PERSONALITY

DISORDERS
MUHAMMAD ARFAN BIN MAHFIDZ
AMIR AIZAT BIN BADROLHISHAM
MUHAMMAD IMRAN BIN ISMAIL
 TABLE OF CONTENTS

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INTRODUCTIO CLUSTER A CLUSTER B
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INTRODUCTIO
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Presenter: Muhammad Arfan Bin Mahfidz
 Introduction
● Personality: the ways someone shapes and adapts in a unique way to
an ever-changing internal and external environment.
● Personality disorder: long-standing, maladaptive behaviour traits that
are pervasive and apparent in wide range of personal and social
contexts. (kaplan and sadock’s synopsis of psychiatry)
● Personality disorder: an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individuals
culture, is pervasive and inflexible, has an onset in adolescence or early
aulthood, is stable over time, and leads to distress or impairment. (DSM-5)
 General personality disorder
Diagnostic Criteria:
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations
of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
3. Interpersonal functioning.
4. Impulse control.
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social
situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence
or early adulthood.
E. The enduring pattern is not better explained as a manifestation or consequence of another mental
disorder.
F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition (e.g., head trauma).
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CLUSTER A
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 Paranoid
● Pervasive mistrust and suspiciousness such that others people motives are interpreted as
malevolent (DSM-5)
● Persistent pattern of fear mistrust and suspiciousness of other people
● Women > men

● Aetiology:
- Chldhood experience
- Temperament
- Defence mechanism
- Sensory impairment
Clinical features

● Other people are deceiving and

exploiting them
● doubt the loyalty of family and friends
● They tend to confiding in others for
fear being betrayed
● Intepret other people statements as
hostile or threatening
● Can bear a long lasting grudges
● Over high sensitivity to attack in their
character
● Socially isolated
Management
1. Psychotherapy
- Supportive psychotherapy
- Problem solving therapy
- Cognitive behaviour therapy
Course and prognosis
- Patient can be hypersensitivity when they are young
with poor peer relationships and eccentricity
- Paranoid may intensify during stress

2. Pharmacotheray
- Antidepressant
- Antipsychotics
 Schizoid
● Pervasive pattern of detachment from social relationships and a restricted range of expression
of emotions interpersonal settings (DSM-5).
● Restricted affective expression, impoverished social relationships and avoidance of social
acivities.
● Lacks of extroversion = Introversion
● Consistent lack of interest and social relationship
● Schizoid = Avoid
● Men > Women
 Clinical features

● Preference for solitary activity

● Disinterest in seeking new
relationships
● Difficulty in experiencing pleasure
● Lack of close confidence
● Indeference to praise or critiscism
● Emotional coldness or aloofness
when interacting socially
● Often estragement from family and
friends

Management
- Psychotherapy (supportive/CBT)
- Pharmactherapy (low dose of antipscychotics and antidepressant may be used)
 Schizotypal
● A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and
reduced capacity for close reltionships as well as cognitive or perceptual distortion,
eccenericities of behaviour.
● More common in first degree relatives of schizophrenia
● Linked to dopamine dysregulation
Clinical features

● Presence of odd belief (supernatural,

superstitious, paranormal activity to ideas of
reference)
● Unusual perceptual experience
● Often difficulty in relating to other people
makes them feel lonelinesss and isolation
● The avoidance is often out of fear that oter
people will judge them for their ways of
thinking, eccenteric behaviour,
unconventional of clothing and unusual way
of expressing their emotions
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CLUSTER B
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Presenter:Amir Aizat Bin Badrolhisham
 Borderline

● Patients with BPD have unstable

moods,behaviors,and interpersonal
relationships.
● They fear abandonment and have
poorly formed identity.
● Relationships begin with intense
attachments and end with the
slightest conflict.
● Aggression is common.They are
impulsive and may have a history of
repeated suicide attempts/gestures
or episodes of self mutilation.
 Epidemiology

● 1 to 2 of the
● percent
More commonlypopulation
in women as
in men
● Suicide rate: 10%
 Diagnosi
s
● According to DSM-5 Criteria,at
least five of the following must
be present.
IMPULSIVE
• Impulsive
• Moody
• Paranoid under stress
• Unstable self image
• Labile,intense
relationships
• SuicidalInappropriate
anger
• Vulnerable to
abandonment
• Emptiness
 Course and Prognosis

• Variable,but may develop stability in middle

age.
• High incidence of coexisting major
depression and/or substance use disordes.
• Risk of suicide.
 Treatment

PSYCHOTHERAP PHARMACOTHERAPY
Y
● Dialectical ● To treat psychotic or
Behaviour Therapy depressive symptoms may be
helpful.
 Antisocial

• Patients diagnosed with antisocial

personality disorder are exploitive of others
and break rules to meet their own needs.
• They lack empathy,compassion and remorse for
their actions.
 Epidemiology
● Male : 3% of general population
● Female : 1% of general
● There is a population
higher incidence in poor urban areas and in
prisoners but no racial difference.
● Genetic component : risk among first-degree relatives
Signs & symptoms
 Diagnosis and DSM-5 Criteria
• Pattern of disregard for and violation of the rights of others since age
15.
• Patients must be at least 18 years old
• 3 or more of the following should be present:
• Failure to conform to social norms by commiting 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.
 Course
● Usually has a chronic course,but some improvement of
symptoms may occur as the patient ages.
● Many patients have multiple somatic complaints and coexistence
of substance use disorders and/or major depression is common.
● There is morbidity from substance use,trauma,suicide or
homicide.
 Treatment

