultural norms
3. Unusual perceptual experiences including
bodily illusions
4. Odd thinking & speech
5. Suspiciousness/ paranoid features
6. Inappropriate/ constricted affect
7. Behaviour/ appearance odd/ eccentric/
peculiar
8. Lack of close friends
9. Social anxiety a/w paranoid fears (not –ve
judgement about self)
B Does not occur exclusively during the course of
schizophrenia/ BPAD/ depressive disorder with
psychotic features or another psychotic disorder
or medical disorder
Cluster B
Dramatic, emotional, erratic
- Familial a/w mood disorder
Antisocial
A pattern of disregard for, and violation of the rights
of others.
- Inability to conform (behave in socially acceptable)
to the social norms that ordinarily govern many
aspects of a person’s adolescent and adult behaviour.
- ↑ risk of somatic symptoms disorder, Substance
use disorder
- Comorbid: depressive disorder, alcohol/ substance
abuse
Epidemiology
Men>Women
↑ in 1st degree relatives of men with anti-
social PD
↑poverty & immigrants
CALLOUS MAN
C – conduct disorder before 15 y/o, current age ≥ 18
A – antisocial act
L – lies frequently
L – lacks of superego
O – obligations not honoured
U – unstable (cant plan ahead)
S – safety of self and other people
M – money problems - spouse & child not supported
A – aggressive + assaultives
N – not according exclusively during schio & mania
A Disregard for and violation of the rights of
others, since 15 y/o, ≥ 3 of the following
1. Failure to conform to social norms with
respect to lawful behaviours, as indicated by
repeatedly performing acts that are grounds
for arrest
2. Deceitfulness, as indicated by repeated lying,
use of aliases, or conning others for personal
profit to plan pleasure
3. Impulsivity (failure to plan ahead)
4. Irritability and aggressiveness, as indicated
by repeated physical fights/ assault
5. Reckless disregard for safety of self/ others
6. Consistent irresponsibility, as indicated by
repeated failure to sustain consistent work
behaviour/ honour financial obligations
7. Lack of remorse (regret), as indicated by
being indifferent to or rationalizing having
hurt, mistreated, stolen from another
B ≥ 18 years old
C Conduct disorder with onset before 15 y/o
D Not exclusively during the course of
schizophrenia/ bipolar disorder
Histrionic
A pattern of excessive emotionally and attention
seeking.
- excitable and emotional and behave in a colourful,
dramatic, extroverted fashion
Epidemiology
Women > Men
Associated with somatization disorder &
alcohol use disorder
I CRAVE SIN
I –inappropriate behaviour (seductive/ provocative)
C – centre of attention
R –relationship are seen as closer than they really are
A – appearance is most important
V –vulnerable to others’ suggestion
E –emotional expression is exaggerated
S –shifting emotions, Shallow
I –impressionistic manner of speaking (lacks detail)
N –novelty is craved

A 1. Uncomfortable in situations in which he is
not the centre of attention
2. Interaction with others is often characterized
by inappropriate sexually seductive/
provocative behaviour
3. Displays rapidly shifting and shallow
expression of emotions
4. Consistently uses physical appearance to
draw attention to self
5. Has a style of speech that is excessively
impressionistic and lacking in detail
6. Shows self-dramatization, theatricality and
exaggerated expression of emotion
7. Is suggestible (easily influenced by others/
circumstances)
8. Consider relationships to be more intimate
than they actually are
Narcissistic
A pattern of grandiosity, need for admiration, and
lack of empathy
- characterized by a heightened sense of self-
important, lack of empathy, and grandiose feelings of
uniqueness.
