PERSONALITY DISORDERS

Mohamad Amirul b Ahmad Shahar

Mohd Harith b Nordin
Amirul Aizat b Amir
Mohamad Hafizi Lut b Mat Jusoh
DEFINITION
• Personality is one’s set of stable, predictable, emotional and behavioral
traits.
• Personality disorders involve enduring patterns of inner experience and
behavior that deviate markedly from expectations of an individual’s culture
• They are pervasive, maladaptive, and cause significant impairment in social
or occupational functioning
• Patients with personality disorders often lack insight about their problems,
their symptoms are either ego-syntonic or viewed as immutable
• Patients with personality disorders are vulnerable to developing symptoms
of other mental disorders during stress
ETIOLOGY
• Genetics
• Cluster A : more common in the biological relatives of patients with
schizophrenia then among control groups
• Cluster B : Antisocial personality disorder is associated with alcohol use
disorders, depression is common in family background of patients with
borderline personality disorder, a strong correlation between histrionic and
somatization disorders
• Cluster C : Patients with avoidant personality often have high anxiety levels,
obsessive-compulsive traits are more common in monozygotic twins than in
dizygotic twins – they also show some signs of depression
• Environmental Factors
• Children with minimal brain damage are at risk for antisocial personality
disorder
• Link between fearful children raised by fearful mothers and avoidant
personality disorder
• Cultures that encourage aggression may contribute to paranoid and antisocial
personality disorders
CLASSIFICATION
• Cluster A
• Schizoid, schizotypal, and paranoid
• Patients seem eccentric, peculiar or withdrawn
• Cluster B
• Antisocial, borderline, histrionic, and narcissistic
• Patients seem emotional, dramatic, or inconsistent
• Cluster C
• Avoidant, dependent, and obsessive-compulsive
• Patients seem anxious or fearful
DIAGNOSIS AND DSM-5 CRITERIA
• Enduring pattern of inner experience that deviates from the person’s
cultere and manifested in two or more of followings :
1. Cognition
2. Affect
3. Interpersonal functioning
4. Impulse control
• The pattern :
1. Is pervasive and inflexible in a broad range of situations
2. Is stable and has an onset no later than adolescence or early childhood
3. Leads to significant distress in functioning
4. Is not accounted for by another mental/medical illness or by use of a substance
Treatment
• Personality disorders are generally very difficult to treat, especially
since few patients are aware that they need help. The disorders tend
to be chronic and lifelong
• In general, pharmacologic treatment has limited usefulness except in
treating comorbid mental conditions ( e.g major depressive disorder )
• Psychotherapy
CLUSTER A
MOHD HARITH BIN NORDIN
MBBS 0914149
 •Paranoid personality disorder
•Schizoid personality disorder
•Schizotypal personality disorder
Paranoid personality disorder
A pattern of being suspicious of others and seeing them as mean or spiteful.
People with paranoid personality disorder often assume people will harm or
deceive them and don’t confide in others or become close to them.
PATIENT WITH THIS DISORDER ARE:
• SUSPICIOUS
• MISTRUSTFUL
• LITIGIOUS
• ATTRIBUTES RESPONSIBILTY FOR PROBLEMS TO OTHERS
DEFENSE MECHANISM USED ARE
• PROJECTION
• DENIAL
A.A pervasive distrust & suspiciousness of others such that their motives are interpreted as
malevolent, beginning by early adulthood & present in a variety of contexts as indicated by ≥ 4 of the
following;
i. Suspects without sufficient basis, that others are exploiting, harming or deceiving him/ her
ii. Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or
associates
iii. Reluctant to confide in others because of unwarranted fear that the information will be used
maliciously against him or her
iv. Reads hidden demeaning or threatening meanings into benign remarks or events
v. Persistently bear grudges
vi. Perceives attacks on his/ her character or reputation that are not apparent to others & quick
to react angrily or to counterattack
vii. Has recurrent suspicions without justification regarding fidelity of spouse or sexual partner

B. Does not occur exclusively during schizophrenia, mood disorder with psychosis or other psychotic
disorder and is not due to general medical condition
 Mrs A constantly accuses her boyfriend of cheating on
her, although he has never done this in the past and
shows no signs of it. At work, she is fairly certain that all
of her coworkers are conspiring to get her fired, mostly
because everyone seems “too nice.” She believes that
her two roommates are cheating her when it comes to
the rent and utilities and rarely trusts anything they say.
• Differential Diagnosis
• Delusional disorder

