Personality disorders

PERSONALITY DISORDERS
PRESENTED BY
RICHARD OPOKU ASARE
SAHS - UDS, TAMALE
asareor@yahoo.com ©2014 1

INTRODUCTION
The term personality refers to enduring qualities of an
individual that are shown in his ways of behaving in a
wide variety of circumstances. It can be defined as the
sum total of a person’s intellectual, emotional and
volitional traits; and it is revealed by his appearance,
behavior, habits and relationships with other people,
which differentiate him as unique individual.

INTRODUCTION
For instance, when you say of someone ‘She is a kind
woman but loses his temper easily’, you are describing
her personality. Thus, personality means a person’s
qualities and character as seen by others.
Every personality is unique. It develops as a reflection
of the life experiences which shape the feelings and
behaviour of the individual from the moment he is born.

INTRODUCTION
Personality disorders are chronic psychological
disorders that begin in childhood, or by early
adulthood at the latest. They are pervasive,
negatively affecting people’s work, family, and
social lives, and causing a great deal of distress,
discomfort, either for the affected people
themselves, or for those who are around them.

INTRODUCTION
Personality disorder, also known as “character
disorder”, is the possession of one or more
personality traits that deviates from the normal
that they interfere with the individual’s well-
being or adjustment to society and require
psychiatric attention.

INTRODUCTION
Personality disorder is not the same as mental
illness, so to speak. The symptoms of mental
illness are not continuous, but mostly episodic.
The symptoms of personality disorders are
continuous and start from adolescence or even
before.

INTRODUCTION
These patients, as Nambi (2005) described, are
odd but not mad. It is worth mentioning that
personality disorder increases one’s vulnerability
to mental illness and worsens the course and
treatment response, especially in conditions like
substance abuse, anxiety and depression.

DEFINITION – DSM-IV
A personality disorder is an “enduring pattern of
inner experience and behavior that deviates
markedly from the expectation 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.” asareor@yahoo.com ©2014 8

DEFINITION – Cont’d
A personality disorder is a type of mental disorder in
which you have a rigid and unhealthy pattern of
thinking, functioning and behaving. A person with
a personality disorder has trouble perceiving and
relating to situations and to people. This causes
significant problems and limitations in
relationships, social encounters, work and school

CHARACTERISTICS OF PERSONALITY
DISORDERS
a) It is not a mental illness.
b) It is a maladaptive/rigid/pervasive/chronic behavior.
c) It is the possession of abnormal personality traits.
d) It is a long lasting, most of the time life-long problem.

CHARACTERISTICS OF PERSONALITY
DISORDERS
e) It causes significant impairment in social or
occupational functioning.
f) It produces distress to the individual and others.
g) His/her behaviour deviates from cultural
standards.
h) The behaviour is consistent over time.

HOW ARE PERSONALITY DISORDERS
DIAGNOSED?
In order to be diagnosed with a
personality disorder, an individual
must exhibit symptoms that meet the
diagnostic criteria established in the
DSM-IV.

DIAGNOSED?
a) These patterns of behavior must be chronic and
pervasive, affecting many different aspects of the
individual’s life, including social functioning, work,
school and close relationships.
b) The individual must exhibit symptoms that affect
two or more of the following areas: thoughts,
emotions, interpersonal functioning and impulse
control.

DIAGNOSED?
c) The pattern of behaviors must be stable across
time and have an onset that can be traced back to
adolescence or early adulthood.
d) These behaviors cannot be explained by any
other mental disorders, substance abuse or
medical conditions.

DIFFERENTIAL DIAGNOSIS
•
Substance Abuse
•
Anxiety Disorders
•
Depression
•
Dissociative Disorders
•
Social Phobia
•
Post Traumatic Stress Disorder
•
Schizophrenia

CAUSES
GENES. Certain personality traits may be
passed on to us by our parents through
inherited genes. These traits are sometimes
called temperament.
ENVIRONMENT. This involves the
surroundings one grew up in, events that
occurred, and relationships with family
members and others.asareor@yahoo.com ©2014 16

CAUSES – Cont’d
Personality disorders are thought to be caused
by a combination of these genetic and
environmental influences. Your genes may
make you vulnerable to developing a
personality disorder, and a life situation may
trigger the actual development.

RISK FACTORS
Although the precise cause of personality
disorders is not known, certain factors seem
to increase the risk of developing or
triggering personality disorders, including:
1) Family history of personality disorders
or other mental illness.

RISK FACTORS – Cont’d
2) Low level of education and lower social and
economic status
3) Verbal, physical or sexual abuse during
childhood
4) Neglect or an unstable or chaotic family life
during childhood
5) Being diagnosed with childhood conduct disorder
6) Variations in brain chemistry and structureasareor@yahoo.com ©2014 19

SYMPTOMS OF PERSONALITY
DISORDERS
Symptoms of personality disorders are grouped
according to the types of the disorder. Types of
personality disorders are grouped into three (3)
clusters, based on similar characteristics and
symptoms.
However, many people with one personality
disorder also have signs and symptoms of at
least one additional personality disorder.

