Upasana Baruah

Ph.D. Scholar
Dept. of Psychiatric Social Work
Personality specific character traits-
temperament, emotional reactivity, fairness,
interpersonal relations establishment, needs,
expectations, stinginess, generosity,
arrogance, independence and others.
Formed by early adulthood, persist
throughout life.
Gordon Allport defined personality as the
dynamic organization within the individual
of those psychophysical systems that
determine his/her unique adjustment to
his/her environment.
Personality- is formed and exists in
interaction between hereditary factors and
large psychosocial contact
Hereditary factors seem to be basic to
establish the type of personality
Various influences in ontogenetical
expierience can modify it.
Its prevalence is estimated between 10 and
20 percent in the general population
Personality disorders
Personality disorder- when personality
traits are rigid and self-defeating, they may
interfere with functioning and even lead to
psychiatric symptoms
cause more or less suffering of patient or
other persons or both and lead to social
maladaptation (relations, family, work...)
such personality seems to be disbalanced,
whithout harmonical coordination of
behaviour
Definition of Personality Disorder
Personality disorders are enduring
patterns of perceiving, relating to, and
thinking about the environment and
oneself that are exhibited in a wide
range of important social and personal
contexts, and are inflexible and
maladaptive, and cause either significant
functional impairment or subjective
distress (DSM-IV)
Psychiatric comorbidity
About one half of all psychiatric patients
have personality disorder, frequently
comorbid with other diagnosis
Personality factors interfere with the
response to treatment and increase
personal incapacitation, morbidity, and
mortality of these patients
Personality disorders are also a
predisposing factor for many other
psychiatric diseases, including substance
use disorders, suicide, mood disorders,
impulse-control disorders, eating
disorders, and anxiety disorders.

Classifications

ICD-10 (F60 Specific P.D.)- WHO
DSM-IV TR (Diagnostical and statistical
manual) -American Psychiatric
Association
both are similar with some differences
General diagnostic criteria- ICD-10
Conditions not directly attributable to gross
brain damage or disease, or to another
psychiatric disorder, meeting the following
criteria:
(a)markedly disharmonious attitudes and
behaviour, involving usually several areas of
functioning, e.g. affectivity, arousal, impulse
control, ways of perceiving and thinking, and
style of relating to others;
(b)the abnormal behaviour pattern is enduring,
of long standing, and not limited to episodes of
mental illness;
(c)the abnormal behaviour pattern is
pervasive and clearly maladaptive to a
broad range of personal and social
situations;
(d)the above manifestations always appear
during childhood or adolescence and
continue into adulthood;
(e)the disorder leads to considerable
personal distress but this may only become
apparent late in its course;
(f)the disorder is usually, but not invariably,
associated with significant problems in
occupational and social performance.
ICD 10 Classification
F 60 -Specific personality disorders:
Paranoid P.D.
Schizoid P.D.
Dissocial P.D.
Emotionally unstable P.D.
Histrionic P.D.
Anancastic P.D.
Anxious (avoidant) P.D.
F 61 Mixed and Other P.D.

Paranoid personality disorder
(1) excessive sensitivity to setbacks and
rebuffs
(2) tendency to bear grudges persistently
(3) suspiciousness, tendency to distort
experience by misconstruing the neutral or
friendly actions as hostile
(4) situation inadeqate sense of personal
rights
(5) recurrent suspicions regarding sexual
fidelity of sexual partner
(6) self-referential attitude, associated
particularly with excessive self-importance
(7) "conspiratorial" explanations
Schizoid personality disorder
(1) few, if any, activities provide pleasure
(2) emotional coldness or flattened affectivity
(3) limited capacity to express feelings
(4) an appearance of indifference to valuation
(5) little sexual interest with another person
(6) consistent choice of solitary activities
(7) preoccupation with fantasy and
introspection
(8) low or no need of any confiding relationships
(9) insensitivity to social norms and conventions
Dissocial personality disorder
(1) callous unconcern for the feelings of others
(2) attitude of irresponsibility and disregard for
social norms, rules, obligations
(3) incapacity to maintain enduring
relationships, no difficulty in establishing them
(4) very low tolerance to frustration and a low
threshold for aggression
(5) incapacity to experience guilt or to profit
from adverse experience
(6) proneness to blame others or to plausible
rationalizations for the conflict behavior
Emotionally unstable personality disorder
Impulsive type
(1) tendency to act unexpectedly without
consideration of the consequences
(2) marked tendency to quarrelsome
behavior and to conflicts with others
(3) liability to outbursts of anger or violence,
with inability to control the behavioral
explosions
(4) difficulty in maintaining any course of
action that offers no immediate reward
(5) unstable and capricious mood

