GEETANJALI MEDICAL COLLEGE

AND HOSPITAL

TOPIC – CLUSTER - B

PRESENTER-
MODERATOR- DESHANA SHARMA
Dr. SHIKHA SHARMA -M.Sc. CLINICAL
PSYCHOLOGY
 PSYCHOPATHOLOGY

UNIT IV: Psychopathology of Adult

Personality Disorders

CLUSTER - B
 CONTENT -
 Introduction
 Clusters of personality disorders

CLUSTER -B
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
 Tools

 Conclusion
 References
 INTRODUCTION -

According to Gordon Allport (1961) ,

“ Personality is the dynamic organization within the
individuals of those psychophysical systems that
determine his unique adjustment to the environment .’’
A personality disorder is an enduring pattern of
inner experience and behavior that deviates
markedly from the expectations of the individual's
culture.
It is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time,
and leads to distress or impairment.
Personality disorder is characterized by problems
in :
- functioning of aspects of the self (e.g., identity,
self-worth, accuracy of self-view, self-direction),
- and/or interpersonal dysfunction (e.g., ability to
develop and maintain close and mutually
satisfying relationships, ability to understand
others’ perspectives and to manage conflict in
relationships) that have persisted over an
extended period of time (e.g., 2 years or more).
(acc. to ICD -11)
The disturbance is manifested in patterns of
cognition, emotional experience, emotional
expression, and behavior that are maladaptive
(e.g., inflexible or poorly regulated) and is manifest
across a range of personal and social situations
(i.e., is not limited to specific relationships or social
roles).
The disturbance is associated with substantial
distress or significant impairment in personal, family,
social, educational, occupational or other
important areas of functioning.
Personality disorders are common and chronic.
They occur in 10 to 20 percent of the general
population, and their duration is expressed in
decades.
Approximately 50 percent of all psychiatric
patients have a personality disorder.
When a patient meets the criteria for more than
one personality disorder, clinicians should
diagnose each.
 CLUSTER OF PERSONALITY DISORDER

CLUSTER A CLUSTER B CLUSTER C

1. Paranoid 1. Antisocial
personality 1. Avoidant
personality disorder
disorder personality disorder
2. Borderline
2. Schizoid 2. Dependent
personality disorder
personality personality disorder
3. Histrionic
disorder 3. Obsessive-
personality disorder
compulsive
3. Schizotypal 4. Narcissistic personality disorder
personality personality disorder
disorder
ANTISOCIAL
PERSONALITY DISORDER
According to
DSM -5 : F60.2
Antisocial personality disorder is an inability to
conform to the social norms that ordinarily
govern many aspects of a person’s
adolescent and adult behavior.
Although characterized by continual
antisocial or criminal acts, the disorder is not
synonymous with criminality.
 Epidemiology
 The 12-month prevalence rates of antisocial personality disorder are
between 0.2 and 3 percent according to DSM-5.
 More common in poor urban areas.
 It is much more common in males than in females.
 Boys with the disorder come from larger families than girls with the
disorder.
 The onset of the disorder is before the age of 15 years.
 Girls usually have symptoms before puberty and boys even earlier.
 A familial pattern is present; the disorder is five times more common
among first-degree relatives of men with the disorder.
 Diagnosis
Patients with antisocial personality disorder can fool even the
most experienced clinicians.
patients often show abnormal EEG results and soft
neurological signs suggesting minimal brain damage in
childhood, these findings can be used to confirm the clinical
impression.
Failure to conform to social norms with respect to lawful
behaviors, as indicated by repeatedly performing acts that
are grounds for arrest.
Deceitfulness, as indicated by repeated lying, or victimizing
others for personal profit or pleasure.
lmpulsivity or failure to plan ahead.
 Irritability and aggressiveness, as indicated by repeated
physical fights or assaults.
Reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated
failure to sustain consistent work behavior or honor
financial obligations.
Lack of guilt, as indicated by being indifferent to having
hurt, mistreated, or stolen from another.
 Clinical features
Patients with antisocial personality disorder can often seem to
be normal and even charming.
Their histories, however, reveal many areas of disordered life
functioning.
Lying, truancy, running away from home, thefts, fights,
substance abuse, and illegal activities are typical
experiences that patients report as beginning in childhood.
They are extremely manipulative and can frequently talk
others into participating in schemes for easy ways to make
money or to achieve fame or notoriety.
Patients with antisocial personality disorder exhibit no
anxiety or depression, although suicide threats and
somatic preoccupations may be common.
Mental content reveals the complete absence of
delusions and other signs of irrational thinking. In fact, they
frequently have a heightened sense of reality testing and
often impress observers as having good verbal
intelligence.
Promiscuity (sleeping around), spousal abuse, child abuse,
and drunk driving are common events in their lives.
 Course and Prognosis -

