PERSONALIT

Y DISORDERS
Christine Bernadette U. Cruz
 DSM Personality Disorder Clusters

• Cluster A
• Odd or eccentric
• Paranoid, schizoid, schizotypal

• Cluster B
• Dramatic, emotional, erratic
• Antisocial, borderline, histrionic, narcissistic

• Cluster C
• Fearful or anxious
• Avoidant, dependent, obsessive-compulsive
 Personality Disorders: Facts and
Statistics
• Prevalence = 0.5 - 2.5%, may be closer to 10%
• Outpatient = 2 - 10%
• Inpatient = 10 – 30%

• Origins and Course

• Begin in childhood
• Chronic course
• High comorbidity
 Personality Disorders: Gender
Differences
• Differences in diagnostic rates
• Borderline (75% female)
• Clinician bias
• Assessment bias
• Measures
• Criterion bias
• Histrionic = extreme “stereotypical female”
• No “macho” disorder
 01 / 
HISTRIONIC PERSONALITY
DISORDER

CONTENTS
02 / 
NARCISSISTIC PERSONALITY
DISORDER
03 / 
AVOIDANT PERSONALITY DISORDER
04 / 
DEPENDENT PERSONALITY
DISORDER

05/ 
OBSESSIVE COMPULSIVE
PERSONALITY DISORDER
 A pattern of excessive emotionality
WHAT IS and attention seeking behavior.

HISTRIONIC According to ICD-10 F60.4:-

PERSONALIT Histrionic personality disorder is a
pattern of excessive emotionality and
Y DISORDER attention seeking including an
excessive need for approval and
inappropriate seductiveness.

Overly dramatic
Sensational
Sexually provocative
Impulsive
Attention-seeking
Appearance-focused
CLINICIAL
Impressionistic
Vague, superficial speech DESCRIPTIO
Common diagnosis in females
N
DIAGNOSTIC CRITERIA
CLUSTER B: Histrionic Personality Disorder
(301.50) (F60.4)

Strong need to Rapidly shifting

01 be the center of
attention 02 expression of emotions

Use of physical
Inappropriate
appearance to draw
sexually
attention to self
seductive

03 behavior
04
DIAGNOSTIC CRITERIA
CLUSTER B: Histrionic Personality Disorder

Speech that is Overly suggestible

05 excessively
impressionistic and 06
lacking in detail

Misreads
Exaggerated,
relationships as
theatrical
more intimate than
emotional
they are
07 expression
08
 A mnemonic for HPD is
PRAISE ME:
P - provocative (or seductive) behavior
R - relationships, considered more intimate than they are
A - attention, must be at center of
I - influenced easily
S - speech (style) - wants to impress, lacks detail
E - emotional lability, shallowness
M - make-up - physical appearance used to draw attention to self
E - exaggerated emotions - theatrical z
01 CAUSES? LITTLE RESEARCH ; LINKS WITH ANTISOCIAL
PERSONALITY

02 Sex-types alternative expression?

03 Psychodynamic Treatment; Cognitive Therapy

04 Complications?

WARNING SIGNS
of HPD
 FACTS AND FIGURES
(HPD)

Prevalence: 2-3% in general Aging presents special

population difficulties

Gender: diagnosed more Course: chronic, but may

frequently in women; prevalence improve with age
may be equal for males &
females Contributing Factors: Unmet
needs for attention & success
Sex role stereotypes influence
the behavioral expression of the
disorder
 DEFENSE
MECHANISMS
--Denial
--Identification
--Somatization
--Repression
--Acting out
--Fantasy of love and attention
--Dissociation
--Regression
 DDx:

-- Narcissistic PD
Borderline PD
Dependent PD

WHAT IS
NARCISSISTIC
PERSONALITY
DISORDER?
Egocentrism
a personality characteristic in which
people see themselves and their
interests and opinions as the only
ones that really matter.
Not interested in feelings of others
they lack empathy; they are unable
to feel or appreciate feelings which
are not their own.
(definition) is a pattern of grandiosity, need for
admiration, and lack of empathy.
is a disorder in which the individual has a
distorted self image, unstable and intense
emotions, is overly preoccupied with vanity,
prestige, power and personal adequacy, lacks
empathy, and has an exaggerated sense of
superiority.
Kohut’s Self-Psychology Model
Characteristics mask low self-esteem
In childhood, narcissist valued as a means to increase
parent’s own self-esteem
Not valued for his or her own competency and
self-worth
Parental emotional coldness and overemphasis on child’s
achievements reported by narcissists
Social cognitive model
Narcissist has low self-esteem
Interpersonal relationships are a way to bolster
sagging self-esteem rather than increase closeness to
others
Lab studies reveal cognitive biases that maintain
narcissism
DIAGNOSTIC CRITERIA
CLUSTER B: Narcissistic Personality
Disorder
(301.81) (F60.81)

Has a grandiose Is preoccupied with fantasies

01 02
of unlimited success, power,
sense of self- brilliance, beauty, or ideal
importance love.

