PERSONALITY

DISORDERS
Katherine M. Napalinga, M.D.
Department of Child and Adolescent Psychiatry
Drexel University College of Medicine/
Hahnemann University Hospital

March 16, 2007

What is a Personality Disorder?
 An enduring pattern of
 Thinking
 Ways of looking at
 Self
 Others
 World
 Feeling
 Relating
 Behaving
 Seen across many situations
 Onset beginning at adolescence
 Maladaptive and inflexible
Patterns and Themes
 Each disordered personality is patterned around a kind
of theme
 The theme often tells about the motive behind the
patterns found in the person’s
 Thinking
 Feeling
 Behaving
 Relating
 The theme also gives some hints at difficulties the
person has experienced that contribute to the
development of the disorder
 CLUSTERS
A. Odd or Eccentric (Weird)
Paranoid Schizotypal
Schizoid
B. Dramatic or Erratic (Wild)
Antisocial Histrionic
Borderline Narcissistic
C. Anxious (Worried)
Avoidant Obsessive - Compulsive
Dependent
 CHARACTERISTICS OF
PERSONALITY DISORDERS
 Relation to Axis I
 10% - 20% of General Population
 Gender : ♂  Antisocial, Schizoid
♀  Avoidant, Dependent
 Etiological Theories
 Dynamic
 Biological / Genetic
 CLUSTER A
“Weird”

 Paranoid: Watching for injustice

 Schizoid: Detached loner
 Schizotypal: Peculiar/eccentric
 PARANOID PD
Pervasive Distrust + Suspiciousness, Interpret
Motives as Evil

4 + of :
Suspicious Feels Attacked
Preoccupation with Distrust Jealous
Won’t Confide Grudges
Misinterprets Motives
 SCHIZOID PD
Detached + Few Emotions

4 + of :
Eschew Closeness No Close Friends
Solitary Indifferent
No Sex Interest Cold
Not Enjoy Activities
SCHIZOTYPAL PD
Discomfort with Relationships, Cognitive
Distortions + Eccentric
5 + of :
Ideas of Reference Odd Magical Beliefs
Perceptual Disturbances Odd Thoughts/Speech
Paranoia Inappropriate Affect
Odd Behavior/Appearance Loner
Anxious Socially
 CLUSTER B
“Wild”

 Antisocial: Disregard for others’ rights

 Borderline: Intense, unstable, extremes
 Histrionic: High drama
 Narcissistic: Grandiose entitlement
 ANTISOCIAL PD (ASPD)
Disregards Rights of Others (and meet
Conduct Disorder)
3 + of :
Unlawful Reckless
Deceitful Irresponsible
Impulsive Lacks Remorse
Aggressive
 BORDERLINE PD
Unstable Relationships, Affect, Self-
Image Plus Impulsiveness
5 + of :
Fears Abandonment Mood Shifts
Unstable Relationships Feels Empty
Changing Self-Image Anger
Impulsive Sex, Spending Transient
Suicidal Behavior Paranoia
 HISTRIONIC PD
Excessive Emotionality,
Attention Seeking
5 + of :
Needs Attention Preens
Seductive Dramatic
Mood Shifts Suggestible
Impressionistic, Exaggerates
relationships
Vague Speech
NARCISSISTIC PD
Grandiose, Needs Admiration, Without Empathy
5 + of :
Self Important Exploitative
Fantasies of Success Lacks Empathy
Feels Special Envious
Needs Admiration Arrogant
Entitled
 CLUSTER C
“Worried”

 Avoidant: Involvement is risky.

 Dependent: Excessive need to be taken care of
 Obsessive-Compulsive: Order and structure
 AVOIDANT PD
Inhibited, Inadequate, Sensitive
4 + of : Avoids Social Activity
Reluctant Relationships
Fears Intimacy
Fears Criticism
Avoids New Activities
Sees Self Inferior
Fears Embarrassment
DEPENDENT PD
Needs to be Taken Care of, Fears Separation
5 + of :
Indecisive Seeks Nurturance
Avoids Responsibility Fears Solitude
Avoids Frantic for
Disagreements Relationships
Lacks Initiative Fears Abandonment
 OBSESSIVE-COMPULSIVE PD
Orderliness, Perfectionist, Inflexible
4 + of :
Detail Oriented Unable to Discard
Perfectionism Can’t Delegate
Work Oriented Miserly
Over Conscientious Rigid
 SUMMARY PART I
Paranoid Suspicious, Jealous, But Not
Psychotic or Unlawful
Schizoid Unemotional, Cold, Indifferent
Schizotypal Odd + Magical Beliefs,
Behaviors, Not
Paranoid
ASPD Aggressive, Unlawful, Impulsive
Borderline Unstable, Chaotic, Impulsive Not
Aggressive or Unlawful
Histrionic Dramatic, Seductive But Not
Chaotic
Narcissistic Self-Centered, Entitled, Lacks
Empathy But Not Unlawful or Chaotic
 SUMMARY PART II
Avoidant Needs People But Fears
Relationships
Dependent Needs Relationships,
Indecisive, Fears
Abandonment
Obsessive- Rigid, Perfectionist +
Compulsive Inefficient
INSTRUMENTS FOR PD
 MostlyCurrent Status
 Some Focus on
Temperament or
Personality Components
 Few Consider Full
Diagnostic Syndrome