10/09/17

What we shall cover today:

Personality Disorder deni0on/s
Personality Disorders Clinical features of Personality Disorders
3 Clusters of Personality Disorders
Day 6 Treatments/Interven0ons

Dr. Yogesh Pahuja

Deni=on:
What is a Personality Disorder? Personality Disorder an enduring pa=ern of
inner experience and behavior that deviates
markedly from the expecta0ons of the individuals
culture, has an onset in adolescence or early
adulthood, is stable over0me, and leads to distress
or impairment. (DSM-5)

( formerly known as a character disorder )

Personality Disorders causes:

Deni=on:
Personality Disorder A type of mental Gene=c
disorder in which you have rigid and unhealthy Childhood Trauma
pa=ern of thinking, func0oning and behaving. Verbal Abuse
High Reac=vity
Peers

(source: www.apa.org American Psychological Associa=on )

1
 10/09/17

Clinical Features of Personality Disorder:

Clinical Features of Personality
Disorder chronic interpersonal dicul0es
problems with ones iden0ty ( sense of self )
(Livesly, 2001)

Diagnosing Personality Disorder

(criteria summary) 3 Clusters of Personality Disorder
Must be pervasive and inexible
Stable and of long dura0on
Causes clinically signicant distress or impairment
(cogni0on, interpersonal, func0oning, impulse control)

Clusters of Personality Disorder:

Cluster A Cluster B Cluster C

Paranoid Histrionic Avoidant
Schizoid NarcissisJc Dependent
Schizotypal AnJsocial Obsessive-
Borderline compulsive
People with these
disorders oFen seem People with these People with these
odd or eccentric, with disorders have a disorders oFen show
unusual behavior tendency to be anxiety and fearfulness.
ranging from distrust dramaJc, emoJonal,
and suspiciousness to
and erraJc.
social detachment

2
 10/09/17

Cluster A (3) Paranoid Personality Disorder

vParanoid Personality Disorder

vSchizoid Personality Disorder
vSchizotypal Personality Disorder

Paranoid Personality Disorder Paranoid Personality Disorder

(Cluster A) (Cluster A)

Paranoid Personality Disorder have

Causes: Little is known (maybe genetic/heritability)
pervasive suspiciousness and distrust of others.
Treatment: People diagnosed with PPD are hard to
treat. If sought: Psychotherapy
other characteris0cs include: tendency to see self as
blameless; on guard for perceived a7acks by others.

Case: Paranoid Personality Disorder

Case: Paranoid Personality Disorder
Paranoid Construc=on Worker

A 40-year-old construc0on worker believes that his co-workers do
not like him and fears that someone might let his scaolding slip
in order to cause him injury on the job. This concern followed a
recent disagreement on the lunch line when the pa0ent felt that a
coworker was sneaking ahead and complained to him. He began
no0cing his new enemy laughing with other men and oTen
wondered if he were the bu= of their mockery.

3
 10/09/17

Case: Paranoid Personality Disorder Case: Paranoid Personality Disorder

Paranoid Construc=on Worker Paranoid Construc=on Worker
The pa0ent oers li=le spontaneous informa0on, sits tensely in that he has been discriminated against because of Catholicism but
the chair, is wide-eyed, and carefully tracks all movements in the can oer li=le convincing evidence. He gets on poorly with bosses
room. He reads between the lines of the interviewer is siding his and coworkers, is unable to appreciate joking around, and does
coworkers best in situa0ons where he can work and have lunch alone. He
has switched jobs many 0mes because he felt he was being
He was a loner boy and felt that other children would form mistreated.
cliques and be mean to him. He did poorly in school but blamed
his teachers he claimed that they preferred girls or boys who The pa0ent is distant and demanding with his family. His children
were sissies. He dropped out of school and has since been a call him Sir and know that it is wise to be seen but not heard
hard and eec0ve worker, but he feels he never gets the breaks. when he is around He prefers not to have people visit his house
He believes.. and becomes restless when his wife is away visi0ng others.

Schizoid Personality Disorder

Schizoid Personality Disorder Schizoid Personality Disorder

(Cluster A)
(Cluster A)

Schizoid Personality Disorder are usually Cause/s: Little is known

unable to form social rela0onships and usually lack Treatment: People diagnosed with Schizoid dont really
much interest in doing so. come for treatment.

other characteris0cs include: unable to express their
feelings, seen by others as distant and cold. Dont
take pleasure in many ac>vi>es like sexual ac>vity.
Rarely marry.

4
 10/09/17

Schizotypal Personality Disorder

(Cluster A)

Schizotypal Personality Disorder

Schizotypal Personality Disorder are
excessively introverted and have pervasive social and
interpersonal decits (like those that occur in
schizoid personality disorder), but in addi0on they
have cogni0ve and perceptual distor0ons, as well as
oddi0es and eccentrici0es in their communica0on
and behavior.

