Personality disorders by dr. rujul modi

Personality Disorders -II
DR. RUJUL MODI, FIRST YEAR RESIDENT
DEPT. OF PSYCHIATRY, MGMCH,JAIPUR

DSM -5 ICD-10
CLUSTER - B
Dramatic , Impulsive
& Erratic
Antisocial PD (301.7) Dissocial PD (F-60.2)
Narcissitic PD (301.81) --
Histrionic PD (301.50) Histrionic PD (F-60.4)
Borderline PD (301.83)
Emotionally unstable PD (F-60.3)
- Impulsive type (F-60.30)
- Borderline type (F-60.31)
CLUSTER – C
Anxious & Fearful
Avoidant (301.82) Anxious (Avoidant) (F-60.6)
Dependent (301.6) Dependent (F-60.7)
Obsessive-Compulsive PD
(301.4)
Anankastic PD (F-60.5)

Cluster-B disorders
1. Antisocial Personality Disorder
2. Narcissistic Personality Disorder
3. Histrionic Personality Disorder
4. Borderline Personality Disorder
B

1. Antisocial Personality Disorder B
▪ Hallmarks : Pervasive disregard for & violation of rights of others,
occurring, since the age of 15 years and continuing into adulthood.
▪ Sex ratio - M:F = 3:1 (As per DSM-5)
▪ Clinical criteria : A person should be ≥ 18 years, and with evidence of
Conduct disorder before the age of 15years.

▪ Diagnostic features (at least 3 of the following should be present) :
I. Failure to conform to social norms (resulting in frequent arrests)

II. Deceitfulness, including lying and conning (persuading to do by lying)
others, for personal profit or pleasure.
III. Impulsivity or failure to plan ahead.

IV. Irritability and aggressiveness, including repeated physical fights or
assaults
V. Reckless disregard for safety of self of others.

VI. Irresponsibility, indicated by the failure, to honor financial obligations, or
to sustain consistent work behavior.
VII. Lack of remorse, indicated by indifference or rationalizing having hurt,
mistreated, or stolen from others.

▪ Associated features :
• Promiscuity and inability to sustain a monogamousrelationship.
• Inflated and arrogant self-appraisal.
• Lack of empathy, Cynicism.
• Lying, truancy, running away from home, thefts, fights, substance abuse.
• They often impress opposite-sex
• Clinicians exhibit no anxiety or depression although suicide threats and
• somatic pre-occupations maybe common.
• Have good verbal intelligence.
Cont…

• They are extremely manipulative and can frequently talk others,
into participating in schemes, for easy ways to makemoney.
• Those with this disorder do not tell the truth and cannot be trusted to
carry out any task.
• Promiscuity, spousal abuse, child abuse, and drunk driving are
common events in theirlives.
▪ Comorbidity : At increased risk for …
Impulse Control Disorder, Substance Abuse/Dependence
Major depression, and Pathological Gambling

▪ Epidemiology :
✓ Prevalence rates : 0.2 - 3 % (As per DSM-5.)
✓ Morecommonin poor urban areasandamongmobile residentsof theseareas.
✓ The highest prevalence is found among the, most severe samples of men with
Alcohol Use Disorder (> 70 %) and in Prisoners, wherethe prevalence is 75 % .
✓ Onset, is before the age of 15 years.
✓ Girls usually have symptomsbefore puberty and boys even earlier

▪ Course :
After the age of 30 years, both the most flagrant antisocial behaviors
(promiscuity, crime) and the less severe behaviors,and substance use
tend to decrease.
Even after the severe antisocial behavior “burns out,” people with antisocial
PD usually continue to be irritable,impulsive, and detached.

▪ Genetics and Familial factors :
o Antisocial PD is more frequent among the first-degree biological
relatives of probands, with this disorder.
o Biological relatives, of female pts. with Antisocial PD are at increased risk
for the same disorder than biological relatives of males.
o Genetic studies have suggested familial transmission of Antisocial PD,
Substance Use, and Somatization Disorder

o Both adopted and biological children, of parents with Antisocial PD, are
at increased risk for this disorder.
o Conduct Disorder, is more likely, to develop into, Antisocial Disorder
with erratic parenting, neglect, or inconsistent parental discipline.
o Conduct Disorder (before the age of 10 years) and accompanying ADHD
increase the likelihood of developing antisocial personality in adult life.

