Understanding PERSONALITY

Disorder

Dr Ivona Amlehpsychiatrist

Lat. Persona - mask

The First Classification of Personalities

Hippocrates (ca.460 – 370 BC)

Four temperaments

Phlegmatic Choleric

Sanguine Melancholic

Definition of PersonalityTotality of emotional and behavioural traits that

characterize the person in everyday living under ordinary conditions

والسلوكيه العاطفية الميزات التي مجمل وهيالحياة في العادية الظروف تحت الشخص تميز

اليومية Traits – enduring patterns of perceiving, relating to

and thinking about environment and oneselfالشخصية من - ميزات المالحظة نماذج

المحيطة البيئة حول والتفكير واالرتباطوالذات

Traits / Classification

• C. G. Jung (1921) extroversion / introversion

• K. Schneider (1923) “abnormal personalities are those who suffer

or make others suffer” – “psychopaths”

“The Big Five Factors” Model

• Costa & McRea’s (1992) descriptive and comprehensive structure behind all personality traits:

OPENNESS (curiosity, liking variety) CONSCIENTIOUSNESS (discipline, achievements) EXTRAVERSION (assertiveness, talkativeness) AGREEABLENESS (helpfulness, cooperation) NEUROTICISM (anxiety, impulsivity)

Where is the dividing line between ‘NORMAL’ personality / Personality PROBLEM /

Personality DISORDER?

Definition of Personality Disorder• Enduring behavioural patterns manifested as

inflexible, maladaptive responses in personal and social situations

الدائمة • السلوكية االستجابات انماط تتسم التيمتكيفه وغير مرنة األوضاع غير مختلف في

واالجتماعية الشخصية• Significant deviations from the average in a given

culture• Associated with subjective distress and problems

in social functioning• Recognisable from early adulthood

Are PDs Illnesses or Not?

• Barely fit to medical concept of disease: - almost impossible to define - may have no actual symptoms - unknown cause - lacking specific treatment• But, impossible to ignore, can cause a lot of

damage, elevated morbidity/mortality

Etiology heredity / physiology

psychological factors

interpersonal factors

Classification of Personality Disorders

Paranoid Schizoid

Schizotypal

NarcissisticHistrionicBorderlineAntisocial

Obsessive-CompulsiveAvoidant

DependentPassive-Aggressive

Paranoid PD

• Distrustful• See enemies everywhere• Live lonely, tortured lives• Outbursts of rage• Project their malevolence to others

maintaining thereby their self-esteem• May decompensate into delusion or

depression

Schizoid PD

• A quiet loner• Aloof and distant• Loving relationships neither felt nor sought• No fear of rejection, because no desire for

acceptance• Like reading (may like religion, science,

philosophy…), solitary activities• Well preserved reality testing

Schizotypal PD

• Seem to lack a core• Vivid fantasy, vague speech• They sense ghostlike presences,

magic influences, telepathy • Withdrawn, but have some relatedness• Rejection sensitive• May develop micro-psychotic episodes

Narcissistic PD

The stable variant:• Feel superior, enjoy themselves• Not seeing the needs of others• Spoiled upbringing, sharing was not common• Difficult to get along with• If rejected in something important to them,

may become depressed

Narcissistic PD

The unstable variant:• The mask of narcissism• Life is a constant threat• Easily wounded and enraged or sad• May have reasonably good impulse control in

public or on the job, keeping more primitive qualities in specific relationships

Histrionic PD

• Demand central stage• Feel little responsibility• The past is a collection of images• Life is exciting for them, a long string of over-

reactions, tantrums and lost loves• Behind is a painfully fragile self-esteem• Their tragedy: adults are not made to live as

children

Borderline PD

• Feeling of emptiness• Fear of abandonment• Unstable relationships• Impulsivity and self-harm• Affective instability and aggression• Face a harsh world over which they have no

control, vulnerability for addiction• Develop depression and micro-psychosis

Antisocial PD

• Charming or nasty• No responsibility, no anxiety• Playing games in which others exist as pieces

to be manipulated and utilized• At their worst – cruel, sadistic and violent• Their amoral behaviour at least in a part a

reflection of defenses to some intense pain

Obsessive-Compulsive PD

• Hard on themselves• Any failure – the ultimate one• Love and resent their work• Must prove themselves worthy of being loved• Appear serious, cool and distant• Even free-time has to be well spent• Angry if someone is disrespectful for rules• May develop depression

Avoidant PD

• Extremely low self-esteem• Desperate hope for affection• Do not dare to approach others• Unsure of their identity and self worth,

sometimes denigrating and self-ridicule• Frequently appear aloof and cool, living a

lonely, painful and introspective existence

Dependent PD

• Craving for safety• Extremely rejection sensitive• View themselves as weak and ineffectual, do

not want to make any decision• Their unfortunate answer to insecurity is the

safety of slavery• May develop depression

Passive-Aggressive PD

• Negativistic or late• Perplexing ambivalence• Intentionally ineffective• Fearing rejection, they attack by passive

means• The result is world lived through the eyes of

someone bitterly resigned to sitting on the bench

Signal Behaviours

Complaints about clinician or the system

Antisocial Paranoid

Borderline Narcissistic

Passive-Aggressive

Signal Behaviours

Flirtatious behaviour

Antisocial Narcissistic

Histrionic

Signal Behaviours

Dramatic behaviour or dress

Histrionic Borderline

Signal Behaviours

Helpless and child-like

Dependent Histrionic

Borderline

Signal Behaviours

Manipulative

Antisocial Narcissistic

Borderline Histrionic

Passive-Aggressive