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1. Adult Personality Disorder
Nabina Paneru

2. Personality
• “ Enduring pattern of perceiving, relating to and thinking about the
environment and oneself that are exhibited in a wide range of social and
personal context.”
- American Psychiatric Association (APA)

4. Personality Disorder
• Personality disorder is an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the culture
of the individual who exhibits its.
- American Psychiatric Association (APA)
• According to WHO abnormal personality can be defined as “deeply
ingrained maladaptive pattern of behavior, continuing throughout
the most of adult life, although often becoming less obvious in
middle or old age.

5. Characteristics of Personality Disorder
• It is pervasive and inflexible
• It has an onset in adolescence or early adulthood
• It is not a mental illness but is a maladaptive behavior
• It is long lasting, most of time lifelong problem
• It leads to distress or impairment of functioning
• It cannot be diagnosed before the age of 18 years

6. Etiology
• Genetic Factors
• Biological Factors
- Hormones
- Neurotransmitters
- Electrophysiology
• Psychoanalytic theory

7. Contd.
• Genetic
- Concordance rate among monozygotic twins is several
times higher than among dizygotic twins
(Similarities in multiple measures of personality,
occupational and leisure time interest, social attitudes)
- Common in biological relatives than general populations

8. Contd.
• Biological factors
- Hormonal
 Testosterone
 17 estradiol
 Estrone
• Androgen increase the likelihood of aggression and sexual behavior
- Electrophysiology: Slow wave activity in EEG in individual with
antisocial and borderline personality
Higher among impulsive traits

9. Contd.
• Biological factors
- Hormonal
 Endorphin (suppression of arousal)
 Dopaminergic system (increase dopamine 
Psychostimulation)
 Serotonergic system (decreased serotonin  depression,
suicidality, aggression)

10. Contd.
• Psychoanalytic theory
- Maladaptive defense mechanism
- Fixation in one of the psychosexual stage of development

11. Classification of Personality Disorders
• Avoidant (anxious) Personality Disorder
• Dependent Personality Disorder
• Obsessive – compulsive Personality
Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Paranoid Personality Disorder
• Schizoid Personality Disorder
• Schizotypal Personality Disorder
Cluster A
(Odd and
eccentric)
Cluster B
(dramatic,
emotional,
erratic)
Cluster C
(anxious
and fearful)

12. - Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Cluster
A

13. Cluster A
a. Paranoid personality disorder:
- A pervasive distrust and suspiciousness of others such
that their motives are interpreted as malevolent,
beginning by adulthood and present in a variety of
contexts.

14. Signs and Symptoms
• Suspicious and distrustful (Hallmark)
• Over sensitive to criticism and misinterpret everything other says or do
• Argumentative and stubborn
• Avoid interaction
• Tensed and irritable
• Maintain their self esteem by attributing their short comings to others.

15. Cluster A Contd.
b. Schizoid personality disorder
- Characterized by detachment and social withdrawal.
- Loners, with solitary interest and occupations and no
close friends.

16. Sign and symptoms
• Aloof, emotionally cold, unempathetic, isolated
• Unable to experience pleasure
• Shy, anxious and uneasy in the presence of others
• Humorless and loss in thought
• Lack of close and confiding relationships

17. Cluster A Contd.
c. Schizotypal personality disorder
- Marked by odd thinking and behavior, odd or eccentric
and usually have few, if any, close relationships
- hold peculiar beliefs and may have difficulty with
responding appropriately to social cues

18. Signs and Symptoms
• Odd ideas or magical thinking
• Eccentricity
• Social withdrawal
• Lack of close relationship
• Social isolation
• Not fitting easily with others

19. - Antisocial Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Borderline Personality Disorder
Cluster
B

20. Cluster B personality disorder
a. Antisocial personality disorder
- dramatic, emotional and erratic
- Characterized by chronic antisocial behavior that violates
other rights or social norms which predisposes the
affected person to the criminal behavior
- Unable to maintain the consistent, responsible
functioning at work, school or as a parent

21. Sign and symptoms
• Disregard for the right of others
• Tendency to cause violence
• Difficulty sustaining consistent employment and in
developing stable relationships
• Lack of guilt
• Failure to sustain the relationship
• Restless and easily bored
• Persistent lying or stealing

