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Personality Disorders Clusters (DSM-IV-TR)

  1. Cluster A (Odd and Eccentric)
    Personality disorders, thought to be on a ‘schizophrenic-continuum.
These are:
  1. Paranoid Personality Disorder
  2. Schizoid Personality Disorder
  3. Schizotypal Personality Disorder
  1. Cluster B (Dramatic, Emotional and Erratic)
    Personality disorders, Thought to be on a ‘psychopathic continuum. These are:
    1. Antisocial or Dissocial Personality Disorder
    2. Histrionic Personality Disorder
    3. Narcissistic Personality Disorder
    4. Borderline (Emotionally Unstable) Personality Disorder
  2. Cluster C (Anxious and Fearful)
    Personality disorders, characterized by ‘introversion’. These are:
    1. Anxious (Avoidant) Personality Disorder
    2. Dependent Personality Disorder
    3. Obsessive-Compulsive (Anankastic) Personality Disorder
Cluster A
  1. Paranoid personality disorder Personality disorder characterized by:
    1. Excessive sensitiveness to setbacks and rebuffs;
    2. Tendency to bear grudges persistently,-i.e. refusal ,to forgive insults and injuries or slights.
    3. Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly act of others as hostile or contemptuous
    4. Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
Treatment is        
  1. Individual Psychotherapy
  2. Supportive Psychotherapy
  1. Schizoid personality disorder
    Personality disorder meeting the following description: 
    1. Few, if any, activities, provide pleasure;
    2. Emotional coldness, detachment or flattened affectivity;
    3. Limited capacity to express either warm, tender feelings or anger towards others;
    4. Apparent indifference to either praise or criticism;
    5. Almost invariable preference for solitary activities-’.
    6. Excessive preoccupation with fantasy and introspection;
Treatment is         
  1. Individual Psychotherapy
  2. Supportive Psychotherapy
  3. Gradual involvement in group Psychotherapy
  1. Schizotypal Personality Disorder : Characterized by odd and eccentric behaviour & poor rapport with others
Magical thinking (thinking has power) – Merely by thinking, action would happen.
Suspiciousness or paranoid ideas
Obsessive ruminations without inner resistance, often with dysmorphophobia, sexual or aggressive contents.
Occasional transient quasi-psychotic episodes
Cluster - B
  1. Narcissistic Personality Disorder:
    1. Grandiose sense of self-importance,
    2. Preoccupation with fantasies of unlimited success, power / intellectual brilliance,
    3. Crave attention from other people but show few warm feelings in return,
    4. Lack of empathy with others,
    5. Shaky self esteem, underlying sense of Inferiority
Drug of choice - High dose SSRI
  1. Dissocial (Antisocial) personality disorder
    Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by:
    1. Callous unconcern for the feelings of others;
    2. Gross and persistent attitude of irresponsibility and disregard for social norms rules.
    3. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
    4. Incapacity to experience guilt and to profit from experience, particularly punishment;
Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.
Treatment - They often do not seek treatment.
Treatment is        
  1. Individual Psychotherapy
  2. Supportive Psychotherapy
  1. Emotionally Unstable Personality Disorder
    1. A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability.
    2. The ability to plan ahead may be minimal and outbursts of intense anger may often lead to violence or behavioral  explosions”; these are easily precipitated when impulsive acts are criticized or thwarted by others.
    3. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.
Impulsive type
The predominant characteristics are emotional instability and lack of impulse control.
Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.
Borderline type
  1. Several of the characteristics of emotional instability are present; in addition, the patient’s own self image, aims, and internal preference (including sexual) are often unclear or disturbed.
  2. Usually chronic feelings of emptiness.
  3. Intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment.
  4. Series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).
  5. Low frustration tolerance & poor coping skills.
  6. Impulsive behaviour.
  7. Micro psychotic episodes
Recurrent suicidal threats or behavior. It is the most common cause of suicidal attempts. Treatment of choice
- Dialectic behavior therapy ( DBT ), & drug of choice for impulsivity is high dose of SSRI
  1. Histrionic Personality Disorder
    Personality disorder characterized by:- It is the most common cause of suicidal attempts.
    1. Suggestibility, easily influenced by others or by circumstances;
    2. Continual seeking for excitement appreciation by others, and activities in which the patient is the centre of attention
    3. Over concern with physical attractiveness.
Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.
Cluster - C
  1. Anankastic personality disorder or (obsessive compulsive per sonality disorder) Personality disorder characterized by:
    1. Feelings of excessive doubt and caution
    2. Preoccupation with details, rules, lists, order, organization or schedule;
    3. Perfectionism that interferes with task completion;
    4. Excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.
    5. Excessive pedantry and adherence to social conventions, bound to rules & regulations
    6. Rigidity and stubbornness;
      No increased risk of OCD in future, but there is a risk of depression in future.
  2. Anxious (Avoidant) personality disorder Personality disorder characterized by:-
    1. Persistent and pervasive feelings of tension and apprehension;
    2. Belief that one is socially inept, personally unappealing or inferior to others;
    3. Unwillingness to become involved with people unless certain of being liked;
    4. Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism disapproval or rejection.
  3. Dependent personality disorder
    Personality disorder characterized by;
    1. Encouraging or allowing others to make most of one’s important life decision;
    2. Subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes;
    3. Unwillingness to make even reasonable demands on the people one depends on;
    4. Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself;
    5. Preoccupation with fears of being abandoned by a person with whom one has a close relationship and of being left to care for oneself.
Treatment for all personality disorders is usually not seeked, and even if started, not continued for long time.
- Comprised of Individual psychotherapy, Group psychotherapy, Behaviour therapy and cognitive -Behaviour Therapy
Type Characteristics
Chronic wariness, suspiciousness, hypersensitivity, jealousy, envy;
lack of insight or humor, tendency to blame others
Isolation, seclusiveness, secretiveness, discomfort in relationships;
often eccentric and lacking in energy
Chronic worries about standards; excessive concern about self-
image; overly meticulous, conscientious, and perfectionist
Immaturity, histrionic behavior, excitability, emotional instability,
secularization of relationship and shallow interpersonal ties;
Obstructive behavior, stubbornness, intentional errors or omissions;
externalization of conflicts and blaming other for untoward events
Unsocialized or antisocial behavior in conflict with society, long
history of interpersonal and social difficulties and arrests
Lack of self-confidence, indecisiveness, tendency to seek support f
rom others
Ineffectual responses to social, psychologic, and physical demands;
poor adaptation to ordinary situations
Poorly regulated emotions, self-injury, dysphoria, unstable
interpersonal relationships

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