Personality Disorders
Adesola Ogunsakin
Personality Disorders?
• Inflexible, maladaptive
and rigidly pervasive
pattern of behavior
causing subjective distress
and/or impaired
functioning
• Person is usually not
aware of problem
• Presents by early
adulthood
General characteristics:
•
•
•
•
•
•
Inflexible, inability to adapt
One way of responding
Lifelong
All areas of life are affected
Maladaptive patterns of behavior
Ego-syntonic- when a person’s behavior is
acceptable to the aims of the ego and the
related psychological needs of the individual
• Cluster A- Odd or Eccentric
Paranoid
Schizoid
Schizotypal
• Cluster B- Dramatic and Emotional
Histrionic
Narcissistic
Borderline
Antisocial
• Cluster C- Anxious and Fearful
Avoidant
Obsessive-compulsive
Dependent
Cluster A
• Higher prevalence in biologic relative of
schizophrenics
• Higher prevalence in males
PARANOID
SCHIZOID
SCHIZOTYPAL
Cluster A- PARANOID
• Long-standing suspiciousness or mistrust of others
• Reluctant to confide in others
• Preoccupied with issues of trust
• Reads hidden meaning into comments or events
• Carries grudges
Differentiate from:
 Paranoid schizophrenic has hallucinations and formal thought
disorders; PPD does not
 Delusional disorder, paranoid type has fixed, focal delusions; PPD
does not
Cluster A- SCHIZOID
• Lifelong pattern of
social withdrawal,
and they like it that
way
• Seen by others as
eccentric, isolated,
withdrawn
• Restricted emotional
expression
Cluster A- SCHIZOTYPAL
•
•
•
•
•
•
•
•
Very odd, strange, weird
Magical thinking, ideas of reference, illusions
Social anxiety
Suspiciousness
Lack of close friends
Incongruous affect
Odd speech, social isolation
May have short-lived psychotic episodes
Cluster B
• Dramatic and Emotional
• Genetic association with mood disorders &
substance abuse
HISTRIONIC
NARCISSISTIC
BORDERLINE
ANTISOCIAL
Cluster B- HISTRIONIC
• Colorful, dramatic,
extroverted
• Inability to maintain
long-lasting
relationships
• Attention-seeking
• Seductive behavior
Cluster B- NARCISSISTIC
• Grandiose sense of selfimportance
• Preoccupation with fantasies of
unlimited wealth, power, love
• Demands constant attention
• Fragile self-esteem, prone to
depression
• Criticism met with indifference
or rage
• Genuine surprise and anger
when others don’t do as they
want
• Can be charismatic
Cluster B- BORDERLINE
•
•
•
•
•
•
•
•
•
•
•
•
Females 2x more than males
Very unstable affect, behavior, self-image
In constant state of crisis, chaos
Self-detrimental impulsivity: promiscuity, gambling, overeating, substance
abuse
Unstable but intense interpersonal relationships: very dependent and
hostile, love/hate
Great problems with being alone
Self-injurious behavior
History of sexual abuse
Common defenses: splitting, passive-aggressive
Particularly incapable of tolerating anxiety
Often coupled with mood disorder
50% commit suicide
Cluster B- BORDERLINE
• Instability of
mood, self-image
and relationships
• W>M
• Increased mood
disorders in
families
• Associated
defense
mechanismsplitting
Cluster B- ANTISOCIAL
• 3% males, 1% females
• Continual criminal acts
• Inability to conform to social
norm: truancy, delinquency,
theft, running away
• Cant hold job, no enduring
attachments, reckless,
aggressive
• Onset before age 15; if
younger than 19, diagnose
as conduct disorder
Cluster C
• Anxious and Fearful
AVOIDANT
OBSESSIVE-COMPULSIVE
DEPENDENT
Cluster C- AVOIDANT
• Extreme sensitivity to
rejection
• Sees self as socially inept
• Excessive shyness, high
anxiety levels
• Social isolation, but an
intense, internal desire for
affection and acceptance
• Wants the world to change,
to be nicer, more accepting
• Tends to stay in same job,
same life situation, same
relationships
Cluster C- OBSESSIVE-COMPULSIVE
•
•
•
•
•
•
•
•
Orderliness, inflexible, perfectionist
More common in males, firstborn, harsh discipline upbringing
Loves lists, rules, order
Unable to discard worn-out objects
Doesn’t want change
Excessively stubborn
Lack sense of humor
Wants to keep routine
Differentiate from:
 Obsessive-compulsive anxiety disorder the anxiety disorder has
obsessions and compulsions that are focal and acquired. Personality
disorders are lifelong and pervasive
Cluster C- DEPENDENT
• Gets others to assume
responsibility
• Subordinates own
needs to others
• Cant express
diasgreement
• Great fear of having to
care for self
• May be linked to
abusive spouse
Sources
• Kaplan
• First Aid- USMLE STEP 1 2014