Personality Disorders: A Comprehensive Overview and Classification
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Personality Disorders- Prof. Al-Sughayir
1
Objectives
At the end of this lecture, student should be able to
1.
Know the terms related to personality.
2.
Understand the concept of personality & its disorders.
3.
Know the various types of personality disorders.
4.
Be able to detect personality disorders & act accordingly.
Personality Disorders- Prof. Al-Sughayir
2
What is personality?
Personality Disorders- Prof. Al-Sughayir
3
Relationships
Motives &
self-control
Thinking &
Core Beliefs
Moral
standards
Self-
confidence
Stress
adaptation
Behavior
Emotions
Judgment
Others
Ingrained/habitual
Enduring Not situational
What is personality?
Distinctive
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Personality:
The distinctive set of traits that defines the individual’s interaction with
himself (
intra
personal), others (
inter
personal), and life.
Trait:
A prominent enduring aspect and qualities of a person
(range not a point e.g. trust)
Character:
A trait that represents adherence to the
social values and moral standards
.
Temperament:
A trait before the age at which the personality is well formed 18
years.
(children and adolescents characteristics/mood-related/biological constitutions).
Personality Disorders- Prof. Al-Sughayir
4
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Personality Disorders- Prof. Al-Sughayir
5
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Personality Disorders- Prof. Al-Sughayir
6
Traits: within the
acceptable range.
No functional
impairment due to
traits.
No intra/interpersonal
suffering due to traits.
Wide range of
variation of normal
personality. E.g., MBTI
16 types.
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Traits: enough abnormal traits.
Significant functional impairment due to
traits.
Significant
intra/interpersonal suffering
due to traits.
Age > 18 years.
Exclusion of primary causes
(TBI/medical
diseases/medications/substance abuse…).
Lifelong not situational.
E.g., Paranoid PD, BPD, OCPD
.
Traits: some
abnormal traits but
not enough to fulfil
the criteria of any
personality disorder.
E.g., Paranoid traits,
Obsessional traits.
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No specific etiology.
Determinants of Personality and its Disorders
Biological factors
(genetics/brain structure & functions/ NTs).
Psycho-social
(upbringing, cultural values & rules, …)
Personality Disorders- Prof. Al-Sughayir
7
Types
Personality Disorders- Prof. Al-Sughayir
8
DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense
mechanisms involved.
Avoid premature Dx.
Personality Disorders- Prof. Al-Sughayir
9
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Personality Disorders- Prof. Al-Sughayir
10
DDx:
other personality disorders and psychotic
disorders
.
Patient concern:
Exploitation and betrayal.
Approach:
Acknowledge complaints without
arguing and honestly explain medical illness.
Treatment:
Psychotherapy + Antipsychotics (e.g.
olanzapine 5 mg).
Excessive exaggeration
Mistrust & suspiciousness of others
including relatives & friends/idea of
reference.
Secrecy.
Denial & projection of faults onto others.
Sensitivity to offenses & counterattacking
and reacting angrily with abusive
behavior.
Bearing of grudges/insults persistently.
Argumentation/stubbornness.
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Personality Disorders- Prof. Al-Sughayir
11
DDx:
Avoidant PD-Paranoid PD- Schizotypal PD
Patient concern:
Violations of privacy.
Approach:
Accept his unsociability and need for
privacy. Reduce the patient's isolation as tolerated.
Treatment:
Psychotherapy + Antipsychotics (e.g.
olanzapine 5 mg).
Very limited social interactions/skills
with self-sufficiency (not to avoid
criticism).
Indifference to criticism/
praise
.
Preference of solitary activities and
jobs
.
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Personality Disorders- Prof. Al-Sughayir
12
DDx:
Schizoid PD, Paranoid PD, & schizophrenia.
Patient concern:
Exploration of oddities.
Approach:
Empathize with the patient's oddities
without confrontation.
Treatment:
Psychotherapy + Antipsychotics (e.g.
olanzapine 5 mg).
Odd patterns of thoughts,
imaginations, perception, feelings,
appearance & behavior.
Excessive unusual perceptual
experiences (e.g. bodily illusions),
superstitious thinking, and idea of
reference.
