Personality Disorders and Their General Characteristics

Prepared by: ROSELO A. OCAMPO, JR. RN, MAN

Personality Disorder General Characteristics Management

1. Borderline Personality Disorder  Frantic efforts to avoid real or imagined abandonment Dialectical behavior therapy
(BPD )  A pattern of unstable and intense interpersonal relationships characterized by (DBT) is a specific type of
alternating between extremes of idealization and devaluation cognitive-behavioral
- The main feature of borderline  Identity disturbance, such as a significant and persistent unstable self-image or sense of psychotherapy developed in the
personality disorder (BPD) is a self late 1980s by psychologist
pervasive pattern of instability in  Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Marsha M. Linehan to help better
interpersonal relationships, self- substance abuse, reckless driving, binge eating) treat borderline personality
image and emotions. People with  Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior disorder.
borderline personality disorder are  Emotional instability due to significant reactivity of mood (e.g., intense episodic
also usually very impulsive. dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a
few days)
 Chronic feelings of emptiness
 Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights)
 Transient, stress-related paranoid thoughts or severe dissociative symptoms

2. Paranoid personality disorder is a It is characterized by at least 3 of the following: Because of reduced levels of
psychiatric diagnosis characterized by trust, there can be challenges in
paranoia and a pervasive, long-standing 1. excessive sensitivity to setbacks and rebuffs; treating paranoid personality
suspiciousness and generalized mistrust of 2. tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or disorder. However,
others. slights; psychotherapy, antidepressants,
3. suspiciousness and a pervasive tendency to distort experience by misconstruing the antipsychotics and anti-anxiety
Cause: A genetic contribution to paranoid neutral or friendly actions of others as hostile or contemptuous; medications can play a role when
traits and a possible genetic link between 4. a combative and tenacious sense of personal rights out of keeping with the actual an individual is receptive to
this personality disorder and situation; intervention.
schizophrenia exist. Psychosocial theories 5. recurrent suspicions, without justification, regarding sexual fidelity of spouse or
implicate projection of negative internal sexual partner;
feelings and parental modelling. 6. tendency to experience excessive self-importance, manifest in a persistent self-
referential attitude;
Paranoid personality disorder occurs in 7. preoccupation with unsubstantiated "conspiratorial" explanations of events both
about 0.5%-2.5% of the general immediate to the patient and in the world at large.
population. It is seen in 2%-10% of
psychiatric outpatients. It occurs more Includes:
commonly in males.
 expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)

Excludes:

 delusional disorder
 schizophrenia

3. Schizotypal personality disorder, or It is characterized as: Common Treatment of

simply schizotypal disorder, is a Schizotypal Personality Disorder
personality disorder that is characterized A disorder characterized by eccentric behaviour and anomalies of thinking and affect which
by a need for social isolation, odd resemble those seen in schizophrenia, though no definite and characteristic schizophrenic Medications. Antipsychotic
behavior and thinking, and often anomalies have occurred at any stage. There is no dominant or typical disturbance, but any medications to help alleviate
unconventional beliefs. of the following may be present: associative conditions such as
anxiety, depression or other mood
Causes:  Inappropriate or constricted affect (the individual appears cold and aloof); disorders. For example, treatment
 Behaviour or appearance that is odd, eccentric, or peculiar; for distorted thinking may be with
Genetic  Poor rapport with others and a tendency to social withdrawal; the prescription medications
 Odd beliefs or magical thinking, influencing behaviour and inconsistent with risperidone (Risperdal) and
Although listed in the DSM-IV-TR on subcultural norms; olanzapine (Zyprexa).
Axis II, schizotypal personality disorder is  Suspiciousness or paranoid ideas;
widely understood to be a "schizophrenia  Obsessive ruminations without inner resistance, often with dysmorphophobic, Psychotherapy. Building a
spectrum" disorder. Rates of schizotypal sexual or aggressive contents; trusting rapport in therapy may
PD are much higher in relatives of  Unusual perceptual experiences including somatosensory (bodily) or other illusions, help people with schizotypal
individuals with schizophrenia than in the depersonalization or derealization; personality disorder contradict the
relatives of people with other mental  Vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, mistrust or discomfort they have
illnesses or in people without mentally ill manifested by odd speech or in other ways, without gross incoherence; with developing interpersonal
relatives. Technically speaking,  Occasional transient quasi-psychotic episodes with intense illusions, auditory or relationships.
 other hallucinations, and delusion-like ideas, usually occurring without external
schizotypal PD is an "extended provocation. Behavioral therapy. People with
phenotype" that helps geneticists track the schizotypal personalities often
familial or genetic transmission of the The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves need to learn specific
genes that are implicated in into overt schizophrenia. There is no definite onset and its evolution and course are usually interpersonal skills and new
schizophrenia[1] There are dozens of those of a personality disorder. It is more common in individuals related to schizophrenics behaviors, as they often have
studies showing that individuals with and is believed to be part of the genetic "spectrum" of schizophrenia. difficulty responding
schizotypal PD score similar to appropriately to social cues.
individuals with schizophrenia on a very
wide range of neuropsychological tests. Cognitive therapy. People with
Cognitive deficits in patients with schizotypal personality disorder
schizotypal PD are very similar to, but may respond to exercises that
somewhat milder than, those for patients focus on interrupting distortions
with schizophrenia.[2] in thought.

Social / Environmental Family therapy. Treatment can be

more effective when family
People with schizotypal PD, like patients members are involved. Seeking
with schizophrenia, may be quite sensitive professional counseling as a
to interpersonal criticism and hostility, group may help diminish angry
and there is now evidence to suggest that confrontations or emotional
parenting styles, early separation, and distancing in the home. Family
early childhood neglect can lead to the therapy may also offer the
development of schizotypal traits affected person reassurances of a
support structure and a boost in
Schizotypal personality disorder occurs in morale.
3% of the general population and occurs
slightly more commonly in males
4. Antisocial Personality Disorder Characteristics of people with antisocial personality disorder may include: The role of psychological
(ASPD or APD) is defined by the interventions
American Psychiatric Association's  Persistent lying or stealing • For people with antisocial
Diagnostic and Statistical Manual as "...a  Apparent lack of remorse[3] or empathy for others personality disorder with a history
pervasive pattern of disregard for, and  Cruelty to animals of offending behaviour who are in
violation of, the rights of others that  Poor behavioral controls — expressions of irritability, annoyance, impatience, threats, community and institutional care,
begins in childhood or early adolescence aggression, and verbal abuse; inadequate control of anger and temper consider offering group-based
and continues into adulthood."  A history of childhood conduct disorder cognitive and behavioural
 Recurring difficulties with the law interventions (for example,
 Tendency to violate the boundaries and rights of others programmes such as ‘reasoning
  Substance abuse and rehabilitation’) focused on
 Aggressive, often violent behavior; prone to getting involved in fights reducing offending and other
 Inability to tolerate boredom antisocial behaviour.
 Disregard for safety