When an antisocial personality disorder develops, it

runs an unremitting (continuing) course.
The prognosis varies.
Some reports indicate that symptoms decrease as
persons grow older.
Many patients have somatization disorder and
multiple physical complaints. Depressive disorders,
alcohol use disorders, and other substance abuse
are common.
 Managements-

Psychotherapy :
If patients with antisocial personality disorder are immobilized
(e.g., placed in hospitals), they often become amenable to
psychotherapy.
Therapy may include, for example, anger and violence
management, treatment for alcohol or substance misuse,
and treatment for other mental health conditions.
But psychotherapy is not always effective, especially if
symptoms are severe and the person can't admit that he or
she contributes to serious problems.
SELF HELP GROUPS :
When patients feel that they are among peers,
their lack of motivation for change disappears.
 Perhaps for this reason, self-help groups have
been more useful than jails in alleviating the
disorder.

Pharmacotherapy :
It is used to deal with incapacitating symptoms
such as anxiety, rage, and depression, but
because patients are often substance abusers,
drugs must be used judiciously.
BORDERLINE
PERSONALITY
DISORDER -
According to
DSM -5 : F60.3
Patients with borderline personality disorder stand on the
border between neurosis and psychosis, and they are
characterized by extraordinarily unstable affect, mood,
behavior, and self-image.
 The disorder has also been called ambulatory
schizophrenia , pseudo neurotic schizophrenia and
psychotic character disorder.
The 10th revision of the International Classification of
Diseases 10 (ICD-10) uses the term emotionally
unstable personality disorder.
 Epidemiology
No definitive prevalence studies are available, but
borderline personality disorder is thought to be present in
about 1 to 2 percent of the population.
It is twice as common in women as in men.
 An increased prevalence of major depressive disorder,
alcohol use disorders, and substance abuse is found in first-
degree relatives of persons with borderline personality
disorder.
 Diagnosis

According to DSM-5, the diagnosis of borderline personality

disorder can be made by early adulthood when patients show
at least five of the criteria listed .
Recurrent suicidal behavior.
Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships
Chronic feelings of emptiness.
 Identity disturbance: persistently unstable self-image or
sense of self.
lmpulsivity in at least two areas that are potentially self-
damaging.
Affective instability due to a marked reactivity of mood.
Inappropriate, intense anger or difficulty controlling
anger.
Shortened REM latency and sleep continuity disturbances, &
abnormal thyrotropin releasing hormone test results.
 Clinical features

Persons with borderline personality disorder almost always

appear to be in a state of crisis.
Mood swings are common.
 Patients can be argumentative at one moment, depressed
the next, and later complain of having no feelings.
Patients can have short-lived psychotic episodes rather than
full-blown psychotic breaks, and the psychotic symptoms of
these patients are almost always circumscribed, fleeting, or
doubtful.
Behavior is highly unpredictable, and their achievements
are rarely at the level of their abilities.
Tumultuous interpersonal relationships. They can be
dependent on those with whom they are close and, when
frustrated, can express enormous anger toward their
intimate friends.
They often complain about chronic feelings of emptiness
and boredom and the lack of a consistent sense of
identity.
Distort their relationships by considering each person to be
either all good or all bad.
 Course and Prognosis -