• Treatment
• Psychotherapy
• Group psychotherapy should be avoided
• Short course of antipsychosis for transient psychosis
Schizoid personality disorder
• These patients have a life long pattern of voluntary social withdrawal
• Similar to delusional disorder and schizophrenia but without frank
psychotic symptoms
• In the young can be mistaken for mild autistic disorder
• Eccentric and reclusive
• Quiet and unsociable and have constricted affect
• No desire for closer relationship
• Prefer to be alone
Mrs B is a 20yr. woman who hardly ever leaves her house
except to go to work. Spends most her time attempting to
communicate telepathically with the president of the US.
She has worked for the past several months at a grocery
store, but is having trouble with the managers because of
her belief that she has the power to stock the shelves
without actually touching any of the items. In addition, she
often doesn’t maintain a professional appearance, leaving
the house with her hair disheveled and unwashed.
• Differential Diagnosis
• Delusional disorder

• Treatment
• Antidepressant if comorbid major depression is diagnosed
• Individual psychotherapy
• Day programs or drop-in-centers
Schizotypal personality disorder
• THESE PATIENTS HAVE:
• PECULIAR APPEARANCE
• MAGICAL THINKING
• ODD THOUGHT PATTERNS AND
• BEHAVIOR WITHOUT PSYCHOSIS
• MAJOR DEPRESSION COULD BE FOUND (CO-MORBIDEDLY) IN THESE PATIENTS
• DENIAL AND PROJECTION ARE USED AS DEFENSE MECHANISMS
A.Pervasive pattern of social & interpersonal deficits marked by acute discomfort with,
and reduced capacity for, close relationships, as well as by cognitive or perceptual
distortions & eccentricities of behaviour, beginning by early adulthood with ≥ 5 of the
following
i. Ideas of reference (excluding delusion of reference)
ii. Odd beliefs or magical thinking that influences behaviour & inconsistent with cultural norm
iii. Unusual perceptual experiences including bodily illusions
iv. Odd thinking & speech
v. Suspiciousness or paranoid ideation
vi. Inappropriate or constricted affect
vii. Behaviour or appearance that is odd, eccentric or peculiar
viii. Lack of close friends or confidants other than 1st degree relatives
ix. Excessive social anxiety that doesn’t diminish w familiarity & tend to be associated w paranoid
fears rather than negative judgments about self

B. Does not occur exclusively during schizophrenia, mood disorder with psychosis or
other psychotic disorder or pervasive developmental disorder
 Mr C lives alone, has no close friends and prefers it that
way. If his family comes to visit, he never starts
conversations and seems to dislike it when they try talking
to him. He attends a local community college and sits by
himself in everyone of his classes. His classmates rarely try
to talk to him, because when they do, they are met with
blank stares or a flat rejection.
• Differential Diagnosis
• DELUSIONAL DISORDER
• SCHIZOPHRENIA
• MOOD DISORDER WITH PSYCHOSIS

• Treatment
• Psychotherapy; to develop social skills training
• Short course of low-dose antipsychotic if necessary; to decrease social anxiety
and suspicion in interpersonal relations
CLUSTER B
MOHAMAD HAFIZI LUT BIN MAT JUSOH
MBBS 0914 102

• Antisocial Personality Disorder

• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
ANTISOCIAL PERSONALITY DISORDER

 Pattern of disregard for and violation of the rights of others since age 15.
 Patients must be at least 18 years old for this diagnosis; history of behavior as a child/adolescent must be
consistent with conduct disorder
 Three or more of the following should be present:
 Failure to conform to social norms by committing unlawful acts
 Deceitfulness/repeated lying/manipulating others for personal gain
 Impulsivity/failure to plan ahead
 Irritability and aggressiveness/repeated fights or assaults
 Recklessness and disregard for safety of self or others
 Irresponsibility/failure to sustain work or honor financial obligations
 Lack of remorse for actions
A 29 YEAR- OLD MAN TELLS YOU THAT HE
HAS STOLEN VALUABLE ITEMS FROM
FRIENDS AND FAMILY ON MANY
OCCASSIONS WITH NO INTENTION OF
RETURNING THEM AND WITHOUT
CONCERN FOR THE PEOPLE HE STOLE
FROM. HE HAS BEEN UNEMPLOYED ON
AND OFF FOR MANY YEARS AND HAS
BEEN ARRESTED ON A VARIETY OF
MINOR CHARGES.
EPIDEMIOLOGY
• Prevalence : 3% in men 1% in women
• Higher incidence in poor urban areas and in prisoners
• Genetic component : high risk among first degree relatives