5. Histrionic personality disorder (HPD)  Manipulative  Family therapy

is defined by the American Psychiatric  Medications
Association as a personality disorder  Person is uncomfortable in situations in which he or she is not the center of attention;  Alternative therapies
characterized by a pattern of excessive  interaction with others is often characterized by inappropriate sexually seductive or  Flushing
emotionality and attention-seeking, provocative behavior;
including an excessive need for approval  displays rapidly shifting and shallow expression of emotions;
and inappropriate seductiveness, usually  consistently uses physical appearance to draw attention to self;
beginning in early adulthood. These  has a style of speech that is excessively impressionistic and lacking in detail;
individuals are lively, dramatic,  shows self-dramatization, theatricality, and exaggerated expression of emotion;
enthusiastic, and flirtatious.  is suggestible, i.e., easily influenced by others or circumstances;
 considers relationships to be more intimate than they actually are.
They may be inappropriately sexually
provocative, express strong emotions with Additional symptoms include:
an impressionistic style, and be easily
influenced by others. Associated features  Exhibitionist behavior.
may include egocentrism, self-indulgence,  Constant seeking of reassurance or approval.
continuous longing for appreciation,  Excessive dramatics with exaggerated displays of emotions.
feelings that are easily hurt, and persistent  Excessive sensitivity to criticism or disapproval.
manipulative behavior to achieve their  Inappropriately seductive appearance or behavior.
own needs.  Excessive concern with physical appearance.
 Somatic symptoms, and using these symptoms as a means of garnering attention.
 A need to be the center of attention.
 Low tolerance for frustration or delayed gratification.
 Rapidly shifting emotional states that may appear superficial or exaggerated to others.
 Tendency to believe that relationships are more intimate than they actually are.
 Making rash decisions.

6. Narcissistic personality disorder  Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, Most psychiatrists and
(NPD) is a personality disorder defined by expects to be recognized as superior without commensurate achievements) psychologists regard NPD as a
the Diagnostic and Statistical Manual of  Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love relatively stable condition when
Mental Disorders, the diagnostic  Believes that he or she is "special" and unique and can only be understood by, or should experienced as a primary
classification system used in the United associate with, other special or high-status people (or institutions). disorder.
States, as "a pervasive pattern of  Rarely acknowledges mistakes and/or imperfections  Schema Therapy
grandiosity, need for admiration, and a  Requires excessive admiration  psychodynamic
lack of empathy."[1]  Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment  Cognitive
or automatic compliance with his or her expectations  behavioral
The narcissist is described as being  Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
excessively preoccupied with issues of  Lacks empathy: is unwilling or unable to recognize or identify with the feelings and needs
personal adequacy, power, and prestige.[2] of others.
Narcissistic personality disorder is closely  Is often envious of others or believes that others are envious of him or her
linked to self-centeredness.  Shows arrogant, haughty behaviors or attitude.

Lifetime prevalence is estimated at 1% in

the general population and 2% to 16% in
clinical populations
7. Avoidant personality disorder  Hypersensitivity to criticism or rejection Treatment of AvPD can employ
(AvPD) (or anxious personality  Self-imposed social isolation various techniques, such as social
disorder) is a personality disorder  Extreme shyness or social anxiety in social situations, though feels a strong desire for close skills training, cognitive therapy,
recognized in the DSM-IV TR handbook relationships exposure treatment to gradually
in a person over the age of eighteen years  Avoids physical contact because it has been associated with an unpleasant or painful increase social contacts, group
as characterized by a pervasive pattern of stimulus therapy for practising social
social inhibition, feelings of inadequacy,  Avoids interpersonal relationships skills, and sometimes drug
extreme sensitivity to negative evaluation,  Feelings of inadequacy therapy.[12] A key issue in
and avoidance of social interaction.  Severe low self-esteem treatment is gaining and keeping
 Self-loathing the patient's trust, since people
People with AvPD often consider  Mistrust of others with AvPD will often start to
themselves to be socially inept or  Emotional distancing related to intimacy avoid treatment sessions if they
personally unappealing, and avoid social  Highly self-conscious distrust the therapist or fear
interaction for fear of being ridiculed,  Self-critical about their problems relating to others rejection. The primary purpose of
humiliated, rejected, or disliked.  Problems in occupational functioning both individual therapy and social
 Lonely self-perception, although others may find the relationship with them meaningful skills group training is for
AvPD is usually first noticed in early  Feeling inferior to others individuals with AvPD to begin
adulthood, and is associated with  In some more extreme cases — Agoraphobia challenging their exaggeratedly
perceived or actual rejection by parents or  Utilizes fantasy as a form of escapism and to interrupt painful thoughts negative beliefs about themselves
peers during childhood.

