Personality Disorders

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Personality refers to a distinctive set of traits, behaviour styles, and patterns that make up our character or individuality. How we perceive the world, our attitudes, thoughts, and feelings are all part of our personality. People with healthy personalities are able to cope with normal stresses and have no trouble forming relationships with family, friends, and co-workers.

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PERSONALITY DISORDERS
Personality
Personality refers to a distinctive set of traits, behaviour styles, and patterns that make up our character or individuality. How we perceive the world, our attitudes, thoughts, and feelings are all part of our personality. People with healthy personalities are able to cope with normal stresses and have no trouble forming relationships with family, friends, and co-workers.

Personality Disorders
Personality Disorders are mental illnesses that share several unique qualities. They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person's life. While many disorders swing back and forth in terms of symptom presence and intensity, personality disorders typically remain relatively constant. According to the Diagnostic and Statistical Manual (DSM-IV-TR), personality disorders are defined as“enduring patterns of perceiving, relating to and thinking about the environment and one’s self that are exhibited in a wide range of social and personal contexts and are inflexible and maladaptive and cause significant functional impairment or subjective distress”. Personality disorders are defined by the American Psychiatric Association (APA) as “an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the individual who exhibits it”. These behavioural patterns in personality disorders are typically associated with severe disturbances in the behavioural tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behaviour is ego-syntonic(i.e., the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behaviour can result in maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress and depression.

What Causes a Personality Disorder?
Some experts believe that events occurring in early childhood exert a powerful influence upon behaviour later in life. The onset of these patterns of behaviour can typically be traced back to late adolescence and the beginning of adulthood, and, in rare instances, childhood. Others indicate that people are genetically predisposed to personality disorders. In some cases, however, environmental facts may cause a person who is already genetically vulnerable to develop a personality disorder. Child

abuse and neglect consistently show themselves as antecedent risks to the development of personality disorders in adulthood.

Diagnosis of Personality Disorders
To be diagnosed with a disorder in this category, a psychologist will look for the following criteria: 1. Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood. 2. The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person’s life. 3. Symptoms are seen in at least two of the following areas:
o o o o

Thoughts (ways of looking at the world, thinking about self or others, and interacting) Emotions (appropriateness, intensity, and range of emotional functioning) Interpersonal Functioning (relationships and interpersonal skills) Impulse Control

According to the International Classification of Diseases (ICD-10), the diagnosis of a personality disorder must satisfy the following general criteria, in addition to the specific criteria listed under the specific personality disorder under consideration: 1. There is evidence that the individual's characteristic and enduring patterns of inner experience and behaviour as a whole deviate markedly from the culturally expected and accepted range (or “norm”). Such deviation must be manifest in two or more of the following areas: a) cognition (i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others); b) affectivity (range, intensity, and appropriateness of emotional arousal and response); c) control over impulses and gratification of needs; d) manner of relating to others and of handling interpersonal situations. 2. The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e., not being limited to one specific “triggering” stimulus or situation). 3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to in criterion 2.

4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence. 5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders. 6. Organic brain disease, injury, or dysfunction must be excluded as the possible cause of the deviation.

Classification of Personality Disorders
There are many formally identified personality disorders, each with their own set of behaviours and symptoms. Many of these fall into three different categories or clusters:
  

Cluster A: Odd or eccentric behaviour Cluster B: Dramatic, emotional or erratic behaviour Cluster C: Anxious fearful behaviour

1. Cluster A  Paranoid Personality Disorder:characterized by irrational suspicions and mistrust of others. The essential feature for this type of personality disorder is interpreting the actions of others as deliberately threatening or demeaning. People with paranoid personality disorder are untrusting, unforgiving, and prone to angry or aggressive outbursts without justification because they perceive others as unfaithful, disloyal, condescending or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious. Schizoid Personality Disorder:lack of interest in social relationships, seeing no point in sharing time with others, anhedonia, introspection. Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker. Schizotypal Personality Disorder:characterized by odd behaviour or thinking. A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of “magical thinking” by saying they can see into the future or read other people’s minds.





