F.

60 Specific personality disorders

F. 62 Enduring personality changes , not attributable to

brain damage and disease

F. 63 Habit and impulse disorders

F. 64 Gender identity disorders

F. 65 Disorder of sexual preference

F. 66 Psychological and behavioural disorders

associated with sexual development and orientation

F. 68 Other disorders of adult personality and behaviour

 Personality

Keseluruhan emosi & bentuk TL manusia yg nampak dalam

kehidupan sehari-hari, bersifat stabil dan dapat diduga

Didapatkan variasi luas yang beragam dari setiap individu

Rigid, maladaptive & ggn fungsional  subjective distress

Personality disorder
 OCPD 2%

Paranoid 2%

Antisocial 1-4%

Schizoid 1%?

Schizotypical 1%

Avoidant 1-2%

Histrionic 2%

Borderline 2-3%

Dependent 0.5%

Narcissistic .5-1%
Torgerson, S.2009 The nature and nurture of personality disorders. Scan J psychol 50:624-632
Severe disturbance of personality and behaviour that are
pronounced deviations from normal cultural patterns

Disturbance of long standing duration in several areas of

functioning

Pervasive, maladaptive behaviour

Onset in childhood / adolescence & continuation into

adulthood

Usually significant problems in work & social behaviour

Spesific personality disorder DSM-IV
Enduring subjective experiences & behaviour
 deviate from cultural standards
Rigidly pervasive
Stable through time
Lead to unhappiness & impairment
• Alloplastic

• Ego Syntonic

• Malaadaptiv behavior  Tidak Cemas/ anxious

• Menolak Pemeriksaan psikiatrik

• 10-20% of gen pop

• Freq comorbid with Axis I

• Predisposing for other psych disorder
 Spesifik • Paranoid
personality • Skizoid
disorder • Disosial

• Borderline
• Hystrionic
Unstable
• Anankastik
Emotion
• Avoidant
• ‘dependent

Uncategorized
Cluster A Cluster B Cluster C
(odd/ecentric) (dramatic, (anxious/fearful)
• Paranoid emotional . • avoidant
Erratic) • dependent
• Schizoid
• schizotypal • Antisocial/dis • obsessive -
osial compulsive,
• borderline
• histrionic
• narcistic
 Monozygote >> dyzigotic twin

Cluster A more common among biological relatives of SR

patients, >> schizotypal relatives in SR px

B apparently have a genetic base . Antisocial ~ alcohol use disorder.

Depression fam background (borderline). Hyystrionic ~ somatization

C, probably

Testosterone , 17 estradiol & estrone : impulsive traits

Androgens : aggressions & sexual behaviour

MAO : low platelet level  sociability

Endorphins   phlegmatic

Serotonin  depression,

Dopamine : euphoria

EEG : slow wave activity antisocial, borderline

personality disorders
 Fixation at one psychosexual stage of development (oral :
passive dependent, anal stubborn , highly conscientious )
 Wilhelm Reich  Character Armor defensive style defense
mechanismunconscious mental proscess ego uses resolve
conflict among 4 important think of inner life : instinct
(wish or need) /reality/important persons &
conscience.
 Defensees work effectiiively  mastery anxious, depression,
anger, shame, guilt, etc

 Temperament, Familial, Environmental

› Fearful children  avoidant personality, childhood MBD 
antisocial personality, poor parental fit, cultural factors . Etc.
Fantasy

•Creating imaginary lives / friends

Dissociation

•Replacement unpleasent affect with pleasent one

Isolation

•Orderly, controlled, fine detail without affect

Projection

•Attribute their own unacknowledged feeling to others

•Sensititve to criticism

Splitting

•good / bad

Passive agression

•Turn their anger against them self

Acting out

•Directly express unconsious wishes

•Tuntrum (child)
Skizoid Brain
 avoidant
Abusive antisocial
personality
child by Fearful personality,
childhood
parents / children poor
/Conduct
environment parental fit,
disorder
 0.5 - 2.5 % of gen pop

M  F, minority groups, immigrants.

