Anti-Social Histrionic

Personality Personality
Disorder
By:
DisorderBy:
Pesante, Ace Miguel, Tula
Pascua, Kharen Minorca, Alexandra

Narcissistic Borderline
Personality Personality
Disorder
By:
Disorderby:
Parlade, Ludwig Pesquera, Reymar
Murala. Jalaja Monera, Thessa
ANTISOCIAL PERSONALITY DISORDER

Pesante, Ace
Pascua, Kahren
 ANTISOCIAL
PERSONALITY DISORDER

• An inability to
conform to the social
norms that ordinarily
govern many aspects
of a person's
adolescent and adult
behavior.
• Notsynonymous with
criminality.
Epidemiology
• The 12-month prevalence rates
between 0.2 and 3 % (DSM-5)
• More common in:
 poor urban areas
 mobile residents of these areas.

• The highest prevalence

 men with alcohol use
disorder (over 70 %)
 prison populations
(as high as 75 %)
Epidemiology
 Males > Females.
 Onset of the disorder
 before the age of 1 5 years.
 Five times more common among
first-degree relatives of men
Diagnosis
Patients can:
• fool
even the most
experienced clinicians.
• appear composed and
credible, (but beneath
the veneer lurks tension,
hostility, irritability, and
rage)
Diagnosis
• A stress interview - may be
necessary to reveal the
pathology.
• Thorough neurological
examination
• Patients often show abnormal
EEG results and soft
neurological signs  minimal
brain damage in childhood 
used to confirm the clinical
impression.
DSM-5 Diagnostic Criteria for Antisocial Personality
Disaorder

A. Apervasive pattern of disregard for and violation of the

rights of others, occuring since age 15 years, as
indicated by three (or more) of the following:

1.Failureto conform to social norms with respect to lawful

behaviors, as indicated by repeatedly performing acts
that are grounds of arrest.

2.Deceitfulness, as indicated by repeated lying, use of

aliases, or conning others for personal profit or pleasure.

3.Impulsivityand aggressiveness, as indicated by repeated

physical fights or assaults.
DSM-5 Diagnostic Criteria for Antisocial Personality Disorder

4. Irritability and aggressiveness, as indicated by repeated

physical fights or assaults.

5. Reckless disregard for safety of self or others.

6. Consistent irresponsibility, as indicated by repeated failure

to ssutain consistent work behavior or honor financial
obligations

7. Lack of remorse, as indicated by being indifferent to or

rationalizing having hurt, mistreated, or stolen from another
DSM-5 Diagnostic Criteria for Antisocial Personality
Disorder

B. The individual is at least age 18 years.

C. There is evidence of conduct disorder with onset before

age 15 years.

D. The occurrence of antisocial behavior is not exclusively

during the course of schizophrenia or bipolar disorder.
Clinical Features

• Often normal and even

charming and
ingratiating.
• Lying, truancy, running
away from home, thefts,
fights, substance abuse,
and illegal activities
report as beginning in
childhood.
Clinical Features
 Impress opposite-sex
clinicians with the colorful,
seductive aspects of their
personalities,
• same-sex clinicians may
regard them as manipulative
and demanding.
• Exhibitno anxiety or
depression
• suicide threats and
somatic preoccupations
may be common.
Clinical Features
• own explanations seem
mindless, but their mental
content reveals the complete
absence of delusions and other
signs of irrational thinking.
• heightened sense of reality
testing
• often impress observers as
having good verbal intelligence.
• Highly representative of so-
called con men.
Clinical Features

• extremely manipulative and can

frequently talk others into
participating in schemes for easy
ways to make money or to achieve
fame or notoriety.
• do not tell the truth and cannot be
trusted to carry out any task or
adhere to any conventional
standard of morality.
• Promiscuity, spousal abuse, child
abuse, and drunk driving
common events in their lives.
• lack a conscience.
 Differential Diagnosis
Differential Diagnosis
• Criminal behavior
• When illegal behavior is
only for gain and is not
accompanied by the rigid,
maladaptive, and
persistent personality
traits characteristic of a
personality disorder
• Substance abuse
 Course and Prognosis
• The prognosis varies.
• Some reports indicate that
symptoms decrease as persons
grow older.
• Many patients have
somatization disorder and
multiple physical complaints.
• Depressivedisorders, alcohol
use disorders, and other
substance abuse are common.
Treatment- Psychotherapy.

• Immobilized patient(e.g., placed

in hospitals),
• self-help groups have been more
useful
Treatment-Pharmacotherapy

• Psychostimulants : methylphenidate (Ritalin)

• If a patient shows evidence of attention-
deficit/hyperactivity disorder.
 Attempts have been made to alter catecholamine
metabolism with drugs and to control impulsive
behavior with antiepileptic drugs, for example,
carbamazepine (Tegretol) or valproate (Depakote ),
especially if abnormal waveforms are noted on an EEG.
 B-Adrenergic receptor antagonists
-have been used to reduce aggression.
Narcissistic Personality Disorder
Murala, Jalaja
Parlade, Ludwig A.

