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PERSONALITY DISORDER
Tutor: Miss Caroline Parchment
Presenter: Sandra Whyte
WHAT IS PERSONALITY
Personality refers to a distinctive set of traits, behavior styles, and patterns that make up
our character or individuality. How we perceive the world, our attitudes, thoughts, and
feelings are all part of our personality. People with healthy personalities are able to cope
with normal stresses and have no trouble forming relationships with family, friends, and co-workers.
Or the word personality describes deeply ingrained patterns of behavior and the manner in which
individuals perceive, relate to, and think about themselves and their world.
WHAT IS PERSONALITY DISORDER?
Those who struggle with a Personality Disorder have great difficulty dealing with other people.
They tend to be inflexible, rigid, and unable to respond to the changes and demands of life.
Although they feel that their behavior patterns are "normal" or "right," people with personality
disorders tend to have a narrow view of the world and find it difficult to participate in social
activities.
PERSONALITY DISORDER CONT’D
While personality disorders may differ from mental disorders like schizophrenia
and bipolar disorder, they do, by definition, lead to significant impairment.
They are estimated to affect about 10 per cent of people, although this figure
ultimately depends on where clinicians draw the line between a ‘normal’
personality and one that leads to significant impairment
The concept of personality disorder itself is much more recent and
tentatively dates back to psychiatrist Philippe Pinel’s 1801 description of
manie sans délire, a condition which he characterized as outbursts of rage
and violence (manie) in the absence of any symp- toms of psychosis such
as delusions and hallucinations (délires).
RECOGNIZING A PERSONALITY
DISORDER
A Personality Disorder must fulfill several criteria.
A deeply ingrained, inflexible pattern of relating, perceiving,
and thinking serious enough to cause distress or impaired
functioning is a personality disorder.
Personality Disorders are usually recognizable by adolescence
or earlier, continue throughout adulthood, and become less
obvious throughout middle age.
CAUSES OF PERSONALITY
DISORDER
Some experts believe that events occurring in early childhood
exert a powerful influence
upon behavior later in life.
Others indicate that people are genetically predisposed to
personality disorders.
In some cases, however, environmental facts may cause a
person who is already
genetically vulnerable to develop a personality disorder.
CLASSIFYING PD ACCORDING TO
DSM -5
According to DSM-5, a personality disorder can be diagnosed if there are
significant impairments in self and interpersonal functioning together with one or
more pathological personality traits.
In addition, these features must be
(1) relatively stable across time and consistent across situations,
(2) not better understood as normative for the individual’s developmental stage or
socio-cultural environment, and
(3) not solely due to the direct effects of a substance or general medical
condition.
PERSONALITY DISORDER IS CLASSIFIED
INTO THREE CLUSTERS PERSONALITY
CLUSTER A
CLUSTER B
CLUSTER C
-
Odd,
-
Dramatic,
-
Anxious,
-
bizarre,
-
erratic)
-
fearful
-
eccentric)
{Paranoid PD,
{Antisocial PD,
{Avoidant PD,
Schizoid PD,
Borderline PD,
Dependent PD,
Schizotypal PD}
Histrionic PD,
Obsessive-compulsive PD}
Narcissistic PD}
TYPES OF PERSONALITY DISORDERS
There are many formally identified personality disorders, each with their own set of
behaviors and symptoms. Many of these fall into three different categories or clusters:
• Cluster A: Odd or eccentric behavior
• Cluster B: Dramatic, emotional or erratic behavior
• Cluster C: Anxious fearful behavior
CLUSTER A:
ODD OR ECCENTRIC BEHAVIORPARANOID
Paranoid Personality Disorder is an unwarranted tendency to
interpret the actions of other people as deliberately threatening or
demeaning. The disorder, surfacing by early adulthood, is
manifested by an omnipresent sense of distrust and unjustified
suspicion that yields persistent misinterpretation of others' intentions
as being malicious.
They will not confide in people, even if they prove trustworthy, for
fear of being exploited or betrayed. They will often misinterpret
harmless comments and behavior from others and may build up
and harbor unfounded resentment for an unreasonable length of
time.
SYMPTOMS OF PARANOID PD
•Suspicion
•Concern with hidden motives
•Expects to be exploited by others
•Inability to collaborate
•Social isolation
•Poor self image
•Detachment
•Hostility
People with this disorder typically exhibit a strong need for selfsufficiency, are rigid and often litigious. Because of their avoidance of
closeness with others, they may appear calculating and cold. Usually
men are diagnosed with it more than women.
CAUSES OF PARANOID PD
The specific cause of this disorder is unknown. It appears to be more
common in families with psychotic disorders such as schizophrenia and
delusional disorder, which suggests that genes may be involved.
