PERSONALITY DISORDERS

Presented to
Ms. Maham Abdullah
Presenters
• Hafsa Khan – 52077
• Shahzadi Razia Sultana – 52153
 WHAT IS PERSONALITY DISORDER?

An enduring pattern of inner experience and behavior that deviates markedly

from the norms and expectations of the individual’s culture, is pervasive and
inflexible, has an onset in adolescence or early adulthood, is stable over time,
and leads to distress or impairment.
 RISK FACTORS OF PERSONALITY DISORDER

Lower
SES and Young
Education Age
Levels

Being
Male Sex
Unmarried

Reference
Zhang, T. T., Huang, Y. Q., Liu, Z. R., & Chen, H. G. (2016). Distribution and Risk Factors of Disability Attributed to Personality
Disorders: A National Cross-sectional Survey in China. Chinese medical journal, 129(15), 1765–1771. https://doi.org/10.4103/0366-
6999.186649
 Cluster A Cluster B Cluster C
odd and eccentric dramatic, emotional, unpredictable anxious, fearful

 Antisocial Personality
 Paranoid Personality  Avoidant Personality
Disorder
Disorder Disorder
 Borderline Personality
 Schizoid Personality  Dependent Personality
Disorder
Disorder  Histrionic Personality Disorder
 Schizotypal Personality Disorder  Obsessive-compulsive
Disorder  Narcissistic Personality
Personality Disorder
Disorder
Other Personality Disorders

 Personality Change Due to

Another Medical Condition
 Other Specified Personality
Disorder
 Unspecified Personality
Disorder
 GENERAL PERSONALITY DISORDER

Diagnostic Criteria

A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture. This pattern is manifested in two (or more) of the
following areas:

Cognition Affectivity

Interpersonal
Impulse Control
functioning
 GENERAL PERSONALITY DISORDER

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or
other important areas of functioning.

D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or
early adulthood.

E. The enduring pattern is not better explained as a manifestation or consequence of another mental
disorder.

F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition (e.g., head trauma).
 GENERAL PERSONALITY DISORDER

Etiology

• Features of a personality disorder usually become recognizable during adolescence or early

adult life.

• For diagnosis in an individual younger than 18 years, the features must have been present for
at least 1 year.

• Antisocial personality disorder cannot be diagnosed in individuals younger than 18 years.

• A personality disorder may be exacerbated following the loss of significant supporting

persons (e.g., a spouse) or previously stabilizing social situations (e.g., a job)
 GENERAL PERSONALITY DISORDER

Differential Diagnosis
• Other mental disorders and personality traits.

• Psychotic disorders.

• Anxiety and depressive disorders.

• Posttraumatic stress disorder.

• Substance use disorders.

• Personality change due to another medical condition.

 PARANOID PERSONALITY DISORDER

Diagnostic Criteria

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as
malevolent, beginning by early adulthood and present in a variety of contexts, as indicated
by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

3. Is reluctant to confide in others because of unwarranted fear that the information will be used
maliciously against him or her.
 PARANOID PERSONALITY DISORDER

Diagnostic Criteria

4. Reads hidden demeaning or threatening meanings into benign remarks or events.

5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).

6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react
angrily or to counterattack.

7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder
with psychotic features, or another psychotic disorder and is not attributable to the physiological effects
of another medical condition.
 PARANOID PERSONALITY DISORDER

Etiology
• First apparent in childhood and adolescence with solitariness, poor peer relationships, social
anxiety, underachievement in school, and interpersonal hypersensitivity.

• Adolescent onset of paranoid personality disorder is associated with a prior history of childhood
maltreatment, externalizing symptoms, bullying of peers, and adult appearance of interpersonal
aggression.

Environmental: exposure to social stressors

Genetic and Physiological: prevalence of paranoid personality disorder in relatives of probands

with schizophrenia
 PARANOID PERSONALITY DISORDER

Differential Diagnosis
• Other mental disorders with psychotic symptoms.