DIFFERENTIAL DIAGNOSIS
Drug abuse

TREATMENT
• Psychotherapy
• Pharmacotherapy to treat symptoms (anxiety or depression) but with caution due to high addictive potential
BORDERLINE PERSONALITY DISORDER

 Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early
adulthood and in a variety of contexts.
 At least five of the following must be present:
 Frantic efforts to avoid real or imagined abandonment
 Unstable, intense interpersonal relationships (e.g., extreme love–hate relationships)
 Unstable self-image
 Impulsivity in at least two potentially harmful ways (spending, sexual activity, substance use, binge eating, etc.)
 Recurrent suicidal threats or attempts or self-mutilation
 Unstable mood/affect
 Chronic feelings of emptiness
 Difficulty controlling anger
 Transient, stress-related paranoid ideation or dissociative symptoms
A 39 – YEAR – OLD FEMALE PATIENT
TELLS YOU ON HER SECOND VISIT
THAT SHE IS IN LOVE WITH YOU.
WHEN YOU REFER HER TO ANOTHER
PRACTITIONER, SHE ATTEMPTS
SUICIDE
EPIDEMIOLOGY
• Prevalence : 3 times more often in women than men
• Suicide rate : 10%

DIFFERENTIAL DIAGNOSIS
Schizophrenia

TREATMENT
• Psychotherapy
• Pharmacotherapy to treat psychotic or depressive symptoms
HISTRIONIC PERSONALITY DISORDER

 Pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts.
 At least five of the following must be present:
 Uncomfortable when not the center of attention
 Inappropriately seductive or provocative behavior
 Rapidly shifting but shallow expression of emotion
 Uses physical appearance to draw attention to self
 Speech that is impressionistic and lacking in detail
 Theatrical and exaggerated expression of emotion
 Easily influenced by others or situation
 Perceives relationships as more intimate than they actually are
25 YEAR-OLD FEMALE PATIENT COMES TO
YOUR OFFICE DRESSED IN A LOW – CUT
BLOUSE AND VERY SHORT SKIRT AND
BRINGS A GIFT FOR YOU. SHE FISHES FOR
COMPLIMENTS FROM THE OFFICE STAFF
AND TELLS YOU THAT YESTERDAY SHE
“ALMOST BLEED TO DEATH” WHEN SHE
CUT HER FINGER.
EPIDEMIOLOGY
• Women are more likely to have than men

DIFFERENTIAL DIAGNOSIS
Borderline personality disorder

TREATMENT
• Psychotherapy
• Pharmacotherapy to treat psychotic or depressive symptoms
NARCISSISTIC PERSONALITY DISORDER

 Pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood and present in a
variety of contexts.
 Five or more of the following must be present:
 Exaggerated sense of self-importance
 Preoccupation with fantasies of unlimited money, success, brilliance, etc.
 Believes that he or she is “special” or unique and can associate only with other high-status individuals
 Requires excessive admiration
 Has sense of entitlement
 Takes advantage of others for self-gain
 Lacks empathy
 Envious of others or believes others are envious of him or her
 Arrogant or haughty
 40 YEAR – OLD MALE PATIENT TELLS
YOU THAT BECAUSE YOU ARE A
DOCTOR,YOU CAN UNDERSTAND
THAT HE IS “ BETTER THAN MOST
PEOPLE.” HE THEN ASKS TO BE
REFERRED TO A PHYSICIAN WHO
GRADUATED FROM AN HARVARD MEDICAL
SCHOOL.
EPIDEMIOLOGY
Prevalence : Up to 6%

DIFFERENTIAL DIAGNOSIS
Antisocial personality disorder

TREATMENT
• Psychotherapy
• Antidepressant if a comorbid mood disorder is diagnosed
CLUSTER C PERSONALITY DISORDERS
BY AMIRUL AIZAT BIN AMIR

AVOIDANT PERSONALITY DISORDER

DEPENDENT PERSONALITY DISORDER
OBSSESIVE COMPULSIVE PERSONALITY DISORDER
AVOIDANT PERSONALITY DISORDER
• DEFINITION: AVOIDANT PERSONALITY DISORDER (AVPD) IS A
PERVASIVE PATTERN OF SOCIAL INHIBITION, FEELINGS OF
INADEQUACY AND HYPERSENSITIVITY TO NEGATIVE
EVALUATION, BEGINNING BY ADULTHOOD AND PRESENT IN A
VARIETY OF CONTEXT.
 CLINICAL EXAMPLE