Early adulthood pervasive suspiciousness, mistrust, pathological jealousy,

hostile, irritable, angry, ideas of reference, lack of warmth, arrogant.

DD/ delusional disorder, paranoid SR

Lifelong , occupational, marital problems

Psychotherapy : straightforward, no defensive explanation, limited

interpretation , limitation of intimacy

Pharmacotherapy : diazepam, haloperdol, thioridazine.

 7.5 % of gen pop.

M : F = 2 : 1 , solitary jobs, night workers

short answers, no spontaneous conversation, cold, aloof, quiet, distant, seclusive,

unsociable, introvert , eccentric , little need for emotional ties (human being) , prefer
solitary non-competitive jobs, threats faced by fantasy or resignation, heterosexual
relations postponed indefinitely.

DD/ SR, schizotypal pers. dis.

Onset in early childhood , long lasting, SR ?

Psychotherapy : individual, group (respect pt silency &

solitarian attitude)

Pharmacotherapy : anti psychotics , antidepressant (SSRI),

psychostimulants
 3 % of gen pop, mono > dizygot twin, biol
relative SR
 Odd, strange, thinking & communication
disturbed (magical-peculiar way of thinking) ,
speech has a personal meaning & often need
interpretation, sensitive to negative feeling of
others, ideas of reference, derealization, may
act inappropriately , claim of having special
abilities, illusion.
 DD / SR, schizoid pers dis
 Lifelong , 10 % committed suicide, SR.
 Psychotherapy : do not ridicule pt strange
activities
 Pharmacotherapy : haloperidol,antidepressant
 3 % of men , 1 % of women in the gen. pop. ( 75 % of prison
pop), poor urban areas ( mobile residents), onset
conduct disorder < 15 y.o.a.
 Often Seem to be Normal even credible, charming &
ingratiating, Histories of (many area disorders) lying,truancy,
running away from home, thefts, fights, substance abuse,
illegal activities (beginning in childhood), oposite sex :
seductive, same sex manipulative & demanding,
untrustworthy. Spouse & child abuse, promiscuity. No Adhere
any conventional morality standart. At least 18 yo
 no anxiety / depression/remorse, abn EEG, soft neurological
signs.
 DD / ADHD, Subst Abuse disorder, Affective dis (mania)
 Unremitting course (peak : adolescence) decrease older
 Psychotherapy : firm limit,
 Pharmacotherapy : cautiously (anti anxiety,
antidepressant, psycho stimulants , DA, anti epileptic)
 1 - 2 % of the gen pop. M : F = 1 : 2
 In the border between neurosis & psychosis (panphobia ,
pananxiety , panambivalence , chaotic sexuality) , almost
always in state of crisis, extraordinary unstable affect-mood -
behaviour - self image , mood swings, micro psychotic
episodes, highly unpredictable behaviour, self
destructive acts, tumultuous interpersonal relations, frantic
need of companionship, feeling of emptiness, boredom ,
depression .
 DD/ Paranoid personality disorder, schizotypal pers. Dis.
 course & prognosis : Change little over time
 Psychotherpy (individual , group : hospital setting),
behaviour therapy
 Pharmacotherapy : anti - psychotics, - depressant -
convulsant .
Impulsive type : emotional instability,
lack of impulse control; outburst of
violence or threatening behaviour are
common, esp. in response to criticism
by others (explosive personality dis)
Borderline type
 2-3% of gen pop
 Attention seeking behaviour, excitable,
emotional, colorful, dramatic, extroverted,
exaggerate thoughts & feelings, dependent,
superficial-manipulative relationships,
seductive, but usually also have psychosexual
dysfunction; under stress, reality testing
easily impaired
 DD/ Borderline pers dis, somatization dis
 Age , symptoms  (lack of energy);
sensation seekers  trouble with the law,
PAS abuse, promiscuity
 Psychotherapy
 Pharmacotherapy : antidepressant, anti
anxiety, anti psychotic
 < 1% of gen pop
 Heightened sense of self-importance &
uniqueness  need special treatment,
unable to tolerate critics, ambitious for
fame and fortune, superficial-exploitative
relationships, fragile self-esteem 
depression
 DD/ Borderline, Histrionic, Antisocial pers
dis
 Chronic, aging is handled poorly
 Psychotherapy
 Pharmacoth/ : lithium, SSRI
 2.5% of pers dis, F > M