• Substance use disorders.

• Personality change due to another medical condition.

• Paranoid traits associated with physical handicaps.

• Other personality disorders and personality traits.

 SCHIZOID PERSONALITY DISORDER

Diagnostic Criteria
A. A pervasive pattern of detachment from social relationships and a restricted range of expression of
emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family.

2. Almost always chooses solitary activities.

3. Has little, if any, interest in having sexual experiences with another person.

4. Takes pleasure in few, if any, activities.

5. Lacks close friends or confidants other than first-degree relatives.

 SCHIZOID PERSONALITY DISORDER

Diagnostic Criteria
6. Appears indifferent to the praise or criticism of others.

7. Shows emotional coldness, detachment, or flattened affectivity.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive
disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not
attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “schizoid personality
disorder (premorbid).”
 SCHIZOID PERSONALITY DISORDER

Etiology
• First apparent in childhood and adolescence with solitariness, poor peer relationships, social
anxiety, underachievement in school.

Genetic and Physiological: increased prevalence in relatives of individuals with schizophrenia or

schizotypal personality disorder.
 SCHIZOID PERSONALITY DISORDER

Differential Diagnosis
• Other mental disorders with psychotic symptoms.

• Autism spectrum disorder.

• Personality change due to another medical condition.

• Substance use disorders.

• Other personality disorders and personality traits.

 SCHIZOTYPAL PERSONALITY DISORDER

Diagnostic Criteria

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity
for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior,
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the
following:

1. Ideas of reference (excluding delusions of reference).

2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness,
belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).

3. Unusual perceptual experiences, including bodily illusions.

4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).

5. Suspiciousness or paranoid ideation

 SCHIZOTYPAL PERSONALITY DISORDER

Diagnostic Criteria
4. Inappropriate or constricted affect.

5. Behavior or appearance that is odd, eccentric, or peculiar.

6. Lack of close friends or confidants other than first-degree relatives.

7. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears
rather than negative judgments about self.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder
with psychotic features, another psychotic disorder, or autism spectrum disorder.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality
disorder (premorbid).”
 SCHIZOTYPAL PERSONALITY DISORDER

Etiology
• First apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety,
underachievement in school, hypersensitivity peculiar thoughts and language, and bizarre
fantasies. These children may appear “odd” or “eccentric” and attract teasing.

Genetic and Physiological: more prevalent among the first-degree biological relatives of individuals
with schizophrenia than among the general population.
 SCHIZOTYPAL PERSONALITY DISORDER

Differential Diagnosis
• Other mental disorders with psychotic symptoms.

• Neurodevelopmental disorders.

• Personality change due to another medical condition.

• Substance use disorders.

• Other personality disorders and personality traits.

QUICK EVALUATION ALERT!!!
 Paranoid Personality Disorder

Schizotypal Personality Disorder

 ANTISOCIAL PERSONALITY DISORDER

Diagnostic Criteria
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as
indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing
acts that are grounds for arrest.

2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or
pleasure.

3. Impulsivity or failure to plan ahead.

4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

5. Reckless disregard for safety of self or others.

 ANTISOCIAL PERSONALITY DISORDER

Diagnostic Criteria
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor
financial obligations.

7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen
from another.

B. The individual is at least age 18 years.

C. There is evidence of conduct disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or
bipolar disorder.
 ANTISOCIAL PERSONALITY DISORDER

Etiology
• Chronic course but may become less evident or remit as the individual grows older, often by age 40.

• Cannot be diagnosed before age 18 years.

Environmental: Child abuse or neglect, unstable or erratic parenting, or inconsistent parental

discipline increases the likelihood of evolving conduct disorder into antisocial personality disorder.

Genetic and Physiological: more prevalent among the first-degree biological relatives of those with
the disorder than in the general population. Family that has a member with antisocial personality
disorder, males more often have antisocial personality disorder
 ANTISOCIAL PERSONALITY DISORDER

Differential Diagnosis
• Substance use disorders.