Personality Disorders- Prof. Al-Sughayir
13
Types
Personality Disorders- Prof. Al-Sughayir
14
DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense
mechanisms involved.
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Personality Disorders- Prof. Al-Sughayir
15
DDx:
other personality disorders and psychotic
disorders
(esp. bipolar mood disorders).
Patient concern:
Abandonment & loss of support.
Approach:
Empathize and set limits. Use logic
thinking to counteract an emotional style of
relationship.
Treatment:
Psychotherapy + mood stabilizers,
SSRIs, Antipsychotics.
Sense of identity is unstable
(changing to
extremes).
Chronic feelings of deep inner
emptiness.
Mood is very unstable + tendency to intense
extreme emotions
(anger/hatred/
jealousy/love)
.
Behavior is unstable + impulsive/destructive
potentially self-damaging behavior (e.g.,
self-injury/suicidal behavior).
Relationships are unstable
(intense/changing).
Efforts to avoid abandonment.
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Personality Disorders- Prof. Al-Sughayir
16
DDx:
1.
BPD. 2. Narcissistic personality disorder.
3.
Somatoform disorders
(may co-exist)
Patient concern:
Loss of recognition/love.
Approach:
Set limits and avoid being too warm.
Use logic thinking to counteract an emotional style
of relationship.
Treatment:
Directive psychotherapy to increase
awareness of the real feelings underneath the
behavior.
Pharmacological treatment: antianxiety or
antidepressant drugs may transiently be used.
Excessive attention seeking behavior
(verbal and nonverbal).
Self – dramatization and exaggeration.
Provocative and seductive behavior.
Suggestibility with superficial thinking.
Excessive superficial emotions (shallow
and shifting).
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Personality Disorders- Prof. Al-Sughayir
17
DDx:
other personality disorders and psychotic disorders
.
Coping style
:
Idealizing self with self-inflation to protect &
augment self-esteem.
Patient concern:
Devaluation and loss of prestige.
Approach:
Avoid confronting his self-inflation.
Treatment:
Rarely seek or accept treatment. Episodes of
anxiety or depression can be treated symptomatically.
Exaggerated sense of superiority & priority.
Constant seeking of admiration
(not only
attention/
meetings, social media, …)
Preoccupation with success for entitlement.
Excessive and unrealistic ambitions.
Excessive concern about appearance more
than truth & essence.
Exploitative, envious, and lacks empathy.
Fragile self-esteem when defeated.
(
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Personality Disorders- Prof. Al-Sughayir
18
DDx:
other personality disorders and psychotic disorders
.
Patient concern:
Exploitation and loss of self-esteem.
Approach:
Verify symptoms & discover malingering. Control
wish to punish patient. Explain that deception results in patient
poor care.
Treatment:
Treatment of substance abuse often effectively
reduces antisocial attitude and tendency.
Long-term
hospitalization is sometimes effective + group therapy.
Lack of remorse, guilt, shame, &
loyalty.
Violation of rules (lying, dishonest,
deceptive, and exploiting).
Failure to learn from experience.
Impulsive toward desires/little
concern about consequences.
Consistent irresponsibility.
Tendency to violence.
Personality Disorders- Prof. Al-Sughayir
19
Types
Personality Disorders- Prof. Al-Sughayir
20
DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense
mechanisms involved.
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Personality Disorders- Prof. Al-Sughayir
21
DDx:
Schizoid PD. / Dependent PD.
Social phobia (may coexist)
Patient concern:
Exploration of low self-esteem, inadequacy
shame, and rejection.
Approach:
Empathize, support self-esteem, and encourage
assertiveness.
Treatment:
Psychological treatment: posting self-
confidence and self-acceptance, assertiveness training
social skills, and group therapy. Pharmacological treatment
to manage anxiety or depression when present.
Sensitivity to criticism and rejection.
Fearfulness of disapproval.
Timidity and shyness.
Feelings of inadequacy in new
situation.
Reluctance to take personal risks.
Very restricted number of friends.
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Personality Disorders- Prof. Al-Sughayir
22
DDx:
Avoidant personality disorder.
•
Agoraphobia (may co-exist).
Patient concern:
Independence
Approach:
Explore why independence is so frightening and
encourage independence and assertiveness.