Believes that he or she is

“special” and unique and
can only be understood by, Requires excessive
or admiration.
should associate with, other
special or high-status

03 people (or institutions).

04
DIAGNOSTIC CRITERIA
CLUSTER B: Narcissistic Personality
Disorder

Has a sense of entitlement Is interpersonally

05 06 exploitative

Is often envious of
Lacks empathy: is
others or believes
unwilling to recognize
that others are
07 or identify with the
feelings and needs of
others.
08 envious of him or
her

Shows arrogant,

09 haughty behaviors or
attitudes.
01 CAUSES?

02 Mania or hypomania.

03 Psychodynamic Treatment; CBT

04 Complications?

WARNING SIGNS
of NPD
 FACTS AND FIGURES
(NPD)
Prevalence: From 0% to 6.2% in
community samples
Gender: Of those diagnosed with
narcissistic personality disorder,
50%–75% are male.
Have high level of CORSTISOL
Particularly common in
adolescents and do not
necessarily dicate that the
individual will go on to have
narcissistic personality disorder.
Untreated with NPD has a
higher chance of substance
abuse, depression, problems a
work and school
 DDx:
Bipolar Disorder
-- Antisocial PD
Histrionic PD
Christine Bernadette Cruz
 (definition) A pervasive pattern of social
WHAT IS AVOIDANT inhibition, feelings of inadequacy, and
PERSONALITY hypersensitivity to negative evaluation, beginning
DISORDER by early adulthood and present in a variety of
contexts

Inferiority Complex
DIAGNOSTIC CRITERIA
CLUSTER B: APD
(301.82) (F60.6)

Avoids occupational Unwilling to get

01 activities
02 involved

Preoccupied with
getting criticized

Shows restraint with

03 intimate relationships
04
DIAGNOSTIC CRITERIA
CLUSTER B: APD

Inhibited in new interpersonal Socially Inept,

05 situations because of feelings

of inadequacy 06 personally unappealing
or inferior to others

Reluctant to take
personal risks or to

07 engage in any new

activities
 Associated Features
Supporting Diagnosis

SHYNESS TIMID LONELY ISOLATED LOW SELF-

ESTEEM
 EPIDEMIOLOGY
01 02 03 04 05

Prevalence Rates Gender 10% for Infants with Characterized

psychiatric timid with inferiority
patients temperament complex
2-3% of general Equally frequent in
population males and females Susceptible with
This disorder
2.4 (DSMV)
01 CAUSES?

02 Social Phobia?

03 Psychotherapy; Pharmacotherapy

04 Complications?

WARNING SIGNS
of APD
 FACTS AND FIGURES
(APD)

COMORBIDITY IMPAIRMENT

About 25-50% have Panic Disorder

Can be severe; typically
10-25% have Generalized Anxiety Disorder includes occupational and social
difficulties
20-25% have an Eating Disorder, and;

more than 33% have Body Dysmorphic

Disorder (Alden LE et al. 2002).

The most common co-occurring disorders

are Schizotypal, Schizoid, Paranoid,
Dependent, and Borderline. (explain)
 DDx

Social Phobia
Panic Disorder with Agrophobia
Schizotypal and Schizoid PD
Paranoid PD
Dependent PD
 (definition) A pervasive and excessive need to be
WHAT IS taken care of that leads to submissive and clinging
DEPENDENT behavior and fears of separation.
PERSONALITY
DISORDER

CLINGY
DIAGNOSTIC CRITERIA
CLUSTER B: DPD
(301.6) (F60.7)

1.Has difficulty making everyday Need for others to take

01
decisions without an excessive
amount of advice and
reassurance from others.
02
responsibility for most
major areas of life

Difficulty Difficulty doing

disagreeing with things on own
others for fear of because of lack of
losing their self-confidence
03 support
04
DIAGNOSTIC CRITERIA
CLUSTER B: DPD
(301.6) (F60.7)