• Schizophrenia and bipolar disorders.

• Other personality disorders.

• Criminal behavior not associated with a mental disorder.

 BORDERLINE PERSONALITY DISORDER

Diagnostic Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity,
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior
covered in Criterion 5.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of
idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless
driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
 BORDERLINE PERSONALITY DISORDER

Diagnostic Criteria
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety
usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger,
recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

 BORDERLINE PERSONALITY DISORDER

Etiology
• Adolescents as young as age12 or 13 years can meet full criteria for the disorder.

• Lessen in severity as those with borderline personality disorder entered their 30s and 40s. However, stable
remissions of 1–8 years are very common.

• Impulsive symptoms of borderline personality disorder remit the most rapidly, while affective symptoms
remit at a substantially slower rate.

Environmental: childhood abuse, sexual abuse and emotional neglect

Genetic and Physiological: five times more common among first-degree biological relatives.
 BORDERLINE PERSONALITY DISORDER

Differential Diagnosis
• Depressive and bipolar disorders.

• Separation anxiety disorders

• Substance use disorders.

• Other personality disorders.

• Personality change due to another medical condition.

• Identity problems.
 RESEARCH ARTICLE

Personal agency and borderline personality disorder:

a longitudinal study of outcomes

Reference

Hashworth, T., Reis, S., Townsend, M. et al. Personal agency and borderline personality disorder: a
longitudinal study of outcomes. BMC Psychiatry 22, 566 (2022). https://doi.org/10.1186/s12888-022-04214-5
 RESEARCH

Hashworth et al. (2022)

Type of Study Longitudinal
Sample • 57 adults (predominantly female)
(Mean age= 35.86 years) • Diagnosed BPD
• Comorbid diagnoses of depression, anxiety, PTSD, and bipolar disorder
• 23.37% sample withdraw from in-take to follow-up.
• Post-treatment: 37 adults
• 12 month follow-up: 41adults
Sampling Technique Purposive Sampling
Measures 1. The Mental Health Inventory (MHI-5)
2. The Mental Health Locus of Control Scale (MH-LOC)
3. Borderline Personality Disorder Checklist (BPD CL)
4. The Personality Inventory Brief Form for the DSM-5 (PID-5-BF)
Data Analysis • Three time points:
1. Intake (prior to participants first treatment session)
2. Post-treatment (12 weeks after intake)
3. Follow-up (12 months after intake)
 RESEARCH

Hashworth et al. (2022)

Results • DBT therapy led to significant reductions in BPD symptoms over time.
• Depression and anxiety symptoms did not significantly reduce as a result of treatment.
• Low personal agency was associated with greater BPD symptom severity.
• High personal agency is associated with successful treatment outcomes.
• Half of the sample still met criteria for BPD at follow-up (47%).
• Despite the reductions in BPD symptomology, personal agency did not signifcantly
change over time.
 HISTRIONIC PERSONALITY DISORDER

Diagnostic Criteria

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood
and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention.

2. Interaction with others is often characterized by inappropriate sexually seductive or provocative

behavior.

3. Displays rapidly shifting and shallow expression of emotions.

4. Consistently uses physical appearance to draw attention to self.

 HISTRIONIC PERSONALITY DISORDER

Diagnostic Criteria

5. Has a style of speech that is excessively impressionistic and lacking in detail.

6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

7. Is suggestible (i.e., easily influenced by others or circumstances).

8. Considers relationships to be more intimate than they actually are.

 HISTRIONIC PERSONALITY DISORDER

Etiology
• Pattern begins by early adulthood and is present in a variety of contexts.

• Histrionic personality disorder may develop as a result of trauma experienced during childhood.

• Parenting which lacks boundaries is over-indulgent or inconsistent may predispose children to develop
histrionic personality disorder.