Treatment:
Psychological treatment: behavior therapy and
insight oriented therapy. Pharmacological treatment: for
specific symptoms e.g. anxiety agoraphobia
•
Fear of separation/abandonment.
•
Excessive compliance with others.
•
Lack of self-reliance and self-
confidence.
•
Submissive and clinging behavior.
•
Excessive demands for reassurance
and advice.
•
Excessive worries about Difficulty in
initiating tasks.
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Personality Disorders- Prof. Al-Sughayir
23
DDx:
Narcissistic PD. (patient seeks perfectionism and
more likely to believe that he has achieved it).
OCD: presence of obsessions / compulsions
(However, both
can coexistence may occur).
Patient concern:
Imperfection and guilt.
Approach:
Tolerate the patient's critical judgments and
unnecessary details. Beware of his controlling behavior.
Treatment:
Psychological: supportive and directive
individual or group therapy Pharmacological: SSRI or
clomipramine.
Excessive perfectionism interfering with
achievement very idealistic views.
Preoccupation with minor unnecessary
details.
Inflexibility and rigidity.
Indecisiveness and hesitation
Excessive self-blame and guilt feeling.
Scrupulousness about issues of morality.
Excessive devotion of time and energy to
work, at the expense of social life.
Reluctance in delegating tasks to others.
Personality Disorders- Prof. Al-Sughayir
24
Personality Disorders- Prof. Al-Sughayir
25
Dive into the world of personality disorders with this informative presentation by Professor Al-Sughayir. Explore the definition of personality, various types of disorders, traits, terminologies, and etiology. Gain insights into normal versus abnormal traits, functional impairments, and the role of biological and psycho-social factors in the development of personality disorders.
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1 http://t0.gstatic.com/images?q=tbn:ANd9GcRQ1K-vYkNuvqPAA0oQDIkN4BgtTNVUxvjJmmCws9or0gcYQfSad8p5TFmZwg Personality Disorders Course 462 PME 4thyear College of Medicine Mohammed Al-Sughayir Professor, Psychiatry Department, College of Medicine, KSU, KSA
2 Objectives At the end of this lecture, student should be able to 1. Know the terms related to personality. 2. Understand the concept of personality & its disorders. 3. Know the various types of personality disorders. 4. Be able to detect personality disorders & act accordingly. What is personality? Personality Disorders- Prof. Al-Sughayir
3 What is personality? Self- confidence Thinking & Core Beliefs Motives & self-control Emotions Judgment Moral standards Distinctive Stress adaptation Behavior Relationships Others Ingrained/habitual Enduring Not situational Personality Disorders- Prof. Al-Sughayir
4 Terminology Personality: The distinctive set of traits that defines the individual s interaction with himself (intrapersonal), others (interpersonal), and life. Trait: A prominent enduring aspect and qualities of a person (range not a point e.g. trust) Character: A trait that represents adherence to the social values and moral standards. Temperament: A trait before the age at which the personality is well formed 18 years. (children and adolescents characteristics/mood-related/biological constitutions). Personality Disorders- Prof. Al-Sughayir
5 Is a trait a point or a range? E.G, TRUSTING OTHERS E.G, PERFECTIONISM
6 Personality Normal Abnormal traits Traits: some abnormal traits but not enough to fulfil the criteria of any personality disorder. Personality Disorder Traits: enough abnormal traits. Traits: within the acceptable range. Significant functional impairment due to traits. No functional impairment due to traits. Significant intra/interpersonal suffering due to traits. Age > 18 years. No intra/interpersonal suffering due to traits. Exclusion of primary causes (TBI/medical E.g., Paranoid traits, Obsessional traits. Wide range of variation of normal personality. E.g., MBTI 16 types. diseases/medications/substance abuse ). Lifelong not situational. E.g., Paranoid PD, BPD, OCPD. Personality Disorders- Prof. Al-Sughayir
7 Etiology of personality disorders No specific etiology. Determinants of Personality and its Disorders Biological factors (genetics/brain structure & functions/ NTs). Psycho-social (upbringing, cultural values & rules, ) Personality Disorders- Prof. Al-Sughayir
8 Types DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense mechanisms involved. Cluster DSM Paranoid - Schizoid - Schizotypal A: Eccentric thinking with ++idea of reference Borderline - Histrionic (Emotions+++/Control------) Narcissistic - Antisocial (Emotions---/Control++++) B: Emotions toward others (interpersonal problems) C: Emotions toward self (intrapersonal problems) Avoidant - Dependent - Obsessive compulsive Personality Disorders- Prof. Al-Sughayir