Doing unpleasant things Feelings of helplessness

05 06
when alone because of lack
as a way to obtain the of confidence in ability to
approval and support of handle things without others
others

Preoccupation with
Urgently
fears of having to
seeking new
take care of self
relationship

07 when one ends

08
 Associated Features
Supporting Diagnosis

LACK SELF- INTENSE SUBORDINAT DIFFICULTY PASSIVE;

CONFIDENCE; DISCOMFORT E THEIR IN MAKING PESSIMISM;
STUPID WHEN ALONE NEEDS TO LIFE SELF DOUBT
THOSE OF DECISIONS
OTHERS
 EPIDEMIOLOGY
01 02 03 04 05

Prevalence Rates Gender More common Person with chronic

in children than physical illness in
older ones childhood
0.6 -3.7 % More common in
women than male Susceptible with
This disorder
01 CAUSES?

02 Social Phobia?

03 Psychotherapy; Pharmacotherapy

04 Complications?

WARNING SIGNS
of DPD
 FACTS AND FIGURES
(DPD)

COMORBIDITY IMPAIRMENT

Eating Disorders, Anxiety

Frequently only mild;
Disorders, Somatoform Disorders,
typically includes interpersonal
and other Personality Disorders relationships and occupational
(Histrionic, Avoidant, and functioning if independence is
Borderline). About 30% of these required.
individuals can be diagnosed with
Depression, over 10% with
Bipolar Disorder, and about 7%
have Dysthymia (Overholser JC
1996).
 DDx

Borderline PD (Submissiveness)

Histrionic PD

Avoidant PD
 (definition) A pervasive preoccupation with
WHAT IS orderliness, perfectionism, and control (with no
OBSESSIVE- room for flexibility) that ultimately slows or
COMPULSIVE interferes with completing a task.
PERSONALITY
DISORDER

OVERCONSCENTIOUSNESS

CONSTRICTED EMOTIONS
DIAGNOSTIC CRITERIA
CLUSTER B: OCPD
(301.6) (F60.7)

1.RULE/ DETAIL OBSESSED PERFECTIONISM

01 02 THAT INTERFERES
WITH TASK
COMPLETION

UNABLE TO EXCLUSD
DISCARD LEISURE DUE TO
WORTHLESS DEVOTION TO
OBJECTS WORK
03 04
DIAGNOSTIC CRITERIA
CLUSTER B: OCPD
(301.6) (F60.7)

RELUCTANT TO INFLEXIBLE IN MATTERS

05 06
OF MORALITY, ETHICS,
WORK WITH OTHERS VALUES

MISERLY
RIGIDITY AND
STUBBORNNESS
“Control freaks”

07 08
 EPIDEMIOLOGY
01 02 03 04 05

Prevalence Rates Gender More common Person with mood and 8-9 % of
in higher in anxiety disorders psychiatric
educations and outpatients
1-2% Men are two times
more likely to have those in higher Susceptible with
OCPD income brackets This disorder
01 CAUSES?

02 Orthorexia Nervosa?

03 Psychotherapy; Pharmacotherapy

04 Complications?

WARNING SIGNS
of OCPD
 FACTS AND FIGURES
(PD)

COMORBIDITY IMPAIRMENT
These patients are at
Frequently severe; typically
increased risk for Major includes occupational and social
Depression and Anxiety difficulties.
Disorder. There is
equivocal evidence for an
increased risk of
Obsessive Compulsive
Disorder.
OCPD
with OCPD, the behaviors are not directed by thoughts
that are unable to control or irrational behaviors that
repeat over and over again, often with no apparent aim.
Ego syntonic
In OCPD, the behaviors tend to be persistent and
unchanging over the long term
Usually not seek help because they don't see that
anything they are doing is particularly abnormal or
irrational
Entire personality is affected
Take pride in their personality
OCD
OCD is defined by the presence of true obsessions
(unwanted thoughts) and/or compulsions (excessive
urges0.
Ego dystonic
Symptoms of OCD tend to fluctuate in association with
the underlying anxiety
Often seek professional help to overcome the irrational
nature of their behavior and the persistent state of
anxiety they live under
Specific obsessions and compulsions
Do not want their symptoms
 DDx

Schizoid PD
Antisocial PD
Avoidant PD
THANK
YOU!
We're one step away from making everyone
aware about mental health issues.