Emotionally unstable personality disorder
Borderline type
At least three of the symptoms mentioned in
criterion for impulsive type, and:
(1) disturbances in and uncertainty about
self-image, aims, and internal preferences
(2) liability to become involved in intense
and unstable relationships, often leading to
emotional crises
(3) excessive efforts to avoid abandonment
(4) recurrent threats or acts of self-harm
(5) chronic feelings of emptiness
Histrionic personality disorder
(1) self-dramatization, theatricality, or
exaggerated expression of emotions
(2) suggestibility
(3) shallow and labile affectivity
(4) continual seeking for excitement and
activities in which is the center of attention
(5) seductiveness in appearance or behavior
(6) overconcern with physical attractiveness
Egocentricity, continuous longing for
appreciation, lack of consideration for others,
and persistent manipulative behavior complete
the clinical picture, but are not required for the
diagnosis.

Anankastic personality disorder
(1) feelings of excessive doubt and caution
(2) preoccupation with details, rules, order,
organization, or schedule
(3) perfectionism that interferes with task
completion
(4) conscientiousness and scrupulousness
(5) undue preoccupation with productivity to the
exclusion of pleasure and relationships
(6) pedantry and adherence to conventions
(7) rigidity
(8) unreasonable insistence that others submit to
exactly way of doing things, or unreasonable
reluctance to way of doing of them
Anxious (avoidant) personality disorder
(1) persistent feelings of tension and
apprehension
(2) belief that one is socially inept, personally
unappealing, or inferior to others
(3) excessive preoccupation with being
criticized or rejected in social situations
(4) unwillingness to become involved with
people unless certain of being liked
(5) restrictions in lifestyle because of need for
physical security
(6) avoidance of social or occupational
activities that involve significant interpersonal
contact, because of fear of criticism,
disapproval, or rejection.

Dependent personality disorder
(1) encouraging or allowing others to make the most
of one's important life decisions
(2) subordination of own needs to others on whom is
dependent, and compliance with their wishes
(3) unwillingness to make reasonable demands on the
people one depends on
(4) feeling uncomfortable or helpless when alone,
because of exaggerated fears of inability to care for
oneself
(5) preoccupation with fears of being left to care for
oneself
(6) limited capacity to make everyday decisions
without an advice and reassurance from others
Mixed and other personality
disorders(F61)
Features of several of the specific
personality disorders are present
but not to the extent that the criteria
for any of the specified personality
disorders in that category are met.
DSM-IV-TR
According to DSM-IV-TR, the critical criterion
for distinguishing deviant personality traits is
the presence (evidence) of long-term
maladaptation and inflexibility that are
manifested as subjective distress or socio-
occupational functional impairment, or both.