• Family history of personality disorders, psychiatric illness, or substance use disorders is a risk factor for
histrionic personality disorder.

Reference

French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2022 Sep 26]. In: StatPearls [Internet].Treasure Island
(FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/
 HISTRIONIC PERSONALITY DISORDER

Differential Diagnosis
• Substance use disorders.

• Other personality disorders and personality traits.

• Personality change due to another medical condition.

 RESEARCH ARTICLE

Histrionic Personality Disorder, Physical Attractiveness, and Social Adjustment

Reference

Bornstein, R.F. Histrionic Personality Disorder, Physical Attractiveness, and Social Adjustment. Journal of
Psychopathology and Behavioral Assessment 21, 79–94 (1999). https://doi.org/10.1023/A:1022816428515
 RESEARCH

Bornstein (1999)
Type of Experiment Laboratory Experiment
Sample 1. 668 students in pre-screening sessions (345 women, 323 men)
(Mean age= 18-22 years) 2. 32 students in follow-up sessions (18 women, 14 men)
*10$ incentive for both sessions

Sampling Technique Volunteered turned into Opportunity Sampling

Measures 1. Personality Diagnostic Questionnaire
2. The Social Network Scale
3. The Social Performance Survey Schedule
4. The Revised Hassles Scale
5. The Defense Style Questionnaire

Procedure 1. Participants were told that they were taking part in a study of personality and self-
perception.
2. Participants who received a score greater than 0 on the PDQ-R TG or SQ scale were
dropped from the study.
3. Attractiveness ratings of each participant were made on 9-point scales (1 = not at all
attractive; 9 = very attractive) by two independent raters (one female, one male).
 RESEARCH

Bornstein (1999)

Procedure (cont.) 4. Participants who scored above the PDQ-R HPD threshold were contacted by phone
5. Asked to take part in a follow-up session where SNS, SPSS, HS-R, and DSQ data were
obtained.
6. Thirty-two of 35 participants (91%) agreed to take part in the follow-up session (2 men
and 1 woman declined).

Results 1. HPD women were rated higher in attractiveness than women with other PDs or no PD.
2. More attractive HPD women
a) had a more varied and supportive social network
b) exhibited more negative behaviors in important relationships
c) showed greater use of immature defenses, and less reliance on image-distorting,
self-sacrificing, and mature defenses.
3. HPD-attractiveness link was not found in men.
4. Histrionic men use alternative social influence strategies to obtain gratification from
others
 NARCISSISTIC PERSONALITY DISORDER

Diagnostic Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy,
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the
following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be
recognized as superior without commensurate achievements).

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3. Believes that he or she is “special” and unique and can only be understood by, or should associate with,
other special or high-status people (or institutions).
 NARCISSISTIC PERSONALITY DISORDER

Diagnostic Criteria
4. Requires excessive admiration.

5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic
compliance with his or her expectations).

6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).

7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8. Is often envious of others or believes that others are envious of him or her.

9. Shows arrogant, haughty behaviors or attitudes.

 NARCISSISTIC PERSONALITY DISORDER

Etiology
• Narcissistic traits may be particularly common in adolescents but do not necessarily indicate that the
individual will develop narcissistic personality disorder in adulthood.

• Specific traits of this disorder can be exacerbated in the context of unexpected or extremely challenging
life experiences or crises, such as bankruptcies, demotions or loss of work, or divorces.

• Individuals with narcissistic personality disorder may have specific difficulties adjusting to the onset of
physical and occupational limitations that are inherent in the aging process.
 NARCISSISTIC PERSONALITY DISORDER

Differential Diagnosis
• Mania or hypomania.

• Substance use disorders.

• Persistent depressive disorders.

• Other personality disorders and personality traits.

QUICK EVALUATION ALERT!!!
 Antisocial Personality Disorder

Narcissistic Personality Disorder

 AVOIDANT PERSONALITY DISORDER

Diagnostic Criteria
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism,
disapproval, or rejection.

