cluster A Personality Disorders

1. Personality Disorders
CLUSTER A
Guided by, Guided to
Dr.V.Jesinda Vedanayagi C.Ponnaruvi
HOD of Mental Health Nursing

2. INTRODUCTION
• Personality disorder is a common and chronic
disorder. Its prevalence is estimated between 10 and
20 percent in the general population, and its duration
is expressed in decades. Persons with personality
disorder are frequently labelled as aggravating,
demanding, or parasitic and are generally considered
to have poor prognosis.

3. DEFINITION
Personality disorders are a class of mental
disorder characterized by enduring
maladaptive patterns of behaviour, cognition,
and inner experience, exhibited across many
contexts and deviating markedly from those
accepted by the individual's culture. These
patterns develop early, are inflexible, and are
associated with significant distress or
disability.

4. Classification
• Personality disorder subtypes classified in DSM-IV-
TR are:
• schizotypal, schizoid, and paranoid (Cluster A);
• narcissistic, borderline, antisocial, and histrionic
(Cluster B); and
• obsessive-compulsive, dependent, and avoidant
(Cluster C).

5. Paranoid Personality Disorder
• Persons with paranoid personality disorder are
characterized by long-standing suspiciousness and
mistrust of persons in general. They refuse
responsibility for their own feelings and assign
responsibility to others. They are often hostile,
irritable, and angry. Bigots, injustice collectors,
pathologically jealous spouses, and litigious cranks
often have paranoid personality disorder.

6. Epidemiology
The prevalence of paranoid personality disorder is 0.5 to
2.5 percent of the general population. Those with the
disorder rarely seek treatment themselves; when
referred to treatment by a spouse or an employer, they
can often pull themselves together and appear
undistressed.

7. ETIOLOGY
• Parental antagonism and harassment
• Anticipating humiliation
• Betrayal by others

8. Clinical Features
• A pervasive distrust and suspiciousness of others such
that their motives are interpreted as malevolent,
beginning by early adulthood and present in a variety of
contexts, as indicated by four (or more) of the
following:
– suspects, without sufficient basis, that others are
exploiting, harming, or deceiving him or her
– is preoccupied with unjustified doubts about the loyalty
or trustworthiness of friends or associates
– is reluctant to confide in others because of
unwarranted fear that the information will be used
maliciously against him or her

9. – reads hidden demeaning or threatening meanings into
benign remarks or events
– persistently bears grudges, i.e., is unforgiving of
insults, injuries, or slights
– perceives attacks on his or her character or reputation
that are not apparent to others and is quick to react
angrily or to counterattack
– has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner
• Does not occur exclusively during the course of schizophrenia, a
mood disorder with psychotic features, or another psychotic disorder
and is not due to the direct physiological effects of a general medical
condition

10. Diagnosis
• On psychiatric examination, patients
with paranoid personality disorder
may be formal in manner and act
baffled about having to seek
psychiatric help. Muscular tension, an
inability to relax, and a need to scan
the environment for clues may be
evident, and the patient's manner is
often humourless and serious.

11. Differential Diagnosis
• Paranoid personality disorder can usually be
differentiated from delusional disorder by the
absence of fixed delusions. Unlike persons with
paranoid schizophrenia, those with personality
disorders have no hallucinations or formal thought
disorder. Paranoid personality disorder can be
distinguished from borderline personality disorder
because patients who are paranoid are rarely capable
of overly involved, tumultuous relationships with
others.

12. Treatment
• Psychotherapy-is the treatment of choice for
paranoid personality disorder. Therapists should
be straightforward in all their dealings with these
patients. If a therapist is accused of
inconsistency or a fault, such as lateness for an
appointment, honesty and an apology are
preferable to a defensive explanation. Therapists
must remember that trust and toleration of
intimacy are troubled areas for patients with this
disorder

13. • Pharmacotherapy- diazepam (Valium)
• haloperidol (Haldol) in small dosages
• The antipsychotic drug pimozide (Orap) has
successfully reduced paranoid ideation in some
patients

14. Schizoid Personality Disorder
• Schizoid personality disorder is diagnosed
in patients who display a lifelong pattern of
social withdrawal. Their discomfort with
human interaction, their introversion, and
their bland, constricted affect are
noteworthy. Persons with schizoid
personality disorder are often seen by others
as eccentric, isolated, or lonely.

15. Epidemiology
• The prevalence of schizoid personality disorder is not
clearly established, but the disorder may affect 7.5
percent of the general population. The sex ratio of the
disorder is unknown; some studies report a 2-to-1
male-to-female ratio. Persons with the disorder tend
to gravitate toward solitary jobs that involve little or
no contact with others. Many prefer night work to day
work, so that they need not deal with many persons.

