Personality traits and disorders

Personality: Personality is the dynamic organization within the

individual of those psychosocial systems that determine his
unique adjustments to his environment.
Personality is the combination of thoughts, emotions and
behaviors that makes you unique. It's the way you view,
understand and relate to the outside world, as well as how you
see yourself. Personality forms during childhood, shaped
through an interaction of two factors:
Inherited tendencies, or your genes.
Environment, or your life situations.
 Personality trait:
Personality traits are conspicuous features
of personality and are not necessarily
pathological, although certain styles of
personality traits may cause interpersonal
problems.
 Five factor model of personality:
Most widely accepted model of classifying personality
traits,
The Big Five personality traits are:

Openness refers to traits, such as how inclined

someone is to conform to societal or cultural norms,
how concretely or abstractly someone thinks about
things, and how open or resistant someone is to
change. A person who is a creative thinker and always
looking for ways to do things better would likely score
high on measures of openness.
Conscientiousness has to do with a person's degree of
organization, level of discipline, and how prone he or
she is to taking risks.

 Extraversion is a personality characteristic that describes

things like how social a person is or how warm and loving
they tend to be. Extraverts are people who would typically
prefer to go out to a party with lots of friends, as opposed to
stay in and watch a movie with one or two friends.
Agreeableness takes into account how kind, dependable, and
cooperative a person is. People who score high on scales of
agreeableness are typically more interested in doing things
for the common good, as opposed to fulfilling their own self-
interests.
Neuroticism is a personality characteristic that describes how
nervous or anxious a person tends to be, as well as the
degree of self-confidence and self-contentment he or she
possesses. They tend to be worrisome and preoccupied with
things that might not be with in their control.
 Sample Descriptors of the Big Five
Agreeableness vs. Hostility: helpful, warm, caring,
softhearted, sympathetic, hostile (-), unfriendly (-)
Conscientiousness vs. Impulsivity: organized,
responsible, hardworking, thorough, careless (-),
unreliable (-), impulsive (-)
Emotional Stability vs. Neuroticism: calm, cool,
collected, moody (-), worrying (-), nervous (-),
Extraversion vs. Introversion: outgoing, friendly,
lively, active, talkative, shy (-), reserved (-)
Openness vs. Closedness: creative, imaginative,
intelligent, curious, broad-minded, sophisticated,
adventurous, closed-minded (-), unintellectual (-)
 Several studies have documented that higher
neuroticism, lower agreeableness, lower
conscientiousness are related to alcohol abuse and
dependence.
Neuroticism is also associated with greater negative
consequences from drinking.
 Personality disorder is defined as
is an enduring pattern of inner experience and
behavior that differs markedly from the
expectations of the individual's culture, is
pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over
time, and leads to distress or impairment.
 Overview of clusters
Cluster A: odd or eccentric behavior or bizarre
thinking, including: paranoid, schizoid, schizotypal
personality disorders.
Cluster B: dramatic or emotional behaviors,
including: antisocial, borderline, histrionic,
narcissistic personality disorders .
Cluster C: anxious or fearful behaviors, including:
avoidant, dependant, obsessive compulsive
personality disorders.
 Prevalence
Personality disorders are common and chronic. They occur in 10-20 % of
general population.
Approximately 50 % of all psychiatric patients have a personality disorder.
Individuals may have more than one personality disorder.
Personality disorder is also a predisposing factor for other psychiatric
disorders like substance use, suicide, eating disorders, impulse control
disorders.
The following are prevalences for specific personality disorders in the
general population:
Paranoid personality disorder : 0.5-2.5%
Schizoid personality disorder : 3%
Schizotypal personality disorder: 3%
Antisocial personality disorder : 2-3%
Borderline personality disorder :2-3%
Histrionic personality disorder : 2-3%
Narcissistic personality disorder : 1%
Avoidant personality disorder : 0.5-1%
Dependent personality disorder: 1.5%
Obsessive-compulsive personality disorder:1.5%
 Prevalence of PD in alcohol use disorders:
In most of the studies Cluster B PDs are especially
prevalent and showed significantly higher levels of
impulsivity at intake. Subjects with Cluster B PD
showed significantly poorer course in early alcohol
treatment.
Some studies are stating that cluster c personality
disorders are as prevalent as cluster B PD.
The variation of prevalence rates and type of
personality disorders in alcohol-dependent
individuals can be accounted for by a number of
reasons, which can be classified as either sampling
factors, diagnostic criteria applied or assessment
procedures used.
 Epidemiological facts
Race: No differences in prevalence across the races have been noted.

