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Personality Disorders
Dr Ayomide ADEBAYO
DocAyomide.com
4-12%
DocAyomide.com
Diagnosable PD in ~10% (2008 study)
Clinically severe in ~4%
35% psychiatric inpatients
Prisoners: female 50%; male 60-80%
Nearly all marked by impaired impulse
control à ↑risk of addictive behaviour
DocAyomide.com
Qu’est que c’est?
An enduring pattern of inner experience
& behaviour 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.
DSM-IV-TR
DocAyomide.com
Qu’est que c’est?
A severe disturbance in the
characterological condition and
behavioural tendencies of the individual,
usually involving several areas of the
personality, and nearly always associated
with considerable personal and social
disruption.
WHO
DocAyomide.com
Simple English
Deeply ingrained maladapative patterns
of behaviour
Extreme deviation from average cultural
norms of perceiving, thinking, feeling &
relating à problems for the person
“Weird” or “different”
DocAyomide.com
What’s Really Going On…
Internally
Disturbed ways
of thinking
Difficulties with
mood &
impulse control
Externally
Disturbed ways
of relating
Disturbed
behaviour
DocAyomide.com
5-Factor Model of Personality
Openness to Experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
DocAyomide.com
DSM Clusters
Cluster A
(odd, eccentric)
Cluster B
(dramatic, emotional)
Cluster C
(anxious, fearful)
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcisstic
Avoidant
Dependent
Obsessive-
compulsive
DocAyomide.com
Psychopathy
Extreme form of antisocial/dissocial PD
Narrower group – often also fulfil criteria
for antisocial, narcissistic, histrionic &
paranoid
Strongly correlated with risk of future
violence
DocAyomide.com
PCL-R
Glibness, superficial charm
Promiscuous sexually
Grandiose sense of self-
worth
Early behaviour problems
Pathological lying
Impulsivity
Cunning/manipulative
No realistic long term goals
Need stimulation/prone to
boredom
Irresponsibility
Lack of remorse/ guilt
Failure to accept
responsibility
Shallow affect
Callous/lack of empathy
Juvenile delinquency
Parasitic lifestyle
Criminal versatility
Poor behavioural control
Multiple short-term marital
relationshipsDocAyomide.com
Psychodynamic Model
Theory of unconscious motivations: not all
“manipulative” behaviour is consciously
under the person’s control
Developmental view & focus on defence
mechanisms
Attempts to understand the internal processes
Problem: not easily generalisable to provide
simple plan of action
DocAyomide.com
Psychiatric Model
Reconsidered for ICD-11 & DSM-V
People often fit more than one category
Same diagnoses with different symptoms
Types shown to alter & change
Imprecise, too much overlap, despite
efforts to pin categories
DocAyomide.com
Relationships
Paranoid/schizotypal PD ≡ delusional disorders
or schizophrenia
Borderline PD ≡ disorders of mood & anxiety,
impulse control, eating, substance use or
ADHD
Avoidant PD ≡ social anxiety disorder
DocAyomide.com
DSM-5
Single axis
Hybrid method (further study)
Borderline Obsessive-Compulsive
Avoidant Schizotypal
Antisocial Narcissistic
PD-TS
DocAyomide.com
Management
Psychotherapy core
Basis: symptoms ß poor/limited coping skills
Aim: ↑perception of & response to social
stressors
Inpatient care rare – occasional short stay
DocAyomide.com
Management Principles*
Consistency
Reliability
Encouraging autonomy
Sensitive management of change
*BMJ 2013;347:f5276
DocAyomide.com
Medication
Minimal role
Adjunct to psychotherapy
For symptom clusters
cognitive-perceptual symptoms
affective dysregulation
impulsive-behavioural dyscontrol
DocAyomide.com
Issues in PD
Under-diagnosis
Stigma
Treatment options
Prognosis
Research
DocAyomide.com
DocAyomide.com

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Personality Disorders: An Overview

  • 1. Personality Disorders Dr Ayomide ADEBAYO DocAyomide.com
  • 3. Diagnosable PD in ~10% (2008 study) Clinically severe in ~4% 35% psychiatric inpatients Prisoners: female 50%; male 60-80% Nearly all marked by impaired impulse control à ↑risk of addictive behaviour DocAyomide.com
  • 4. Qu’est que c’est? An enduring pattern of inner experience & behaviour 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. DSM-IV-TR DocAyomide.com
  • 5. Qu’est que c’est? A severe disturbance in the characterological condition and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. WHO DocAyomide.com
  • 6. Simple English Deeply ingrained maladapative patterns of behaviour Extreme deviation from average cultural norms of perceiving, thinking, feeling & relating à problems for the person “Weird” or “different” DocAyomide.com
  • 7. What’s Really Going On… Internally Disturbed ways of thinking Difficulties with mood & impulse control Externally Disturbed ways of relating Disturbed behaviour DocAyomide.com
  • 8. 5-Factor Model of Personality Openness to Experience Conscientiousness Extraversion Agreeableness Neuroticism DocAyomide.com
  • 9. DSM Clusters Cluster A (odd, eccentric) Cluster B (dramatic, emotional) Cluster C (anxious, fearful) Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcisstic Avoidant Dependent Obsessive- compulsive DocAyomide.com
  • 10. Psychopathy Extreme form of antisocial/dissocial PD Narrower group – often also fulfil criteria for antisocial, narcissistic, histrionic & paranoid Strongly correlated with risk of future violence DocAyomide.com
  • 11. PCL-R Glibness, superficial charm Promiscuous sexually Grandiose sense of self- worth Early behaviour problems Pathological lying Impulsivity Cunning/manipulative No realistic long term goals Need stimulation/prone to boredom Irresponsibility Lack of remorse/ guilt Failure to accept responsibility Shallow affect Callous/lack of empathy Juvenile delinquency Parasitic lifestyle Criminal versatility Poor behavioural control Multiple short-term marital relationshipsDocAyomide.com
  • 12. Psychodynamic Model Theory of unconscious motivations: not all “manipulative” behaviour is consciously under the person’s control Developmental view & focus on defence mechanisms Attempts to understand the internal processes Problem: not easily generalisable to provide simple plan of action DocAyomide.com
  • 13. Psychiatric Model Reconsidered for ICD-11 & DSM-V People often fit more than one category Same diagnoses with different symptoms Types shown to alter & change Imprecise, too much overlap, despite efforts to pin categories DocAyomide.com
  • 14. Relationships Paranoid/schizotypal PD ≡ delusional disorders or schizophrenia Borderline PD ≡ disorders of mood & anxiety, impulse control, eating, substance use or ADHD Avoidant PD ≡ social anxiety disorder DocAyomide.com
  • 15. DSM-5 Single axis Hybrid method (further study) Borderline Obsessive-Compulsive Avoidant Schizotypal Antisocial Narcissistic PD-TS DocAyomide.com
  • 16. Management Psychotherapy core Basis: symptoms ß poor/limited coping skills Aim: ↑perception of & response to social stressors Inpatient care rare – occasional short stay DocAyomide.com
  • 17. Management Principles* Consistency Reliability Encouraging autonomy Sensitive management of change *BMJ 2013;347:f5276 DocAyomide.com
  • 18. Medication Minimal role Adjunct to psychotherapy For symptom clusters cognitive-perceptual symptoms affective dysregulation impulsive-behavioural dyscontrol DocAyomide.com
  • 19. Issues in PD Under-diagnosis Stigma Treatment options Prognosis Research DocAyomide.com