Scribd
Upload
123 views23 pages

Personality Disorders: Dr. Amjad Hakro Consultant Psychiatrist, Senior Registrar ATMCH, Karachi

The document discusses personality disorders, defining them as enduring patterns of inner experiences and behaviors that deviate from a person's culture and cause impairment. Personality disorders are common, affecting 6-13% of adults. They are influenced by genetic and environmental factors like childhood abuse or insecure attachments. The disorders are grouped into clusters based on characteristics. Key features of each disorder are provided. Treatment involves psychological and medical support tailored to the individual, with a long-term focus on understanding difficulties, building relationships, limiting harm, and treating any co-occurring conditions.

Uploaded by

Muhammad Makki
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
123 views23 pages

Personality Disorders: Dr. Amjad Hakro Consultant Psychiatrist, Senior Registrar ATMCH, Karachi

The document discusses personality disorders, defining them as enduring patterns of inner experiences and behaviors that deviate from a person's culture and cause impairment. Personality disorders are common, affecting 6-13% of adults. They are influenced by genetic and environmental factors like childhood abuse or insecure attachments. The disorders are grouped into clusters based on characteristics. Key features of each disorder are provided. Treatment involves psychological and medical support tailored to the individual, with a long-term focus on understanding difficulties, building relationships, limiting harm, and treating any co-occurring conditions.

Uploaded by

Muhammad Makki
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 23

PERSONALITY DISORDERS

Dr. Amjad Hakro


Consultant Psychiatrist, Senior Registrar
ATMCH, Karachi
Objectives:
• Why it is important to identify personality disorders

• Understand the etiology of personality disorders

• Identify screening questions for personality disorders

• List the key features of each personality disorder


Personality
• The innate and enduring characteristics of an individual which shape
their attitudes, thoughts, and behaviors in response to situations.
What is a Personality Disorder?
• An enduring pattern of inner experience and behavior that manifests
in two or more of the following:
 cognition (i.e., ways of perceiving and interpreting self and others);
 Affectivity (i.e., range, intensity, lability) ;
 Interpersonal functioning;
 Impulse control
OR
• The enduring patterns of thinking, feeling and reacting that define a
person

OR
• An enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individual’s culture
• Pattern must be inflexible and pervasive across a broad range of
personal and social situations

• Must be a source of clinically significant distress or impairment in social,


occupational or other important areas of functioning

• Must be stable and of long duration, with an onset that can be traced
back to at least adolescence of early adulthood

• The pattern is stable and can be traced back to adolescence or early


adulthood
Why should you look for personality
disorders?

• They are common! Prevalence estimated between 6-13% of the adult


population

• Recognizing personality disorders can guide your approach to them

• Identifying a personality disorder allows you to assess for comorbities


and suicide risk
Knowing how to approach these patients
helps with:
• Understanding confusion about why patients do not act as you expect
them to

• The emotional distress they can elicit

• Protecting you from inappropriate relationships and engaging in


medical practice outside your standard of care
Etiology
• Genetic
• Neurophysiology
 EEG changes (posterior temporal slow waves) in psychopathy;
 Functional imaging abnormalities in psychopathy (e.g. decreased
activity in amygdala during affective processing task)
 low 5-HT levels in impulsive violent individuals
• Childhood development:

• Conduct disorder
Difficult
temperament
• Antisocial PD

• antisocial PD
ADHD

• PDs
Insecure
Attachment
• Conduct Disorder

• Conduct Disorder
Harsh/Inco
nsistent • Antisocial PD
Parenting

• Borderline PD
Physical/S
exual • other Cluster B PDs
Abuse
Psychodynamic theories
• Freudian explanations of arrested development at oral, anal, and
genital stages leading to dependent, obsessional, and histrionic
personalities
• Maladaptive problem-solving
• Emotional dysregulation
• Abusive experiences in childhood lead to internalization of the harsh
parental object leading to intrapsychic conflict which is repressed or
produces symptomatic behaviors.
• Deficits in self-reflection,
• poor emotional vocabulary & narrow focus of attention
• Incoherent sense of self and others
• unmanageable repeated external threats
Epidemiology
• Community: 2–18%
• Primary care: of patients presenting with conspicuous psychiatric
morbidity, 5–8% will have a primary diagnosis of PD
• Psychiatric patients: 30–40% of outpatients and 40–50% of inpatients
have a PD
The prevalence rates of the categories of personality
disorder in the general population are approximately:
Personality Disorder Clusters
• Cluster A: Suspicious, Odd
 Paranoid, Schizoid, Schizotypal

• Cluster B: Dramatic, Erratic


 Antisocial, borderline, histrionic, narcissistic

• Cluster C: Anxious
 Avoidant, dépendent, obsessive-compulsive
Paranoid PD
• Sensitive, suspicious, preoccupied with conspiratorial explanations, self-
referential, distrust of others.

Schizoid PD
• Emotionally cold, detachment, lack of interest in others, excessive
introspection and fantasy.

Schizotypal PD
• Interpersonal discomfort with peculiar ideas, perceptions, appearance,
& behavior.
Antisocial PD
• Callous lack of concern for others, irresponsibility, irritability, aggression,
inability to maintain enduring relationships, disregard and violation of
others’ rights, evidence of childhood conduct disorder.

Borderline PD
• Unclear identity, intense and unstable relationships, chronic feelings of
emptiness, unpredictable affect, threats or acts of self-harm. Inability to
control anger or plan, with unpredictable affect and behavior.
Histrionic PD
• Self-dramatization, shallow affect, egocentricity, craving attention and
excitement, manipulative behavior.
Narcissistic PD
• Grandiosity, lack of empathy, excessive need for admiration.

Anxious-Avoidant PD
• Tension, self-consciousness, fear of negative evaluation by others, timid,
insecure.
Obsessive–compulsive PD
• Doubt, indecisiveness, caution, pedantry, rigidity, perfectionism,
preoccupation with orderliness and control.
Dependent PD
• Clinging, submissive, excess need for care, feels helpless when not in
relationship.
Management plan
• Tailored to the individual’s needs

• Realistic goals

• Jointly agreed

• Take a long-term view

• Avoid substance use


Management goals
• psychological and practical support

• monitoring and supervision; intervening in crises; increasing motivation &


compliance;

• increasing understanding of difficulties;

• building a therapeutic relationship;

• limiting harm; reducing distress; treating comorbid psych dx

• treating specific areas (e.g. anger, self-harm, social skills)


Management:
Specific treatments
• Medication:

Antipsychotics
Antidepressants
Anticonvulsants and Lithium
• Psychological treatments

Therapeutic community
Dialectical behavioral therapy (DBT) esp. for Borderline PD
Cognitive behavioral therapy (CBT)
Thank you

You might also like