Sex
Cluster A: Schizoid personality disorder is slightly more common in males
than in females.
Cluster B: Antisocial personality disorder is 3 times more prevalent in men
than in women. Borderline personality disorder is 3 times more common in
women than in men. Of patients with narcissistic personality disorder, 50-
75% are male.
Cluster C: Obsessive-compulsive personality disorder is diagnosed twice as
often in men than in women.

Age: Personality disorders generally should not be diagnosed in children and

adolescents because personality development is not complete and
symptomatic traits may not persist into adulthood. Therefore, the rule of
thumb is that personality diagnosis cannot be made until the person is at
least 18 years of age.
 Risk factors
Nobody, actually, knows what causes personality disorders are we
born this way or do we learn to become this way; chances are its
going to be a little bit of both.
Thus risk factors or more likely the predisposing factors to PDs
include:
Innate temperamental difficulties
Adverse environmental events
Personality disorders in parents something we learn from
parents and we watch them react to things and thats how we
become as well.
Low socioeconomic status
Verbal, physical or sexual abuse during childhood
Neglect during childhood
An unstable or chaotic family life during childhood
Being diagnosed with childhood conduct disorder
Loss of parents through death or traumatic divorce during
childhood
 Etiology
Genetics: The traits associated with personality
disorders, such as fear, anxiety or obsessive thinking,
often run in families, indicating that they may be part
of the individuals genetic makeup.
Psychological: Many PDs are associated with extreme
stress, verbal abuse, or physical abuse in childhood.
Borderline PD, obsessive-compulsive PD and paranoid
PD, for example, have been linked to psychological
distress and lack of emotional validation at a
vulnerable age. According to the American
Psychological Association, a high percentage of
individuals with borderline PD have a childhood
history of sexual abuse.
 High reactivity: Sensitivity to light, noise, texture
and other stimuli may also play a role.
Overly sensitive children, who have what researchers call
high reactivity, are more likely to develop shy, timid or
anxious personalities.
Stressful environments. While stressful situations
may not directly cause PDs, they can contribute to their
development, especially if the stress occurs in childhood.
Situations like a parents death, a divorce, an unwanted
relocation, or episodes of bullying could lead to the
evolution of a personality disorder.
 Common clinical features
General symptoms of a personality disorder
Frequent mood swings
Stormy relationships
Social isolation
Angry outbursts
Suspicion and mistrust of others
Difficulty making friends
A need for instant gratification
Poor impulse control
Alcohol or substance abuse
Paranoid personality disorder 301.0 (F60.0)

A. Pervasive distrust and suspiciousness of

others , beginning early adulthood, as indicated
by 4 or more of the following:
1. Suspects, without sufficient basis, that others
are exploiting, harming, or deceiving them.
2. Preoccupied with unjustified doubts about
the loyalty or trustworthiness of others.
3. Reluctant to confide others because of
unwarranted fear that the information will be
used against them.
 Paranoid personality disorder
4. Reads hidden demeaning or threatening
meanings into benign remarks or events.
5. Persistently bears grudges, i.e., is unforgiving of
insults, injuries, or slights.
6. Perceives attacks on their character or reputation
that are not apparent to others and is quick to react
angrily or to counterattack.
7. Has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner
 Paranoid personality disorder
B. Doesn't occur exclusively during the course of
schizophrenia, a mood disorder with psychotic
features, or another psychotic disorder and is
not due to the direct physiological effects of a
general medical condition.
 Paranoid personality disorder
Other features:
Difficult to have close relation, fear love.
They are rigid.
Less impairment in social and occupational
functioning.
Comorbid with schizotypal, borderline, and
avoidant personality disorders.
 Schizoid personality Disorder 301.20 (F60.1)