TYPES OF PERSONALITY
DISORDERS
CLUSTER A (odd, eccentric thinking or
behavior)
1.Paranoid personality disorder
2.Schizoid personality disorder
3.Schizotypal personality disorder
NB: It’s not necessary to exhibit all the signs
and symptoms listed for a disorder to be
diagnosed. asareor@yahoo.com ©2014 21

DISORDERS – Cont’d
CLUSTER B (dramatic, flamboyant, erratic,
overly emotional or unpredictable thinking)
1.Antisocial/Psychopath/Sociopath/Dissocial
personality disorder
2.Borderline personality disorder
3.Histrionic personality disorder
4.Narcissistic personality disorder

CLUSTER C (anxious, fearful thinking or
behavior)
1. Avoidant/Anxious personality disorder
2.Dependent personality disorder
3.Obsessive-compulsive/Anankastic personality
disorder

Others that are reserved for disorders that fall short
of specific criteria but still demonstrate behavior
that is consistent with personality disorders in
general include:
1)Passive-aggressive personality disorder
2)Depressive personality disorder

Paranoid personality disorder
•
Pervasive distrust (mistrust) and suspicion of
others and their motives.
•
Unjustified belief that others are trying to harm or
deceive him/her.
•
Unjustified suspicion of the loyalty or
trustworthiness of others.
•
Hesitant or unwillingness to confide in others due
to unreasonable fear that others will use the
information against him/her.

Paranoid personality disorder
•
Perception of innocent remarks or nonthreatening
situations as personal insults or attacks.
•
Angry or hostile reaction to perceived slights or
insults.
•
Tendency to hold grudges/unforgiving of insults.
•
Unjustified, recurrent suspicion that spouse or
sexual partner is unfaithful.
•
Argumentative; stubborn

Schizoid personality disorder
•
Lack of interest in social or personal relationships,
preferring to be alone
•
Limited range of emotional expression
•
Inability to take pleasure in most activities
•
Inability to pick up normal social cues
•
Appearance of being cold or indifferent to others
•
Little or no interest in having sex with another person
•
Has no close friends or confidents, except close
relatives

Schizotypal personality disorder
•
Peculiar dress, thinking, beliefs, speech or
behavior.
•
Odd perceptual experiences, such as hearing a
voice whisper his/her name, i.e., has ideas of
reference.
•
Flat emotions or inappropriate emotional
responses.
•
Social anxiety and a lack of or discomfort with
close relationships.asareor@yahoo.com ©2014 28

Schizotypal personality disorder
•
Indifferent, inappropriate or suspicious response to
others
•
“Magical thinking” — believing s/he can influence
people and events with his/her thoughts.
•
Belief that certain casual incidents or events have
hidden messages meant specifically for him/her/.
•
Paranoid thinking.

Antisocial personality disorder
•
Disregard for others’ needs or feelings.
•
Persistent lying, stealing, using aliases,
conning others.
•
Recurring problems with the law.
•
Repeated violation of the rights of others.
•
Fails to plan ahead

Antisocial personality disorder
•
Aggressive, often violent behavior
•
Disregard for the safety of self or others
•
Impulsive behavior
•
Consistently irresponsible
•
Lack of remorse for behavior
•
Appear intelligent or charming

Borderline personality disorder
•
Impulsive and risky behavior, such as having
unsafe sex, gambling or binge eating
•
Unstable or fragile self-image
•
Unstable and intense relationships
•
Up and down moods, often as a reaction to
interpersonal stress
•
Suicidal behavior or threats of self-injury

Borderline personality
disorder
•
Intense fear of being alone or abandoned
•
Ongoing feelings of emptiness
•
Frequent, intense displays of anger
•
Stress-related paranoia that comes and goes
•
Difficulty controlling anger
•
Assumes little responsibility for problems

Histrionic personality disorder
•
Constantly seeking attention
•
Excessively emotional, dramatic or sexually
provocative to gain attention
•
Speaks dramatically with strong opinions, but
few facts or details to back them up
•
Easily influenced by others or circumstances

Histrionic personality disorder
•
Shallow, rapidly changing emotions
•
Excessive concern with physical appearance
•
Thinks relationships with others are closer
than they really are
•
Use repression to ignore unpleasant feelings,
i.e., unconscious forgetting of events.