▪ Complications:
Dysphoria
Tension
Low tolerance for boredom
Depressed mood
Premature Violent death
LUIS GARAVITO
JOHN WAYNE GACY
TED BUNDY

MOVIES
1971 1991

2. Narcissistic Personality Disorder B
▪ Hallmarks : pervasive sense of grandiosity (in fantasy or in behavior),
need for admiration, lack of empathy, and chronic intense envy.

▪ Diagnostic features includes at least 5 of the following :
I. Grandiose sense of self-importance and specialness
II. Preoccupation with fantasies of, unlimited success, power, brilliance, beauty,
or ideal love

III. Sense of entitlement (having a right to do something)
IV. Regards self as “special” and unique
V. Interpersonal exploitativeness, such as, taking advantage of others to
achieve own needs

VI. Lack of empathy VII. Excessive need for
admiration and acclaims

VIII. Intensive and chronic envy
(jealous)
IX. Arrogant and haughty
(superior, lack of respect) attitude

• Fragile self-esteem (which exclusively depends on external
admiration) with hypersensitivity to criticism.
• High achievements more frequent than in any other PD
• Strong feelings of shame and humiliation
• Exhibitionism (behavior motivated by the pleasure of being looked at)
• Fear of having their “hidden” imperfections and flaws revealed

▪ Sex ratio :
More common in males (50 to 75 % of diagnosed cases are males)
▪ Epidemiology :
Prevalence rates of 2 to 16 % in the clinical population.
< 1% in the general population.
▪ Course : Chronic.
However, narcissistic symptoms, tend to diminish after the age of 40 years,
when pessimism usually develops.

▪ Predisposing Features :
➢ Higher risk for this PD, in the off-springs of narcissistic parents, who
impart on their children, an unrealistic sense of grandiosity.
➢ Most Narcissistic persons are, realistically talented , beautiful or highly
intelligent, as these features serves, as the nucleus, around which the sense
of specialness is, further organized.

3. Histrionic Personality Disorder B
▪ Hallmarks : pervasive and excessive self-dramatization, excessive
emotionality, and attention seeking.

▪ Diagnostic features also include at least five of the following :
I. Inappropriate sexual seductiveness
or provocativeness
II. Excessive need to be in the center of
attention

III. Rapidly shifting and shallow
expression of emotions
IV. Suggestibility

V. Physical appearance used for
attention-seeking purposes
VI. Impressionistic speech lacking
detail

VII. Self-dramatization, theatricality,
exaggerated expression of emotions.
VIII. Relationships considered more
intimate than they really are.

• Difficulties, in achieving emotional intimacy, in romantic or sexual
relationships.
• Promiscuity.
• Seductive behavior is common in both sexes. Sexual fantasies.
• in fact, histrionic patients may have a psychosexual dysfunction; women
may be anorgasmic, and men may be impotent.
• Their need for reassurance is endless.
• They may act on their sexual impulses to reassure themselves that they
are attractive to the other sex.

▪ Sex ratio :
In general more frequent in females.
According to DSM-5, it might be equally frequent among men and women.
▪ Epidemiology :
Prevalence rates : 2 % in the general population, 10 to 15 % for psychiatric
inpatients and outpatients, are reported in DSM-IV-TR and DSM-5.
▪ Genetics : A genetic ‘link’ between Histrionic and antisocial PD &
Alcoholism.

▪ Complications :
• Frequent suicidal gestures and threats to coerce, better caregiving
• Interpersonal relations are unstable, shallow, and generally ungratifying.
• Frequent marital problems.
• Tendency to neglect, long-term relationship, for the excitement of new
relationship.
• Frequent job losses, interrupted education. Substance abuse.
▪ Comorbidity :
• increased risk for…
Major Depression, Anxiety Disorders,
Somatization Disorder and Conversion Disorder.

ANTISOCIAL-NARCISSISTIC-HISTRIONIC
SPECTRUM DISORDER
▪ These 3 PDs are, qualified for the spectrum disorders as..
I. They shown to aggregate in the same family
II. May co-exist in the same person.
▪ Symptoms of these 3 PDs, tends to group around
Impulsivity, Aggression and Dramatic affects.
▪ These spectrum interferes with one’s character
development and maturity
➢ The severity of, underlying antisocial behaviours ,
increases, if one proceeds from Histrionic via
Narcissistic to Antisocial.

4. Borderline Personality Disorder B
▪ Hallmarks : Pervasive and excessive instability of affects, self-image, and
interpersonal relationships as well as marked impulsivity.