Borderline personality disorder is fairly stable; patients

change little over time.
patients have a high incidence of major depressive
disorder episodes.
The diagnosis is usually made before the age of 40 years,
when patients are attempting to make occupational,
marital, and other choices and are unable to deal with
the normal stages of the life cycle.
 Management
I ] Psychotherapy –
1. DIALECTICAL BEHAVIOR THERAPY - modified type of CBT ;
main goal is to teach people how to live in the moment,
develop healthy ways to cope with stress, regulate their
emotions & improve relationships.
2. MENTALIZATION-BASED TREATMENT- Mentalization is a social
construct that allows a person to be attentive to the mental
states of oneself and of others; it comes from a person’s
awareness of mental processes and subjective states that
arise in interpersonal interactions.
3. TRANSFERENCE-FOCUSED PSYCHOTHERAPY- The therapist
relies on two major processes in working with the patient:
The first is clarification, in which the transference is
analyzed more directly than in traditional
psychotherapy so that the patient becomes quickly
aware his or her distortions about the therapist.
The second is confrontation, whereby the therapist
points out how these transferential distortions interfere
with interpersonal relations toward others (objects).
Both therapist and client now can better recognize and
develop positive alternatives to destructive or potentially
unhealthy behavior as it happens.
 II ]Pharmacotherapy
 Pharmacotherapy is useful to deal with specific personality
features that interfere with patients’ overall functioning.
Antidepressants improve the depressed mood common in
patients with borderline personality disorder.
Antipsychotics have been used to control anger, hostility,
and brief psychotic episodes.
HISTRIONIC
PERSONALITY DISORDER
According to
DSM -5 : F60.4
Persons with histrionic personality disorder
are excitable and emotional and behave
in a colorful, dramatic, extroverted
fashion.
Accompanying their flamboyant
(excited) aspects, however, is often an
inability to maintain deep, long-lasting
attachments.
 Epidemiology
prevalence of histrionic personality disorder of about 1 to 3
percent.
 Rates of about 10 to 15 percent have been reported in
inpatient and outpatient mental health settings when
structured assessment is used.
The disorder is diagnosed more frequently in women than in
men.
Some studies have found an association with somatization
disorder and alcohol use disorders.
 Diagnosis
In interviews, patients with histrionic personality
disorder are generally cooperative and eager to
give a detailed history.
Gestures and dramatic punctuation in their
conversations are common; they may make frequent
slips of the tongue, and their language is colorful.
Affective display is common, but when pressed to
acknowledge certain feelings (e.g., anger, sadness,
and sexual wishes), they may respond with surprise,
or denial.
Pervasive pattern of excessive emotionality and
attention seeking, beginning in early adulthood.
Uncomfortable in situations in which he or she is not
the center of attention.
Interaction with others is often characterized by
inappropriate sexually seductive or provocative
behavior.
Consistently uses physical appearance to draw
attention to self.
Has a style of speech that is excessively
impressionistic and lacking in detail.
Shows self-dramatization, theatricality, and
exaggerated expression of emotion.
Is suggestible (i .e., easily influenced by others or
circumstances).
Considers relationships to be more intimate than
they actually are.
 Clinical features
Show a high degree of attention-seeking behavior.
They tend to exaggerate their thoughts and feelings and
make everything sound more important than it really is.
They display temper tantrums, and tears, when they are not
the center of attention or are not receiving praise or
approval.
Seductive behavior is common in both sexes.
Histrionic patients may have a psychosexual dysfunction.
Women may be anorgasmic, and men may be impotent.
Their need for reassurance is endless.
Their relationships tend to be superficial.
 Course and Prognosis -

With age, persons with histrionic personality disorder show

fewer symptoms, but because they lack the energy of
earlier years, the difference in number of symptoms may
be more apparent than real.
Persons with this disorder are sensation seekers, and they
may get into trouble with the law, abuse substances, and
act promiscuously.
 Management

1. Psychotherapy-
Patients with histrionic personality disorder are often
unaware of their own real feelings; clarification of
their inner feelings is an important therapeutic
process.
Psychoanalytically oriented psychotherapy, whether
group or individual, is probably the treatment of
choice for histrionic personality disorder.
2. Pharmacotherapy-

Pharmacotherapy can be added when symptoms are

targeted.
the use of antidepressants for depression and somatic
complaints
antianxiety agents for anxiety
antipsychotics for derealization and illusions).
NARCISSISTIC
PERSONALITY DISORDER
According to
DSM -5 : F60.81
Persons with narcissistic personality disorder are
characterized by a heightened sense of self-
importance, lack of empathy, and grandiose
feelings of uniqueness.
Underneath, however, their self-esteem is
fragile and vulnerable to even minor criticism.
 Epidemiology
According to DSM-5, estimates of the prevalence of
narcissistic personality disorder range from less than 1 to
6 percent in community samples.
 Persons with the disorder may impart an unrealistic
sense of omnipotence, grandiosity, beauty, and talent
to their children; thus, offspring of such parents may
have a higher than usual risk for developing the disorder
themselves.
 Diagnosis
 Lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others.
 Is often envious of others or believes that others are envious of
him or her.
 Shows arrogant attitudes.
Has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as
superior without commensurate achievements).
Need for admiration, beginning by early adulthood.
Is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love.
Believes that he or she is "special" and unique and can
only be understood by, or should associate with, other
special or high-status people (or institutions).
Requires excessive admiration.
Has a sense of entitlement (i.e., unreasonable
expectations of especially favorable treatment or
automatic compliance with his or her expectations).
Is interpersonally exploitative (i .e., takes advantage of
others to achieve his or her own ends.
 Clinical features
 Their sense of entitlement is striking.
 Has a grandiose sense of self-importance.
 They cannot show empathy, and they show sympathy only to achieve
their own selfish ends.
 Because of their fragile self-esteem, they are susceptible to depression.
 Interpersonal difficulties, occupational problems, rejection, and loss are
among the stresses that narcissists commonly produce by their
behavior—stresses they are least able to handle.
 Course and Prognosis

