PERSONALITY DISORDERS

ALLISTAIR ADAM ANAK NE LSO N

INT E RNAT IO NAL M E DICAL SCHO O L

M AN AG E M E N T AND SCIE NCE UNIVE R SIT Y

 INTRODUCTION

• Commonly seen in psychiatric practice

• Challenging to treat

• Individuals with personality disorders

have difficulties seeing themselves as
others see them
DEFINITION

• Enduring pattern of inner experience and behaviour that

deviates markedly from norms and expectations of culture.

• Inflexible, maladaptive patterns and stable over time which

lead to distress and impairment

• Onset in adolescence or early adulthood

I M P O R TA N T T O
KNOW
• Treatments can be complex/complicated
• Repercussion of diagnosis
• Difficult to diagnosis
• Can be confused with other mental illnesses
• Stigma
• Long-term treatment
• Mental health professionals do not like to deal with possible
personality disorders
ETIOLOGY
• Genetics

• Brain changes

• Childhood trauma

• Abuse

• Cultural factor
GENETICS
• Human personality is 30–60% heritable according
to twin and adoption studies.
• Twin studies of personality have shown that
identical twins are more concordant than non-
identical twins
• Environmental differences can increase or decrease
the importance of genetic factors, and may also
reflect gene-environment interactions
BRAIN CHANGES
• Phineas Gage
• Rod penetrated Gage's left cheek, tore
through his brain, and exited his skull
before landing 80 feet away.
• Pre-accident: hardworking, pleasant man
• Post-accident: aggressive, heavy drinker
 C L A S S I F I C AT I O N

Cluster A Cluster B Cluster C

(Odd and eccentric) (Dramatic, emotional and erratic) (Anxious or fearful)

Paranoid Personality Disorder Histrionic Personality Disorder Avoidant Personality Disorder

Schizoid Personality Disorder Narcissistic Personality Disorder Dependent Personality Disorder

Schizotypal Personality Disorder Antisocial Personality Disorder Obsessive Compulsive Disorder

Borderline Personality Disorder

CLUSTER A
PA R A N O I D
PERSONALITY
DISORDER
• Characterized by a pattern of suspiciousness and mistrust of
others
• Assume people will exploit, harm or deceive them even if no
evidence is presented
• Preoccupied with unjustified doubts about loyalty or
trustworthiness and can be pathologically jealous
• Reluctant to confide to others
• Lack warmth, restricted and appear unemotional
• Bear grudges and unwilling to forgive
SCHIZOID PERSONALITY
DISORDER
• A lifelong pattern of detachment from a social
relationship
• Restricted range of expression of emotions in
interpersonal settings

• Lacking in desire for intimacy

• Often seen by others as eccentric, isolated and lonely

• Prefer solitary/ mechanical/ abstract activities

• Indifferent to approval or criticism

S C H I Z O T Y PA L P E R S O N A L I T Y D I S O R D E R
• A pervasive pattern of social and interpersonal deficits with cognitive or
perceptual distortions with eccentricities of behaviour
• Odd beliefs and magical thinking
• Speech may include unusual or idiosyncratic phrasing or construction
• Often considered to be eccentric because of unusual mannerisms
• May be superstitious and have special powers
CLUSTER B
ANTISOCIAL
PERSONALITY
DISORDER
• A pervasive pattern of disregard for and violation of rights

• Occurring since 15 years old

• Inability to conform to social norms with respect to lawful behaviour

• Destroying property and objects, harassing, stealing

• Disregard the wishes, rights and feelings of others

• Deceitful or manipulative

• Reckless, little remorse, irresponsible and neglectful

BORDERLINE
PERSONALITY
DISORDER
• Pervasive pattern of instability of interpersonal relationship,
self-image and affects

• Frantic effort to avoid abandonment

• Impulsive actions such as self-mutilating, suicidal behaviour

• Unstable and intense relationship, idolizing then devaluating

• A drastic change in self-image, chronic feeling of emptiness

• Exhibit impulsivity
HISTRIONIC
PERSONALITY
DISORDER
• Characterized by excessive
emotionality and attention seeking-
behaviour

• Uncomfortable if not being the center

of attention

• Often lively and dramatic

• Appearance and behaviour are often

sexually provocative and seductive

• Rapid shifting and shallow expression

of emotion
• Characterized by a pattern of
grandiosity

• Heighten sense of importance

• Believe that they are special and

unique

• Excessive need for admiration

• Unreasonable sense of
entitlement

• Lack of empathy

N A RC I S S I S T I C P E R S O N A L I T Y D I S O R D E R
CLUSTER C
AV O I DA N T P E R S O N A L I T Y D I S O R D E R
• Pervasive pattern of social inhibition

• Preoccupied with being criticized or rejected in a social

situation

• Tend to be timid and quiet to avoid attention

• View self as socially inept, personally unappealing or inferior

• Show restraint within intimate relationships

• Avoid occupational activities

DEPENDENT
PERSONALITY
DISORDER
• Excessive need to be taken care

• Develop submissive, clinging behaviour with fear of

separation

• Difficulty making everyday decisions without excessive

advice and reassurance

• Feels uncomfortable and helpless because of fear of

being unable to take care of self
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
• Preoccupation with orderliness, perfectionism, and mental
and interpersonal control
• Preoccupied with details, rules, lists, order, organization, or
schedules to the extent that the major point of the activity is
lost
• Excessively careful and prone to repetition, paying
extraordinary attention to detail and repeatedly checking for
possible mistakes, losing track of time in the process
• Things done the one “correct” way
T R E AT M E N T
• Psychotherapy

• Counselling

• Psychopharmacology

• Social support