Pervasive dependency & submissiveness, lack of self-

confidence, self-doubt, pessimistic, passive, fear to express
sexual-aggressive feelings, let others make most of the
important life decisions, limited capacity to make everyday
decisions, feel helpless when alone

DD/ Histrionic, Borderline pers dis; Agoraphobia

Impaired occupational functioning, limited social relations

Psychotherapy, Behaviour th/

Pharmacoth/: anti anxiety, SSRI

 1-10% of gen pop

Timid, shy, hypersensitive to rejection, criticism, lack of self-confidence,

inferiority complex, socially withdrawn life, avoid social/occupational
activities that involve significant interpersonal contact because of fear of
criticism, disapproval or rejection

DD/ Schizoid, Dependent per dis

Need protective-supportive environment

Psychoth/ : alliance ship, assertiveness training

Pharmacoth/ : beta blockers

 M > F; 1st degree biol relatives

Harsh childhood discipline

Emotional constriction, stubbornness, indecisiveness, fear of making mistakes, pervasive

pattern of perfectionism & inflexibility, preoccupied with rules, regulations, orderliness,
neatness, details and the achievement of perfection, limited interpersonal skills &
relations

DD/ OCD traits

Course variable, unpredictable, enjoy detailed predictable work,

vulnerable to unexpected changes (SR, major depressive dis)

Psychotherapy (long, complex); group th/, behaviour th/

Pharmaco th/ clomipramine, SSRI

Depressive
 M=F
 Early loss, poor parenting, punitive SE, guilt
feelings >>, abn adrenergic & serotonergic
system, genetic predisposisition
 Chronic feelings of unhappiness, self-critical,
self-derogatory, pessimistic, anhedonic, poor
posture, depressed facies, hoarse voice,
psychomotor retardation
 DD/ Dysthymic dis, Avoidant pers dis
 Higher rates of mood dis
 Psychoterapy (longterm)
 Pharmacoth/ : SSRI, psychostimulant
F 62 Enduring personality changes, not
attributable to brain damage and
disease

Criteria, ICD 10-PPDGJ 3

Develop following catastrophic/excessive

prolonged stress or following a severe
psychiatric illness, in people with no previous
personality dis  definite, enduring change in
a person’s pattern of perceiving, relating to,
or thinking about the environment and the
self  inflexible, maladaptive behaviour
After catastrophic experience
 A hostile, mistrust attitude towards the world,
social withdrawal, feelings of emptiness,
hopelessness, a chronic feeling of as if constantly
threatened, estrangement

After psychiatric illness

 Excessive dependence on and demanding
attitude towards others, conviction of being
“changed”, leading to social isolation, passivity,
reduced interest (incl in leisure activities),
persistent complaints of being ill
(hypochondriacal claims), dysphoric/labile mood,
impairment in social & occupational functioning
The above manifestations must have been present
for a period of 2 years or more
F 63 Habit and impulse disorder
Criteria
ICD 10-PPDGJ 3
Uncontrollable repeated acts that have no clear
rational motivation and that generally harm the
patient’s own interests and those of other people
DSM IV
Patients do not resist impulses, drives or enticements
to do something harmful to themselves or to
others
 Pt may/may not try to resist the impulses and plan
their behaviours
 Before the act : increase tension; afterward :
feelings of pleasure, satisfaction, +/- remorse,
guilt
 Ego-syntonic
 Etiology
Psychodynamic
 To decrease tension related to heightened
instinctual drives/diminished ego defenses
 To master anxiety, guilt, depression & other
painful affects by means of action
 Weak SE, E due to childhood deprivation
Biological
 Limbic sys abn, testosterone, temporal lobe
epilepsy: violent, aggressive and impulsive
behaviour
 ADHD; abn of SE,DA,NA-ergic system
Psychosocial
 Early life events : improper model for
identification and parental figures
Types
Pathological gambling