Narcissistic personality disorder
•
Belief that s/he is special and more important
than others.
•
Fantasies about power, success and
attractiveness.
•
Failure to recognize others’ needs and
feelings.
•
Exaggeration of achievements or talents.
•
Expects to be given preferential treatment over

Narcissistic personality disorder
•
Expectation of constant praise and admiration.
•
Arrogance.
•
Unreasonable expectations of favors and
advantages, often taking advantage of others.
•
Envy of others or belief that others envy
him/her.
•
Only concern with selfish pursuits.

Avoidant personality disorder
•
Too sensitive to criticism or rejection
•
Feeling inadequate, inferior or unattractive
•
Avoidance of work activities that require
interpersonal contact
•
Social inhibition, timidity and isolation,
especially avoiding new activities or meeting
strangers
•
Has sense of inferiority complex

Avoidant personality disorder
•
Extreme shyness in social situations and
personal relationships
•
Fear of disapproval, embarrassment or ridicule
•
Unusually reluctant to take personal risks or to
engage in any new activities because they may
prove embarrassing.
•
Differ from schizoid personality disorder
because s/he does desire friendship.

Dependent personality disorder
•
Excessive dependence on others and feels the
need to be taken care of.
•
Submissive or clingy behavior toward others.
•
Fear of having to provide self-care or fend for
him/herself if left alone.
•
Lack of self-confidence, requiring excessive
advice and reassurance from others to make
even small decisions.

Dependent personality disorder
•
Difficulty starting or doing projects on his/her
own due to lack of self-confidence.
•
Difficulty disagreeing with others, fearing
disapproval.
•
Tolerance of poor or abusive treatment, even
when other options are available.
•
Urgent need to start a new relationship when a
close one has ended.

Obsessive-compulsive personality
disorder
•
Preoccupation with details, orderliness and rules
•
Extreme perfectionism, resulting in dysfunction and
distress when perfection is not achieved, such as
feeling unable to finish a project because s/he doesn’t
meet his/her own strict standards.
•
Desire to be in control of people, tasks and situations
and inability to delegate tasks.

Obsessive-compulsive personality
disorder
•
Neglect of friends and enjoyable activities because of
excessive commitment to work or a project.
•
Inability to discard broken or worthless objects, i.e.,
difficulty throwing away of unnecessary items.
•
Rigid and stubborn.
•
Inflexible about morality, ethics or values.
•
Tight, miserly control over budgeting and spending
money.

Passive-aggressive personality
disorder

These people procrastinate, do not perform
tasks adequately, and make excuses for their
behaviour.

They manipulate themselves into dependent
positions and force others to become
responsible for them.

disorder

Friends become angry and frustrated with
these people and often feel manipulated.

They deny unacceptable feelings by adopting
the opposite attitude.

Unreasonably criticizes and scares authority.

disorder

Complains of being misunderstood or
unappreciated by others.

Envy towards those who are ahead of him.

They are pessimistic and generally lack self-
confidence.

Depressive personality disorder

These people are chronically unhappy, anhedonic,
and generally pessimistic.

Their lives are usually described as lonely and sad.

They tend to feel hopeless and inadequate with
frequent self-doubting.

Their personality traits are consistent with
depressive symptoms.

TREATMENT OF PERSONALITY
DISORDERS
Psychotherapy
Medications, e.g.,
antidepressants, antipsychotics,
mood stabilisers
Coping skills for family members
Hospitalization – in severe cases.

PSYCHOTHERAPY
Talk therapy
Insight therapy
Group therapy
Counseling therapy

Medical treatment
•
Antidepressants. Antidepressants may be useful if
you have a depressed mood, anger, impulsivity,
irritability or hopelessness, which may be associated
with personality disorders.
•
Mood stabilizers. As their name suggests, mood
stabilizers can help even out mood swings or reduce
irritability, impulsivity and aggression.
•
Antipsychotics. To treat any perceptual disturbances;
reduce aggressiveness.

Coping skills for family members
If you have a loved one with antisocial
personality disorder, it’s critical that you also
get help for yourself. Mental health
professionals with experience managing this
condition can teach you skills to learn how to
set boundaries and help protect yourself
from the aggression, violence and anger
common to antisocial personality disorder.
They can also recommend strategies for
coping.

Medical treatment
•
Antipsychotic medications. These may be
helpful if symptoms include losing touch with
reality (psychosis) or in some cases if the person
has anxiety or anger problems.
•
Anti-anxiety medications. These may help if the
individual has anxiety, agitation or insomnia. But
in some cases, they can increase impulsive
behavior, so they’re avoided in some personality
disorders.

NURSING MANAGEMENT OF
PERSONALITY DISORDERS
KINDLY READ THE NURSING INTERVENTIONS
FOR THE VARIOUS PERSONALITY DISORDERS
FROM THE BOOKS
FURTHER READING:
Asare, R. O. (2010). Lessons in basic psychiatry and mental health nursing
(Vol. 1). Kumasi: Frans Graphics.
McMahon, E., & Weistein, E. (Eds.). (1995). Professional care guide:
Psychiatric disorders. Pennsylvania: Springhouse Corporation.
Nambi, S. (2005). Psychiatry for nurses. Bangalore: Jaypee Brothers.