• A 30 YEAR OLD POSTAL WORKER RARELY GOES OUT WITH HER COWORKERS AND OFTEN MAKE

EXCUSES WHEN THEY ASK HER TO JOIN THEM BECAUSE SHE IS AFRAID THEY WILL NOT LIKE HER. SHE

WISHES TO GO OUT AND MEET NEW PEOPLE BUT ACCORDING TO HER, SHE IS TOO “SHY”.
A PATTERN OF SOCIAL INHIBITION, HYPERSENSITIVITY, AND FEELINGS OF INADEQUANCY SINCE
EARLY ADULTHOOD
AT LEAST FOUR OF THE FOLLOWING MUST BE PRESENT
• AVOIDS OCCUPATIONAL ACTIVITIES THAT INVOLVE SIGNIFICANT INTERPERSONAL CONTACT,
BECAUSE OF FEARS OF CRITICISM, DISAPPROVAL, OR REJECTION
• IS UNWILLING TO GET INVOLVED WITH PEOPLE UNLESS CERTAIN OF BEING LIKED
• SHOWS RESTRAINT WITHIN INTIMATE RELATIONSHIPS BECAUSE OF THE FEAR OF BEING SHAMED OR
RIDICULED
• IS PREOCCUPIED WITH BEING CRITICIZED OR REJECTED IN SOCIAL SITUATIONS
• IS INHIBITED IN NEW INTERPERSONAL SITUATIONS BECAUSE OF FEELINGS OF INADEQUACY
• VIEWS SELF AS SOCIALLY INEPT, PERSONALLY UNAPPEALING, OR INFERIOR TO OTHERS
• IS UNUSUALLY RELUCTANT TO TAKE PERSONAL RISK OR TO ENGAGE IN ANY NEW ACTIVITIES
BECAUSE THEY MAY PROVE EMBARRASSING
EPIDEMIOLOGY:
• PREVALANCE: 2-4%
• EQUALLY FREQUENT IN MALE AND FEMALE

DIFFERENTIAL DIAGNOSIS:
• SCHIZOID PERSONALITY DISORDER
• SOCIAL ANXIETY DISORDER
• DEPENDENT PERSONALITY DISORDER

TREATMENT:
• PSYCHOTHERAPY, INCLUDING ASSERTIVENESS AND SOCIAL SKILL TRAINING
• EXPOSURE TREATMENT TO GRADUALLY INCREASE SOCIAL CONTACTS, GROUP THERAPY FOR
PRACTICING SOCIAL SKILLS
• SELECTIVE SEROTONIN REUPTAKE INHIBITORS(SSRIS) MAY BE PRESCRIBED FOR COMORBID SOCIAL
ANXIETY DISORDER OR MAJOR DEPRESSION
 DEPENDANT PERSONALITY DISORDER

• DEFINITION : A PERVASIVE AND EXCESSIVE NEED TO BE TAKEN

CARE OF THAT LEADS TO SUBMISSIVE AND CLINGING BEHAVIOR
AND FEARS OF SEPARATION.
 CLINICAL EXAMPLE

• A 40 YEARS OLD MAN WHO LIVES WITH HIS PARENTS HAS TROUBLE DECIDING HOW TO GET HIS

CAR FIXED. HE CALL HIS FATHER AT WORK SEVERAL TIMES TO ASK TRIVIAL THINGS. HE HAS BEEN

UNEMPLOYED OVER THE PASS 3 YEARS

A PATTERN OF EXCESSIVE NEED TO BE TAKEN CARE OF THAT LEADS TO SUBMISSIVE AND CLINGING
BEHAVIOR
THE DISORDER IS INDICATED BY AT LEAST FIVE OF THE FOLLOWING FACTORS:
• HAS DIFFICULTY MAKING EVERYDAY DECISIONS WITHOUT AN EXCESSIVE AMOUNT OF ADVICE AND
REASSURANCE FROM OTHERS.
• NEEDS OTHERS TO ASSUME RESPONSIBILITY FOR MOST MAJOR AREAS OF THEIR LIFE.
• HAS DIFFICULTY EXPRESSING DISAGREEMENT WITH OTHERS BECAUSE OF FEAR OF LOSS OF SUPPORT OR
APPROVAL.
• HAS DIFFICULTY INITIATING PROJECTS OR DOING THINGS ON THEIR OWN (BECAUSE OF A LACK OF SELF
CONFIDENCE IN JUDGMENT OR ABILITIES RATHER THAN A LACK OF MOTIVATION OR ENERGY).
• GOES TO EXCESSIVE LENGTHS TO OBTAIN NURTURANCE AND SUPPORT FROM OTHERS, TO THE POINT OF
VOLUNTEERING TO DO THINGS THAT ARE UNPLEASANT.
• FEELS UNCOMFORTABLE OR HELPLESS WHEN ALONE BECAUSE OF EXAGGERATED FEARS OF BEING
UNABLE TO CARE FOR THEMSELVES.
• URGENTLY SEEKS ANOTHER RELATIONSHIP AS A SOURCE OF CARE AND SUPPORT WHEN A CLOSE
RELATIONSHIP ENDS.
• IS UNREALISTICALLY PREOCCUPIED WITH FEARS OF BEING LEFT TO TAKE CARE OF THEMSELVES.
EPIDEMIOLOGY
• PREVALENCE: APPROXIMATELY <1%
• WOMEN MOST LIKELY TO BE DIAGNOSED WITH DPD THEN MEN