Paranoid personality disorder can result from negative childhood
experiences fostered by a threatening domestic atmosphere. It is
prompted by extreme and unfounded parental rage and/or
condescending parental influence that cultivate profound child
insecurities.
TREATMENTS OF PARANOID PD
Consumer self-help programs, family self-help, advocacy, and
services for housing and vocational assistance complement and
supplement the formal treatment system
Treatment of paranoid personality disorder can be very effective in
controlling the paranoia but is difficult because the person may be
suspicious of the doctor. Without treatment this disorder will be
chronic. Medications and therapy are common and effective
approaches to alleviating the disorder.
Self-care approaches to paranoid personality disorder are not likely
to be effective forms of treatment. The high levels of suspicion and
mistrust pervasive in people with this disorder make the work of
support groups improbably helpful and potentially damaging.
Schizotypal Personality Disorder
A pattern of distinctiveness best describes those with schizotypal personality
disorder. People may have odd or eccentric manners of speaking or dressing.
Strange, outlandish or paranoid beliefs and thoughts are common. People
with schizotypal personality disorder have difficulties forming relationships
and experience extreme anxiety in social situations. They may react
inappropriately or not react at all during a conversation or they may talk to
themselves. They also display signs of "magical thinking" by saying they can
see into the future or read other people's minds.
Schizotypal Personality Disorder.
People with schizotypal personality disorder:
may be eccentric in their manners or clothing
are socially anxious
hold strange beliefs
may talk to themselves
People with schizoid PD rarely present to medical attention because,
despite their reluctance to form close relationships, they are generally
well functioning, and quite untroubled by their apparent oddness.
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SCHIZOID
PERSONALITY DISORDER
The term ‘schizoid’ designates a natural tendency to direct attention
toward one’s inner life and away from the external world. A person with
schizoid PD is detached and aloof and prone to introspection and fantasy.
He has no desire for social or sexual relationships, is indifferent to others and
to social norms and conventions, and lacks emotional response.
People with schizoid personality disorder:
are withdrawn and distant
are preoccupied with their own thoughts
are fearful of close relationships
CLUSTER B: DRAMATIC, EMOTIONAL
OR ERRATIC BEHAVIOR- ANTISOCIAL
PD
Antisocial personality disorder is
characterized by a pattern of disregard
for and violation of the rights of others. The
diagnosis of antisocial personality disorder
is not given to individuals under the age of
18 and is only given if there is a history of
some symptoms of conduct disorder
before age 15.
The more egregious, harmful, or dangerous behavior
patterns are referred to as sociopathic or
psychopathic.
- Sociopathy is chiefly characterized as a something
severely wrong with one's conscience;
- psychopathy is characterized as a complete lack
of conscience regarding others.
Complications of this disorder include imprisonment,
drug abuse, and alcoholism
SYMPTOMS
OF ANTISOCIAL PD
•Disregard for society's laws
•Violation of the physical or emotional rights of others
•Lack of stability in job and home life
•Lack of remorse
•Superficial wit and charm
•Recklessness, impulsivity
•A childhood diagnosis (or symptoms consistent with) conduct disorder
Diagnosis is given to those over 18 years of age. Antisocial personality is
confirmed by a psychological evaluation. Other disorders should be ruled
out first, as this is a serious diagnosis.
CAUSES
OF ANTISOCIAL PD
While the exact causes of this disorder are unknown, environmental and genetic
factors have been implicated.
 Genetic factors are suspected since the incidence of antisocial behavior is higher
in people with an antisocial biological parent.
 Environmental factors are believed to contribute to the development of antisocial
personality disorder since a person whose role model had antisocial tendencies is
more likely to develop the disorder.
About 3 percent of men and about 1 percent of women have antisocial personality
disorder, with much higher percentages among the prison population.
TREATMENTS
OF ANTISOCIAL PD
Antisocial personality disorder is one of the most
difficult personality disorders to treat.
Individuals rarely seek treatment on their own and
may only initiate therapy when mandated by a
court.
Family support but,
there is no known effective treatment for this
disorder.
BORDERLINE PERSONALITY
DISORDER
Borderline personality disorder (BPD) is a serious mental illness characterized
by pervasive instability in moods, interpersonal relationships, self-image, and
behavior. This instability often disrupts family and work life, long-term
planning, and the individual's sense of identity.
While less well known than schizophrenia or bipolar disorder, BPD is more
common, affecting 2 percent of adults, mostly young women.
There is a high rate of self-injury without suicide intent, as well as a
significant rate of suicide attempts and completed suicide in severe cases.
Patients often need extensive mental health services, and account for 20
percent of psychiatric hospitalizations.