 1-3% of gen pop (USA), M > F

 Persistent recurrent maladaptive gambling behaviour 
preoccupation with gambling despite the consequences
(family, social, monetary, vocational, legal problems)
 Early loss (<15 yrs), inappropriate parental discipline,
exposure to gambling activity, family emphasis on
material-financial symbols, catecholamine & SE abn
 DD/ Social gambling, Manic episodes, Antisocial pers dis
 Onset in adolescence (M) or late in life (F) : chronicity
 3 phases of gambling : winningprogressive
lossdesperate (15 yrs)totally deteriorated (2 yrs)
 Th/ Gamblers Anonymous; hospitalization (3 mos, prep.
for psychoth/), SSRI, lithium, clomipramine
Pathological fire-setting (pyromania)
 M > F, mildly retarded, antisocial traits
 Deliberate-purposeful fire-setting on more than one
occasion due just to fascination with, interest in, curiousity
about or attraction to fire and the activities and equipment
associated with fire fighting  not related to monetary,
sociopolitical, criminal reasons or vengeance
 Sexual excitation, abn craving for power, symbol of
braveness, compensation for inferiority complex, longing for
(an absent) father
 DD/ Conduct dis, Antisocial pers dis, SR, Brain dysfunct
 Onset usually in childhood (high recurrency); if treated prog
is better than if the onset is in adolescence/adulthood
 Th/ Incarceration : behaviour th/; children, intensive
intervention
Pathological stealing (kleptomania)

 3.8%-24% of arrested shoplifters, F > M

 Recurrent intrusive, irresistible urges to steal
(unplanned) not needed, not valuable objects
(returned surreptitiously, discarded, hoarded) 
the act of stealing is the ultimate goal, not the
object
 Losses, separations, endings of important
relationships, feelings of being neglected,
unwanted, symbolism (sexual act, aggression,
oneness of mother-child etc), brain dis, mental
retardation
 DD/ Stealing, Malingering, SR
 Begin in childhood, tends to be chronic
 Psychoth/, behaviour th/, SSRI, tricyclics, ECT
Trichotillomania

 F>M
 Recurrent failure to resist impulses to pull out
hairs which can cause noticeable hair loss
 Onset related to stressful situations; disturbance
of mother-child relationships, fear of being left
alone, recent object loss, depression, self
stimulation
 DD/ OCD, Factitious dis
 Generally begins in childhood/adolescence; late
onset may be associated with chronicity
 Psychoth/, behaviour th/, hypnoth/, SSRI, lithium,
anxiolytic with antihistamine properties
 tricotillomani
Others
Intermittent explosive disorder
 M>F
 Discrete episodes of losing control of aggressive
impulses which are grossly out of proportion to any
precipitating stressors, followed by sincere
regret/self-reproach
 Unfavorable childhood environment, brain damage,
decreases in serotonergic transmission
 Psychoth/, anticonvulsant, SSRI, neurosurgery (?)