▪ Diagnostic features also include at least five of the following :
II. Unstable and intense, interpersonal
relationships, with alternating
between idealization & devaluation
III. Markedly andpersistently unstable
self-image or senseof self
I. Frantic efforts to avoid real or imagined abandonment.

IV. Impulsivity in, at least two
potentially self-damaging areas
(spending, sex, substance abuse,
binge eating, reckless driving).
V. Recurrent suicidal behavior,
gestures, threats, or
self- mutilating behaviors.

VI. Instability of affect, due to marked
reactivity of mood
VII. Chronic feelings of emptiness

VIII. Inappropriately intense anger or
difficulty controlling Anger.
IX. Stress related, transient paranoid
ideation or dissociative symptoms.

• Tendency to undermine self when close to realizing a goal
• Feeling more secure with nonhuman objects (pets, inanimate objects).
• Mood swings are common.
• Patients can 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 fleeting, or
doubtful.
• Their achievements are rarely at the level of their abilities.

• Patients cannot tolerate being alone, and they prefer a frantic search for
companionship
• Some clinicians use the concepts of panphobia, pananxiety,
panambivalence, and chaotic sexuality to delineate these patients’
characteristics.

▪ Sex ratio :
According to DSM-5, more common in females.
( 75 % of diagnosed cases are females ).
▪ Epidemiology : Prevalence rates –
2 % in the general population,
10 % for psychiatric outpatients,
20 % for psychiatric inpatients,
30 to 60 % among patients with PDs
more common in younger than in older samples.

• Course : Variable.
Most commonly follows, a pattern of chronic instability in early adulthood,
with episodes of serious affective and impulsive dyscontrol.
The impairment and the risk of suicide are the at the young adult years and
gradually wane with advancing age.
In the fourth and fifth decades, these individuals tend to attain greater
stability in their relationships and functioning.

▪ Familial Pattern and Genetics :
• Childhood history of physical and sexual abuse, neglect, hostile conflict,
and early parental loss or separation are more common in these patients.
• Five times more common among relatives of probands with these disorder
▪ Complications :
• Psychotic like symptoms in response to stress. ( ex. Hallucinations, Body
image distortions, hypnagogic phenomena, ideas of reference)
• Self injurious behaviour and failed sucide.
• Premature death/Physical handicap from sucide/suicidal gestures.

Neuro-Endocrinological Aspects of
Borderline Personality Disorder B
1. Oxytocin and BPD :
• The neuropeptide Oxytocin has been shown to play a central role in pro-social behavior1.
• Patients, with BPD, specially women had a decreased levels of plasma Oxytocin, thus indicating a
positive relationship of Oxytocin with BPD2.
• A study by Chahen Andrew et.al (2017) indicates that , Oxytocin is critically involved in disunion
distress, bond formation, affection, affinity and affiliation. Further, Oxytocin administered nasally,
increased trusting behavior and improve facial recognition and shifts attention away from
negative social information. Oxytocin may thus, be a useful agent to increase pro-social behavior
in individuals with BPD3.
1. Heinrichs M, von Dawans B, Domes G. Oxytocin, vasopressin, and human social behavior. Frontiers in neuroendocrinology. 2009 Oct
1;30(4):548-57.
2. Blazer D. Neurocognitive disorders in DSM-5. American Journal of Psychiatry. 2013 Jun;170(6):585-7.
3. Chanen A, Sharp C, Hoffman P, for Prevention GA. Prevention and early intervention for borderline personality disorder: a novel public
health priority. World Psychiatry. 2017 Jun;16(2):215.

2. Role of Sex hormones :
• Previous studies, suggest that rising or changing levels of estrogen may have,
more influence on BPD symptoms, than absolute levels.4
• BPD symptoms were more common in, women assessed on Menstruation days,
(during which estrogen starts rising), relative to women assessed on other days
• Women using OCPs showed, elevated BPD symptoms as compared with women
not on OCPs.5,6
4. Ali Khan., et al. “Neuro-Endocrinological Aspects of Borderline Personality Disorder: A Short Review”. EC Neurology 11.1 (2019): 94 -102.
5. DeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L. Estrogen fluctuations, oral contraceptives and borderline personality.
Psychoneuroendocrinology. 2003 Aug 1;28(6):751-66.
6. Eisenlohr-Moul TA, DeWall CN, Girdler SS, Segerstrom SC. Ovarian hormones and borderline personality disorder features: preliminary
evidence for interactive effects of estradiol and progesterone. Biological psychology. 2015 Jul 1;109:37-52.