Narcissistic personality disorder is chronic and difficult to

treat.
Aging is handled poorly; patients value beauty, strength,
and youthful attributes, to which they cling
inappropriately.
They may be more vulnerable, therefore, to midlife crises
than are other groups.
 Management
1. Psychotherapy-
 Because patients must reject their narcissism to make progress, the
treatment of narcissistic personality disorder is difficult.

2. Pharmacotherapy-
 Lithium (Eskalith) has been used with patients whose clinical picture
includes mood swings.
 Because patients with narcissistic personality disorder tolerate rejection
poorly and are susceptible to depression, antidepressants, especially
serotonergic drugs, may also be of use.
 TOOLS -
International Personality Disorder Examination
(IPDE)
Personality Assessment Inventory (PAI)
Narcissistic personality inventory (NPI)
The Personality Disorders Questionnaire
(PDQ-IV)
Standardised Assessment of Personality –
Abbreviated Scale (SAPAS)
 IPDE (International Personality Disorder
Examination)

 Developed by Armand W. Lorenger

 It is a self report instrument.
 Purpose: helps to diagnose personality disorder.
 Format: paper pencil test
 Age range: 18-70 years
 Can be administered on individual or group.
 IPDE assigns a definite, probable or negative diagnosis for each
personality disorder.
 There are two parallel sets of IPDE
 Personality Assessment Inventory (PAI)
 Developed by Leslie Morey.
 is a self-report 344-item
 Each item is a statement about the respondent that the
respondent rates with a 4-point scale (1-"Not true at all, False", 2-
"Slightly true", 3-"Mainly true", and 4-"Very true").
 Constitute 22 non-overlapping scales covering the constructs most
relevant to a broad-based assessment of mental disorders:
1) four - validity scales
2) eleven - clinical scales
3) five - treatment consideration scales
4) two - interpersonal scales
 An objective inventory of adult personality, the PAI assesses
psychopathological syndromes and provides information relevant for
clinical diagnosis, treatment planning, and screening for
psychopathology.
 Administration time is up to 40 minutes shorter than that for similar
instruments.
 Narcissistic personality inventory

Developed in 1979 by Raskin and Hall, and since then, has

become one of the most widely utilized personality measures
for non-clinical levels of the trait narcissism.
 Since its initial development, the NPI has evolved from 220
items to the more commonly employed NPI-40 (1984) and
NPI-16 (2006), as well as the novel NPI-1 inventory (2014).
 Derived from the DSM-III criteria for Narcissistic Personality
Disorder (NPD), the NPI has been employed heavily by
personality and social psychology researchers.
The test consists of 40 pairs of statements. For
each pair you should select the one that you feel
best reflects your personality. It should take most
people 5-10 minutes to complete.
 The Personality Disorders Questionnaire
(PDQ-IV)

It is a 99-item self-report measure used to identify the

key features or possible presence of a personality
disorder.
responses are in a true/false format, with the
exception of the last two items, which are checklists
of behaviors.
 Standardised Assessment of Personality
– Abbreviated Scale (SAPAS)

Consists of 8 –items.
Yes/ no responses.
If the scored are 3 or above – the person is
considered 90% inclined towards psychiatric
disorders in DSM-IV .
CONCLUSION -

 A personality disorder is an enduring pattern of inner experience and

behavior that deviates 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.
REFERENCES-

 Sadock, B.J , Sadock, V.A , and Ruiz,P . Synopsis of psychiatry (11th ed.).
 Diagnostic and statistical manual of Mental disorder(5th edition)
 International Statistical Classification of Diseases and Related Health
Problems (11th ed,; ICD-11; World Health Organization, 2019)
 https://www.parinc.com/Products/Pkey/287#:~:text=An%20objective%20in
ventory%20of%20adult,than%20that%20for%20similar%20instruments.
 https://openpsychometrics.org/tests/NPI/