Personality Disorders

Nabil Numan, MD. PhD.

A. Professor
University of Taiz
Personality Disorders
 Personality – is the set of characteristics that defined
the behaviour, thoughts, and emotion of the
individual.
 A personality disorder is present when the personality
traits are inflexible and maladaptive, causing either
significant impairment in social or occupational
functioning or subjective distress.
 Manifestations of personality disorder are usually
recognized by adolescence and continue into adulthood.
 Prevalence
In the United States, 9.1% of the population has been diagnosed with a
personality disorder (National Institute of Mental Health, n.d.).
On a global level, it is estimated that 3-10% of the population has a
personality disorder (Tyrer et al., 2010).
Personality disorders have several effects on the psyche
over time, both in the short- and long-term.
They include, but are not limited to, the following:
 Difficulty in relationships
 Increased withdrawal from socialization
 Mood swings
 Depression
 Suicidal thoughts
 Attempted suicide
 Decline in physical health due to lack of care
 DSM-5 Criteria for Personality Disorder
Significant impairments in self and interpersonal
functioning
At least one pathological personality trait domain
or facet
The personality impairments are stable across
time (persistent) and pervasive (consistent across
situations)
The personality impairments are not explained by
developmental stage, socio-cultural environment,
substance abuse, another psychological condition,
or a medical condition
Personality disorders are classified in three types
of behaviors:
 Cluster A

The odd or eccentric group includes the paranoid,

schizoid, and schizotypal personality disorders.
 Cluster B

The dramatic, emotional, and erratic group includes

histrionic, narcissistic, antisocial, and borderline
personality disorders.
 Cluster C

The anxious and fearful group includes of avoidant,

dependent, and obsessive-compulsive personalities
Paranoid Personality Disorder
Includes four or more of the following:
– Suspiciousness of others
– Unjustified doubts about disloyalty
– Reluctance ‫ تردد‬to confide in others
– Reading threatening meanings into benign events
– Persistent tendency to bear grudges ‫الضغائن‬
– Tendency to feel attacked and counterattack
– Unjustified suspiciousness about infidelity of
partner
The prevalence of paranoid personality disorders is 0.5-
2.5% in general population
More common in males and lower socioeconomic class
individuals
More common in relatives of patients with schizophrenia
Schizoid Personality Disorder
 Include four or more of the following:

◦ Neither desires nor enjoys close relationships

◦ Almost always chooses solitude
◦ Little if any interest in sexual relationships
◦ Takes pleasure in few activities
◦ Lacks close friends
◦ Indifferent to praise or criticism
◦ Emotional coldness, detachment or flatness
 The prevalence Schizoid personality disorders is 0,5-
1.5%
 More common in males
 May be more common in relatives of patients with
schizophrenia
Schizotypal Personality Disorder
Five or more of the following:
◦ Ideas of reference
◦ Odd beliefs or magical thinking
◦ Unusual perceptual experiences
◦ Odd thinking and speech
◦ Suspiciousness or paranoid ideas
◦ Inappropriate or constricted affect
◦ Odd, eccentric or peculiar behavior or appearance
◦ Lack of close friends
◦ Excessive social anxiety
 The prevalence indicates 3% of the population.
 May be more common in relatives of patients with
schizophrenia
 May be slightly more common in males
Antisocial Personality Disorder
Includes three or more of the following:
• Failure to conform to lawful behavior
• Deceitfulness
• Impulsivity
• Irritability or aggressiveness
• Reckless disregard for safety of self and others ‫االستهتار‬
‫بسالمة الذات واآلخرين‬
• Consistent irresponsibility
• Lack of remorse
 The prevalence of this disorder suggests that men may over 7%
and women <1%.
 Highest prevalence in 25-44 years-old
 Associated with school drop-out, conduct disorder, and urban
settings
 Very high prevalence in prisons and forensic settings.
 High comorbidity with substance abuse
Borderline Personality Disorder
 Impulsive, self-damaging behaviors
 Unstable, stormy, intense relationships
 Emotional reactivity
 Feelings towards others can change drastically and inexplicably ‫لسبب‬
‫ غير مفهوم‬very quickly
 Emotions are intense, erratic, shift abruptly-often from passionate
idealization to contemptuous anger
 Frantic efforts to avoid abandonment ‫التخلي عنهم‬.
 Unstable sense of self
 Anger-control problems
 Chronic feelings of emptiness
 Recurrent suicidal gestures
 Transient psychotic or dissociative symptoms