8. Dependent personality disorder It is characterized by at least 3 of the following: Group psychotherapy

(DPD), formerly known as asthenic
personality disorder, is a personality 1. encouraging or allowing others to make most of one's important life decisions;
disorder that is characterized by a 2. subordination of one's own needs to those of others on whom one is dependent, and undue
pervasive psychological dependence on compliance with their wishes; Biological therapies
other people. 3. unwillingness to make even reasonable demands on the people one depends on;
4. feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to Residential and day treatment
The difference between a 'dependent care for oneself; therapies
personality' and a 'dependent personality 5. preoccupation with fears of being abandoned by a person with whom one has a close
disorder' is somewhat subjective, which relationship, and of being left to care for oneself;
makes diagnosis sensitive to cultural 6. limited capacity to make everyday decisions without an excessive amount of advice and
influences such as gender role reassurance from others.
expectations.
Associated features may include perceiving oneself as helpless, incompetent, and lacking
Dependent personality disorder occurs in stamina.
about 0.5% of the general population. It is Includes:
more frequent in females.
 asthenic, inadequate, passive, and self-defeating personality (disorder)

9. Obsessive–compulsive personality A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and Treatment for OCPD normally
disorder (OCPD) is a personality interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by involves psychotherapy and self-
disorder which involves an obsession with early adulthood and present in a variety of contexts, as indicated by four (or more) of the help. Medication in isolation is
perfection, rules, and organization. People following: generally not indicated for this
with OCPD may feel anxious when they personality disorder, but
perceive that things are not right. This can 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the fluoxetine has been prescribed
lead to routines and rules for ways of extent that the major point of the activity is lost with success. Anti-anxiety
doing things, whether for themselves or 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete medication may reduce feelings
their families. a project because his or her own overly strict standards are not met) of fear while SSRIs (anti-
3. Is excessively devoted to work and productivity to the exclusion of leisure activities depressants) can ease frustration,
and friendships (not accounted for by obvious economic necessity) reducing stubbornness and
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or negative rumination. A mild
values (not accounted for by cultural or religious identification) tranquilizer can reduce alcohol
5. Is unable to discard worn-out or worthless objects even when they have no dependence, if present. Attention
sentimental value Deficit Disorder medication can
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his improve task completion by
or her way of doing things improving mental focus, which
7. Adopts a miserly spending style toward both self and others; money is viewed as will provide visible success and
something to be hoarded for future catastrophes improve outlook for recovery.
8. Shows rigidity and stubbornness Caffeine sensitivity may be an
 exacerbating factor.

10. Schizoid personality disorder (SPD) A. A pervasive pattern of detachment from social relationships and a restricted range of Since schizoid traits are very
is a personality disorder characterized by expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen similar to negative schizophrenic
a lack of interest in social relationships, a or older) and present in a variety of contexts, as indicated by four (or more) of the symptoms, atypical
tendency towards a solitary lifestyle, following: antipsychotics may have efficacy
secretiveness, and emotional coldness. in alleviating them
There is increased prevalence of the 1. neither desires nor enjoys close relationships, including being part of a family
disorder in families with schizophrenia. 2. almost always chooses solitary activities
SPD is not the same as schizophrenia, 3. has little, if any, interest in having sexual experiences with another person
although they share some similar 4. takes pleasure in few, if any, activities
characteristics such as detachment or 5. lacks close friends or confidants other than first-degree relatives
blunted affect. 6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affect
SPD is rare compared with other
personality disorders. Its prevalence is B. Does not occur exclusively during the course of schizophrenia, a mood disorder with
estimated at less than 1% of the general psychotic features, another psychotic disorder, or a pervasive developmental disorder and is
population not due to the direct physiological effects of a general medical condition.