9 Avoid premature Dx.
10 Paranoid Personality Disorder ) ) Excessive exaggeration Mistrust & suspiciousness of others including relatives & friends/idea of reference. Secrecy. Denial & projection of faults onto others. Sensitivity to offenses & counterattacking and reacting angrily with abusive behavior. Bearing of grudges/insults persistently. Argumentation/stubbornness. DDx: other personality disorders and psychotic disorders. Patient concern: Exploitation and betrayal. Approach: Acknowledge complaints without arguing and honestly explain medical illness. Treatment: Psychotherapy + Antipsychotics (e.g. olanzapine 5 mg). Personality Disorders- Prof. Al-Sughayir
http://t2.gstatic.com/images?q=tbn:ANd9GcTd22xKWTug4kLJuCxk5_7tZ9wpNC8X5x3LTKt5eRX_IqsTXswShttp://t2.gstatic.com/images?q=tbn:ANd9GcTd22xKWTug4kLJuCxk5_7tZ9wpNC8X5x3LTKt5eRX_IqsTXswS 11 Schizoid Personality Disorder ) ( DDx: Avoidant PD-Paranoid PD- Schizotypal PD Very limited social interactions/skills with self-sufficiency (not to avoid criticism). Indifference to criticism/praise. Preference of solitary activities and jobs. Patient concern: Violations of privacy. Approach: Accept his unsociability and need for privacy. Reduce the patient's isolation as tolerated. Treatment: Psychotherapy + Antipsychotics (e.g. olanzapine 5 mg). Personality Disorders- Prof. Al-Sughayir
12 Schizotypal Personality Disorder ) ) DDx: Schizoid PD, Paranoid PD, & schizophrenia. Odd patterns of thoughts, Patient concern: Exploration of oddities. imaginations, perception, feelings, Approach: Empathize with the patient's oddities without confrontation. appearance & behavior. Treatment: Psychotherapy + Antipsychotics (e.g. olanzapine 5 mg). Excessive unusual perceptual experiences (e.g. bodily illusions), superstitious thinking, and idea of reference. Personality Disorders- Prof. Al-Sughayir
14 Types DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense mechanisms involved. Cluster DSM Paranoid - Schizoid - Schizotypal A: Eccentric thinking with ++idea of reference Borderline - Histrionic (Emotions+++/Control------) Narcissistic - Antisocial (Emotions---/Control++++) B: Emotions toward others (interpersonal problems) C: Emotions toward self (intrapersonal problems) Avoidant - Dependent - Obsessive compulsive Personality Disorders- Prof. Al-Sughayir
15 Borderline Personality Disorder ) ( Sense of identity is unstable (changing to extremes). Chronic feelings of deep inner emptiness. Mood is very unstable + tendency to intense extreme emotions (anger/hatred/ jealousy/love). Behavior is unstable + impulsive/destructive potentially self-damaging behavior (e.g., self-injury/suicidal behavior). Relationships are unstable (intense/changing). Efforts to avoid abandonment. DDx: other personality disorders and psychotic disorders(esp. bipolar mood disorders). Patient concern: Abandonment & loss of support. Approach: Empathize and set limits. Use logic thinking to counteract an emotional style of relationship. Treatment: Psychotherapy + mood stabilizers, SSRIs, Antipsychotics. Personality Disorders- Prof. Al-Sughayir
16 Histrionic Personality Disorder ( ) Excessive attention seeking behavior DDx: 1. BPD. 2. Narcissistic personality disorder. 3. Somatoform disorders (may co-exist) (verbal and nonverbal). Patient concern: Loss of recognition/love. Self dramatization and exaggeration. Approach: Set limits and avoid being too warm. Use logic thinking to counteract an emotional style of relationship. Provocative and seductive behavior. Suggestibility with superficial thinking. Treatment: Directive psychotherapy to increase awareness of the real feelings underneath the behavior. Pharmacological treatment: antianxiety or antidepressant drugs may transiently be used. Excessive superficial emotions (shallow and shifting). Personality Disorders- Prof. Al-Sughayir