Schizotypal Personality Disorder Schizotypal Personality Disorder

(Cluster A)
(Cluster A)


other characteris0cs include: highly personalized and

supers>>ous thinking, experience transient psycho>c
Cause/s: Li=le is known/linked with Schizophrenia
symptoms. OBen believe they have magical powers and (gene0c/heritability)
may engage in magical rituals. Odd speech, and Treatment: Psychotherapy
paranoid beliefs. Possible Medica0ons (no specic drugs)

Case: Schizotypal Personality Disorder

The Introverted Computer Analyst
Case: Schizotypal Personality Disorder
Bill, a highly intelligent but quiet introverted and withdrawn 33-
year old computer analyst, was referred for psychological
evalua0on by his physician, who was concerned that Bill might be
depressed and unhappy. Bill had virtually no contact with other
people. He lived alone in his apartment, worked in a small oce
by himself, and usually saw no one at work except his supervisor,
who occasionally visited to give him new work and picked up
completed projects.

5
 10/09/17

Case: Schizotypal Personality Disorder Case: Schizotypal Personality Disorder

The Introverted Computer Analyst The Introverted Computer Analyst

He ate lunch by himself, and about once a week, on nice days, In college he had spent a lot of 0me with one rela0vely close
went to the zoo for lunch break. Bill was a lifelong loner; as a friend mostly drinking. However, this friend now lived in
child he had few friends and had always preferred solitary another city. Bill reported rather ma=er-of-factly that he ahd a
ac0vi0es over family ou0ngs (he was the oldest of ve children). hard 0me making friends; he never knew what to say in a
In high school he had never dated and in college had gone out conversa0on. On a number of occasions he had thought of
with a woman only once and that was with a group of students becoming friends with other people but simply couldnt think of
aTer a game. He had been ac0ve in sports, however, and had the right words, so the conversa0on just died.
played varsity football in both high school and college.

Case: Schizotypal Personality Disorder

Cluster A

The Introverted Computer Analyst

He reported that he had given some thought lately to changing
his life in an a=empt to be more posi0ve", but it had never
seemed worth the trouble. It was easier for him not to make
eort because he became embarrassed when someone tried to
talk to talk with him. He was happiest when he was alone

Cluster B Personality Disorders (4)

6
 10/09/17

Cluster B (4)

1. Histrionic Personality Disorder Histrionic Personality Disorder

2. Narcissis0c Personality Disorder
3. An0social Personality Disorder
4. Borderline Personality Disorder

Histrionic Personality Disorder

(Cluster B)
Histrionic Personality Disorder
(Cluster B)

Histrionic Personality Disorder includes

e x c e s s i v e a = e n 0 o n - s e e k i n g b e h a v i o r a n d
Cause/s: Li=le is known/Gene0c and Environmental
emo0onality.
Treatment: Psychotherapy

other characteris0cs include: have lively, drama>c,

and excessively extraverted styles of rela>onship,
appearance and behavior are oBen theatrical and
emo>onal. Speech is oBen vague and impressionis>c.

Case: Histrionic Personality Disorder

A Histrionic Wife
Case: Histrionic Personality Disorder
Lulu, a 24-year-old housewife, was seen in an impa0ent unit
several days aTer she had been picked up for vagrancy aTer
her husband had leT her at the bus sta0on to return her to her
own family because he was 0red of her behavior and of taking
care of her. Lulu showed up for the interview all made-up and in a
very feminine robe, with her hair done in a very special way.

7
 10/09/17

Case: Histrionic Personality Disorder Case: Histrionic Personality Disorder

A Histrionic Wife A Histrionic Wife

Throughout the interview with a male psychiatrist, she showed Indeed, she complained that she had never had female friends,
irta0ous and somewhat childlike seduc0ve gestures and talked whom she felt just didnt like her, although she wasnt quite sure
in a rather vague way about her problems and her life. Her chief why, assuring the interviewer that she was a very nice and kind
complaints were that her husband had deserted her and that she person.
couldnt return to her family because two of her brothers had
abused her. Moreover, she had no friends to turn to and wasnt
sure how she was going to get along.

Case: Histrionic Personality Disorder Case: Histrionic Personality Disorder

A Histrionic Wife A Histrionic Wife

Recently, she and her husband had been out driving with a couple This incident led to a big argument with her own husband, one in
who were friends of her husbands. The wife had accused Lulu of a long series over the past six months in which he complained
being overly seduc0ve toward the wifes husband, and Lulu had about her inappropriate behavior around other men and about
been hurt, thinking her behavior was perfectly innocent and not how vain and needing of a=en0on she was. These arguments and
out of line. her failure to change her behavior had ul0mately led her husband
to desert her.