A. Pervasive pattern of detachment from social

relationships and a restricted range of expression
of emotions in interpersonal settings, beginning by
early adulthood, as indicated by 4 or more of the
following:
1. Neither desires nor enjoys close relationships,
including being part of a family.
2. Almost always chooses solitary activities that dont
include interaction with others (mechanical:
computer or abstract thinking: math games.
 Schizoid personality Disorder
B. Does not occur during the course
of schizophrenia, mood disorder with Psychotic
Features, another Psychotic Disorder and is not due
to the direct physiological effects of a general
medical condition.

Other information:
M more than F
Uncommon in clinical setting, long lasting
disorders, have successful work history.
 Schizotypal personality disorder(301.22, (F21)

Perception, thinking and communication are disturbed.

A. Pervasive pattern of social and interpersonal deficits

marked by acute discomfort with, and reduced capacity for,
close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, beginning by early
adulthood and, as indicated by 5 or more of the following:

1. ideas of reference: incorrect interpretation of events as

having unusual meaning (excluding delusions of reference).
2. odd beliefs or magical thinking that influences behavior and
is inconsistent with subcultural norms (special powers to
sense events before they happen or read others thoughts).
 Schizotypal personality disorder
3. Unusual perceptual experiences, including bodily
illusions.
4. Odd thinking and speech.
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or
peculiar .
8. Lack of close friends or confidants other than
first-degree relatives .
9. Excessive social anxiety that does not diminish
with familiarity and tends to be associated with
paranoid fears.
 Schizotypal personality disorder
B. Does not occur during the course
of schizophrenia, mood disorders with psychotic
features, another Psychotic Disorder, or
a pervasive developmental disorder.
 Schizotypal personality disorder
Other information:
Seek treatment for depression, anxiety and
another symptoms rather than for personality
disorder.
Antisocial personality disorder(301.7)(F60.2)

A. Pervasive pattern of disregard for and

violation of the rights of others occurring since
age 15 years, as indicated by 3or more of the
following:
1. Failure to conform to social norms with
respect to lawful behaviors.
2. Deceitfulness (repeated lying) .
3. Impulsivity or failure to plan ahead (take
decisions without thinking about
consequences).
 Antisocial personality disorder
4. Irritability and aggressiveness, as indicated by
repeated physical fights or assaults.
5. Reckless disregard for safety of self or others
(driving, accidents).
6. Consistent irresponsibility (repeated failure to
sustain consistent work behavior or honor
financial obligations).
7. Lack of remorse (being indifferent to or
rationalizing having hurt, mistreated, or stolen
from another).
 Antisocial personality disorder
B. The individual is at least age 18 years.

C. There is evidence of conduct disorder with

onset before age 15 years.

D. The occurrence of antisocial behavior is not

during the course of schizophrenia or a manic
episode.
 Antisocial personality disorder
Other information:
It occurs in low socioeconomic class and urban
settings.
M>F
It is chronic disorder and becomes less evident
as individual grows older.
Borderline personality disorder 301.83 (F60.3)