-Underneath, however their self-esteem is fragile and
vulnerable to even minor criticism
Epidemiology
May impart unrealistic sense of omnipotence,
grandiosity, beauty and talent to their children
(Parent to children)
A FAME GAME
A – admiration required in excessive amounts
F – fantasize about unlimited success, brilliance
A – arrogant
M – manipulative
E – envious of others
G – grandiose sense of importance
A – associate with special people
M – me first attitude
E – empathy lacking for others
A Grandiosity (fantasy and behaviour), need for
admiration, lack of empathy, begin in early
adulthood, ≥ 5 of following
1.Grandiose sense of self-importance
(exaggerates achievements and talents,
expects to be recognized as superior without
commensurate achievements)
2.Preoccupied with fantasies of unlimited
success, power, brilliance, beauty, ideal love
3.Believes that he is special and unique and can
only be understood by/ associate with special/
high status people
4.Require excessive admiration
5.Sense of entitlement
6.Interpersonally exploitative (take advantages
of others to achieve his own ends)
7.Lacks of empathy (unwilling to recognize/
identify with the feelings and need of others)
8.Envious of others/ believes that others are
envious of him
9.Shows arrogant, haughty behaviours or
attitude
Borderline
A pattern of instability in interpersonal relationship,
self-image, and affects and marked impulsivity
- stand on the border b/w neurosis and psychosis
- characterized by extraordinarily unstable affect,
mood, behaviour, object relations, and self-images
 ↑ incidence to develop MDD
Epidemiology
Women > Men
↑ in 1st degree relatives with MDD, alcohol use
disorder, substance abuse
High genetic factors
↓ in older people
I RAISED A PAIN
I – Identity disturbance
R – relationship are unstable
A – abandonment frantically avoided (weather real/
imagined)
I – impulsivity
S – suicidal gestures (threats, self-mutilation)
E – emptiness
D – dissociative symptoms
A – affective instability
P – paranoid ideation (stress-related and transient)
A – anger is poorly controlled
I – idealization followed by controlled
N – Negativistic (undermine themselves with
self0deteating behaviour)
A Instability of interpersonal relationships, self-
image, and affects, and markedly impulsivity,
begin by early adulthood, ≥ 5 of following
1. Frantic efforts to avoid real/ imagined
abandonment
2. a pattern of unstable and intense
interpersonal relationships characterized by
alternating between extremes of idealization
and devaluation
3.Identify disturbance markedly and persistently
unstable self-image/ sense of self
4.Impulsivity in ≥ 2 areas that are potentially self-
damaging (spending, sex, substance abuse etc)
5.Recurrent suicidal behaviour, gestures or
threats or self-mutilating behaviour
6.Affective instability d/t a marked reactivity of
mood (intense episodic dysphoria, irritability,
or anxiety usually lasting a few hours and only
rarely more than a few days)
7.Chronic feeling of emptiness
8.Inappropriate intense anger/ difficulty
controlling anger
9.Transient, stress related paranoid ideation/
severe dissociative symptoms

Cluster C
Anxious, fearful
- Familial a/w anxiety disorder
Avoidant
A pattern of social inhibition and intense fear of
rejection.
-avoid situation which he may be rejected & this fear
is so overwhelming that if affects all aspect of life.
- Desire companionship but extremely shy and easily
injured.
- fear of rejection + restricted interpersonal contact
= low self esteem
Epidemiology
Male = Female
Tendencies to early rejection experience
Parents: inconsistent, absence, lack of
demonstration of parental love, discouraging,
rarely show pride in children, higher rates of
rejection and isolation.