SYMPTOMS OF BPD
a person with BPD may experience intense bouts of anger,
depression, or anxiety that may last only hours, or at most a day.
These may be associated with episodes of impulsive aggression,
self-injury, and drug or alcohol abuse.
Distortions in cognition and sense of self can lead to frequent
changes in long-term goals, career plans, jobs, friendships,
gender identity, and values. Sometimes people with BPD view
themselves as fundamentally bad or unworthy. They may feel
unfairly misunderstood or mistreated, bored, empty, and have
little idea who they are.
People with BPD exhibit other impulsive behaviors, such as
excessive spending, binge eating, and risky sex.
CAUSES OF BPD
Although the cause of BPD is unknown, both environmental and genetic factors are
thought to play a role in predisposing patients to BPD symptoms and traits.
Studies show that many but not all individuals with BPD report a history of abuse, neglect,
or separation as young children. Forty to 71 percent of BPD patients report having been
sexually abused, usually by a no caregiver.
Researchers believe that BPD results from a combination of individual vulnerability to
environmental stress, neglect, or abuse as young children, and a series of events that
trigger the onset of the disorder as young adults
CAUSES CONTINUES BPD
Studies shows that Areas in the front of the brain (prefrontal area) act to
dampen the activity of this circuit. Recent brain imaging studies show that
individual differences in the ability to activate regions of the prefrontal
cerebral cortex thought to be involved in inhibitory activity predict the ability
to suppress negative emotion.
Such brain-based vulnerabilities can be managed with help from behavioral
interventions and medications, much like people manage susceptibility to
diabetes or high blood pressure.
TREATMENTS OF BPD
 Group and individual psychotherapy are at least partially effective for many
patients.
 Pharmacological treatments are often prescribed based on specific target
symptoms shown by the individual patient.
 Antidepressant drugs and mood stabilizers may be helpful for depressed and,
or, labile mood.
 Antipsychotic drugs may also be used when there are distortions in thinking.
HISTRIONIC PERSONALITY
DISORDER
Histrionic Personality Disorder is characterized by constant attention-seeking,
emotional overreaction, and suggestibility.
This personality's tendency to over-dramatize may impair relationships and lead to
depression, but sufferers are often high-functioning.
SYMPTOMS
HISTRIONIC PERSONALITY DISORDER
 Constantly seeking reassurance or approval
 Excessive dramatics with exaggerated displays of emotion• Excessive
sensitivity to criticism or disapproval
 Inappropriately seductive appearance or behavior• Overly concerned
with physical appearance
 Tendency to believe that relationships are more intimate than they actually
are
 Self-centeredness, uncomfortable when not the center of attention• Low
tolerance for frustration or delayed gratification
 Rapidly shifting emotional states that appear shallow to others• Opinions
are easily influenced by other people, but difficult to back up with details
 Being easily influenced by other people
 Blaming failure or disappointment on others
HISTRIONIC PERSONALITY
DISORDER
CAUSES OF HISTRIONIC
PERSONALITY DISORDER
The cause of this disorder is unknown, but childhood events and genetics may both be
involved.
It occurs more frequently in women than in men, although some feel it is simply more
often diagnosed in women because attention seeking and sexual forwardness are less
socially acceptable for women than for men.
TREATMENTS
 Patients often seek treatment for depression associated with failed romantic
relationships.
 Medication may be helpful with symptoms such as depression. Professional
counseling, such as psychotherapy, may also be of benefit.
 Histrionic personality disorder does not usually affect the person's ability to function
adequately in a superficial work or social environment.
NARCISSISTIC PERSONALITY
Narcissistic Personality Disorder involves arrogant
DISORDER
behavior, a lack of empathy for
other people, and a need for admiration-all of
which must be consistently
Narcissists tend to have high selfesteem.
evident at work and in relationships. People who
are narcissistic are frequently
However, narcissism is not the same
described as cocky, self-centered, manipulative,
and demanding. Narcissists
may concentrate on unlikely personal outcomes
(e.g., fame) and may be
convinced that they deserve special treatment
thing as self-esteem; people who
have high self-esteem are often
humble, whereas narcissists rarely
are.
SYMPTOMS
OF NARCISSISTIC PD
•Reacts to criticism with anger, shame or humiliation
•Takes advantage of others to reach his or her own goals
•Exaggerates own importance
•Exaggerates achievements and talents
•Entertains unrealistic fantasies about success, power, beauty, intelligence or
romance
•Has unreasonable expectation of favorable treatment
•Requires constant attention and positive reinforcement from others
•Is easily jealous
•Disregards the feelings of others, lacks empathy
•Has obsessive self-interest
•Pursues mainly selfish goals
CAUSES & TREATMENT OF
NARCISSISTIC PD
Causes are not yet well-understood. Genes play
a significant role (approximately 50%), but the
unique ways that environments shape people
(e.g., peer interactions) also influence narcissism.