• A study by Roepke Stephan et al. (2010), suggested a relationship between BPD
and Polycystic Ovarian Syndrome.
Roepke S, Ziegenhorn A, Kronsbein J, Merkl A, Bahri S, Lange J, Lübbert H, Schweiger U, Heuser I, Lammers CH. Incidence of
polycystic ovaries and androgen serum levels in women with borderline personality disorder. Journal of psychiatric research.
2010 Oct 1;44(13):847-52.

• One potential link between estrogens and BPD is the serotonin system.
A study by Dolan M, et.al (2001), revealed that, the subjects characterised by
high level of impulsivity and aggression have reduced, central 5-HT functions
(By using 5-HT specific challenge agent Fenfluramine)
1. Dolan M, Anderson IM, Deakin JF. Relationship between 5-HT function and impulsivity and aggression in male offenders with
personality disorders. The British Journal of Psychiatry. 2001 Apr;178(4):352-9.

2000 1999, Oscar Winner
Borderline PD with
Eating disorder with
Depression

TREATMENT
▪ Psychotherapy :
When placed in hospitals, they often become amenable to psychotherapy. When
patients feel that they are among peers, their lack of motivation for change
disappears. Perhaps for this reason, self-help groups have been more useful
than jails in alleviating the disorder.
Behavior therapy to control patient’s impulses and angrer outbursts and to reduce
their sensitivity to criticism and rejection.
Social skills training, especially with videotape playback, helps enable patients to
see how their actions affect others, and thereby improve their interpersonal
behavior.

Projective identification :
These defense mechanism consists of three steps.
• First, an aspect of the self, is projected on to someone else.
• The projector then tries to coerce the other person, into identifying with
what has been projected.
• Finally, the recipient of the projection and the projector feel a sense of oneness
or union.
• Projective identification may also cause counter-transference problems.

▪ Splitting :
In splitting, persons toward whom patients’ feelings are, or have been
ambivalent are divided into good and bad.
For example, in an inpatient setting, a patient may idealize some staff
members and uniformly disparage others.
• The splitting defense mechanism causes, patients to alternately love
and hate therapists and others in the environment.

Dialectical Behavior Therapy (DBT) B
• It is the psychosocial treatment with the most empirical support for
patients, with borderline personality disorder.
• Developed for chronically self-injurious patients and parasuicidal
behavior.
• Patients are seen weekly, with the goal of improving interpersonal skills
and decreasing self-destructive behavior, using techniques, involving
advice, metaphor, storytelling, and confrontation.
• They are helped to deal with the ambivalent feelings that are characteristic
of the disorder.

• Marsha Linehan, Ph.D., developed the treatment method, based on her
theory, that such patients, cannot identify emotional experiences and
cannot tolerate frustration or rejection.
• As with other behavioral approaches, DBT assumes, all behavior (including
thoughts and feelings) is learned and that patients with borderline
personality disorder, behave in ways, that reinforce or even reward their
behavior, regardless of how maladaptive it is.

Five essential "functions" in DBT:
1. To enhance and expand the patient’s repertoire of skillful behavioral patterns;
2. To improve patient motivation to change by reducing reinforcement of
maladaptive behavior, including dysfunctional cognition and emotion;
3. To ensure that, new behavioral patterns generalize from the therapeutic to the
natural environment;
4. To structure the environment, so that elective behaviors, rather than
dysfunctional behaviors, are reinforced; and
5. To enhance the motivation and capabilities of the therapist, so that elective
treatment is rendered.

Mentalization Based Therapy (MBT) B
• Mentalization is a social construct that allows a person, to be attentive to the
mental states of oneself and of others.
• MBT is based on a theory, that borderline personality symptoms, such as
difficulty in regulating emotions and managing impulsivity, are, result of
patients' reduced capacities to mentalize.
Thus, it is believed that recovery of mentalization helps patients build
relationship skills as they learn to better regulate their thoughts and feelings.
Transference-focused psychotherapy.
• Transference-focused psychotherapy (TFP) is a modified form of psychodynamic
psychotherapy that is based on Otto Kemberg's object relations theory.

Pharmacotherapy :
• Useful to deal with specific personality features that interfere with patients'
overall functioning.
Antipsychotics - used to control anger, hostility, and brief psychotic episodes.
Antidepressants (SSRIs) - improves depressed mood common in patients with BPD
MAO inhibitors (MAOI) have successfully modulated impulsive behavior in some
patients.
Benzodiazepines, helps in anxiety and depression, but some patients show a
disinhibition with this class of drugs.