AFRAID
A – avoids occupation with others
F – fear of embarrassment and criticism
R – reserved unless they are certain that they’re liked
A – always thinking rejection
I – isolates from relationship
D – distances self unless certain that they are liked
A Social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation, begin by
early childhood, ≥ of following
1. Avoids occupational activities that involve
significant interpersonal contact because of
fears of criticism, disapproval, or rejection
2. Unwilling to get involved with people unless
certain of being liked
3. Shows restraint within intimate relationships
because of the fear of being shamed/
ridiculed
4. Preoccupied with being criticized/ rejected in
social situations
5. Is inhibited in new interpersonal situations
because of feelings of inadequacy
6. Views self as socially inept, personally
unappealing or inferior to others
7. Is unusually reluctant to take personal risks/
to engage in any new activities because they
may prove embarrassing
Dependent
Poor self-confident, fear of separation, excessive
need to be taken care of, need others to make
decision for them, helpless when left home
- self-perception of being unable to function without
others’ help, so they behave needy and submissive in
order to elicit caregiving from others
- pessimist (mikir negative sokmo) & full of self-doubt
- belittling his abilities and call himself stupid in from
of others
- use criticism receive to prove worthlessness → lost
faith in himself
- comorbid : borderline, avoidant, histrionic
Epidemiology
female > male
↑ in childhood medical illness/ separation
anxiety disorder
DARN HURT
D – Disagreement is difficult to express
A – Advice (need major input)
R – Responsibility for major areas delegated to other
N – Nurturance (seek excessive degree from other)
H – Helpless when alone
U – Unrealistically preoccupied with being left to care
for self
R – Relationships are desperately sought (when
established)
T – Tasks (difficulty initiating projects)
A Excessive need to be taken care of that leads to
submissive and clinging behaviour and fears of
separation, begin by early adulthood, ≥5 of
following
1. Difficulty making everyday decisions w/o an
excessive amount of advice and reassurance
from others
2. Need others to assume responsibility for
most major areas of his life
3. Difficulty expressing disagreement with
others because of fear of loss of support/
approval
4. Difficulty initiating projects/ doing things on
his own (d/t lack of self-confidence in
judgement/ abilities rather than a lack of
motivation/ energy)
5. Goes to excessive lengths to obtain
nurturance (emotional & physical nourishment and
care given by someone) and support from others,
to the point of volunteering to do things that
are unpleasant.
6. Feels uncomfortable/ helpless when alone
because of exaggerated fears of being unable
to care for himself
7. Urgently seeks another relationship as source
of care and support when a close relationship
ends]
8. Unrealistically preoccupied with fears of
being left to take care of himself
Anyone can develop dependent traits at any
point in life (down with severe illness), but to
diagnose DPD = early adulthood + unrealistic to
the situation
Obsessive - Compulsive
A pervasive pattern of perfectionism, inflexibility,
orderliness.
- Preoccupied with unimportant details that they are
often unable to complete simple tasks in a timely
fashion.
- Appear stiff, serious, formal with constricted affect
- successful professionally but have poor
interpersonal skills
 Indecisive → time consuming
  Easily upset when not met his standard
 Behave reservedly because he not act on
emotion
 Not flexible – no sudden changes/ situation
Epidemiology
Men 2X > Women
↑ eldest sibling
Children brought up with strict disciple, excessive
parental control, excessive criticism
↑ 1st degree relatives with the disorder OCPD
LOW MIRTH
L – Leisure activity is minimal
0 – Organizational focus
W – Work & productivity predominate
M – Miserly spending habits
I – Inflexible around morals, values
R – Rigidity and stubbornness
T – Task completion impaired (by perfectionism)
H – Hoards items – cannot discard them
A Preoccupation with orderliness, perfectionism,
mental and interpersonal control at the expense
of flexibility, openness and efficiency, begin by
early adulthood, ≥ 4 of following
1. Is preoccupied with details, rules, lists, order,
organization, schedules to the extent that
the major point of the activity is lost
2. Shows perfectionism that interferes with task
completion
3. Excessively devoted to work and productivity
to the exclusion of leisure activities and
friendships
4. Overconscientious, scrupulous, and inflexible
about matters of morality, ethics or values
5. Unable to discard worn-out/ worthless
objects even when they have no sentimental
value
6. Reluctant to delegate tasks/ to work with
other unless they submit to exactly his way
of doing things
7. Adopts a miserly spending style toward both
self and others; money is viewed as
something to be hoarded for future
catastrophes.
8. Shows rigidity and stubbornness.