DSM-IV-TR defines personality disorders as:
An enduring pattern of inner experience and
behavior that deviates markedly from the
expectations of the individual's culture. The
pattern is manifested in two (or more) of the
following areas:
cognition (i.e., ways of perceiving and
interpreting self, other people, and events)
affectivity (i.e., the range, intensity, lability
and appropriateness of emotional response)
interpersonal functioning
impulse control
DSM-IV TR
Personality disorder subtypes classified in
DSM-IV-TR are:
schizotypal, schizoid, and paranoid (Cluster
A)
narcissistic, borderline, antisocial, and
histrionic (Cluster B)
obsessive-compulsive, dependent, and
avoidant (Cluster C).
In addition to these ten standard disorders,
the DSM-IV-TR classifies two disorders,
passive-aggressive and depressive, among
criteria sets and axes
Some clinical features:
Cluster A includes three disorders with
odd, aloof features, such as paranoid,
schizoid, and schizotypal.
Cluster B includes four disorders with
dramatic, impulsive, and erratic features,
such as borderline, antisocial, narcissistic,
and histrionic.
Cluster C includes three disorders sharing
anxious and fearful features, such as
avoidant, dependent, and obsessive-
compulsive.

Assessment
Structured personality disorder assessment
instruments
Structured categorical (diagnostic) assessments
Observer-rated structured interview
International Personality Disorder Examination
(Loranger 1994)
Diagnostic Interview for DSMIV Personality
Disorders (Zanarini 1996)
Structured Interview for DSMIV Personality
Disorders (Pfohl 1997)
Structured Clinical Interview for DSMIV Axis I
Disorders (First 1997)
Personality Disorder InterviewIV (Widiger 1995)

Self-rated questionnaire
Personality Diagnostic Questionnaire (Hyler
1994)
Structured interview other sources
Standardised Assessment of Personality (Mann
1981)
Personality Assessment Schedule (Tyrer 1979)
Structured dimensional assessments
Observer-rated structured interview
Schedule for Normal and Abnormal Personality
(Clark 1990)

Self-rated questionnaire
Personality Assessment Inventory (Morey 1991)
Minnesota Multiphasic Personality InventoryII
(Butcher 1989)
Millon Clinical Multiaxial InventoryIII (Millon 1997)
Eysenck Inventory Questionnaire (Eysenck 1975)
NEO Five-Factor Inventory (McCrae 1992)
Unstructured assessments
Interview based
Clinical interview
Psychodynamic formulation
Other
Rorschach test (Rorschach 1964)
Thematic Apperception Test (Morgan 1935)
Complications
Secondary mental illnesses (depression,
drug or alcohol abuse or addiction,
eating disorders, impulse-control
disorders, anxiety disorders, short
psychosis)
Suicidal behavior
Acts of self-harm
Violence and crimminal behaviour
Risk behaviour (sexualy transmitted
infections, drug application...)

Treatment
Motivation to the therapy, compliance
and efficiency is different from case to
case.
Psychotherapy
Pharmacotherapy -in some cases,
symptomatic
few controled studies of efficiency
difficult but helpful

Psychotherapy
The choice of the type of psychotherapy
depends on specific type of P.D. and other
factors as motivation to therapy, intelectual
state, ego-syntonicity or dystonicity, age and
another.
The goals are to examine and improve
perceptions and responses in various
situations.
Therapies can include psychodynamic
psychotherapy, cognitivebehavioral therapy,
group therapy, and interpersonal therapy.

Pharmacotherapy
symptomatic, follows symptoms
target: permanent symptoms (long-term)
or actual state (acute anxiety, disquiet,
suicidal beh., agitation, emotional
crises...)





References:
Waldinger RJ.: Psychiatry for medical students,
Washington, DC : American Psychaitric Press, 1997
Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and Sadocks
synopsis of psychiatry, Baltimore: Williams and
Wilkins, 1997
Sadock, Benjamin J.; Sadock, Virginia A. Editors.
Kaplan & Sadock's Comprehensive Textbook of
Psychiatry, 8th Edition (VolumeII). Lippincott Williams
& Wilkins; 2005.
American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders. 4th ed. Text rev.
Washington, DC: American Psychiatric Association;
2000.
Allport G. Personality: A Psychological Interpretation.
London: Constable; 1937