ANTISOCIAL (AMORAL, DISSOCIAL, SOCIOPATH,
PSYCHOPATH) PERSONALITY DISORDER
In the nineteenth century, the antisocial
personality was called moral insanity, and for
most of the 20th
century it was called
psychopathy or sociopathy.

PSYCHOPATH) PERSONALITY DISORDER – Cont’d
Antisocial personality disorder is a type of
chronic mental illness in which a person’s
ways of thinking, perceiving situations and
relating to others are abnormal and destructive.
The disorder is characterised by maladaptive
behaviour beginning in childhood.

It is described by the DSM-IV-TR (2000) as a
pervasive pattern of disregard for, and violation of,
the rights of others that begins in childhood or early
adolescence and continues into adulthood. This
includes lying, stealing, truancy, vandalism, fighting,
drug abuse, physical cruelty, academic failure, and
early sexual activity.

Adults with an antisocial personality may not
conform to social norms. They may fail to hold a
job, to honour financial obligations, or to fulfill
parental responsibilities. They may drive
recklessly because they do not have any sense of
guilt for the pain and suffering they inflict on
others. asareor@yahoo.com ©2014 57

New evidence points to the possibility that children
often develop antisocial personality disorder as a
result of environmental as well as genetic influence.
The individual must be at least 18 years of age to be
diagnosed with this disorder.
The prevalence of this disorder is 3% in males and
1% from females, as stated in the DSM IV-TR.asareor@yahoo.com ©2014 58

Types of Antisocial personality disorder
Antisocial personality disorder may take the following
forms:
Intelligent/Creative Psychopath: These individuals
appear very creative and can be charming, lie with
straight face, and talk their way out of trouble. They are
irresistible, believe their own lies, extremely persuasive,
talented, and also have the ability to manipulate well.

– cont’d
They may pursue careers as shyster lawyers,
crooked politicians/businessmen, or phoney
evangelists or leaders of a congregation to sway
their unsuspecting victims. They are also
referred to as charismatic psychopaths.

– Cont’d
Passive Psychopath: These individuals are very
inadequate who fail to adapt to the requirements of the
society. They are cold, inept, passive and unresponsive.
They hover around aimlessly in the community with no
place to stay permanently. They may move from one
place of residency to another without giving any serious
attention to their behaviours.

– Cont’d
They are withdrawn and have no purpose in life and
easily get themselves into petit stealing, usually landing
them in the law courts. Depending on the assessment by
the judge, they may be sent to the psychiatric hospital
for further observations. They are, most at times, sacked
from their occupations as a result of their careless and
reckless behaviours.

– Cont’d
They may be referred to as emotional masochists because
they would not respond to stress, punishment, or
disapproval. Another strong trait is that they do not
understand the meaning of words well, a condition called
semantic aphasia. They have no life plan and are just
breathing machines with no emotion, good or bad. They are
also known as inadequate, immature, or primary
sociopaths. asareor@yahoo.com ©2014 63

– Cont’d
Secondary psychopaths, who may feel
slight emotions of worry or guilt. These are
avid risk-takers, exposing themselves to
more stress and danger than the average
person, who play by their own rules.

– Cont’d
Aggressive Psychopaths: These individuals are
easily prone to violent acts and demonstrate hostility
to people. They may engage in criminal activities,
yet fail to change their behaviour even after being
punished for it. They may also violate the conditions
of their release from lawful custody.

– Cont’d
They act out their frustrations with the least
provocation and as a result do not have long lasting
relationships. They have immensely strong sex drives,
obsessing with sexual urges during their lives. They
have also huge cravings, such as kleptomania or
sadistic pedophilia, doing this almost solely for the
“rush.” asareor@yahoo.com ©2014 66

– Cont’d
They are always found in the courts for acts of
violent, deception and/or fraud. They are also
referred to as the callous or distempered
psychopaths.

Symptom criteria required for a diagnosis of
antisocial personality disorder
Being at least 18 years old
Having had symptoms of conduct disorder
before age 15, which may include such acts
as stealing, vandalism, violence, cruelty to
animals and bullying
Repeatedly breaking the law
Repeatedly conning or lying to others

Symptom criteria required for a diagnosis of
antisocial personality disorder – cont’d
Being irritable and aggressive, repeatedly
engaging in physical fights or assaults
Feeling no remorse — or justifying behavior —
after harming others
Having no regard for the safety of self or others
Acting impulsively and not planning ahead
Being irresponsible and repeatedly failing to
honor work or financial obligations

END OF LECTURE
THANK YOU

Personality disorders

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