Prevalence may be present in 1-2 % of the population. More prevalent in

younger groups and females. Close to 75% of those diagnosed are
women. Most severe in mid-20 with improvement in late 30s
associated with poor work history and single marita
Histrionic Personality Disorder
Five or more of the following:
Uncomfortable if not the center of attention
Inappropriately seductive or provocative
Rapidly shifting and shallow emotions
Use of appearance to draw attention
Speech is impressionistic and lacking in detail
Self-dramatization, theatricality
Suggestibility
Considers relationships more intimate than they are
Prevalence is 2-3%, recent research shows equal ratio
and associated with parasuicide
 Narcissistic Personality Disorder
◦ Five or more of the following:
 Grandiose sense of self-importance
 Preoccupied with fantasies of unlimited success,
power, brilliance ‫تألق‬, etc.
 Belief that he or she is “special”
 Requires excessive admiration
 Sense of entitlement
 Interpersonally exploitative ‫استغاللية‬
 Lacks empathy
 Often envious ‫في كثير من األحيان حسود‬
 Arrogant or haughty
◦ The prevalence of this disorder is <1% and more
common in males
Avoidant Personality Disorder
Four or more of the following:
 Avoids activities due to fear of criticism, disapproval or
rejection
 Unwilling to get involved with people unless certain of
being liked
 Restrained‫ ضبط النفس‬in relationships due to fear of being
shamed or ridiculed
 Preoccupied with criticism or rejection in social
situations
 Inhibited in new situations due to feelings of inadequacy
 Views self as inept, unappealing, inferior
 Reluctant to take personal risks

Prevalence is 1-5%, equal gender ratio, and comorbid

social phobia.
Dependent Personality Disorder
Five or more of the following:
 Excessive need for advice and reassurance to make
decisions
 Needs others to assume responsibility for most areas of
life
 Difficulty expressing disagreement
 Difficulty initiating or doing things on own
 Goes to excessive lengths for nurturance or support
 Feels helpless when alone, due to exaggerated fears of
being unable to care for self
 Urgently seeks new relationship if close relationship ends
 Preoccupied with fears of being left to care for self

Prevalence is 1-2% and comorbid with borderline

personality.
Obsessive-Compulsive Personality Disorder
Four or more of the following:
 Preoccupation with rules, lists, order, schedules, etc.
 Perfectionism
 Excessive devotion to work and productivity
 Over-conscientious, scrupulous, inflexible about
morality
 Inability to discard worn-out or worthless objects
 Reluctance to delegate tasks or work with others unless
they submit to exactly his or her way of doing things
 Miserly spending style
 Rigidity and stubbornness

Prevalence is 1-2%, more common in males, highly

educated, married and employed individuals
Treatment
Certain types of psychotherapy are effective for treating
personality disorders. During psychotherapy, an
individual can gain insight and knowledge about the
disorder and what is contributing to symptoms, and can
talk about thoughts, feelings and behaviors.
Psychotherapy can help a person understand the effects
of their behavior on others and learn to manage or cope
with symptoms and to reduce behaviors causing
problems with functioning and relationships. The type of
treatment will depend on the specific personality
disorder, how severe it is, and the individual’s
circumstances.
Commonly used types of psychotherapy
include:
Psychoanalytic/psychodynamic therapy
Dialectical behavior therapy
Cognitive behavioral therapy
Group therapy
Psychoeducation (teaching the individual
and family members about the illness,
treatment and ways of coping)
There are no medications specifically to
treat personality disorders. However,
medication, such as antidepressants, anti-
anxiety medication or mood stabilizing
medication, may be helpful in treating
some symptoms. More severe or long
lasting symptoms may require a team
approach involving a primary care doctor,
a psychiatrist, a psychologist, social
worker and family members.