Clinical Features of Schizoid Personality Disorder[18]

Features
Area
Overt Covert

 compliant  cynical
 stoic  inauthentic
 noncompetitive  depersonalized
Self-Concept  self-sufficient  alternately feeling empty, robot-like,
 lacking assertiveness and full of omnipotent, vengeful
 feeling inferior and an fantasies
outsider in life  hidden grandiosity

Interpersonal  withdrawn  exquisitely sensitive

Relations  aloof  deeply curious about others
 have few close friends  hungry for love
 impervious to others'  envious of others' spontaneity
  intensely needy of involvement with
emotions others
 afraid of intimacy  capable of excitement with carefully
selected intimates

 prefer solitary occupational  lack clarity of goals

and recreational activities  weak ethnic affiliation
 marginal or eclectically  usually capable of steady work
Social sociable in groups  sometimes quite creative and may
Adaptation  vulnerable to esoteric make unique and original
movements owing to a strong contributions
need to belong  capable of passionate endurance in
 tend to be lazy and indolent certain spheres of interest

 asexual, sometimes celibate  secret voyeuristic interests

Love and  free of romantic interests  vulnerable to erotomania
Sexuality  averse to sexual gossip and  tendency towards compulsive
innuendo perversions

 idiosyncratic moral and

Ethics,  moral unevenness
political beliefs
 occasionally strikingly amoral and
Standards, and  tendency towards spiritual,
vulnerable to odd crimes, at other
Ideals mystical and para-
times altruistically self sacrificing
psychological interests

 absent-minded
 autistic thinking
 engrossed in fantasy
 fluctuations between sharp contact
 vague and stilted speech
Cognitive Style with external reality and
 alternations between
hyperreflectiveness about the self
eloquence and
 autocentric use of language.
inarticulateness

11. Passive–aggressive behavior, a  Ambiguity or speaking cryptically: a means of engendering a feeling of insecurity in others Psychodynamic
personality trait, is passive, sometimes  Chronically being late and forgetting things: another way to exert control or to punish.
obstructionist resistance to following  Fear of competition Supportive
through with expectations in interpersonal  Fear of dependency
or occupational situations. It is a  Fear of intimacy as a means to act out anger: The passive aggressive often cannot trust. Cognitive
personality trait marked by a pervasive Because of this, they guard themselves against becoming intimately attached to someone.
pattern of negative attitudes and passive,  Making chaotic situations Behavioral
usually disavowed resistance in  Making excuses for non-performance in work teams
interpersonal or occupational situations.  Obstructionism Interpersonal Therapeutic
 Procrastination Methods
It can manifest itself as learned  Sulking
helplessness, procrastination,  Victimization response: instead of recognizing one's own weaknesses, tendency to blame These methods apply to both the
stubbornness, resentment, sullenness, or others for own failures. passive aggressive person and
deliberate/repeated failure to accomplish their target victim.
requested tasks for which one is (often
explicitly) responsible

References:
1. http://psychcentral.com/lib/2007/symptoms-of-borderline-personality-disorder/;
2. http://psychcentral.com/lib/2007/an-overview-of-dialectical-behavior-therapy/;
3. : http://en.wikipedia.org/wiki/Paranoid_personality_disorder;
4. http://en.wikipedia.org/wiki/Schizotypal_personality_disorder;
5. http://www.streetdirectory.com/travel_guide/111458/psychology/schizotypal_personality_disorder_causes_symptoms_treatment.html;
6. http://en.wikipedia.org/wiki/Antisocial_personality_disorder;
7. http://www.nccmh.org.uk/downloads/ASPD/CG77NICEGuideline.pdf;
8. http://en.wikipedia.org/wiki/Histrionic_personality_disorder;
9. http://en.wikipedia.org/wiki/Narcissistic_personality_disorder;
10. http://en.wikipedia.org/wiki/Avoidant_personality_disorder;
11. http://en.wikipedia.org/wiki/Dependent_personality_disorder;
12. http://en.wikipedia.org/wiki/Obssesive_compulsive_personality_disorder;
13. http://en.wikipedia.org/wiki/Passive-aggressive_personality_disorder;
14. http://en.wikipedia.org/wiki/Schizoid_personality_disorder