Oniomania
 F>M
 Compulsive buying; low self-esteem, anxiety,
reduce stress
 Psychoth/, Debtors Anonymous, antipsychotic,
antianxiety, antidepressant, SSRI
F 64 Gender identity disorder
Gender identity is a psychological state that reflects
the self’s sense of being male or female

Assigned sex is how a person reared sexually;

gender identity is consonant with sex of rearing

Gender role is everything that people say and do

(external behavioural pattern that reflects a
person’s inner sense of gender identity) to
indicate they are male or female; usually gender
identity is match with gender role

Sex/biological sex is the anatomical & physiological

characteristics that indicate whether a person is
male or female

Sexual orientation is a person’s erotic response

tendency (object choises, erotic fantasies etc)
 A strong & persistent cross-gender
identification
 Persistent discomfort about one’s assigned
sex or a sense of inappropriateness in the
gender role of that sex
 Persistent preoccupation with getting rid of
their primary & secondary sex characteristics
and with acquiring the sex characteristics of
the other sex
 The wish to dress and live as a member of the
other sex
 M>F
 E/
Biological
Resting tissue is initially F; maleness &
masculinity depend on fetal & perinatal
androgens
Psychosocial
Assigned sex; culturally acceptable gender roles
(learned); resolution of Oedipal complex;
parenthood problems (hostile mothering,
rejected/abuse children; absence of
mother/father figures)
 Clinical features
Children : boys girl, girly boys; claim & wish to
be the opposite sex completely
Adolescent & adult: continuation of the childhood claim &
wish, plus the desire to live & treated as the other sex
and the desire to acquire the sex characteristics of the
opposite sex (“I feel that I’m a woman trapped in a
male body” or vice versa)  ask for hormonal th/, sex
surgery

 Sexual object choice : M, F, both, neither

 Homosexuality develop in 1/3 - 2/3 of cases; < 10%

become transsexual; impaired social, occupational
functioning; depression

 Th/ role model behaviour; parental counseling;

psychoth/ (be comfortable with the desired gender
identity); hormonal treatment (changes of secondary
sex characteristics); sex reassignment surgery :
definitive  cross gender living 3 mos-1 yr & hormonal
treatment  50% still want surgery
 Types
Transsexualism
A persistent desire (at least 2 yrs) to live and be accepted
as a member of the opposite sex, usually accompanied
by a sense of discomfort with one’s anatomic sex and
wish to have hormonal th/ & surgery to be as
congruent as possible with the preferred sex
Dual-role transvestism
The wearing of clothes of the opposite sex in order to
enjoy temporary experience of being the other sex,
with no desire for (permanent) sex change, also no
sexual excitement accompanies the cross-dressing
Gender identity of childhood
Persistent, intense distress about assigned sex & a desire
to be the other sex, usually first manifest during early
childhood
F 65 Disorders of sexual preference
(paraphilias)
Criteria
Unusual fantasies or sexual urges or behaviours that are
recurrent and sexually arousing, and an intense urge to act
out the fantasy, occur at least 6 mos, cause clinically
significant distress/impairment in social, occupational or other
important areas of functioning (can involve illegal activities) 
a special fantasy is the pathognomonic element; sexual
arousal & orgasm are associated phenomena

 M >>; 50% onset before age 18, peaks between 15-25

 E/ Psychosocial: Failure to complete normal psychosexual dev;

early sexual experience; modeling, mimicking
Biological : abn hormonal levels, chromosomal abn, soft
neurological signs
 DD/ Experimental act, foreplay, brain disease
 Early onset, high frequency, no remorse/shame,
substance abuse : poor prognosis
 Th/ Individual psychoth/, group th/ behaviour th/.
antipsychotics, antidepressants, antiandrogen

Types
Exhibitionism
 M
 Recurrent urge to expose the genital to a stranger or
unsuspecting person (opposite sex); orgasm is brought
by masturbation during or after the event
 To assert masculinity : showing  fright, surprise
reaction of the spectators
Fetishism
 M
 Sexual focus are objects intimately associated with
human body (shoes, gloves, panties, bras, stockings),
sometimes with a particular texture (rubber, leather,
plastic)
 Orgasm reached by masturbation with/into the objects
or the objects incorporated into sexual intercourse
 The objects are symbol of phallus, associated with
sexual stimulation at an early age