2. Is unwilling to get involved with people unless certain of being liked.

3. Shows restraint within intimate relationships because of the fear of being shamed or insult.

4. Is preoccupied with being criticized or rejected in social situations.

5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

6. Views self as socially inept, personally unappealing, or inferior to others.

7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove
embarrassing.
 AVOIDANT PERSONALITY DISORDER

Etiology
• Having another mental health condition like depression or anxiety

• A family history of depression, Anxiety, or personality disorders

• Childhood abuse, trauma, or neglect

• Trauma including suffering an extreme incident of rejection in childhood

• Genetics, trauma, or a physical illness that alter your appearance beyond societal norms.
 AVOIDANT PERSONALITY DISORDER

Differential Diagnosis
• Social anxiety disorder.

• Agoraphobia.

• Other personality disorders and personality traits.

• Personality change due to another medical condition.

• Substance use disorders.

 DEPENDENT PERSONALITY DISORDER

Diagnostic Criteria
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears
of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or
more) of the following:

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from
others.

2. Needs others to assume responsibility for most major areas of his or her life.

3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
 DEPENDENT PERSONALITY DISORDER

Diagnostic Criteria
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-
confidence in judgment or abilities rather than a lack of motivation or energy).

5. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care
for himself or herself.

6. Urgently seeks another relationship as a source of care and support when a close relationship ends.

7. Is unrealistically preoccupied with fears of being left to take care of himself or herself.
 DEPENDENT PERSONALITY DISORDER

Etiology
• Some risk factors that might contribute to the development of this disorder include:

• Having a history of neglect

• Having an abusive upbringing

• Being in a long-term, abusive relationship

• Having overprotective or authoritarian parents

• Having a family history of anxiety disorders

• Certain cultural and religious Factors

 DEPENDENT PERSONALITY DISORDER

Differential Diagnosis
• Separation anxiety disorder in adults.

• Other mental disorders and medical conditions.

• Other personality disorders and personality traits.

• Personality change due to another medical condition.

• Substance use disorders.

 OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Diagnostic Criteria
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major
point of the activity is lost.

2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because
his or her own overly strict standards are not met).

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
(not accounted for by obvious economic necessity).

4. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
 OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Diagnostic Criteria

5. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of
doing things.

6. Adopts a miserly spending style toward both self and others; money is viewed as something to be
hoarded for future catastrophes.

7. Shows rigidity and stubbornness.

 OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Etiology
• OCPD may be caused by a combination of genetics and childhood experiences.

• In some case studies, adults can recall experiencing OCPD from a very early age. They may have felt that
they needed to be a perfect or perfectly obedient child. This need to follow the rules then carries over into
adulthood.
 OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Differential Diagnosis
• Obsessive-compulsive disorder (OCD).

• Hoarding disorder.

• Other personality disorders and personality traits.

• Personality change due to another medical condition.

• Substance use disorders.

OTHER PERSONALITY DISORDERS
 PERSONALITY CHANGE DUE TO
ANOTHER MEDICAL CONDITION

Diagnostic Criteria

1. Persistent personality disturbance that represents a change from the individual’s previous characteristic personality
pattern. Note: In children, the disturbance involves a marked deviation from normal development or a significant
change in the child’s usual behavior patterns, lasting at least 1 year.

2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct
pathophysiological consequence of another medical condition.

3. The disturbance is not better explained by another mental disorder (including another mental disorder due to another
medical condition).

4. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas
of functioning.
 PERSONALITY CHANGE DUE TO
ANOTHER MEDICAL CONDITION

Differential Diagnosis

• Chronic medical conditions associated with pain and disability.

• Delirium or major neurocognitive disorder.

• Another mental disorder due to another medical condition.

• Substance use disorders.

• Other mental disorders.

• Other personality disorders.

