Understanding PERSONALITY
Disorder
Dr Ivona Amlehpsychiatrist
Lat. Persona - mask
The First Classification of Personalities
Hippocrates (ca.460 – 370 BC)
Four temperaments
Phlegmatic Choleric
Sanguine Melancholic
Definition of PersonalityTotality of emotional and behavioural traits that
characterize the person in everyday living under ordinary conditions
والسلوكيه العاطفية الميزات التي مجمل وهيالحياة في العادية الظروف تحت الشخص تميز
اليومية Traits – enduring patterns of perceiving, relating to
and thinking about environment and oneselfالشخصية من - ميزات المالحظة نماذج
المحيطة البيئة حول والتفكير واالرتباطوالذات
Traits / Classification
• C. G. Jung (1921) extroversion / introversion
• K. Schneider (1923) “abnormal personalities are those who suffer
or make others suffer” – “psychopaths”
“The Big Five Factors” Model
• Costa & McRea’s (1992) descriptive and comprehensive structure behind all personality traits:
OPENNESS (curiosity, liking variety) CONSCIENTIOUSNESS (discipline, achievements) EXTRAVERSION (assertiveness, talkativeness) AGREEABLENESS (helpfulness, cooperation) NEUROTICISM (anxiety, impulsivity)
Where is the dividing line between ‘NORMAL’ personality / Personality PROBLEM /
Personality DISORDER?
Definition of Personality Disorder• Enduring behavioural patterns manifested as
inflexible, maladaptive responses in personal and social situations
الدائمة • السلوكية االستجابات انماط تتسم التيمتكيفه وغير مرنة األوضاع غير مختلف في
واالجتماعية الشخصية• Significant deviations from the average in a given
culture• Associated with subjective distress and problems
in social functioning• Recognisable from early adulthood
Are PDs Illnesses or Not?
• Barely fit to medical concept of disease: - almost impossible to define - may have no actual symptoms - unknown cause - lacking specific treatment• But, impossible to ignore, can cause a lot of
damage, elevated morbidity/mortality
Etiology
heredity / physiology
psychological factors
interpersonal factors
Classification of Personality Disorders
Paranoid Schizoid
Schizotypal
NarcissisticHistrionicBorderlineAntisocial
Obsessive-CompulsiveAvoidant
DependentPassive-Aggressive
Paranoid PD
• Distrustful• See enemies everywhere• Live lonely, tortured lives• Outbursts of rage• Project their malevolence to others
maintaining thereby their self-esteem• May decompensate into delusion or
depression
Schizoid PD
• A quiet loner• Aloof and distant• Loving relationships neither felt nor sought• No fear of rejection, because no desire for
acceptance• Like reading (may like religion, science,
philosophy…), solitary activities• Well preserved reality testing
Schizotypal PD
• Seem to lack a core• Vivid fantasy, vague speech• They sense ghostlike presences,
magic influences, telepathy • Withdrawn, but have some relatedness• Rejection sensitive• May develop micro-psychotic episodes
Narcissistic PD
The stable variant:• Feel superior, enjoy themselves• Not seeing the needs of others• Spoiled upbringing, sharing was not common• Difficult to get along with• If rejected in something important to them,
may become depressed
Narcissistic PD
The unstable variant:• The mask of narcissism• Life is a constant threat• Easily wounded and enraged or sad• May have reasonably good impulse control in
public or on the job, keeping more primitive qualities in specific relationships
Histrionic PD
• Demand central stage• Feel little responsibility• The past is a collection of images• Life is exciting for them, a long string of over-
reactions, tantrums and lost loves• Behind is a painfully fragile self-esteem• Their tragedy: adults are not made to live as
children
Borderline PD
• Feeling of emptiness• Fear of abandonment• Unstable relationships• Impulsivity and self-harm• Affective instability and aggression• Face a harsh world over which they have no
control, vulnerability for addiction• Develop depression and micro-psychosis
Antisocial PD
• Charming or nasty• No responsibility, no anxiety• Playing games in which others exist as pieces
to be manipulated and utilized• At their worst – cruel, sadistic and violent• Their amoral behaviour at least in a part a
reflection of defenses to some intense pain
Obsessive-Compulsive PD
• Hard on themselves• Any failure – the ultimate one• Love and resent their work• Must prove themselves worthy of being loved• Appear serious, cool and distant• Even free-time has to be well spent• Angry if someone is disrespectful for rules• May develop depression
Avoidant PD
• Extremely low self-esteem• Desperate hope for affection• Do not dare to approach others• Unsure of their identity and self worth,
sometimes denigrating and self-ridicule• Frequently appear aloof and cool, living a
lonely, painful and introspective existence
Dependent PD
• Craving for safety• Extremely rejection sensitive• View themselves as weak and ineffectual, do
not want to make any decision• Their unfortunate answer to insecurity is the
safety of slavery• May develop depression
Passive-Aggressive PD
• Negativistic or late• Perplexing ambivalence• Intentionally ineffective• Fearing rejection, they attack by passive
means• The result is world lived through the eyes of
someone bitterly resigned to sitting on the bench
Signal Behaviours
Complaints about clinician or the system
Antisocial Paranoid
Borderline Narcissistic
Passive-Aggressive
Signal Behaviours
Flirtatious behaviour
Antisocial Narcissistic
Histrionic
Signal Behaviours
Dramatic behaviour or dress
Histrionic Borderline
Signal Behaviours
Helpless and child-like
Dependent Histrionic
Borderline
Signal Behaviours
Manipulative
Antisocial Narcissistic
Borderline Histrionic
Passive-Aggressive