Narcissis=c Personality Disorder

(Cluster B)

Narcissis=c Personality Disorder

Narcissis=c Personality Disorder shows
an exaggerated sense of self-importance, a
preoccupa0on with being admired, and a lack of
empathy for the feelings of others (Pincus &
Lukowitsky, 2010; Rnningstam, 2005, 2009, 2012)

8
 10/09/17

Narcissis=c Personality Disorder Narcissis=c Personality Disorder

(Cluster B)
(Cluster B)

2 subtypes of narcissism: Grandiose and Vulnerable
Narcissism. Cause/s: Parental over-valuation or Parenting styles,
Emotional/Physical/Sexual Abuse
Grandiose Narcissism is manifested by traits related to
Treatment: Psychotherapy, Medications
grandiosity, aggression, and dominance.
Vulnerable Narcissism have fragile and unstable sense
of self-esteem. Arrogance and condescension is merely
a faade for intense shame and hypersensi0vity to
rejec0on.

Case: Narcissis=c Personality Disorder

A Narcissis=c Student
Case: NarcissisJc Personality Disorder
A 25-year-old, single graduate student complains to his
psychoanalyst of diculty comple0ng his Ph.D. in English
literature and expresses concerns about his rela0onships with
women. He believes that his thesis topic may profoundly increase
the level of understanding in his discipline and make him famous,
but so far he has not been able to get past the third chapter.

Case: Narcissis=c Personality Disorder Case: Narcissis=c Personality Disorder

A Narcissis=c Student A Narcissis=c Student

His mentor does not seem suciently impressed with his ideas, The pa0ent brags about his crea0vity and complains that other
and the pa0ent is furious at him but also self-doub0ng and people are jealous of his insight. He is very envious of students
ashamed. He blames his mentor for his lack of progress and thinks who were moving along faster than he and regards them as dull
that he deserves more help with his grand idea, and that his drones and ass-kissers. He prides himself on the brilliance of his
mentor should help him with some of the research. class par0cipa0on and imagines someday becoming a great
professor.

9
 10/09/17

Case: Narcissis=c Personality Disorder Case: Narcissis=c Personality Disorder

A Narcissis=c Student A Narcissis=c Student

He becomes rapidly infatuated with women and has powerful and People get 0red of his con0nual self-promo0on and lack of
persistent fantasies about each new woman he meets, but aTer considera0on of them. For example, he was lonely at Christmas
several sexual experiences feels disappointed and nds them and insisted that his best friend stay in town rather than visit his
dumb, clinging, and physically repugnant. He has many friends, family. The friend refused, cri0cizing the pa0ents self-
but they turn over quickly, and no one rela0onship lasts very long. centeredness; and the pa0ent, enraged, decided never to see his
friend again.

An=social Personality Disorder

(Cluster B)

An=social Personality Disorder are

An=social Personality Disorder individuals who con0nually violate and show
disregard for the rights of others through deceihul,
aggressive, or an0social behavior, typically without
remorse or loyalty to anyone.

other characteris0cs include: being impulsive,

irritable and aggressive and to show pa7ern of
generally irresponsible behavior.

An=social Personality Disorder

(Cluster B)

Cause/s: Gene0c, Temperament/Deciencies in fear and

anxiety, Emo0onal Decits (e.g., rejec0on, parental loss)

Case: AnJsocial Personality Disorder
Treatment: Only if sought - Psychotherapy

10
 10/09/17

Case: An=social Personality Disorder Case: An=social Personality Disorder

A Thief with An=social Personality Disorder A Thief with An=social Personality Disorder

Mark, a 22-year-old, was awai0ng trial for car theT and armed To date he had not held a job for more than a few days at a 0me
robbery. His case records included a long history of arrests even though his generally charming manner enabled him to
beginning at age 9, when he had been picked up for vandalism. obtain work readily. He was described as a loner with few friends.
He had been expelled from high school for disrup0ve behavior. Although ini0ally charming, Mark usually soon antagonized those
On a number of occasions he had run away from home for days or he met with his aggressive, self-oriented behavior. Shortly aTer
weeks at a 0me always returning in a disheveled and his rst therapy session, he skipped bail and presumably leT town
rundown condi0on. to avoid his trial.

Borderline Personality Disorder

(Cluster B)

Borderline Personality Disorder show a

Borderline Personality Disorder pa=ern of behavior characterized by impulsivity and
instability in interpersonal rela0onships, self-image,
and moods.

other characteris0cs include: aec>ve instability,

highly unstable self image, impulsivity, self
mu>la>on.