Transvestic fetishism
 Fantasies & sexual urges to wear the opposite sex
clothing for arousal & adjunct to masturbation/coitus
 M > F ; begins in childhood/early adolescence, cross-
dressing may become permanent; overt symptoms :
since latency, mostly at pubescence/adolescence
Voyeurism (scopophilia)
 Recurrent preoccupation with fantasies and acts to look
at people who are naked or engaging in grooming or
sexual activity (without the observed people being
aware), usually followed with masturbation to orgasm
 Mostly M, first act usually during childhood

Paedophilia
 Recurrent, intense sexual urges toward/arousal by
prepubertal/early pubertal children, for at least 6 mos
(the perpetrator aged 16 years/more, at least 5 years
older than the victim); mostly M
 Genital fondling, oral sex
 95% perpetrators are heterosexual, 60% victims are
boys; some perpetrators are interested only to girls,
some to boys and some in both sexes
Sadomasochism

 A preference for sexual activity that involves

bondage, infliction of pain or humiliation; M >
F
 Prefer to be the recipient : masochism 
childhood experience, that pain is a
prerequisite for pleasure
 Prefer to be the provider : sadism  defense
against fears of castration
 Contributory causes : hereditary
predisposition, hormonal malfunctioning,
pathological relationships, a history of sexual
abuse, having other mental illness
Others
Frotteurism
 M, passive, isolated
 Penis (hands) rubbed against the buttocks or other part
of a fully cloth woman to achieve orgasm
Telephone and computer scatologia
 M ; obscene phone calling to unsuspecting person +
masturbation

Necrophilia
 Obsession of obtaining sexual gratification from
corpses  inflicting the greatest humiliation to the
lifeless victims: psychosis ?
Partialism, oralism
 Oral sex is the only source of sexual gratification;
no coitus
Zoophilia
 Animals are preferentially incorporated into arousal
fantasies or sexual activities

Coprophilia & Klismaphilia

 Attraction to sexual pleasure associated with the desire
to defecate on a partner, to be defecated on, or to eat
feces (coprophagia) or compulsive utterance of
obscene words (coprolalia)
 Use of enemas as part of sexual stimulation  fixation
at anal stage

Urophilia
 Interest in sexual pleasure associated with the desire
to urinate on a partner or to be urinated on; may be
associated with masturbatory technique (insertion of
foreign objects into the urethra for sexual stimulation)
Masturbation
 Achieving sexual pleasure-orgasm by ownself
is prefered than sex with a partner

Hypoxyphilia
 Desire to achieve an altered state of
consciousness due to hypoxia while
experiencing orgasm
F 66 Psychological and behavioural
disorders associated with
sexual development and
orientation

Sexual maturation disorder

Uncertainity about gender identity/sexual orientation 
anxiety, depression

Egodystonic sexual orientation

 Dissatisfaction with sexual (homosexual) arousal
pattern
 a desire to increase heterosexual arousal
 strong negative feelings of being homosexual
 Sexual reorientation (psychoth/ behaviour th/), or be a
happy homosexual
F 68 Other disorders of adult
personality and behaviour

Elaboration of physical symptoms for

psychological
reasons
(Compensation neurosis)