Sec 3A
Narcissistic personality disorder is named for Narcissus, from Greek
mythology, who fell in love with his own reflection
Freud used the term to describe persons who were self-absorbed
Psychoanalysts have focused on the narcissist’s need to bolster his
or her self-esteem through grandiose fantasy, exaggerated ambition,
exhibitionism, and feelings of entitlement.
Characterized by:
• Heightened sense of self importance
• Lack of empathy
• Grandiose feeling of uniqueness
• Fragile self-esteem
• vulnerable to even minor criticism
 Epidemiology
• Prevalenceranges from <1 to high as 6.2% in the
general population
• Most persons receiving diagnosis are male
• Impartunrealistic sense of omnipotence, grandiosity,
beauty and talent to their children
• Offspring may have higher risk of developing disorder
As with many personality disorders definitive
and universal cause has not been found
These may contribute:
Excessive pampering as a child or criticism
Children of Narcissistic parents
Genetic factors
Diagnostic Criteria for Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need
for admiration, and lack of empathy, beginning by early
adulthood and present in a variety of contexts, as indicated by
five (or more) of the following:
• 1.Has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as superior
without commensurate achievements).
• 2. Is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love.
• 3. 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).
• 4. Requires excessive admiration.
• 5.
Has a sense of entitlement (i.e., unreasonable
expectations of especially favorable treatment or
automatic compliance with his or her
expectations).
• 6.
Is interpersonally exploitative (i.e., takes
advantage of others to achieve his or her own
ends).
• 7.Lacks empathy: is unwilling to recognize or
identify with the feelings and needs of others.
• 8.
Is often envious of others or believes that
others are envious of him or her.
• 9.Shows arrogant, haughty behaviors or
attitudes.
 Clinical features
• Grandiose sense of self importance
• Consider themselves special and expect special treatment
• Cannot handle criticism and become enraged easily
• Tenuous relationships
• Can make others furious by refusal to obey conventional rules of behavior
• Frequently ambitious to achieve fame
and fortune
Clinical features
Differential Diagnosis
• Borderline,
histrionic, and anti social
personality disorders
• Difficult to differentiate
•Allof the three often accompany
Narcissistic personality disorder
Narcissistic VS Borderline
• Less anxiety
• Lives tend to be less chaotic
• Less likely to attempt suicide
 Antisocial Histrionic
History of impulsive  Exhibit features of
behavior Exhibitionism
Often associated with  Interpersonal
alcohol and substance Manipulativeness
abuse Resembles those of
Frequently gets into patients with
trouble narcissistic disorder
(Not observed in NPD)
Treatment
• Psychotherapy
• Pharmacotherapy
 Psychotherapy
• Since patients must renounce their
narcissism to make progress, treatment is
difficult
• Psychoanalytic procedures are being used to
effect change, but much research is required
to validate the diagnosis
• Group therapy helps in learning how to share
with others and helps in developing
empathetic response to others
 Pharmacotherapy

• Lithium (Eskalith) if mood swings

• Anti-depressants especially serotonergric drugs
• Persons with NPD tolerate rejection poorly and
are susceptible to depression
Prognosis

• NPD is chronic and difficult to treat

• Patientsconstantly deal with blows to their
narcissism resulting from their own behavior
• Aging is poorly handled
• values beauty, strength, and youthful attributes
• Cling innapropriately
• Maybe more vulnerable to mid life crises than
other groups
1. Do you feel uncomfortable in situations
in which you are not the center of
attention?
 2. Do your interaction with others
often characterized by inappropriate
sexually seductive or provocative
behavior?
3. Do you display rapidly shifting and
shallow expression of emotions?
 4. Do you constantly use physical
appearance to draw attention to self?
 5. Do you have a style of speech that is
excessively impressionistic and lacking of
detail?
6. Do you show self-dramatization,
theatricality and, exaggerated
expression of emotion?
7. Are you suggestible (easily
influenced by others or
circumstances) ?
8. Do you consider relationships to be
more intimate than they actually are?
 HISTRIONIC
PERSONALITY
DISORDER
Diagnostic Criteria for Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention
seeking, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:

• 1.
Is uncomfortable in situations in which he or she is
not the center of attention.
• 2.Interaction with others is often characterized by
inappropriate sexually seductive or provocative
behavior.
• 3.
Displays rapidly shifting and shallow expression of
emotions.
• 4.Consistently uses physical appearance to draw
attention to self.
• 5.
Has a style of speech that is excessively
impressionistic and lacking in detail.
• 6.
Shows self-dramatization, theatricality, and
exaggerated expression of emotion.
• 7.
Is suggestible (i.e., easily influenced by
others or circumstances).
• 8.Considers relationships to be more
intimate than they actually are.
• Person with histrionic personality
disorder are excitable and
emotional and behave in a
colorful,dramatic, extroverted
fashion.
• Accompanying their flamboyant
aspects, however, is often an
inability to maintain deep, long-
lasting attachments,
EPIDEMIOLOGY
• Limited data
• Prevalence of 1-3% for the general
population
• 10-15% in mental health settings
• Women>Men
• Associatedwith somatization disorder
and alcohol use disorder
DIFFERENTIAL DIAGNOSIS
• Borderline Personality Disorder
• Somatization Disorder may occur
in conjunction
COURSE AND PROGNOSIS
• Displays fewer symptoms with
age
• Sensation seekers (may get
into trouble with the law,
abuse substances, and act
promiscuously)
 TREATMENT
Psychotherapy
Clarification of their inner feelings is an
important therapeutic process