16. ETIOLOGY
• Features of introversion appears to be highly
inheritable characteristics.
• Person to be cold and unsatisfying
• temperamental disposition

17. Clinical Features
• A pervasive pattern of detachment from social
relationships and a restricted range of expression of
emotions in interpersonal settings, beginning by early
adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:
– neither desires nor enjoys close relationships, including
being part of a family
– almost always chooses solitary activities
– has little, if any, interest in having sexual experiences
with another person
– takes pleasure in few, if any, activities

18. – lacks close friends or confidants other than first-
degree relatives
– appears indifferent to the praise or criticism of
others
– shows emotional coldness, detachment, or
flattened affectivity
• Does not occur exclusively during the course of
schizophrenia, a mood disorder with psychotic
features, another psychotic disorder, or a
pervasive developmental disorder and is not due
to the direct physiological effects of a general
medical condition

19. Diagnosis
• .Their affect may be constricted, aloof, or
inappropriately serious, but underneath the
aloofness, sensitive clinicians can recognize fear.
These patients find it difficult to be light-hearted:
Their efforts at humour may seem adolescent and
off the mark. Their speech is goal-directed, but they
are likely to give short answers to questions and to
avoid spontaneous conversation.

20. Differential Diagnosis
• Schizoid personality disorder is distinguished from schizophrenia,
delusional disorder, and affective disorder with psychotic features
based on periods with positive psychotic symptoms, such as
delusions and hallucinations in the latter.
• Although patients with paranoid personality disorder share many
traits with those with schizoid personality disorder, the former
exhibit more social engagement, a history of aggressive verbal
behaviour, and a greater tendency to project their feelings onto
others. If just as emotionally constricted, patients with obsessive-
compulsive and avoidant personality disorders experience loneliness
as dysphonic, possess a richer history of past object relations, and do
not engage as much in autistic reverie.

21. Treatment
• Psychotherapy- The treatment of patients with
schizoid personality disorder is similar to that of
those with paranoid personality disorder.
Patients who are schizoid tend toward
introspection, however, these tendencies are
consistent with psychotherapists' expectations,
and such patients may become devoted, if
distant, patients.

22. • Pharmacotherapy- of antipsychotics,
antidepressants.
• Benzodiazepines may help diminish interpersonal
anxiety

23. Schizotypal Personality Disorder
• Persons with schizotypal personality disorder are
strikingly odd or strange, even to laypersons. Magical
thinking, peculiar notions, ideas of reference,
illusions, and derealisation are part of a schizotypal
person's everyday world.

24. Epidemiology
• Schizotypal personality disorder occurs in about 3
percent of the population. The sex ratio is
unknown. A greater association of cases exists
among the biological relatives of patients with
schizophrenia than among controls, and a higher
incidence among monozygotic twins than among
dizygotic twins (33 percent versus 4 percent in one
study).

25. ETIOLOGY
• First degree biological relatives of people with
schizophrenia
• Anatomical deficits or neuro chemical dysfunction

26. Clinical Features
• A pervasive pattern of social and interpersonal deficits marked by acute
discomfort with, and reduced capacity for, close relationships as well as by
cognitive or perceptual distortions and eccentricities of behaviour,
beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
– ideas of reference (excluding delusions of reference)
– odd beliefs or magical thinking that influences behaviour
and is inconsistent with sub cultural norms (e.g.,
superstitiousness, belief in clairvoyance, telepathy, or
sixth sense•; in children and adolescents, bizarre fantasies
or preoccupations)
– unusual perceptual experiences, including bodily illusions
– odd thinking and speech (e.g., vague, circumstantial,
metaphorical, over elaborate, or stereotyped)

27. – suspiciousness or paranoid ideation
– inappropriate or constricted affect
– behaviour or appearance that is odd, eccentric, or peculiar
– lack of close friends or confidants other than first-degree
relatives
– excessive social anxiety that does not diminish with familiarity
and tends to be associated with paranoid fears rather than
negative judgments about self
• Does not occur exclusively during the course of
schizophrenia, a mood disorder with psychotic features,
another psychotic disorder, or a pervasive developmental
disorder

28. Diagnosis
• Schizotypal personality disorder is
diagnosed on the basis of the patients'
peculiarities of thinking, behaviour, and
appearance. Taking a history may be difficult
because of the patients' unusual way of
communicating

29. Differential Diagnosis
• Theoretically, persons with schizotypal personality
disorder can be distinguished from those with
schizoid and avoidant personality disorders by the
presence of oddities in their behaviour, thinking,
perception, and communication and perhaps by a
clear family history of schizophrenia. Patients with
schizotypal personality disorder can be distinguished
from those with schizophrenia by their absence of
psychosis.

30. Treatment
• Psychotherapy- The principles of treatment of
schizotypal personality disorder do not differ from
those of schizoid personality disorder, but clinicians
must deal sensitively with the former. These patients
have peculiar patterns of thinking, and some are
involved in cults, strange religious practices, and the
occult. Therapists must not ridicule such activities or be
judgmental about these beliefs or activities

31. • Pharmacotherapy- Antipsychotic
• Antidepressants are useful when a depressive
component of the personality is present.

33. CONCLUSION
• From this I conclude that you all
have been understood about the
cluster-A personality disorders
definitio,types,clinical
features,diagnosis,treatment.

34. BIBLIOGRAPHY
• Mary c. Townsend.(2007).Psychiatric mental
health nursing.6th edition. Page no:666-670.
• Dr.Lalitha.(2010)Mental health and psychiatric
nursing. Page no:430-435.