DIFFERENTIAL DIAGNOSIS
• AVOIDANT PERSONALITY DISORDER
• BORDERLINE AND HISTORIC PERSONALITY DISORDERS

TREATMENT
• PSYCHOTHERAPY, PARTICULARLY COGNITIVE BEHAVIOURAL, ASSERTIVENESS AND SOCIAL SKILL
TRAINING
• MEDICATION CAN BE USED TO TREAT PATIENTS WHO SUFFER FROM DEPRESSION OR ANXIETY
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

• DEFINITION : A PERVASIVE PATTERN OF PREOCCUPATION

WITH ORDERLINESS, PERFECTIONISM, MENTAL AND
INTERPERSONAL CONTROL, AT THE EXPENSE OF FLEXIBILITY,
OPENNESS AND EFFICIENCY
 CLINICAL EXAMPLE

• A 40 YEARS OLD SECRETARY HAS BEEN RECENTLY FIRED BECAUSE OF HER INABILITY TO PREPARE

SOME WORK PROJECT IN TIMES. ACCORDING TO HER, THEY WERE NOT IN THE RIGHT FORMAT AND

SHE HAD TO REVISE THEM SIX TIMES, WHICH LED TO THE DELAY. THIS HAS HAPPENED BEFORE BUT

SHE FEELS THAT SHE IS NOT GIVEN ENOUGH TIME

 A PATTERN OF PREOCCUPATION WITH ORDERLINESS, CONTROL AND PERFECTIONISM AT THE EXPENSE OF
EFFICIENCY AND FLEXIBILITY, PRESENTED BY EARLY ADULTHOOD

 AT LEAST FOUR OF THE FOLLOWING MUST BE PRESENT

• IS PREOCCUPIED WITH DETAILS, RULES, LISTS, ORDER, ORGANIZATION OR SCHEDULES TO THE EXTENT THAT THE MAJOR
POINT OF THE ACTIVITY IS LOST

• SHOWS PERFECTIONISM THAT INTERFERES WITH TASK COMPLETION

• IS EXCESSIVELY DEVOTED TO WORK AND PRODUCTIVITY TO THE EXCLUSION OF LEISURE ACTIVITIES AND FRIENDSHIPS

• IS OVERCONSCIENTIOUS, SCRUPULOUS, AND INFLEXIBLE ABOUT MATTERS OF MORALITY, ETHICS OR VALUES

• IS UNABLE TO DISCARD WORN-OUT OR WORTHLESS OBJECTS EVEN WHEN THEY HAVE NO SENTIMENTAL VALUE

• IS RELUCTANT TO DELEGATE TASKS OR TO WORK WITH OTHERS UNLESS THEY SUBMIT TO EXACTLY HIS OR HER WAY OF
DOING THINGS

• ADOPTS A MISERLY SPENDING STYLE TOWARD BOTH SELF AND OTHERS; MONEY IS VIEWED AS SOMETHING TO BE
HOARDED FOR FUTURE CATASTROPHES

• SHOWS RIGIDITY AND STUBBORNESS

EPIDEMIOLOGY
• PREVALANCE: 1-2%
• MEN ARE MORE LIKELY TO HAVE OCPD THAN FEMALE

DIFFERENTIAL DIAGNOSIS
• OBSESSIVE COMPULSIVE DISORDER (OCD)
• NARCISSISTIC PERSONALITY DISORDER

TREATMENT
i. PSYCHOTHERAPY
ii. COGNITIVE BEHAVIORAL THERAPHY
iii. PHARMACOTHERAPY MAY BE USE TO TREATED ASSOCIATED SYMPTOMS AS NECESSARY