Related hypotheses include:
1.Heritable narcissistic traits emerged in part due
to natural selection for promiscuous sexuality.
2.Some people develop into narcissists because
of self-reflection on largely heritable traits-"I am
attractive and therefore I deserve special
treatment."
3.Cultural factors may bring-about narcissistic
qualities (e.g., watching narcissistic role models
on TV; adverse, war-torn environments).
Treatments
Clinical treatment is rare because most
narcissists avoid therapy.
However, narcissists can learn to be more
caring about others, and narcissism can be
reduced when these individuals are
included in social groups.
Psychotherapy may be useful in getting
the individual with narcissistic personality
disorder to relate to others in a less
maladaptive manner.
AVOIDANT PERSONALITY
DISORDER
Avoidant Personality Disorder is a
psychiatric condition characterized by a
The cause of avoidant personality disorder is
unknown.
lifelong pattern of extreme shyness,
feelings of inadequacy, and sensitivity to
rejection.
People with avoidant personality disorder are
preoccupied with their own shortcomings and form
relationships with others only if they believe they will
not be rejected.
Personality disorders are long-lived
patterns of behavior that cause problems
with work and relationships
Loss and rejection are so painful to these individuals
that they will choose loneliness rather than risk trying
to connect with others.
SYMPTOMS
AND TREATMENT OF AVOIDANT PERSONALITY DISORDER
Symptoms
Some common signs of avoidant personality
disorder include:
•Easily hurt by criticism or disapproval
•Has no close friends
•Reluctant to become involved with people
•Avoids activities or occupations that involve
contact with others
•Shy in social situations out of fear of doing
something wrong
•Exaggerates potential difficulties
•Shows excessive restraint in intimate
relationships
•Hold the view that they are socially inept,
inferior, or unappealing to other people
Treatments
 Antidepressant medications can often reduce
sensitivity to may be helpful.
 A combination of rejection.
 Psychotherapy, particularly cognitive/behavioral
approaches, medication and talk therapy may be
more effective than either treatment alone.
 People with this disorder may have some ability to
relate to others, and this can be improved with
treatment.
DEPENDENT PERSONALITY
DISORDER
Dependent personality disorder is a psychiatric
condition marked by an overreliance on other
people to meet one’s emotional and physical needs.
People with this disorder do not trust their own ability
to make decisions and feel that others have better
ideas. They may be devastated by separation and
loss, and they may go to great lengths, even
suffering abuse, to stay in a relationship
The cause of this disorder is not known.
The disorder usually appears in early
adulthood.
This disorder is common but not well
studied; however, more women than
men have been found to have
dependent personality disorder.
SYMPTOMS OF DPD
•Difficulty making decisions without reassurance from others
•Extreme passivity
•Problems expressing disagreements with others
•Avoiding personal responsibility
•Avoiding being alone
•Devastation or helplessness when relationships end
•Unable to meet ordinary demands of life
•Preoccupied with fears of being abandoned
•Easily hurt by criticism or disapproval
•Willingness to tolerate mistreatment and abuse from others
Complications of this disorder may include depression, alcohol and drug abuse, and
susceptibility to physical, emotional and sexual abuse.
TREATMENTS FOR DEPENDENT
PERSONALITY DISORDER
Psychotherapy is the preferred form of treatment for people with
dependent personality disorder.
Cognitive-behavioral therapy focuses on patterns of thinking that are
maladaptive, the beliefs that underlie such thinking and resolving
symptoms or traits that are characteristic of the disorder, such as the
inability to make important life decisions or the inability to initiate
relationships.
Improvements are usually seen only with long-term therapy or
treatment.
Medication may be helpful to treat any other underlying conditions.
Certain types of drugs such as antidepressants, sedatives and
tranquilizers are often prescribed for patients with dependent
personality disorder to treat co-occurring conditions.
SOURCES
•American Psychiatric Association
•National Institutes of Health - National Library of Medicine
•Psychnet, United Kingdom
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorders (4th ed.).
National Institutes of Health, National Library of Medicine,
MedlinePlus, 2006. Antisocial Personality Disorder.
www.nlm.nih.gov/medlineplus/ency/article/000921.htm (link is
external)
Stout, M. (2005). The Sociopath Next Door
Westermeyer, J. and Thuras, P. (2005). Association of antisocial
personality disorder and substance disorder morbidity in a clinical
sample. American Journal of Drug and Alcohol Abuse