Cluster B
Borderline Personality Disorder
(Cluster B)

Cause/s: Malfunc0oned gene/Abnormali0es in brain
Treatment: Biological and Psychological Treatments

11
 10/09/17

Cluster C (3)

1. Avoidant Personality Disorder

2. Dependent Personality Disorder
3. Obsessive-compulsive Personality Disorder

Avoidant Personality Disorder

(Cluster C)

Personality Disorder show extreme social

Avoidant Personality Disorder inhibi0on and introversion, leading to lifelong
pa=erns of limited social rela0onships and
reluctance to enter into social interac0ons.

other characteris0cs include: do not enjoy their

aloneness, feeling inept and socially inadequate.

Avoidant Personality Disorder

(Cluster C)

Cause/s: Inhibited temperament/genetic Case: Avoidant Personality Disorder

Treatment: Psychotherapy

12
 10/09/17

Case: Avoidant Personality Disorder

Case: Avoidant Personality Disorder The Avoidant Librarian

The Avoidant Librarian
The moment they had arrived at the party, Sally had felt
extremely uncomfortable because she had not been dressed
Sally, a 35-year-old librarian, lived a rela0vely isolated life and had properly. She leT in a hurry and refused to see her acquaintance
few acquaintances and no close personal friends. From childhood again.
on, she had been very shy and had withdrawn from close 0es with
others to keep from being hurt or cri0cized. Two years before she In the early treatment sessions, she sat silently much of the 0me,
entered therapy, she had had a date to go to a party with an nding it too dicult to talk about herself. ATer several sessions,
acquaintance she had met at the library. she grew to trust the therapist and she related numerous
incidents in her early years in which she had been devastated
by her alcoholic fathers obnoxious behavior in public.

Case: Avoidant Personality Disorder Case: Avoidant Personality Disorder

The Avoidant Librarian The Avoidant Librarian

Although she had tried to keep her school friends from knowing When Sally rst began therapy, she avoided mee0ng people
about her family problems, when this had become impossible, unless she could be assured that they would like her. With
she instead had limited her friendships, thus protec0ng herself therapy that focused on enhancing her asser0veness and social
from possible embarrassment or cri0cism. skills, she made some progress in her ability to approach people
and talk with them.

Dependent Personality Disorder

(Cluster C)

Dependent Personality Disorder

Dependent Personality Disorder extreme need to be taken care of, which leads to
clinging and submissive behavior.

other characteris0cs include: lack of self condence

and feeling helpless without great deal of advice and
reassurance.

13
 10/09/17

Dependent Personality Disorder

(Cluster C)

Cause/s: Possible biological/gene0c or developmental

Case: Dependent Personality Disorder

Treatment: Psychotherapy
Medica0ons may be used.

Case: Dependent Personality Disorder Case: Dependent Personality Disorder

The Dependent Wife The Dependent Wife

Sarah, a 32-year-old mother of two and part-0me tax accountant, Sarah appeared acutely anxious and worried about the future and
came to a crisis center late one evening aTer Michael, her needed to be told what to do. She wanted her husband to
husband of a year and a half, had abused her physically and then come back and seemed rather unconcerned about his regular
leT home. Although he never physically harmed the children, he pa=ern of physical abuse. At the 0me, Michael was an
frequently threatened to do so when he was drunk. unemployed resident in a day treatment program at a halfway
house for paroled drug abusers. He was almost always in a surly
mood and ready to explode.

Case: Dependent Personality Disorder Case: Dependent Personality Disorder

The Dependent Wife The Dependent Wife

Although Sarah had a well-paying job, she voiced great concern Several 0mes in the past few months, Sarah had made up her
about being able to make it on her own. She realized that it was mind to get out of the marriage but couldnt bring herself to
foolish to be dependent on her husband, whom she referred to break away. She would threaten to leave, but when the 0me
as a real loser. (She had had a similar rela0onship with her rst came to do so, she would freeze in the door with a numbness
husband who had leT her and her oldest child when she was 18.) in her body and a sinking feeling in her stomach at the thought of
not being with Michael.

14
 10/09/17

Obsessive Compulsive Personality Disorder

(Cluster C)

Obsessive Compulsive Personality Disorder (OCPD)

Obsessive Compulsive Personality Disorder
perfec0onism and a excessive concern with
maintaining order and control.

other characteris0cs include: excessively devoted to

work, inexible about moral and ethical issues, have
diculty delega>ng tasks to others. Ungenerous.

Obsessive Compulsive Personality Disorder

(Cluster C)

Cause/s: Gene0c/High level of conscien0ousness/ Treatments and Outcomes for Personality Disorders
asser0veness
Treatment: CBT, Medica0on, Relaxa0on Training

Treatment of Borderline Personality Disorder

Cluster C

Biological Treatments

An0depressant medica0on
An0psycho0c medica0on
Mood-stabilizing medica0ons (e.g., carbazemine)

15
 10/09/17

Thank You.

16