Personality Disorders - Detailed Notes
PERSONALITY DISORDERS
• Personality disorders are enduring patterns of inner experience and behavior that deviate
markedly from the expectations of an individual’s culture.
• Core Features: Distorted thinking patterns, problematic emotional responses, over/under-
regulated impulse control, and interpersonal difficulties.
• A diagnosis requires significant and enduring difficulties in at least two of the core areas.
• Not typically diagnosed in children due to evolving personality traits.
• 10 personality disorders are categorized into three clusters: Cluster A (Odd/Eccentric),
Cluster B (Dramatic/Erratic), Cluster C (Anxious/Fearful).
CLUSTER A: ODD OR ECCENTRIC PERSONALITY DISORDERS
• Individuals in this cluster exhibit social withdrawal, unusual thinking patterns, and
detachment from reality.
Paranoid Personality Disorder (PPD)
• Chronic distrust and suspicion of others.
• Hypervigilant, always searching for betrayal.
• Holds grudges and refuses to forgive.
• Reluctant to confide in others due to fear of betrayal.
• Genetic link to schizophrenia; childhood trauma may contribute.
Schizoid Personality Disorder
• Extreme detachment from social relationships, prefers solitude.
• Lacks emotional expression, appearing indifferent.
• Minimal interest in intimacy, avoiding romantic relationships.
• Genetic link to schizophrenia, but distinct due to absence of paranoia.
• Possible cognitive factors, such as maladaptive beliefs about relationships.
Schizotypal Personality Disorder
• Social and interpersonal deficits with odd beliefs and behaviors.
• Eccentric speech and dress, often misunderstood.
• Paranoid tendencies, believing others have hidden motives.
• Mild psychotic symptoms (hallucinations, illusions) under stress.
• Strong genetic association with schizophrenia, with similar cognitive impairments.
CLUSTER B: DRAMATIC, EMOTIONAL, ERRATIC PERSONALITY DISORDERS
• Characterized by impulsivity, unstable emotions, and difficulty maintaining relationships.
Antisocial Personality Disorder (ASPD)
• Disregard for others' rights, engaging in deceit, manipulation, and aggression.
• Lack of remorse, often rationalizing harmful actions.
• Impulsive and reckless, engaging in criminal or risky behaviors.
• Childhood conduct disorder often precedes ASPD.
• Biological and environmental factors, such as genetic predisposition and early trauma.
Borderline Personality Disorder (BPD)
• Emotional instability, with intense mood swings and impulsivity.
• Fear of abandonment, leading to extreme efforts to avoid rejection.
• Unstable self-image, fluctuating between idealization and devaluation.
• Self-harm and suicidal tendencies, often used as a coping mechanism.
• Linked to childhood abuse, genetic factors, and serotonin dysfunction.
Histrionic Personality Disorder (HPD)
• Excessive attention-seeking, craving approval and admiration.
• Theatrical and overly dramatic, often exaggerating emotions.
• Seductive or provocative behavior, using charm to manipulate others.
• Easily influenced, often changing beliefs or behaviors to fit in.
• Genetic and learned behavior factors, possibly linked to reinforcement of attention-
seeking.
Narcissistic Personality Disorder (NPD)
• Exaggerated sense of self-importance, believing they are superior.
• Lack of empathy, struggling to understand others' feelings.
• Fragile self-esteem, easily offended by criticism.
• Grandiose vs. vulnerable subtypes, with different emotional responses.
• Parental overvaluation linked to grandiose NPD; childhood trauma linked to vulnerable
NPD.
CLUSTER C: ANXIOUS OR FEARFUL PERSONALITY DISORDERS
• Individuals in this cluster experience chronic anxiety, fear of rejection, and dependency.
Avoidant Personality Disorder (AvPD)
• Intense fear of rejection, avoiding social situations despite desiring relationships.
• Low self-esteem and self-criticism, believing they are unworthy.
• Reluctant to take risks or try new things due to fear of embarrassment.
• Genetic and environmental influences, including childhood neglect.
• Overlaps with social anxiety disorder, but more persistent and severe.
Dependent Personality Disorder (DPD)
• Excessive reliance on others, leading to submissive and clingy behavior.
• Difficulty making decisions without reassurance.
• Fear of abandonment, often staying in toxic relationships.
• Avoids conflict, suppressing personal opinions to maintain approval.
• Parental overprotection and authoritarian parenting linked to DPD.
Obsessive-Compulsive Personality Disorder (OCPD)
• Preoccupied with order, rules, and control, often perfectionistic.
• Rigid and stubborn, struggling to delegate tasks.
• Work-focused, neglecting leisure and relationships.
• Different from OCD, as it lacks true obsessions or compulsions.
• Linked to genetic personality traits of high conscientiousness.
TREATMENTS AND OUTCOMES
• Personality disorders are difficult to treat due to ingrained behaviors.
• High dropout rates in therapy, especially in Cluster B disorders.
• Comorbidity with mood, anxiety, or substance use disorders complicates treatment.
• Therapeutic Approaches: Cognitive Behavioral Therapy (CBT), Dialectical Behavior
Therapy (DBT), Mentalization-Based Therapy (MBT).
• Medication: Antidepressants, mood stabilizers, and antipsychotics may help with
symptoms.
SEXUAL VARIANTS AND SEXUAL ABUSE
• Paraphilic Disorders: Sexual interests causing distress or harm to others.
• Includes exhibitionistic disorder, fetishism, voyeurism, pedophilia, sadism, masochism.
• Diagnosis requires distress or non-consensual behavior.
• Gender Dysphoria: Discomfort with assigned gender, leading to emotional distress.
• Sexual Abuse and Pedophilic Disorder: Childhood sexual abuse linked to long-term
psychological trauma.