• Anticonvulsants, such as carbamazepine, may improve global functioning .
• Lithium, has been used with patients whose clinical picture includes mood
swings.
• A study by Joel Peris (2005), suggested that
psychotherapy remains the mainstay of management
for patients with BPD.
• Paris J. Recent advances in the treatment of borderline personality disorder. The Canadian Journal of Psychiatry. 2005
Jul;50(8):435-41.

Cluster-C disorders
1. Avoidant personality disorder
2. Dependent personality disorder
3. Obsessive-compulsive personality
disorder (OCPD)
C

1. Avoidant Personality Disorder C
▪ Hallmarks :
• Pervasive and excessive hypersensitivity to
negative evaluation.
• Social inhibition
• Feeling of inadequacy
Beginning by early childhood

▪ Diagnostic criteria (DSM-5) requires atleast 4 of the following :
1. Avoids occupational activities that involve significant social contact, due to
fears of disapproval or rejection.
2. Unwilling to deal with people unless sure of being liked.
3. Restraint within intimate relationships due to fear of being shamed or
ridiculed.
4. Preoccupied with being criticized or rejected in social situations.
5. Inhibited in new social situations because of feelings of inadequacy.

6. Views themselves as socially inept, personally unappealing, or inferior to
others.
7. Unusually reluctant to take risks or to engage in new activities because
they may prove embarrassing.
• Some associated features :
• Fearful and tense demeanor
• Fear of blushing or crying in front of others in response to criticism.
• Social isolation
• Fantasizing about ideal relationship with others.

▪ Epidemiology :
Prevalence rates 2-3% in the general population.
30% in psychiatric outpatients.
Equally frequent in males and females
• Childrens classified as, having a timid temperament
is more susceptible to the disorder.

▪ Comorbidity :
These patients are at increased risk for Mood and Anxiety Disorders
(especially Social Phobia, generalized type).
✓ A study by Alden LE et al. 2002 , revealed that about 25% of these pt. have
Panic disorder 10-25% have GAD , 20-25% have an Eating disorder and
>33% have Body dysmorphic disorder
The most common co-occurring disorders are Schizotypal, Schizoid, Paranoid,
Dependent and Borderline
▪ Impairment : Occupational and social difficulties. ‘Social Phobia’

TREATMANT
Psychotherapy: Social Skills Training & Exposure Therapy are helpful.
Emmelkamp PM et al. 2006, found that 20 sessions of Cognitive Behavioral
Therapy (CBT) brought some improvement in symptoms, and was superior to
20 sessions of Psychodynamic Psychotherapy (PP).
Svartberg M et al. 2004, found that 4o sessions of CBT was equally effective to
40 sessions of PP.
Pharmacotherapy : Used to manage anxiety & depression associated with
disorder. Some pts. are helped by Beta blockers to manage autonomic nervous
system hyperactivity

2. Dependent Personality Disorder C
• Persons with Dependent PD, subordinate their own needs to those of others.
• Get others to assume responsibility for major areas of their lives.
Has difficulty making everyday decisions without an excessive
amount of advice and reassurance from others
• Lack self-confidence.
• Experience intense discomfort when alone
for more than a brief period.

▪ Epidemiology :
• Prevalence rates of 0.6-3.7% in the general population
• Female > Male.
• More common in younger children than in older ones.
• Person with chronic physical illness in childhood may be most susceptible to
disorder.

▪ Diagnostic criteria as per DSM-5 :
A pervasive and excessive need to be taken care of that leads to submissive and
clinging behavior and fears of separation, beginning by early adulthood
and present in a variety of contexts, as indicated by 5 or more of the following:
1. Has difficulty, making everyday decisions, without an excessive amount of
advice and reassurance from others
2. Needs others to assume responsibility for most major areas of his or her life
3. Has difficulty expressing disagreement with others because of fear of loss
of support or approval.
Note: Do not include realistic fears of retribution.