Psychotherapy
● Is generally ineffective.
Pharmacotherap
y
● May be used to treat
symptoms of anxiety or
depression,but use caution
due to high addictive
potential of these patients.
 Narcisstic
● Person with this disorder are characterised by:
○ Heightened sense of self-importance
○ Lack of empathy
○ Grandiose feeling of uniqueness
● However underneath it, they have a fragile & vulnerable self-
esteem.
 Epidemiology
● Estimated prevalence range from less than 1 to 6 percent in the
community samples.
● Male are more commonly affected than female.
● Becomes more evident during adolescent or early adulthood.
● Children of parents with narcissistic personality disorder have a higher risk
for developing the disorder themselves.
Diagnostic
Criteria
 Course
● Usually has a chronic course;higher incidence of depression and midlife crises since these
patients put such a high value on youth and power.

Treatment
• Psychotherapy is the treatment of choice.
• Antidepressants may be used if a comorbid mood disorder is diagnosed.
 Histirionic

Known as adramati personality

disorder c by:
Characterized
● pervasive and excessive emotionality
● attention-seeking behaviour (DSM V)
Described as:
● dramatic, excitable, erratic,
volatile, flirtatious, seductive,
charming, manipulative,
impulsive, and lively
Their self esteem is entirely dependent on
the approval of others.
Retrieved from: DSM V & French JH, Shrestha S. Histrionic Personality Disorder.
[Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
 Diagnosis
● Diagnosis requires 5+ of: ACTRESSS
1. Appearance used to attract attention
2. Centre of attention
(else uncomfortable)
3. Theatrical
4. Relationships (believed to be more
intimate than they are)
5. Easily influenced
6. Seductive behaviour
7. Shallow expression of emotions (which
rapidly shift)
8. Speech (impressionistic and vague)

Retrieved from: DSM V & Toronto Notes

EPIDEMIOLOGYEPIDEMIOLOGY
&
ETIOLOGY
● 2 - 3 of the general
% population
● Diagnosed more infemales

Differential Diagnosis
• Borderline personality disorder.

Retrieved from: French JH, Shrestha S. Histrionic Personality Disorder.

[Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov
 Course
● Usually chronic,with some improvement of symptoms with age.

Treatment
• Psychotherapy is the treatment of choice.
• Pharmacotherapy to treat associated depressive or anxious symptoms as
necessary.

Retrieved from: French JH, Shrestha S. Histrionic Personality Disorder.

[Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov
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CLUSTER C
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 Avoidant
Defined by:
 Pervasive pattern of social
inhibition intense fear of
rejection.
 Fearful of disapproval or criticism.
 Desire companionship but feel shy
and timid Feelings of inadequacy.
 Avoid taking new responsibilities
at work avoid new experiences
generally.
1. Particularly difficult during
adolescence.
2. Increased incidence of
associated anxiety and
depressive disorder.
3. If support system fails,
patient left very susceptible
to depression, anxiety and
anger.

Prevelance
 Prevalence is 2.4%
 Equally in males and females.
Aetiology
Unknown exact causes but believed it is a
combination of genetics, personality traits and
environmental factors;
 Fearful or anxious childhood attachment issues,
 Deficits of parental or caregiver affection in
early childhood,
 Infantile temperaments, such as hypersensitivity
and rigidity,
 Family history of the disorder,
 Abuse,
 Minimal parental encouragement,
 neglect
Diagnostic criteria
 AFRAID
A- avoids occupation with others
F-Fear of embarrassment and
criticism
R- Reserved until they certain
they're liked
A - Always thinking rejection
I- Isolates from relationship
D- Distances self unless they
assured they are liked
 Dependent
 Passive and unduly compliant with wishes of others Fear of separation.
 Have excessive need to be taken care of Lack vigor and self-reliance.
 Avoid responsibility.
 Persuade other people to assist them.
 Have difficulty in dealing with demands and responsibilities of everyday life.

1. Prone to depression

2. Difficulties with employment since they cannot act independently or without

close supervision
 Aetiology
Prevelance
 Traumatic abandonment in childhood
 Approximately <1% through family circumstances
 Women more likely to be diagnosed
 A family history of personality disorders,
than men
depression, or anxiety
 Surviving childhood abuse, including
stifling parenting, withdrawn parenting, or
having parents who punished individual
thinking
 Having a chronic physical illness in
childhood.
Diagnostic criteria
OBEDIENT
O - Obsessive about approval
B - Bound by other's decisions
E - Enterprises rarely initiated due to lack
of self-confidence
D - Difficult to make own decisions
I - Invalid feelings while alone
E - Engrossed with fears of self- reliance
N - Needs to be in a relationship
T - Tentative about decisions
 Obsessive Compulsive Personality Disorder
• Inflexible
• Obstinate, rigid in their opinions
• Focus on unimportant details
• Indecisive, worry about consequences
• Humourless, judgmental while worrying about other's opinions
• Appear outwardly controlled but may be irritated if their
carefully ordered routines disturbed
• May have violent feelings of anger
 Aetiology
Prevelance
 A parent, sibilings, or child with OCPD.
 1-2%
 Men are two times more likely to
have OCPD than women
 Depression, anxienty, ortics.

 Experience with trauma.

 A history or physical or sexual abuse

as a child.
Diagnostic criteria
Any Questions ?
Thank you