Personality Disorders

Dr Annesa Harrypersaud
What is personality?
 Personality
Personality is the combination of thoughts, emotions and
behaviors that are particular to a specific person and remain
somewhat stable and predictable over time. It's the way you
view, understand and relate to the outside world, as well as
how you see yourself.
 Personality trait
A relatively stable, consistent, and enduring internal
characteristic that is inferred from a pattern of behaviors,
attitudes, feelings, and habits in the individual.
 Personality disorder
A personality disorder is a type of mental disorder in
which there is an enduring pattern of inner experiences
and behavior that deviates markedly from the
expectations of the individual’s culture. This causes
significant problems and limitations in relationships,
social activities, work and school.

o It is pervasive and inflexible.

o It has an onset in adolescence or early adulthood.
o It cannot be diagnosed before the age of 18 years.
o It is stable over time.
o It leads to distress or impairment of functioning.
 Epidemiology
o Prevalence in general population: 10-18%
o Outpatient prevalence: 30-50%
o Inpatient prevalence: >50%
o Prevalence among patients with other
mental disorders: 1/3 have comorbid
personality disorder.
o Males = females overall
o Age: stable prevalence with increasing age
o Most common clinically: borderline
personality disorder
 Etiology
Personality forms during childhood, shaped through an
interaction of:

Your genes: Certain personality traits may be passed on to you by

your parents through inherited genes. These traits are sometimes
called your temperament.

Your environment: This involves the surroundings you grew up

in, events that occurred, and relationships with family members
and others.

Personality disorders are thought to be caused by a combination

of these genetic and environmental influences. Your genes may
make you vulnerable to developing a personality disorder, and a
life situation may trigger the actual development.
 Risk factors

Although the precise cause of personality disorders is

not known, certain factors seem to increase the risk of
developing or triggering personality disorders,
including:

o Family history of personality disorders or other

mental illness
o Abusive, unstable or chaotic family life during
childhood
o Being diagnosed with childhood conduct disorder
 Cluster A
Cluster A personality disorders are characterized
by odd, eccentric thinking or behavior.
 Paranoid personality disorder
o Pervasive distrust and suspicion of others and interpret their
motives as malevolent.
o They tend to blame their own problems on others and seem
angry and hostile.
o They are often characterized as being pathologically jealous,
which leads them to think that their partners are cheating on
them.
o Prevalence: 2–4%
o More commonly
diagnosed in men than
in women.
o Higher incidence in
family members of
schizophrenics
 Diagnostic criteria
DSM-5 Criteria

At least four of the following must be present:

1. Suspicion (without evidence) that others are exploiting or
deceiving him or her.
2. Preoccupation with doubts of loyalty or trustworthiness of
friends or acquaintances.
3. Reluctance to confide in others.
4. Interpretation of benign remarks as
threatening or demeaning.
5. Persistence of grudges.
6. Perception of attacks on his or her character that is not
apparent to others; quick to counterattack.
7. Suspicions regarding fidelity of spouse or partner
 Schizoid personality disorder

Patients have a lifelong pattern of social withdrawal.

They are quiet and unsociable and have a constricted
affect. They have no desire for close relationships and
prefer to be alone.

Epidemiology

o Prevalence: 3–5%.
o Diagnosed more often in men than women.
 Diagnostic criteria
DSM-5 Criteria

1.Neither enjoying nor desiring close relationships

(including family)
2. Generally choosing solitary activities .
3. Little (if any) interest in sexual activity with another
person .
4. Taking pleasure in few activities (if any).
5. Few close friends or confidants (if any).
6. Indifference to praise or criticism.
7. Emotional coldness, detachment, or flattened affect.
 Schizotypal personality disorder
o Peculiar dress, thinking, beliefs, speech or behavior
o Flat emotions or inappropriate emotional responses
o Social anxiety and a lack of or discomfort with close relationships
o Indifferent, inappropriate or
suspicious response to others
o "Magical thinking" — believing you
can influence people and events with
your thoughts
o Belief that certain casual incidents or
events have hidden messages meant
only for you

Epidemiology

o Prevalence: 4–5%
 Diagnostic criteria
Diagnosis and DSM-5 Criteria
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking, inconsistent with
cultural norms
3. Unusual perceptual experiences (such as bodily
illusions)
4. Suspiciousness
5. Inappropriate or restricted affect
6.Odd or eccentric appearance or behavior
7. Few close friends or confidants
8. Odd thinking or speech (vague, stereotyped, etc.)
9. Excessive social anxiety Magical thinking may include
 Cluster B
Cluster B personality disorders are characterized by
dramatic, overly emotional or unpredictable thinking or
behavior.
 Antisocial personality disorder

Epidemiology
Prevalence: 3% in men and 1% in women.
There is a higher incidence in poor urban areas and in prisoners
Genetic component: ↑ risk among first-degree relatives
Diagnostic criteria
 Narcissistic personality disorder
o Belief that you're special and more important than others
o Fantasies about power, success and attractiveness
o Failure to recognize others' needs and
feelings
o Exaggeration of achievements or
talents
o Expectation of constant praise and
admiration
o Arrogance
o Unreasonable expectations of favors
and advantages, often taking
advantage of others
o Envy of others or belief that others
envy you

