PERSONALITY

DISORDER

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 A condition comprising deeply ingrained and enduring
behaviour patterns manifesting as inflexible responses
to a broad range of personal & social situations.

 They represent significant deviation from the way the

average individual in a given culture perceives, thinks,
feels and particularly relates to others.


 Such behaviour patterns tend to be stable and are

associated with various degrees of subjective distress
and problems in social functioning and performance.
 WHO 1992.

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WHAT IS NORMALITY?
 The following represent traits that
‘normal’ people possess to a
greater degree than those
diagnosed as ‘abnormal’.

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EFFICIENT PERCEPTION
OF REALITY
 Realistic appraisal of capabilities
and what is going on around them.
They do not consistently
misperceive what others say and
do…they do not overvalue their
abilities…nor do they
underestimate their abilities and
shy away from everyday tasks.
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 SELF-KNOWLEDGE
 Well adjusted people have
awareness of their own feelings.
Although none of us can fully
understand them, most do not hide
important feelings from
themselves. They have more self-
awareness as a result.

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 ABILITY TO EXERCISE
VOLUNTARY CONTROL OVER
BEHAVIOUR

 Confidence in personal ability to

control behaviour. May act
impulsively but can restrain sexual
and aggressive urges when
necessary. May fail to conform to
social norms, but this is voluntary
rather than the result of
uncontrollable urges.
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 SELF-ESTEEM &
ACCEPTANCE
 Appreciation of self-worth and
acceptance by those around.
Comfortable with others and able
to react spontaneously in social
situations. Don’t feel obligated to
subjugate their opinions to those of
a group.

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 ABILITY TO FORM
AFFECTIONATE
RELATIONSHIPS
 Formation of close & satisfying
relationships with others.
Sensitive to the feelings of others,
and do not make excessive
demands to gratify their own
needs. Ability to reciprocate
affection and don’t fear intimacy.

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 PRODUCTIVITY
 Ability to channel their abilities
into productive activity. Have
enthusiasm for life.

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 WHERE THEY FIT INTO
PSYCHIATRY?
 An axis 1 disorder refers to the
traditional mental illnesses such as:
 Anxiety, Depression, Bipolar,
Schizophrenia, Organic dementias
 Personality disorders are categorised as
axis 2 disorders
 Viewing concrete symptoms in axis 2 is
much more difficult than in axis 1.

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 THEORIES OF HOW
THEY DEVELOP

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 1. PSYCHOANALYTIC

 Personality serves as a host mechanism,

comparable to the immune system,
offering protection against the many
psychological and interpersonal stresses
of living, preventing symptom formation
and breakdown.
 There is also the façade – a false self,
outside the true personality that enhances
survival in a potentially hostile world e.g.
the ability to say nothing, be tactful etc.
[Millon 1981]
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 Over compensation – an inborn tendency to
counteract deficiencies and inadequacies through
reparative striding. Undoing this over-compensation
plays a key role in therapy, [Adler 1964].
 Horney [1939] described three groups:
 1. those who move towards people in their
relationships, compliant and self-effacing, self-
esteem determined by others [dependent types]
 2. those who move against others in relationships,
aggressive seeing life as a struggle, seeking power
and exploiting [sociopathic types]
 3. those who move away from others and become
detached, avoiding relationships and consequently
lead restricted lives [avoidant, schizoid types]

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 2. BIOLOGICAL
PERSPECTIVE
 Some evidence for underactive
autonomic nervous system.
 This may explain why some

may crave excitement and fail

to respond to normally to
threats and danger.

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 3. PARENTAL
INFLUENCE /LEARNING
THEORY
 Most children internalise their parents
values [which generally reflect the values
of society] because they want to be like
them. They fear the loss of love if they do
not behave in accordance with these
values.
 A child who receives no love from either
parent does not fear its loss; he does not
identify with the rejecting parents and
does not internalise their rules.

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 A child may develop anti social personality if
learning that punishment can be avoided by
being charming, lovable and repentant.
 Someone who is consistently able to avoid
punishment by claiming to be sorry, promising
never to do it again may fear that it is not the
deed that counts but charm and the ability to
act repentant.
 A child who is protected from frustration or
distress may have no ability to empathise with
the distress of others.

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 4. CHILDHOOD ABUSE
 Strong evidence for association between borderline
personality and sexual abuse
 Evidence also for link between sexual abuse and any
personality disorder diagnosis.
 Beware false memory syndrome though.
 Most children exposed to a specific adversity do not
develop an adult mental disorder. Multiple adversities
have a cumulative effect though.
 Timing is not crucial. Traditional wisdom that the
younger the age of trauma, the more damaging, is not
always necessary. A bitter divorce in adolescence
may outweigh a separation in infancy.

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 TYPES
 Cluster A = suspicious
 Cluster B = emotional and

impulsive
 Cluster C = anxious

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 SUSPICIOUS
 PARANOID - suspicious…feel others are
against them…sensitive to rejection…hold
grudges
 SCHIZOID – emotionally cold…prefer own
company…have fantasy world
 SCHIZOTYPAL – odd ideas…difficulties with
thinking…lack of emotion.. may see or hear
strange things

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 EMOTIONAL AND
IMPULSIVE
 ANTISOCIAL, DISSOCIAL – no care for
feelings of others…easily
frustrated….aggressive…..avoid
intimacy…act on spur of moment…
don’t feel guilty.
 BORDERLINE, EMOTIONALLY
UNSTABLE – impulsive…low self-
worth….self-harm…feel empty….make
and break relationships….feel paranoid.

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 HISTRIONIC – over dramatic…self-
centred….show strong emotions which
change and don’t last…suggestible…
crave new things, excitement.
 NARCISSISTIC – strong sense of self-
importance…dream of power,
success….crave attention of others, no
warm feelings in return…exploit,
manipulate others.
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 ANXIOUS
 OBSESSIVE-COMPULSIVE – worry,
doubt…perfectionist….rigid….worry about
doing wrong thing…..high moral
standards….judgemental…sensitive to
criticism.
 AVOIDANT – anxious, tense….insecure,
inferior….have to be liked, accepted…
sensitive to criticism.
 DEPENDENT – passive…rely on others to
make decisions…feel incompetent…feel
abandoned by others.
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SPECIAL POPULATIONS
 PARASUICIDE
 75% men 60% women have
personality disorder [explosive
type mainly] Casey 1989.
 46% patients have anxious,
paranoid type Haw 2001.

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  SUICIDE
 37% emotionally unstable [Cheng
2000].
 44% antisocial, avoidant,
dependent [Foster 1997].

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 PRISON
 Evaluating the condition in prison runs the risk of assuming
that, because of antisocial behaviour, it is inevitably present.
 Separating the criminal behaviour from underlying traits [e.g.
callousness] is crucial if personality disorder is to be
meaningfully evaluated.
 Prison studies have shown a high prevalence [39 – 76%] of
antisocial type.
 Another study identified personality disorder in 63% of male
remand prisoners, 49% sentenced prisoners and 31% of
female prisoners. Paranoid was second most common
category in males, borderline in women, [Singleton 1998].
 Remand or sentenced prisoners are 10 times more likely to
have antisocial personality disorder than counterparts in
general population, [Coid 1993].


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 GENDER BIAS
 Paranoid male > female
 Schizoid male > female
 Anti social male > female
 Avoidant male = female
 Narcissistic male >>>female
 Obsessive male >> female
 Histrionic female > male
 Dependent female > male
 Borderline female >>>male
 Hartig 1998.


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