what is personality It's the inditing patterns of thinking

feeling behavior which makes one individual distinguishable from

another
It's stable or at least relatively stable

Genetic factor

General F Neuropsychological factors

family environment
determinants social factors

1 Present since teenage years

2 Consistent overtime

General 3 Recognized by friends relatives

Characteristic 4 Stable in different situations

a toast
o assess Areyou usually happy miserable worrying

Personality Are you very tidy Punctual exciting

Doyouever losecontrol or behave violently

How doyou react to frustration

Do you stand up for yourself
Have youtalked about future what you wishforit
Are you able to express feelings

How do you respond to difficult situations

Doyou behave impulsively
Are you Prone to mood Swings

Peri Agreeableness
5 factormode
1 11
Conscientiousness meticulousness Neuroticism
of personality
OCEAY
Personality disorders Characterized by deeply ingrained maladaptive
Patterns of behavior which are recognizable from adolescence continue onto

adult life It's not a mental illness despite the name

Balance of personality elements

Abnormality maybe in f Their quality of expression

or in its total aspect

Personality disorders are axis 11 disorders

animas.iti
Axis 11
ii iii
Personality disorders I mental retardation

Axis IV Psychosocial environmental problems housing diverse employ

Axis V Assessment of overall functioning

A Enduring pattern of inner experience behavior

deviates markedly from expectations of individual's culture

That
which manifested in 7,2 of followings

DX Criteria 1 Cognition Perceiving interpreting self other people events

2 Affectivity Range intensity appropriateness of emotionalespons

3 Interpersonal functioning

y up
B This enduring pattern is inflexible pervasive
across broad range of Personal Social situation

C Leads to clinically significant distress or occupational as

D This Pattern is stable of long duration
the onset can be traced back at least to adolescence or

m c S b mental isorders or substance abuse or

medical condition
PD represented
by severity of traits rather than district categories
Show a restricted range of traits with a dominant single trait
They are egosyntonic ratherthan egodystonic
An individual can have PD becomes less severe with age
Prevalence 10 13 of population higher among mental disorders

Cluster A odd eccentric Paranoid schizoid schizotypal

Cluster B Dramatic erratic Antisocial borderline histrionic Narcissistic

Cluster C anxious fearful Avoidant dependent obsessivecompulsive
Pgcif
Not specified mixed depressive Passive aggressive

Cluster A
Paranoid Schizoid schizotypal
higly suspicious gAloof social isolation Eccentric oddthinking
Preoccupied with distrust withdrawn reserved 3 behavior appearance

toward others Afew interest pleasure U speaks in gnasual vague

No delusions or hallucination in life activitis Circumstantial ways

oftenhostile irritable flacks of close friends I Ideas of reference

argumentative enyiggs f emotional coldness E unconventional beliefs as
Noconfidants detachment or flattenedaffecthaving extrasensory abilities or

Sense of exploitation
f little interest in sexual excessive magicalthinking

Senstivity of any feeling experience D Suspiciousness or Paranoid

for instil't develop 1 Indifferent to praise or ideation Doubt

Lack of close friends
grudges criticism f
can't maintain relationship
1 21 of Population Prevalence It R excessive social anxiety
GET FACT SIR SAFE 21 of pop
UFO AIDER
 reTctant
Cluster B
Antisocial CALLOUS MAN Borderline I RAISED A PAIN
A Disregard for violation of rights of E Feelings of emptiness boredom with
thers occurring since 15yrs indicated fear of rejection loss

I FragileIdentitywith Poor self image

by 73 of the following
1 Failure to conform to social norms unpredictable impulsive Cirritable arytumentative

repeatedly Performing arts that are ground for with bouts of anger when expectations notmet
AAnger maydirected toward themselves self
aliaseshate state
Eiconning
Deceitfulness repeated lying use of
others for personal priff or pleasure 5 Suicide threats action
may
happen but
failure to plan ahead
3hinpitisility usually doesn't lead to real suicides
Irritability aggressiveness A R Rapid Change mood behavior with intense