2. Cluster B:  Antisocial Personality Disorder: a pervasive disregard for the law and the rights of others. People with antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behaviour. These individuals are impulsive, irresponsible, and callous. Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behaviour, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behaviour on others. These people ware at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom. Borderline Personality Disorder: extreme “black and white” thinking, instability in relationships, self-image, identity and behaviour often leading to self-harm and impulsivity. People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behaviour, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and selfdestructive actions characterize the person with borderline personality disorder. These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes, viewing others as either “all good” or “all bad.” A person with borderline personality may form an intense personal attachment with someone only to quickly dissolve it over a perceived slight. Fears of abandonment may lead to an excessive dependency on others. Borderline personality disorder is diagnosed in 3 times as many females as males. Self-mutilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of boredom or emptiness, and bouts of intense inappropriate anger are other traits of this disorder, which is more common among females. Histrionic Personality Disorder:pervasive attention-seeking behaviour including inappropriately seductive behaviour and shallow or exaggerated emotions. It is a pervasive pattern of excessive emotionality and attention seeking. Narcissistic Personality Disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. People with narcissistic personality have an exaggerated sense of selfimportance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.







3. Cluster C:  Avoidant Personality Disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are





sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are fearful of saying something considered foolish by others; worry they will blush or cry in front of others; and are very hurt by any disapproval by others. People with avoidant personality disorder may have no close relationships outside of their family circle, although they would like to, and are upset at their inability to relate well to others. Dependent Personality Disorder:pervasive psychological dependence on other people. People with dependent personality disorder may exhibit a pattern of dependent and submissive behaviour, relying on others to make decisions for them. They require excessive reassurance and advice, and are easily hurt by criticism or disapproval. They feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends. They have a strong fear of rejection. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males. Obsessive-Compulsive Personality Disorder (not the same as Obsessive-Compulsive disorder): characterized by rigid conformity to rules, moral codes and excessive orderliness.Compulsive personalities are conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances. People with compulsive personality are highly cautious, weigh all aspects of a problem, and pay attention to every detail, making it difficult for them to make decisions and complete tasks. When their feelings are not under strict control, events are unpredictable, or they must rely on others, compulsive personalities often feel a sense of isolation and helplessness.

Treatment for Personality Disorders
Treatment for personality disorders generally is biopsychosocial. There are many types of help available for the different personality disorders. a) Psychotherapy: Psychotherapy for patients with personality disorders focuses on helping them see the unconscious conflicts that are contributing to or causing their symptoms. It also helps people become more flexible and is aimed at reducing the behaviour patterns that interfere with everyday living. In psychotherapy, people with personality disorders can better recognize the effects of their behaviour on others. Behaviour and cognitive therapies focus on resolving symptoms or traits that are characteristic of the disorder, such as the inability to make important life decisions or the inability to initiate relationships. Treatment may include individual, group, or family psychotherapy.

Psychotherapeutic techniques employed include:  Counselling  Dynamic psychotherapy  Cognitive therapy  Cognitive analytical therapy  Dialectical behaviour therapy  Treatment in a therapeutic community b) Physical Treatments: Medications, prescribed by a patient’s physician, may also be helpful in relieving some of the symptoms of some personality disorders, including problems with anxiety and perceptions. These include:  Low dose Antipsychotics: o Can reduce the suspiciousness of the three cluster A personality disorders (paranoid, schizoid and schizotypal). o Can help with borderline personality disorder if people feel paranoid, or are hearing noises or voices.  Antidepressants: o Can help with the mood and emotional difficulties that people with cluster B personality disorders have. o Some of the selective serotonin reuptake inhibitor antidepressants (SSRIs) can help people to be less impulsive and aggressive in borderline and antisocial personality disorders. o Can reduce anxiety in cluster C personality disorders (obsessive-compulsive, avoidant and dependent).  Mood stabilizers: o Medication such as lithium, carbamazepine, and sodium valproate can also reduce impulsiveness and aggression. o These medications and treatments also help if someone with a personality disorder develops depression or schizophrenia.

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