 Elaboration of physical symptoms for psychological reasons

 Physical symptoms due to a confirmed physical disorder
/disease/disability become exaggerated/prolonged 
dissatisfaction with the result of treatment, disappointment
with the personal attention received in wards/clinics,
possibility of financial compensation
Intentional production or feigning of
symptoms or disabilities, either
physicalor psychological
(Factitious disorder, Munchhausen’s syndrome)
 Characterized by physical (cuts, abrasion, self injection
of toxic substance etc) or psychological symptoms that
are intentionally produced or feigned to assume the
sick role
 No external incentive; hospitalization is the primary
objective
 M > F; 9% among hospitalized patient
 Childhood abuse, deprivation  frequent
hospitalization  hospitalization is an escape from
traumatic home situation and a place to find loving,
caring caretakers
 DD/ Malingering : intentional production or feigning of
physical/psychological symptoms/disabilities for certain
incentive (monetary)
Psikiatrijayapura.wordpress.com
 Ms Ellie is referred because she is
concerned she has an anxiety disorder.
When the pt comes into your office she is
looking down and when she shakes your
hand it is very sweaty. When asked about
how her relationships were in junior high she
stated “terrible. I never fit in and didn’t do
much with other kids because I was afraid
they would judge me”.
 She has never had an intimate relationship
although she would like to have one and has one
friend that she has known since childhood. She is
intensely afraid of of being ridiculed so works as a
transcriptionist from her home and sits in the back
row when she goes to church. She describes herself
as “not as good as other people” and doesn’t like
to do new things”. She avoids new relationships
unless she “is sure they are going to like me”.
 Social phobia?  What do you
 Avoidant need to know to
personality figure out which
disorder? one if any it is? Is
 Generalized
this circumscribed
anxiety disorder? or more global,
does this person
 Schizoid
have relationships
personality with others?
disorder?
 Given the long standing pervasive
nature of her symptoms her diagnosis is
most consistent with Avoidant Personality
Disorder. Social phobia tends to be very
situational and GAD is less pervasive.
 Jason is a 45 year old male who comes to
see you to establish primary care clinic. In
the ROS he notes he has to be very careful
about what he eats because “certain foods
I can feel work against my system. I feel
them as they are integrated into my body”.
He also notes he tries to be careful about
what he says “because words have
power…they can change the way of
things”.
 He is fairly close to his family but doesn’t really have
any other people in his life. He denied auditory,
visual or tactile hallucinations, has no thought
broadcasting or thought insertion and is able to
provide organized answers although you notice he
speaks in a vague way and his affect is
constricted. His appearance is striking because he
is wearing all yellow including his shoes, belt, hat
and earring which he states “is because yellow is
the color that recharges me”.
 Schizophrenia?  What do you
 Delusional need to know to
disorder? determine which
 Mood disorder
it is?
with psychotic
features?
 Schizotypal
personality
disorder?
 His diagnosis is most consistent with a
Schizotypal personality disorder. He does
not have schizophrenia because of lack of
disorganization and lack of true psychotic
Sx. He does have magical thinking but it is
not crossing into psychosis. Other history to
obtain would be whether he has a
declining course over time which you often
see with schizophrenia.
 You are picking up your daughter from daycare
and one of the other parents engages you in
conversation. He states “I see you got here 5
minutes after the cut off time to…are they going to
charge you extra too? You know I think this
daycare is always trying to stick it to us. I get this
same thing at work. I think they purposely make the
clock in times and pick up times inconvenient so
they can dock you here and there. Its like a
conspiracy I swear!”
 He goes on to tell you that its been the
same story his whole life. He has been
passed over for promotions at work, he
can’t trust his friends any further than he
can throw them and he thinks his wife is
cheating on him too. With your excellent
clinical skills you also find out he doesn’t
actually believe there is a plot and doesn’t
have any psychotic sx.
 Irritated but  What would you
normal parent? need to find out
 Persecutory to determine
delusional which dx is
disorder? correct? Screen
 Schizophrenia?
for psychotic sx,
delusions.
 Paranoid
personality
disorder?
 His diagnosis is most consistent with a
Paranoid personality disorder. He has a
pervasive distrust and suspiciousness of
others but it is not to the point of a
delusion and he is not psychotic.
 Personality disorders are common and
more common in your practice then the
general population
 Identifying personality disordered patients
informs how best to approach them
 Don’t forget to screen for comorbid
diagnoses
 Ask for help if you are feeling overwhelmed!