Personality Disorder

DR REHANA NOOR
 What is personality?

 Personality is one’s own way of thinking, feeling, behaving, and

relating to others.
 Personality disorders are a group of mental disorders.
 They involve long-term patterns of thoughts and behaviors that are
different from what is considered normal in your culture.
 The thoughts and behaviors are unhealthy and inflexible.
 They cause serious problems with relationships, work, and social
activities.
 They can make it hard to deal with everyday stresses and problems.
 What are the types of personality
disorders?

 There are 10 types of personality disorders. They are grouped into

three different categories called clusters. The types in each cluster
have some similar symptoms and characteristics. The clusters and
types are:

 Cluster A personality disorders involve unusual and odd thoughts and

behaviors.
 Cluster B personality disorders involve dramatic and emotional
thoughts and behaviors that can keep changing.
 Cluster C personality disorders involve anxious and fearful thoughts
and behaviors.
 Cluster A

1. Paranoid personality disorder, in which a person has

paranoia (an extreme fear and distrust of others). They may
think that someone is trying to harm them.
2. Schizoidpersonality disorder, in which a person prefers
to be alone and is not interested in having relationships with
others.
3. Schizotypalpersonality disorder, in which a person has
unusual thoughts and ways of behaving and speaking. They
are uncomfortable having close relationships with others.
 Paranoid Personality Disorder

 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.
 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
 Cont…

 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.

 Note: If criteria are met prior to the onset of

schizophrenia, add “premorbid,” i.e., “paranoid
personality disorder (premorbid).”
 Schizoid Personality Disorder

 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.
 6. Appears indifferent to the praise or criticism of others.
 7. Shows emotional coldness, detachment, or flattened affectivity.
 Cont…

 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
 Schizotypal Personality Disorder

 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.
 6. Inappropriate or constricted affect.
 7. Behavior or appearance that is odd, eccentric, or peculiar.
 8. Lack of close friends or confidants other than first-degree relatives.
 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears
rather than negative judgments about self.
 Cont…

 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).”
 Cluster B

1. Antisocial personality disorder, in which a person has a long-term

pattern of manipulating, exploiting, or violating the rights of others.
2. Borderline personality disorder, in which a person has lots of
trouble managing their emotions. This makes them impulsive and
uncertain about how they see themselves. It can cause a lot of trouble
in their relationships.
3. Histrionic personality disorder, in which a person is dramatic, has
strong emotions, and always wants attention from others.
4. Narcissistic personality disorder, in which a person lacks empathy
and wants to be admired by others. They think that they are better than
others and that they deserve special treatment.
 Antisocial Personality Disorder

 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.
 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,
 Cont…

 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.
 Borderline Personality Disorder

 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.)
 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.
 Histrionic Personality Disorder

 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.
 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).

 Narcissistic Personality Disorder

 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).
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.
 Cluster C

1. Avoidant personality disorder, in which a person is very shy and

feels that they are not as good as others. They often avoid people
because they fear rejection.
2. Dependent personality disorder, in which a person depends too
much on others and feels that they need to be taken care of. They
may let others treat them badly because they are afraid of losing the
relationship.
3. Obsessive-compulsive personality disorder, in which a person
needs control and order. They are perfectionists and can be
inflexible. Although some of the symptoms are similar, this is not the
 Avoidant Personality Disorder

 A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to

negative evaluation, beginning by early adulthood and present in a variety of contexts,
as indicated by four (or more) of the following:

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 ridiculed.
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
 Dependent Personality Disorder

 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. (Note: Do
not include realistic fears of retribution.)
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. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do
things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself
or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.
 Obsessive–Compulsive Personality
Disorder

 A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at
the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of
contexts, as indicated by four (or more) of the following:

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 over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not
accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of
doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be
 What causes personality disorders?

 Genetics
 Childhood trauma: People with borderline
personality disorder, for example, had especially high
rates of childhood sexual trauma. People with
borderline and antisocial personality disorders have
issues with intimacy and trust, both of which may be
related to childhood abuse and trauma.
 Cont…

 Verbal abuse: In one study, people who experienced verbal abuse as

children were three times as likely to have borderline, narcissistic,
obsessive-compulsive or paranoid personality disorders in adulthood.

 Cultural factors: Cultural factors may also play a role in the

development of personality disorders, as demonstrated by the varying
rates of personality disorders between different countries. For example,
there are remarkably low cases of antisocial personality disorders in
Taiwan, China and Japan, along with significantly higher rates of cluster
C personality disorders.
Treatment

 Psychotherapies
 Medication
 Family Therapy