Pervasive pattern of instability of interpersonal

relationships, self-image, affects, and marked
impulsivity beginning by early adulthood as
indicated by 5 or more of the following:
1. Frantic efforts to avoid real or imagined
abandonment (panic if somebody important come
late or cancel an apointment) because it implies
they are bad or intolerance of being alone.
2.Unstable and intense interpersonal relationships
(extremes of idealization and devaluation).
 Borderline personality disorder
3. Identity disturbance, unstable self-image or
sense of self .
4. Impulsivity in at least two areas that are
potentially self-damaging (e.g., spending,
sex, Substance Abuse, reckless driving, binge
eating).
5. Recurrent suicidal behavior, gestures, or threats,
or self-mutilating behavior
6. Affective instability .
7. Chronic feelings of emptiness .
 Borderline personality disorder
8. Inappropriate, intense anger or difficulty
controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical
fights)
9. Transient, stress-related paranoid ideation or
severe dissociative symptoms
(depersonalization) which last for minutes or
hours (remission occurs as the caregivers return
their nurturance).
 Borderline personality disorder
Other information:
Undermining themselves at the moment his
goal is about to be realized (drop out of school
just before graduation, destroying relation
when it is clear it could last).
Develop psychotic symptoms (hallucination,
ideas of reference) during stress.
Common, very hard to treat and associated
with suicide.
Histrionic personality disorder(301.50 (F60.4)
(hysterical personality)
Pervasive pattern of excessive emotionality
and attention seeking, beginning by early
adulthood as indicated by 5 or more of the
following:
1. Uncomfortable in situations in which he or
she is not the center of attention, so they
may create scene or gift, providing new
symptoms each visit to attract attention.
2. Interaction with others by inappropriate
sexually seductive or provocative behavior .
 Histrionic personality disorder
(hysterical personality)
3. Displays rapidly shifting and shallow expression of
emotions.
4. Uses physical appearance to draw attention to
self (spend money on cloths, hair color, and grooming
or complains about photos).
5. Style of speech that is excessively impressionistic
and lacking in detail (this person is good without ability
to mention the reason).
6. Shows self-dramatization, theatricality (exaggerated
self display), and exaggerated expression of emotion
(excessive public display of emotions).
 Histrionic personality disorder
(hysterical personality)
7. Is suggestible, (easily influenced by others or
circumstances).
8. Considers relationships to be more intimate than they
actually are (calling the doctor by his/her name or use my
dear, dear friend).
Other information:
Over reaction to minor events, demanding.
They have impaired relation with the same sex.
Initiate job with great enthusiasm but their interest lag
quickly.
Ignore long relation and start new relation.
Dont exhibit feeling of emptiness, or identity diffusion.
Narcissistic personality disorder (301.81
(F60.81)
Pervasive pattern of grandiosity, need for
admiration, and lack of empathy, beginning by
early adulthood as indicated by 5 or more of
the following:
1. Has grandiose sense of self-importance (e.g.,
exaggerates achievements and talents).
2. Preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal
love .
 Narcissistic personality disorder
3. Believes that they are special and unique .
4. Requires excessive admiration .
5. Has a sense of entitlement.
6. Interpersonally exploitative.
7. Lacks empathy.
8. Often envious of others or believes that
others are envious of him or her.
9. Shows arrogant, haughty (superior) behaviors
or attitudes.
Avoidant personality disorder(301.82 )(F60.6)

Pervasive pattern of social inhibition, feelings

of inadequacy, and hypersensitivity to
negative evaluation, beginning by early
adulthood as indicated by 4 or more of the
following:
1. Avoid occupational activities that involve
significant interpersonal contact, because of
fears of criticism, disapproval, or rejection.
 Avoidant personality disorder
2. Unwilling to get involved with people unless
certain of being liked.
3. Shows restraint within intimate relationships
because of the fear of being shamed.
4. Preoccupied with being criticized or rejected
in social situations.
5. Inhibited in new interpersonal situations
because of feelings of inadequacy.
 Avoidant personality disorder
6. Views self as socially inept (having no skill),
personally unappealing, or inferior to others.
7. Reluctant to take personal risks or to engage
in any new activities because they may prove
embarrassing (cancel job interview for fear of
being embarrassed by not dressing
appropriately).
 Avoidant personality disorder
Other notes:
It is often diagnosed with dependent
personality disorders or borderline personality
disorder.
M=F
Dependent personality disorder(301.6) (F60.7)