4. Has difficulty initiating projects or doing things on his or her own
5. Goes to excessive lengths to obtain nurturance and support from others, to
the point of volunteering to do things that are unpleasant
6. Feels uncomfortable or helpless when alone because of exaggerated fears
of being unable to care for himself or herself
7. Urgently seeks another relationship as a source of care and support when a
close relationship ends
8. Is unrealistically preoccupied with fears of being left to take care of himself
or herself

▪ Comorbidity : Eating Disorders, Mood disorders, Anxiety Disorders,
Somatoform Disorders, and other Personality Disorders (Histrionic,
Avoidant, and Borderline).
✓ A study by Overholser JC 1996, found that About 30% of Patients with
Dependent PD is having Depression, >10% having Bipolar Disorder, and
about 7% have Dysthymia
▪ Impairment : Typically includes interpersonal relationships and
occupational functioning if independence is required.

▪ Complications :
• Occupational functioning, tends to be impaired, because the person can’t act
independently & without close supervision
• Social relationships are, limited, to those,
on whom they can depend.
• Risk of MDD , if they lose the person on whom they depend.
• With treatment the prognosis is favourable.

TREATMENT
▪ Psychotherapy : Insight-oriented therapies, enable patients to understand
the antecedents of their behaviour, become more
independent, assertive &self-reliant.
Behavioral therapy, Assertiveness training, Family therapy & Group therapy have
been used with successful outcomes in many cases.
▪ Pharmacotherapy : Medications would not be expected to help very much
for the core symptoms of Dependent Personality Disorder, but will often be
usedto treat any associated psychiatric conditions.

3. Obsessive-Compulsive Personality Disorder C
Characterized by a general pattern of concern with..
• Orderliness
• Perfectionism
• Excessive attention to details,
• Mental and interpersonal control,
• A need for control over one's environment,

▪ Diagnostic Criteria as per DSM-5…
A pervasive pattern of pre-occupation with orderliness, perfectionism, and mental
and interpersonal control, at the expense of flexibility, openness and efficiency,
beginning by early adulthood and present in a variety of context, as indicated by 4
or more of the following:
1. Preoccupied with details, rules, lists, order, organization, or schedules to the
extent that the major point of the activity is lost
2. Shows perfectionism that interferes with task completion (e.g., is unable to
complete a project because his or her own overly strict standards are not met)
3. Excessively devoted to work and productivity to the exclusion of leisure
activities and friendships (not accounted for by obvious economic necessity)

4. Overconscientious, scrupulous, and inflexible about matters of morality,
ethics, or values (not accounted for by cultural or religious identification)
5. Unable to discard worn-out or worthless objects even when they have no
sentimental value
6. Reluctant to delegate tasks or to work with others unless they submit to
exactly his or her way of doing things
7. Adopts a miserly spending style toward both self and others; money is viewed
as something to be hoarded for future catastrophes
8. shows rigidity and stubbornness

▪ Epidemiology :
• Prevalence rates – 2-8 % in the general population.
• 8-9 % in psychiatric outpatients.
• Female: Male = 1:2
• Most often in oldest siblings

▪ Comorbidty : These patients are at increased risk for Major Depression,
Anxiety Disorder and Obsessive-Compulsive Disorder.
▪ Course : Variable & unpredictable.
o Some adolescents with OCPD evolve into warm, open & loving adults.
o The disorder can be the harbinger of Schizophrenia or MDD
o Individuals with OCPD often experience a moderate level of professional
success but they are vulnerable to unexpected changes & their personal
lives may remain barren.
o Late onset Depressive disorder are common.

OCD OCPD
The presence of true obsessions and/or
compulsions.
With OCPD, the behaviors are NOT directed
by thoughts, that are unable to control or
irrational behaviors, that repeat over and
over again, often with no apparent aim.
Ego dystonic Ego syntonic
Symptoms, fluctuates in association with the
underlying anxiety
The behaviors tend to be persistent and
unchanging over the long term
Often seek professional help to overcome,
the irrational nature of their behavior and
the persistent state of anxiety, they live
under.
Usually not seeking help, because they
don't see that anything they are doing, is
particularly abnormal or irrational.

▪ Psychotherapy : Insight-oriented psychodynamic techniques and
cognitive behavioural therapy are helpful.
Specific breathing and relaxation technique can help dectrease the sense of
stress and urgency.
▪ Pharmacology : SSRIs appear to help the OCPD patients with their
rigidity and compulsiveness.

References : R
Kaplan and sadocks comprehensive textbook Of psychiatry - 10th edition
Kaplan and sadocks synopsis of psychiatry -11th edition
Postgraduate textbook of psychiatry – Ahuja
Introduction to Psychology by C.T.Morgan 7th edition.
DSM-5
ICD-10
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