22. Cluster B contd.
b. Histrionic personality disorder
- Immature personality, emotionally unstable and tends to
emotionally overreact
- Most common in female

23. Sign and symptoms
- Attention seeking behavior, labile mood
- Manipulate other through dramatic expressions
- More concern with physical appearance
- Over dress and over use of accessories and make up

24. Cluster B contd.
c. Narcissistic personality disorder
- Self – centered, self – absorbed and lacking in empathy
for others
- Have exaggerated sense of self worth

25. Signs and symptoms
• Grandiose sense of self – importance (e.g., exaggerates
achievements and talents, expects to be recognized as
superior without commensurate achievements)
• Pre occupied with fantasies of unlimited success, power,
brilliance, beauty or ideal love
• Requires excessive admiration
• Arrogant
• Unable to face criticism

26. Cluster B contd.
d. Borderline personality disorder
- Marked by a pattern of instability in personal
relationship, mood, behavior and self – image.

27. Sign and symptoms
4 main categories
- Unstable relationship
- Unstable self image
- Unstable emotions
- Impulsivity
Other S/S are
- Lack of control of anger
- Recurrent suicidal threats or
behavior
- Uncertain about personal identity
- Chronic feeling of emptiness

28. - Avoidant (anxious) Personality Disorder
- Dependent Personality Disorder
- Obsessive – compulsive Personality Disorder
Cluster
C

29. Cluster C personality disorder
a. Avoidant personality disorder
- Have low self-esteem, poor self – confident, they will be
negative and have a difficulty in viewing situation and
interactions and objectives.

30. Sign and Symptoms
• Fear of disapproval or rejection
• Extreme sensitivity to negative evaluation
• Unwillingness to become involved with people
• Shyness
• Insecurity
• Awkward and uncomfortable in social situations
• Depression, anxiety and anger at oneself for failing to develop social relations
• Chronic substance abuse

31. Cluster C contd.
b. Dependent personality disorder
- Characterized by extreme need to be taken care
of, which leads to submissive and fear of
separation or rejection
- They let other make important decision for them
and have a strong need for constant reassurance
and support

32. Signs and symptoms
• Feeling uncomfortable and helplessness
• Inability to make decisions
• Low self esteem and lack of self confidence
• Hypersensitivity
• Passive and submissive role in relationships
• Difficulty expressing disagreement with others

33. Cluster C contd.
c. Obsessive compulsive personality disorder:
- Characterized by general psychological inflexibility,
rigid conformity to rules and procedures, perfectionism,
moral code, and/or excessive orderliness

34. Signs and symptoms
• Feeling of excessive doubts and caution
• Preoccupation with detailed rules, lists order or schedule
• Perfectionism, rigidity and stubbornness
• Excessive devotion to work and productivity
• Over concern with details
• Few leisure activities, cannot relax
• Over conscientious
• Hoards money, objects etc

35. OCD Vs OCPD
OCD OCPD
Form of anxiety disorder Form of personality disorder
Signs and symptoms vary in severity over time Signs and symptoms tend to remain the same
Can be easily identified Cannot be easily recognized
Motive for unusual behavior stems from the need to
prevent distress or anxiety
Motive for unusual behavior stems from the need to
be perfect
Accept their condition and will seek medical help Reluctant to seek medical help since they don’t see
a problem in their behavior
Seek medical help to control their symptoms and
tension on day to day activities
Seek help due to everyday conflicts and arguments
with family and friends.

36. Epidemiology
Personality Disorder Prevalence Male:Female
Paranoid 0.5 to 2.5% M>F
Schizoid 7.5% M>F
Schizotypal 3% M>F
Borderline 1 to 2% F>M (2:1)
Histrionic 2 to 3% F>M
Antisocial 1 to 3% M>F
Narcissistic 2 to 3% 50 to 70% = M
Avoidant 1 to 10% Equal
OCPD 2.1 to 7.9% M>F (2:1)
Dependent 2.5% F>M

37. Management
• Detail History
• Physical examination
• Mental Status Examination
• Personality Questionnaires
• Treatment
- Psychotherapy (Treatment of
choice)
- Pharmacotherapy: Supportive
treatment
 Antidepressants
 Anxiolytics
 Antipsychotics

38. Nursing Management