Treatment of choice
PHARMACOTHERAPHY
• Can
be adjunctive when
symptoms are targeted
• Antidepressant – depression
• Antianxiety agents – anxiety
• Antipsychotics – derealization
and illusions
 BORDERLINE
PERSONALITY
DISORDER
 Borderline Personality Disorder
• Patientswith
borderline
personality disorder
stand on the border
between neurosis
and psychosis, and
they are
characterized by
extraordinarily
unstable affect,
mood, behavior,
object relations, and
self-image.
• Thedisorder has also
been called ambulatory
schizophrenia, as-if
personality (a term
coined by Helene
Deutsch),
pseudoneurotic
schizophrenia
(described by Paul Hoch
and Phillip Politan), and
psychotic character
disorder (described by
John Frosch).
Diagnosis
the diagnosis of borderline personality disorder can
made by early adulthood when patients show at
least five of the criteria listed in Table 22-5.
Diagnostic Criteria for Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-
image, and affects, and marked impulsivity, beginning by early
adulthood and present in a variety of contexts, as indicated by five
(or more) of the following:
• 1.Frantic efforts to avoid real or imagined
abandonment. (Note: Do not include suicidal
• or self-mutilating behavior covered in Criterion 5.)
• 2. A pattern of unstable and intense interpersonal
relationships characterized by alternating
• between extremes of idealization and
devaluation.
• 3.Identity disturbance: markedly and persistently
unstable self-image or sense of self.
• 4. Impulsivity in at least two areas that are potentially self-
damaging (e.g., spending,sex, substance abuse, reckless
driving, binge eating). (Note: Do not include suicidalor self-
mutilating behavior covered in Criterion 5.)
• 5. Recurrent suicidal behavior, gestures, or threats, or self-
mutilating behavior.
• 6. Affective instability due to a marked reactivity of mood
(e.g., intense episodic dysphoria, irritability, or anxiety
usually lasting a few hours and only rarely more than a
fewdays).
• 7. Chronic feelings of emptiness.
• 8. Inappropriate, intense anger or difficulty controlling
anger (e.g., frequent displays of temper, constant anger,
recurrent physical fights).
• 9. Transient, stress-related paranoid ideation or severe
dissociative symptoms.
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.
• Patientscan have short-lived psychotic
episodes (so-called micropsychotic episodes)
rather than full-blown psychotic breaks, and
the psychotic symptoms of these patients
are almost always circumscribed, fleeting, or
doubtful.
• The behavior of patients
with borderline personality
disorder is highly
unpredictable, and their
achievements are rarely at
the level of their abilities.

• The painful nature of their

lives is reflected in repetitive
self-destructive acts. Such
patients may slash their
wrists and perform other
self-mutilations to elicit help
from others, to express
anger, or to numb
themselves to
overwhelming affect.
• They feel both dependent
and hostile, persons with this
disorder have 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.
• Patients with borderline
personality disorder cannot
tolerate being alone, and
they prefer a frantic search
for companionship, no
matter how unsatisfactory,
to their own company.
• Functionally, patients with borderline personality disorder distort
their relationships by considering each person to be either all
good or all bad. They see persons as either nurturing attachment
figures or as hateful, sadistic figures who deprive them of security
needs and threaten them with abandonment whenever they feel
dependent
COURSE and PROGNOSIS

• Borderline personality disorder is

fairly stable;
• patients change little over time.
• Longitudinal studies show no
progression toward
schizophrenia, but 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.
Treatment
• Psychotherapy
• MENTALIZATION-BASED TREATMENT
• TRANSFERENCE-FOCUSED PSYCHOTHERAPY
• Pharmacotherapy
• Antipsychotics have been used to control anger, hostility, and brief
psychotic episodes.
• Antidepressants improve the depressed mood common in patients with
borderline personality disorder.
• MAO inhibitors (MAOis) have successfully modulated impulsive behavior
in some patients. Benzodiazepines, particularly alprazolam (Xanax), help
anxiety and depression, but some patients show a disinhibition with this
class of drugs.
• Anticonvulsants, such as carbamazepine, may improve global functioning
for some patients. Serotonergic agents such as selective serotonin
reuptake inhibitors (SSRis) have been helpful in some cases.
Never be ashamed
of what you feel.
You have the right
to feel any
emotion that you
want, and to do
what makes you
happy