 OTHER SPECIFIED PERSONALITY DISORDER

Diagnostic Criteria
This category applies to presentations in which symptoms characteristic of a personality disorder that cause
clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the personality disorders diagnostic
class. The other specified personality disorder category is used in situations in which the clinician chooses to
communicate the specific reason that the presentation does not meet the criteria for any specific personality
disorder. This is done by recording “other specified personality disorder” followed by the specific reason
(e.g., “mixed personality features”).
 UNSPECIFIED PERSONALITY DISORDER

Diagnostic Criteria
This category applies to presentations in which symptoms characteristic of a personality disorder that cause
clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the personality disorders diagnostic
class. The unspecified personality disorder category is used in situations in which the clinician chooses not
to specify the reason that the criteria are not met for a specific personality disorder and includes
presentations in which there is insufficient information to make a more specific diagnosis.
 RESEARCH ARTICLE

A case study on a severe paranoid personality disorder client treated with

metacognitive interpersonal therapy

Reference

Cheli, S., Cavalletti, V., Popolo, R., & Dimaggio, G. (2021). A case study on a severe paranoid personality
disorder client treated with metacognitive interpersonal therapy. J Clin Psychol, 77, 1807– 1820.
https://doi.org/10.1002/jclp.23201
 RESEARCH ARTICLE

A case study on a severe paranoid personality disorder client treated with

metacognitive interpersonal therapy

WHAT IS METACOGNITIVE INTERPERSONAL THERAPY?

 RESEARCH ARTICLE

MIT is an integrative third‐wave oriented psychotherapy specifically developed for PD. MIT therapists support
patient in recalling the details of interpersonal interactions and identify the relations between feelings,
behaviors, and thoughts involved in these episodes, leading to a shared understanding of recurrent
interpersonal schemas. Once clients have reached an awareness of their maladaptive schemas that guide their
behaviors, as well as an awareness of having healthy aspects of the self as well, therapy aims at sustaining
alternative views of self and others which paves the ground for new avenues, consistent with their goals and
wishes.
 RESEARCH

Cheli et.al (2021)

Type of Experiment Case Study (1 participant, in-depth study)
Sample • 61‐year‐old man with severe PPD
• Presented with ideas of persecution, emotionally charged hostility, and comorbid
antisocial personality disorder
• Diagnosis of PPD from DSM-V criteria
• Secondary diagnosis of APD
• Also reported sub‐threshold criteria for narcissistic PD
Data Collection • Self‐report questionnaires
• Structured interviews
• Metacognition Assessment Scale
• Symptom Checklist‐90‐Revised
Case formulation and alliance • The primary target of the shared conceptualization and then intervention was an
negotiation interpersonal schema that was at the core of all Saul's experiences.
• Saul's interpersonal attitudes appeared early in the therapeutic relationship.
• During the very first session, he started testing if the therapist was the trustworthy and
non‐judgmental.
• Therapist's interpersonal maneuvers and self‐disclosure had the purpose to prevent and
preemptively repair alliance ruptures.
 RESEARCH

Cheli et.al (2021)

Case formulation and alliance • And the result was that the therapeutic relationship was good and stable from the
negotiation therapy's beginning.
• Saul tested the therapist several times. His aim was to confirm whether the therapist was
trustworthy, non‐judgmental and not threatening.
• Once the therapist passed the tests, Saul was able to move to experimenting with a
collaborative stance, as an alternative to seeking social dominance: he appreciated the
psychotherapy metaphor as a “kind of gym,” where he was the one to choose what to do,
but the therapist could support him
Course of Treatment • Session1-8
• Session 9-16
• Session 17-24

Outcomes and Prognosis • Complete remission of both PPD and APD

• General symptomatology showed a reliable change at the end of the intervention
• 6‐month therapy could not have been enough for Saul for two reasons.
• Even if the findings are noteworthy, there are two limitations
QUICK EVALUATION ALERT!!!
 Avoidant Personality Disorder

Obsessive Compulsive Personality

Disorder
THANK YOU…!!