1PSYCHIATRY: PERSONALITY DISORDERS
PERSONALITY DISORDERS
Cluster A Personality Disorders
• Also known as the odd and eccentric
clusters
• These are exemplified by the
following:
– Schizotypal personality
disorder
– Schizoid Personality disorder
– Paranoid personality disorder
Cluster B Personality Disorders
• Also known as the dramatic, erratic
and emotional
• These are exemplified by the following
group
– Histrionic P.D.
– Antisocial P.D.
– Narcissistic P.D.
– Borderline P.D.
Cluster C personality disorders
• Also known as the anxious and fearful
cluster
• These are exemplified by the following
– Avoidant
– Dependent
– Obsessive-compulsive
Genetic Factors
• All clusters have genetic basis
• Cluster A are more common in
biological relatives patients with
schizophrenia than in control groups
• Cluster B especially the antisocial P.D.
is associated with alcohol use
disorders. In borderline P.D.,
depression and mood disorder is
common. Histrionic PD with
somatization disorder.
• Cluster C especially with Avoidant P.D.
have high anxiety levels.
Psychoanalytic factors
• Sigmund Freud suggested that
personality traits are related to a
fixation at one psychosexual stage of
development. e.g. those with oral
character are passive and dependent.
While those of an anal character are
stubborn, parsimonious and highly
conscientious because of struggle over
toilet training.
PARANOID P.D.
• Prevalence rate is 0.5 to 2.5% of the
general population.
• They are characterized by long-
standing suspiciousness and mistrusts
of person in general. They refuse
responsibility of their own feelings and
assign responsibility to others. They
are often hostile, irritable, and angry.
Bigots, injustice collectors,
pathologically jealous spouses, and
litigious.
• They are usually formal in manner,
usually serious and humorless.
• The essential feature is a pervasive
and unwarranted tendency to interpret
other person’s action as demeaning
or threatening.
• They usually dispute friend’s loyalty or
trustworthiness.
• This persons are pathologically jealous
and questions the fidelity of the
spouse or sexual partners.
• Their affect are usually restricted and
unemotional.
SCHIZOTYPAL PD
• Persons with this PD are strikingly odd
or strange even to laymen.
• Magical thinking, peculiar notions,
ideas of reference, illusions and
derealizations are part of his daily
world.
• They exhibit disturbed thinking and
communicating
• They may be superstitious or claim
power of clairvoyance and believe
they have special powers of thought
and insight. This is the premorbid
2PSYCHIATRY: PERSONALITY DISORDERS
personality of patient with
schizophrenia.
SCHIZOID PD
• Patients display a lifelong pattern of
social withdrawal
• They are introvert with constricted
affect.
• They are often seen as eccentric,
isolated or lonely.
• Prevalence rate is about 7.5% of the
general population.
• Always cold and aloof; they display a
remote reserve and show no
involvement with everyday events and
the concerns of the others.
• They are quiet, distant, seclusive, and
unsociable
• They are the last to be aware of the
social fashion.
• The life histories of such persons
reflect solitary interests and success
at noncompetitive levels
• Their sexual lives may exist
exclusively at fantasy levels
• They are usually involved in
nonhuman interests such as
astronomy and mathematics
ANTISOCIAL PD
• Is an inability to conform to the social
norms that ordinarily govern many
aspects of adolescents and adult
behavior.
• Constitute about 75% of the prison
population
• Patients usually appear composed and
credible
• There is usually tension, hostility,
irritability and rage.
• They are usually charming and
ingratiating
• They life histories revealed many
areas of life functioning such as lying,
truancy, running away from home,
thefts, fights, substance abuse and
illegal activities
• Promiscuity, spousal abuse, child
abuse and animal cruelty is common.
Diagnostic Criteria
• Failure to conform with the social
norms with respect to lawful behaviors
• Deceitfulness as indicated by repeated
lying, use of aliases or conning others
for personal profit
• Impulsivity or failure to plan ahead.
• Irritability and aggressiveness by
repeated physical fights
• Reckless disregard of safety of self or
others
• Consistent irresponsibility
• Lack of remorse
• At least 18 years old
• Presence of conduct disorder before
age 15.
BORDERLINE PD
• This PD stands on border between
neurosis and psychosis.
• Almost always appear in the state of
crisis.
• Patients may have micropsychotic
episodes
• They cannot tolerate being alone
• They consider each person as either
all good or all bad.
• The defense mechanism is projective
identification wherein the intolerable
aspects of self are projected onto
another.
Diagnostic Criteria
• Frantic efforts to avoid real or
imagined abandonment
• Unstable and intense interpersonal
relationship.
• Identity disturbance markedly and
persistently unstable self image or
sense of self.
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• Impulsivity that are potentially self
damaging
• Recurrent suicidal behavior or threats
or self mutilating behaviors
• Affective instability due to marked
reactivity of mood
• Chronic feeling of emptiness
• Inappropriate, intense anger or
difficulty in controlling anger.
• Transient stress related paranoid
ideation
HISTRIONIC PD
• They are excitable and emotional and
behave in a colorful, dramatic,
extroverted fashion but unable to
maintain deep, long lasting
attachments.
• Usually cooperative and eager to give
a detailed history. Gestures and
dramatic punctuations in their
conversations
• They make frequent slips of the
tongue and use colorful language
• They show a high degree of attention-
seeking behavior.
• They display temper tantrums, tears
and accusations when they are not the
center of attraction.
• Seductive behavior is common on both
sexes
• Woman maybe anorgasmic while men
are impotent
• Their need for reassurance is endless
• They may act on their sexual impulses
to reassure themselves that they are
attractive to other sex.
NARCISSISTIC PD
• They are characterized by heightened
self-importance and grandiose feelings
of uniqueness.
• They have a grandiose sense of self-
importance
• They consider themselves as special
and expect special treatment
• They become enraged when criticized
• They can make other furious by their
refusal to obey conventional rules of
behavior.
AVOIDANT PD
• Commonly described as persons with
inferiority complex.
• They show extreme sensitivity to
rejection and may lead to a socially
withdrawn life.
• Hypersensitivity to rejection by others
is the central feature.
• Their main personality trait is timidity
• When talking with someone, they
expect uncertainty, show a lack of
self-confidence, and may speak in self-
effacing manner.
DEPENDENT PD
• They subordinate their own needs to
those of others.
• Get others to assume responsibility for
major areas of their lives. Lack self-
confidence
• Pessimist
• Fear of sexuality
• Self doubt
• Passivity
• Suggestibility
• Lack of perseverance
• Persons with this disorder cannot
make decisions without an excessive
amount of assurance or advice
OBSESSIVE-COMPULSIVE PD
• This is characterized by emotional
constriction, orderliness,
perseverance, stubbornness and
indecisiveness.
• A pervasive pattern of perfectionism
and inflexibility.
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• They are preoccupied with rules,

regulations, orderliness, neatness and
details.
• They cannot tolerate infractions
So, what is your personality disorder?