37 - Personality disorders

Personality disorders

© SPMM Course 8. Disorders of adult personality and behaviour Personality disorders x According to ICD-10, a diagnosis of personality disorders cannot be made in individuals younger than age 16 or 17. x Unlike other psychiatric disorders, personal distress is not a criterion for diagnosing personality disorders but this may be a feature seen during the course of a personality disorder. x At least three traits must be present from the list for diagnosing antisocial and borderline personality; the rest of the disorders requires at least four from the lists provided by ICD-10 diagnostic guidelines. x There are not many differences between ICD-10 and DSM-IV in the description of personality disorders. The notable exceptions are listed below. x Passive-Aggressive personality disorder and Depressive personality disorder are placed in an appendix of DSM-IV for research purposes. Passive aggressive is discussed with other personality disorders category in ICD10. DSM-IV ICD-10 Personality disorders are grouped into 3 clusters No clustering of personality disorders Schizotypal disorder is a personality disorder Not a personality disorder, but described as a variant of psychosis under the chapter on Schizophrenia Only single entity of borderline personality disorder Emotionally unstable personality disorder can be of impulsive or borderline type Features of Cluster A (odd, eccentric) personality disorders

© SPMM Course Features of Cluster B (dramatic, erratic) personality disorders

•Suspicious of other people and their motives. •Hold longstanding grudges against people, •Believe others are not trustworthy, •Emotionally detached •Feel other people are deceiving, threatening, or making plans against them. Paranoid personality disorder Paranoid personality disorder •Have difficulties in expressing emotions, particularly around warmth or tenderness. •Prefer loneliness •Aloof or remote, •Have difficulty in developing or maintaining social relationships •Remain unaware of social trends •Unresponsive to praise or criticism Schizoid personality disorder Schizoid personality disorder •Appear odd or eccentric; •May have illusions, magical thinking •Obsessions without resistance •May be members of quasi-cultural groups •Thought disorders and paranoia. •May believe in ESP, clairvoyance etc. •May have transient psychotic features Schizotypal personality disorder Schizotypal personality disorder

© SPMM Course •Lack of regard for the rights and feelings of other people. •Lack of remorse for actions that may hurt others. •Ignore social norms about acceptable behaviour, •May disregard rules and break the law. •Make relations easily but break them equally easily •A small proportion may be psychopathic Antisocial personality disorder Antisocial personality disorder •Poor self-image, •Unstable personal relationships, •Impulsive behaviour in areas such as personal safety and substance misuse. •May self-harm, feel suicidal and act on these feelings, •Experience instability of mood, •Have episodes of micro-psychosis. •Feelings of chronic emptiness •Fears of abandonment – rejection sensitivity hence form intense but short lasting relations Borderline personality disorder Borderline personality disorder •Extreme or over-dramatic behaviour. •May form relationships quickly, but be demanding •Attention-seeking. •May appear to others as being self-centred with shallow emotions •Being inappropriately sexually provocative. Histrionic personality disorder Histrionic personality disorder •Exaggerated sense of own importance. •Frequently self-centred •Intolerant of other people. •Grandiose plans and ideas •Cravings for attention and admiration. •Fear of dependency is the core conflictual theme. •Narcissistic injuries to pride lead to rage reactions. Narcissistic personality disorder Narcissistic personality disorder

© SPMM Course Features of cluster C (anxious, inhibited) personality disorders

DSM IV ICD 10 equivalent Cluster A (odd or eccentric disorders) Paranoid personality disorder Paranoid personality disorder Schizoid personality disorder Schizoid personality disorder Schizotypal personality disorder NONE - classified as a type of schizophrenia like disorder in ICD Cluster B (dramatic, emotional, or erratic disorders) Antisocial personality disorder Dissocial personality disorder Borderline personality disorder Emotionally unstable: 1. Impulsive 2. Borderline subtypes Histrionic personality disorder Histrionic personality disorder Narcissistic personality disorder NONE; mentioned in other personality disorders category Cluster C (anxious or fearful disorders) Avoidant personality disorder Anxious (avoidant) personality disorder Dependent personality disorder Dependent personality disorder Obsessive-compulsive personality disorder Anankastic personality disorder •Fears being judged negatively by other people •Feelings of discomfort in group or social settings. •May come across as being socially withdrawn •Have low self-esteem. •May crave affection but fears of rejection overwhelming. Avoidant personality disorder Avoidant personality disorder •Assumes a position of passivity, •Allowing others to assume responsibility for most areas of their daily life. •Lack self-confidence, •Feel unable to function independently of another person, •Feels own needs are of secondary importance. Dependent personality disorder Dependent personality disorder •Difficulties in expressing warm or tender emotions to others. •Frequently perfectionists •Often lack clarity in seeing other perspectives or ways of doing things, •Rigid attention to detail may prevent them from completing tasks. •Some may be hoarders, scrupulous with money •May not be able to delegate tasks; workaholics. Obsessive-Compulsive personality disorder Obsessive-Compulsive personality disorder