5.5Reckless disregardfor safety of self orother unstable relationship

Consistent irresponsibility repeated failure to P brief psychotic may occur

astain consistent work behavior or financial
gbligation Dthey deride persons into those who like
lack ofremove regret beingindifferent to or those hate them

rationalizinghavinghurt mistreated or stolenfromanother

become more stable in their 3 5 40
B individual C Prevalence 21 751 of them are female
C Evidence of conduct disorder withonset 901 have other psychiatric dx 40 t have2
before 15 yr
Histrionic PD I CRAVE SIN
I The antisocial behavior is not exclusively
N
uring schizophrenic course or manic episode wants to be theGenter of attention
excessive expression
ighrates ofsubstance abuse candie young Shifting Shaggy ofemotion
with age less involveincriminal
violently S veryseductive lifeoftheparty difficultinrelationship mayfrigidsex
Prevalence 31ofmales II of females
consider
I Self dramatization exaggerate
illness
friendships intim
shipsmore
elation

of are substance abuse

V Easily vulnerable
Etiology of APD: influenced
•Family & parenting factors: disruptive family life/
harsh & inconsistent discipline/ lack of monitoring
by others circumstances

•Genetics: concordance rates for criminality;

Defensores
51% for MZ twins & 21% for DZ. include repression regression identification somatization conversion
•Regarding punishment: it increases the frequency of the punished behavior, rather than decreases it dissociation denial externalization
(de ance/opposition
21ofpopulation amore in women
 SPECIAL
Believe that they should associate with high statuspeople or institution
ii
C hypersenstive to criticism theyoffer help or facilities toothers buttoexploitthem in thefuture

egocentricity vengeful butlowselfesteem

l 21 of Pop more common in men doctors surgeons

Cluster cimmmurman
Avoidant anxious PD Dependant PD obsessive compulsive
PD
Pervasive
CExtreme Sensitivity to psychological dependence onothers Inflexibility stubbornness

Criticism disapproval IDifficuity in makingdecisions withoutexcessive desire for Perfection

So avoidthat Situations amount of advice direction reassurance tendto perfectionism feel
Chronic feeling of inadequacyflowopinion oftheirown abilities withfear ants when things aren't right

I Inhibited introverted low esteemofdisapproval Senseofthere'sone to dothings

way
solution
Shy restrain ofintimacy
avoidance ears of beingalone being unable to cope failure to appreciate creative

Nonlyinvolved if sure of praise Notuncommon forsuch a patient tobeliving over meticulous attentiontosystem det

Plackofsocial contact likeschizoid failure

with a controlling domineering or overprotective
togetthingsdoneas a resultof

schizotypal butit'sdueto the P excessiveattention to detail

tendency to check re che

offraidof rejection ADOPTg butabsence of obsessional
Prevalence as I ofpop

CRINGES It of Pop
Ineeds
to be sure SWIFTS
Not otherwise specified not meet full criteria forany PD or it'smixedPD

Passive aggressive PD Depressive PersonalityD

Outwardly Compliant inwardly hostile

butmay alternate with regret behavior by presence of most of following

Procrastinates with ve attitudes but Passive Pessimistic
by gloominess
dominated unhappiness

resistance Beliefs of inadequacy worthlessness low selfesteem

Critical given to worry

Inefficient butexpresses envy resentment Negativistic judgmental toward others

toward those apparently more fortunate feeling guilty

may ask for help but doesn't comply B Doesn't occur exclusively daring MDD
with Physician's advice is not better accounted
by Dysthymia disorder
a mildbut long lasting form of depression experience

a depressed mood mostof the day for712 yr

in children71 yr may also have bouts of MDD
Also called Persistent depressive disorder
 Management of PD

PD have no insight lack of awareness

PD long lasting so Rx require months or yrs

s Be respectful with non judgmental attitude

1 Consider the matter of affect emotion

genera Maintain professional boundaries

Priciples Be aware of transference pit subconsciously transfer their feelings about someone else

ontothetherapist counter transference whentherapist transfers feelings onto the pit

Set limits Provide consistent structure

Label the maladaptive behaviors of Pit

Set realistic expectations
Consult Psychiatrist when needed

2 Medications Drugs have no proven usefulness to change the traits in PD But

Behavioral dyscontrol as seen in APD BPD may respond to carbamazepine

Impulsivity SSRI as sertraline

Affective dysregulation SSRI mood stabilizers

3 Psychotherapy Individual group family psychotherapy self help groups

Tohodynamic Psychotherapy
Based on CBT change ve thinking to push ve behavior
DBT dialectical based on CBT with greater focus on

emotional social aspects where it focuses on motivational

issues Skill development support resolution of many Prb inPD

requires development of new coping mechanism better social skills
g