Pervasive and excessive need to be taken care

of that leads to submissive and clinging
behavior (adhere) and fears of separation,
beginning by early adulthood and as indicated
by 5 or more of the following:
1. Has difficulty making everyday decisions
without an excessive amount of advice and
reassurance from others.
 Dependent personality disorder
2. Needs others to assume responsibility for
most major areas of his or her life.
3. Has difficulty expressing disagreement with
others because of fear of loss of support .
4. Has difficulty initiating projects or doing
things on their own .
5. Goes to excessive lengths to obtain
nurturance and support from others
(volunteering to do things that are unpleasant).
 Dependent personality disorder
6. Feels uncomfortable or helpless when alone
because of exaggerated fears of being unable to
care for themselves.
7. Urgently seeks another relationship as a
source of care and support when a close
relationship ends.
8. Unrealistically preoccupied with fears of being
left to take care of himself or herself.
Obsessive-Compulsive personality
disorder(301.4 )(F60.5)
Pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency, beginning
by early adulthood as indicated by 4 or more
of the following:
1. Preoccupied with details, rules, lists, order,
organization so that the major point of the
activity is lost and repeatedly checking for
mistakes.
 Obsessive-Compulsive
personality disorder
2. Shows perfectionism that interferes with task
completion (restrict standard so the project doesn't
finished).
3. Excessively devoted to work and productivity to
the exclusion of leisure activities and friendships.
4. Inflexible about matters of morality, ethics, or
values.
5. Unable to discard worn-out or worthless object.
 Obsessive-Compulsive
personality disorder
6. Reluctant to delegate tasks or to work with
others unless they submit to exactly his or her
way of doing things.
7. Adopts a miserly spending style toward both
self and others.
8. Shows rigidity and stubbornness.
 Obsessive-Compulsive
personality disorder
Other notes:
Time is poorly managed and leave most
important task to last moment, deadline is
missed.
 Treatment

Treatment modality will be discussed under

the following headlines:

Psychological & Social the gold standard

Biological
 Treatment Psychological & Social

Psychotherapy is at the core of care for personality disorders.

Because personality disorders produce symptoms as a
result of poor or limited coping skills, psychotherapy aims
to improve perceptions of and responses to social and
environmental stressors.
 Psychoanalytical psychotherapy:
The treatment of choice for histrionic PD has been
psychoanalytical psychotherapy.
Treatment focuses on the unconscious motivation
for seeking total satisfaction from others and for
being unable to commit oneself to a stable,
meaningful relationship.
 Cognitive behavioral therapy: (CBT):
Behavioral strategies offer reinforcement for
positive change. Social skills training and
assertiveness training teach alternative ways to deal
with frustration.
Cognitive strategies help the client recognize and
correct inaccurate internal mental schemata.
This type of therapy may be useful in OCPD,
antisocial PD, avoidant PD.
 Interpersonal psychotherapy:
Conceives of patients' difficulties resulting from a
limited range of interpersonal problems including
such issues as role definition and grief. Current
problems are interpreted narrowly through the
screen of these formulations, and solutions are
framed in interpersonal terms. Therapy is usually
weekly for a period of 6-20 sessions.
Suggested in paranoid, schizoid, schizotypal,
borderline, dependent, narcissistic, OCPD.
 Group psychotherapy allows interpersonal
psychopathology to display itself among peer
patients, whose feedback is used by the therapist to
identify and correct maladaptive ideas,
communication, and behavior. Sessions are usually
once weekly over a course that may range from
several months to years.
This therapy is more appropriate in antisocial PD.
 Dialectical behavior therapy (DBT): This is a skills-
based therapy that can be used in both individual
and group formats. It has been applied to
borderline personality disorder.
The emphasis of this is on the development of
coping skills to improve affective stability and
impulse control and on reducing self-harmful
behavior. This treatment is also being used with
other cluster B personality disorders to reduce
impulsive behavior.
 Treatment Biological
Medications are in no way curative for any personality disorder. They
should be viewed as an adjunct to psychotherapy so that the patient
may productively engage in psychotherapy.
Antipsychotics are helpful in the treatment of psychotic
decompensation experienced by patients with paranoid, schizotypal,
and borderline PD.
SSRIs and MAO Is have been successful in decreasing impulsivity and self
destructive acts in patients with BPD.
Lithium and propranolol may be useful for the violent episodes
observed in patients with antisocial PD.
Anxiolytics are useful in avoidant PD.
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 Fish psychopatholgy
Synopsis of psychiatry: Kaplan and sadock.
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