Personality Disorders

By: Mansi Narang

Counseling Psychologist
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 Concept of Personality and
Personality Disorders

• Personality is the “style” of how one deals

with the world
• Personality traits
– Stylistic peculiarities of how one deals with
world
• Personality disorders
– Diagnosed under Axis II in DSM-IV-TR

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 General Characteristics of
Personality Disorders
• Inflexible, maladaptive responses to stress
• Disability in working and loving
• Avoidance and fear of rejection
• Blurred boundaries between self and other
• Insensitivity to needs of others
• Demanding and fault finding
• Lack of accountability
• Evoke intense interpersonal conflict
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 Personality Disorders:
General Information

• Comorbidity
– Often more than one personality disorder
diagnosed
– Axis I disorders common: substance abuse,
somatization, eating disorders, PTSD,
depression, and anxiety disorders

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 Biological Theories of
Personality Disorders

• No single cause identified

• Genetics
– Seem to play role in schizotypal, schizoid, and
paranoid personality disorders
• Neurobiological factors
– Brain imaging suggests borderline personality
disorder related to abnormality in prefrontal,
corticostriatal and limbic systems
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 Other Theories Related to
Personality Disorders
• Psychological
– Childhood abuse and trauma associated with all
disorders
• Borderline: sexual abuse common
• Cultural considerations
– Native Americans, African Americans at
increased risk
– Other risk factors
• Young adult with low socioeconomic status, divorced,
separated, widowed, or never married
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Understanding DSM-IV-TR Clusters of
Personality Disorders
• Cluster A: odd or eccentric behaviors
– Related to schizophrenia
• Cluster B: dramatic, emotional, or erratic
behaviors
– Manipulation is common defense mechanism
– Tendency to blame others for one’s problems
• Cluster C: anxious or fearful behaviors
– Related to Axis I anxiety disorders
– Internalize blame for problems in life
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 Cluster A:
Paranoid Personality Disorder

• Believe others are lying, cheating, or

exploiting them
• Perceive hidden malicious meaning in
benign comments
• Inability to work collaboratively with others
• Emotionally detached
• Hostile to others
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 Cluster A:
Schizoid Personality Disorder

• Neither desires nor enjoys human

relationships
• Fixated on personal thought/fantasies
• Demonstrates emotional coldness,
detachment, and flat affect
• Indifferent to praise or criticism
• Chooses solitary activities
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 Cluster A:
Schizotypal Personality Disorder

• Behavior or appearance is odd, eccentric,

or peculiar
– Odd, elaborate style of dressing, speaking,
interacting
• Magical thinking manifested
• Unusual perceptual experiences
• Lacks close friends
• Excessive and unrelieved social anxiety
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 Cluster B:
Antisocial Personality Disorder

• Chronic irresponsibility and unreliability

• Lack of regard for law and rights of others
• Persistent lying and stealing for personal
gain
• Conning others for personal gain
• Lack of remorse for hurting others
• Reckless disregard for others’ safety
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 Cluster B:
Borderline Personality Disorder (BPD)

• Difficulty controlling emotions

• Stormy relationships with anger and
fighting
• Persistent unstable self-image
• Use of splitting (idealizing and devaluing
same person)

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 Cluster B:
Borderline Personality Disorder (BPD)

• Frantic efforts to avoid real/perceived

abandonment
• Dramatic mood shifts, changes in opinions
and plans
• Impulsive, self-damaging behaviors
– Recurrent suicide attempts or self-mutilation

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 Cluster B:
Histrionic Personality Disorder
• Attention grabbing, self-dramatizing
expression of emotions
• Sexually provocative clothing/behaviors
• Excessive concern with appearance
• Extreme sensitivity to others approval
• False sense of intimacy with others
• Constant sudden emotional shifts
• Impressionistic speech lacking detail
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 Cluster B:
Narcissistic Personality Disorder
• Inflated sense of self-importance
• Constant attention-grabbing behavior
• Manipulation of others
• No regard for feelings of others
• Arrogant manner toward others
• Unreasonable expectation for special
treatment
• Often envious of others with belief that
others are envious of him/her
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 Cluster C:
Avoidant Personality Disorder
• Hypersensitive to criticism/rejection
• Self-imposed social isolation
• Preoccupied with being criticized/rejected
• Strongly wants relationship but shies away
• Avoids occupation involving interpersonal
contact
• Views self as socially inept, inferior

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 Cluster C: Obsessive-Compulsive
Personality Disorder
• Preoccupied with details, rules, lists
• Perfectionist
• Unable to share responsibility with others
• Devoted to work, exclusion of pleasurable
activities
• Financial stinginess
• Inability to discard useless objects
• Discomfort with emotions and relationships
person can’t control
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 Cluster C:
Dependent Personality Disorder

• Difficulty with decision making

• Others assume responsibility for person’s
life
• Fear of disagreeing with others
• Preoccupied with fear of being left alone

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 Interventions for Patient with
Personality Disorder

• Combine limit-setting, trustworthiness, and

dealing with manipulation with own natural
self (therapeutic use of self)
• Use established interventions for:
– Manipulative behaviors
– Impulsive behaviors
– Aggressive behaviors

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 Treatment for Personality Disorders:
Psychotherapy
• Psychodynamic psychotherapy
– Works toward insight development
• Cognitive-behavioral therapy
– Helps patient recognize faulty thinking and
influence on problematic behaviors
• Dialectical behavior therapy (DBT)
– Developed by Marsha Linehan (1993) for
patients with borderline personality disorder
– Focus on stabilizing patient and achieving
behavioral control
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 Treatment for Personality Disorders:
Medications

• Benzodiazepines (BZAs) not appropriate

because of dependency issues
• Use medications with low toxicity
– Antidepressants (SSRIs)
– Lithium carbonate
– Anticonvulsants
– Low-dose antipsychotics
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