Epidemiology

Prevalence: Up to 5%
More common in men.
 Diagnostic criteria
DSM-5 Criteria

1. Exaggerated sense of self-importance

2. Preoccupation with fantasies of unlimited money, success,
brilliance, etc.
3. Believes that he or she is “special” or unique and can
associate only with other high-status individuals
4. Requires excessive admiration
5. Has sense of entitlement
6. Takes advantage of others for self-gain
7. Lacks empathy
8. Envious of others or believes others are envious of him or
her
9. Arrogant
 Borderline personality disorder
o Patients have unstable moods, behaviors, and interpersonal
relationships. They fear abandonment and have poorly formed
identity.
o Relationships begin with intense attachments and end with the
slightest conflict.
o Aggression is common. They are impulsive and may have a history of
repeated suicide attempts/gestures or episodes of self-mutilation.
o Ongoing feelings of
emptiness

Epidemiology

o Prevalence: Up to 6%.
o Diagnosed three times more
often in women than men.
Diagnostic criteria
 Histrionic personality disorder
o Constantly seeking attention
o Excessively emotional, dramatic or
sexually provocative to gain attention
o Speaks dramatically with strong
opinions, but few facts or details to
back them up
o Easily influenced by others
o Shallow, rapidly changing emotions
o Excessive concern with physical
appearance
o Thinks relationships with others are
closer than they really are

Epidemiology
Diagnostic criteria
 Cluster C
Cluster C personality disorders are characterized by
anxious, fearful thinking or behavior.
Obsessive compulsive personality disorder
o Preoccupation with details, orderliness and rules
o Extreme perfectionism, resulting in dysfunction and distress when perfection
is not achieved.
o Desire to be in control of people,
tasks and situations, and inability
to delegate tasks
o Neglect of friends and enjoyable
activities because of excessive
commitment to work or a project
o Inability to discard broken or
worthless objects
o Rigid and stubborn
o Inflexible about morality, ethics
or values

Epidemiology
o Prevalence: 1–2%.
o Men are two times more likely to
have OCPD than women.
 Diagnostic criteria
DSM-5 Criteria

1.Preoccupation with details, rules, lists, and organization

such that the major point of the activity is lost
2. Perfectionism that is detrimental to completion of task .
3. Excessive devotion to work
4. Excessive scrupulousness about morals and ethics
5. Will not delegate tasks
6. Unable to discard worthless objects
7. Miserly spending style
8. Rigid and stubborn
 Avoidant personality disorder
o Too sensitive to criticism or rejection
o Feeling inadequate, inferior or unattractive
o Avoidance of work activities that require interpersonal contact
o Socially inhibited, timid and
isolated, avoiding new activities
or meeting strangers
o Extreme shyness in social
situations and personal
relationships
o Fear of disapproval,
embarrassment or ridicule

Epidemiology
o Prevalence: 2.4%.
o Equally frequent in males and
females
 Diagnostic criteria
DSM-5 Criteria

1. Avoids occupation that involves interpersonal

contact due to a fear of criticism and rejection.
2. Unwilling to interact unless certain of being liked
3. Cautious of interpersonal relationships
4. Preoccupied with being criticized or rejected in
social situations
5. Inhibited in new social situations because he or she
feels inadequate
6. Believes he or she is socially inept and inferior
7. Reluctant to engage in new activities for fear of
embarrassment
 Dependent personality disorder
o Excessive dependence on others and feeling the need to be taken care
of
o Submissive or clingy behavior toward others
o Fear of having to provide self-care or fend for yourself if left alone
o Lack of self-confidence, requiring excessive advice and reassurance
from others to make even small decisions
o Difficulty starting or doing projects on your own due to lack of
self-confidence
o Difficulty disagreeing with others, fearing disapproval
o Tolerance of poor or abusive treatment, even when other options are
available
o Urgent need to start a new relationship when a close one has ended

Epidemiology
o Prevalence: Approximately <1%.
o Women are more likely to be diagnosed with DPD than men.
 Diagnostic criteria
DSM-5 Criteria

1. Difficulty making everyday decisions without

reassurance from others
2. Needs others to assume responsibilities for most areas
of his or her life
3. Difficulty expressing disagreement because of fear of
loss of approval
4. Difficulty initiating projects because of lack of
self-confidence
5.Goes to excessive lengths to obtain support from others
6. Feels helpless when alone
7. Urgently seeks another relationship when one ends
8. Preoccupied with fears of being left to take care of self
 Treatment
The aim of treatment is to improve the social adaptation and
vocational functioning of the patient, as well as to reduce the
suffering of his surrounding family members.

Psychotherapy:
o The modality and type is chosen according to the individual
patient.
o Techniques vary from cognitive behavioral, brief dynamic
and extended deeper forms.
o Group therapy can be extremely helpful in certain types of
personality disorder, e.g. schizoid personality disorder.
o Individual psychotherapy is more helpful in certain cases,
e.g. a well motivated paranoid personality disorder.
 Reference
www.psychiatry.org

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https://www.mayoclinic.org/diseases-conditions/personality-disorders/
symptoms-causes

Diagnostic and statistical manual of mental disorders fifth edition.

First-Aid-psychiatry-Edition-McGraw-Hill-Education