17 Narcissistic Personality Disorder ( ) Exaggerated sense of superiority & priority. DDx: other personality disorders and psychotic disorders. Constant seeking of admiration (not only attention/meetings, social media, ) Coping style: Idealizing self with self-inflation to protect & augment self-esteem. Preoccupation with success for entitlement. Patient concern: Devaluation and loss of prestige. Excessive and unrealistic ambitions. Excessive concern about appearance more than truth & essence. Approach: Avoid confronting his self-inflation. Treatment: Rarely seek or accept treatment. Episodes of Exploitative, envious, and lacks empathy. anxiety or depression can be treated symptomatically. Fragile self-esteem when defeated. Personality Disorders- Prof. Al-Sughayir
18 Antisocial Personality Disorder ) ( DDx: other personality disorders and psychotic disorders. Lack of remorse, guilt, shame, & Patient concern: Exploitation and loss of self-esteem. loyalty. Approach: Verify symptoms & discover malingering. Control wish to punish patient. Explain that deception results in patient poor care. Violation of rules (lying, dishonest, deceptive, and exploiting). Failure to learn from experience. Treatment: Treatment of substance abuse often effectively reduces antisocial attitude and tendency. Long-term hospitalization is sometimes effective + group therapy. Impulsive toward desires/little concern about consequences. Consistent irresponsibility. Tendency to violence. Personality Disorders- Prof. Al-Sughayir
20 Types DSM classifies the personality disorders into three clusters based on similarities in symptoms, traits, and defense mechanisms involved. Cluster DSM Paranoid - Schizoid - Schizotypal A: Eccentric thinking with ++idea of reference Borderline - Histrionic (Emotions+++/Control------) Narcissistic - Antisocial (Emotions---/Control++++) B: Emotions toward others (interpersonal problems) C: Emotions toward self (intrapersonal problems) Avoidant - Dependent - Obsessive compulsive Personality Disorders- Prof. Al-Sughayir
21 Avoidant Personality Disorder ) ( DDx: Schizoid PD. / Dependent PD. Social phobia (may coexist) Sensitivity to criticism and rejection. Fearfulness of disapproval. Patient concern: Exploration of low self-esteem, inadequacy shame, and rejection. Timidity and shyness. Feelings of inadequacy in new Approach: Empathize, support self-esteem, and encourage assertiveness. Treatment: Psychological treatment: posting self- confidence and self-acceptance, assertiveness training social skills, and group therapy. Pharmacological treatment to manage anxiety or depression when present. situation. Reluctance to take personal risks. Very restricted number of friends. Personality Disorders- Prof. Al-Sughayir
22 Dependent Personality Disorder ) ( DDx: Avoidant personality disorder. Fear of separation/abandonment. Agoraphobia (may co-exist). Excessive compliance with others. Lack of self-reliance and self- Patient concern: Independence confidence. Approach: Explore why independence is so frightening and Submissive and clinging behavior. encourage independence and assertiveness. Excessive demands for reassurance Treatment: Psychological treatment: behavior therapy and and advice. insight oriented therapy. Pharmacological treatment: for Excessive worries about Difficulty in specific symptoms e.g. anxiety agoraphobia initiating tasks. Personality Disorders- Prof. Al-Sughayir
23 Obsessive Compulsive Personality Disorder OCPD- ) ( DDx: Narcissistic PD. (patient seeks perfectionism and more likely to believe that he has achieved it). OCD: presence of obsessions / compulsions (However, both can coexistence may occur). Excessive perfectionism interfering with achievement very idealistic views. Preoccupation with minor unnecessary details. Inflexibility and rigidity. Indecisiveness and hesitation Excessive self-blame and guilt feeling. Scrupulousness about issues of morality. Excessive devotion of time and energy to work, at the expense of social life. Reluctance in delegating tasks to others. Patient concern: Imperfection and guilt. Approach: Tolerate the patient's critical judgments and unnecessary details. Beware of his controlling behavior. Treatment: Psychological: supportive and directive individual or group therapy Pharmacological: SSRI or clomipramine. Personality Disorders- Prof. Al-Sughayir
