Personality disorders

Dr. Ayush PandeyMBBS,PG Diploma

August 27, 2020

August 27, 2020

Personality disorders
Personality disorders

Personality disorders are a group of mental disorders that impair thinking by introducing unhealthy, long-term patterns of behaviour that are different from those of an average person. People with personality disorders may not get along with other people or have difficulty in dealing with them in general.

Some of the characteristics of people with personality disorders involve being inflexible in their thoughts, resistant to change in life, and have trouble relating to other people and their situations or emotions. These characteristics can create hurdles for them in their personal or professional relationships, or while performing various social activities as well as difficulty in dealing with different situations.

Read more: Mental illness

A study published in the International Journal of Social Psychiatry in 2010 put the prevalence of personality disorders in north India at about 1.07%—of these, about 69.4% were 21-40 years old. These types of disorders were also more common among men (64.9%), employees (37.3%), students (32.8%), particularly graduates and undergraduates, and unmarried people (56%).

Data from America's National Comorbidity Survey Replication found a 9.1% prevalence of any type of personality disorders in the United States, and the figure was about 1.4% for borderline personality disorder, although sex and race did not emerge as factors in this.

Not only are personality disorders of varying types, but they also differ in how they affect a person's quality of life—many people may not even realise they have a personality disorder. Unusual patterns of thought may come naturally to some, which may seem natural to them, followed by several other personality traits. 

While there isn't a definitive reason as to why personality disorders affect some people, genetic predisposition, social and environmental factors as well as traumatic incidents from childhood or while growing up are known to play an important role in the development of these conditions.

Read more: Psychosis

A trained psychiatrist can accurately diagnose the specific condition, based on feedback and responses from the patient.

Types of personality disorders

Personality disorders are of broadly 10 kinds, each of them characterised by different sets of feelings, behaviour and symptoms. Personality disorders are grouped into three clusters:

  • Cluster A personality disorders: This type of personality disorder is marked by odd, eccentric and unusual behaviour and is also known as suspicious personality disorder, which includes the following conditions:
    • Paranoid personality disorder: People with this disorder look at others with suspicion as they are usually distrustful of their motives. People with this personality disorder tend to view the actions of others as deliberately threatening. They may be unforgiving and lash out, with frequent outbursts of anger. They may also be considered jealous and secretive while appearing to be serious at all times.
    • Schizotypal personality disorder: People with this type of personality disorder are considered to have odd or eccentric ways of expressing themselves while speaking or through their manner of dressing up. They are known for having strange and unusual thoughts and have generalised difficulty in forming new relationships. They may be extremely anxious in social settings. They are also confident about being able to influence others with their thoughts and actions, although that may not be true.
    • Schizoid personality disorder: In schizoid personality disorder, people are usually reserved, introverted and appear to be emotionally distant from others, and show little interest in forming new relationships or taking part in social gatherings. They appear to be mostly lost in their own thoughts and avoid forming close bonds or intimacy with others. (Read more: Schizophrenia)
  • Cluster B personality disorders: Four different conditions are clubbed under this type of personality disorders, which is commonly known as the emotional and impulsive type.
    • Antisocial personality disorder: People with this condition have a general disregard for the feelings or emotions of others, and are known to be adept at lying, stealing or manipulating most of the time. They are also considered to be careless and irresponsible, taking decisions on an impulse and typically have a history of problems with the law. People with this condition may also indulge in substance abuse, typically with alcohol.
    • Borderline personality disorder: People with borderline personality disorder are considered to be unstable in various aspects of their behaviour, relationships, as well as their mood. They are characterised by frequent mood swings and acts of self-destruction, while also having a latent fear of being alone or abandoned (read more: health effects of loneliness). They have issues with self-image on most occasions and have a tendency to harm themselves along with paranoia. According to Mental Health America, impulsive behaviour, feelings of emptiness and violent, inappropriate anger are common signs among women.
    • Narcissistic personality disorder: As the name suggests, people with this condition have a feeling of self-importance and entitlement. They may go on and on about their personal and professional achievements and crave attention and appreciation, all the while lacking empathy for others. They are also very sensitive to failure.
    • Histrionic personality disorder: Those with histrionic personality disorder also tend to have the same craving for attention and admiration, but are extremely emotional and overly dramatic. They may be identified with their provocative gestures to gain the attention of people around them, and often have strong opinions about various subjects, without necessarily having arguments to back them up. They are also characterised by frequent mood swings and are obsessed with physical appearances.
  • Cluster C personality disorders: This cluster of personality disorders are marked by feelings of anxiety, with fearful thoughts and behaviour characterising them. This group of disorders includes:
    • Avoidant personality disorder: This type of personality disorder sees people being overly sensitive to things, as well as rejection or criticism. They are powered by thoughts of not feeling adequate or general inferiority to others. They often find themselves to be unattractive or uninteresting. They do not like social situations and avoid activities that require them to work with others. They are often found to be isolated and timid. They are also afraid of speaking up in public for fear of being ridiculed by others and limit their social interactions to immediate family members on most occasions.
    • Dependent personality disorder: Those with this type of personality disorder tend to be submissive and overly dependent on others to get things done or make decisions for them. They avoid being alone, are afraid of rejection and have the need to be reassured when making choices for themselves, and tend to be tolerant of physical or verbal abuse.
    • Obsessive-compulsive personality disorder: People with this disorder have the urge or need to be in control and have order around them. They are extremely adept at following rules and are law-abiding in general. They can feel dejected when things are not how they envisioned them to be. They pay attention to every detail and are cautious when dealing with situations, often making it difficult for them to get things done on time. They have a feeling of isolation or being helpless when a situation is beyond their control.

Personality disorders symptoms

Different personality disorders have different signs and symptoms that are characteristic of the condition. In general, personality disorders are marked by:

  • A manner of thinking or perceiving things from a viewpoint that only serves one's own interests
  • Being distressed by one's own thinking and behaviour can be considered to be a personality disorder
  • These characteristics may be more noticeable in childhood or in the formative years though they may become more prominent in adulthood.

Read more: Pathological laughter and crying

Personality disorders causes

As mentioned earlier, the cause(s) for personality disorders isn't known, although it can sometimes be put down to the genetic makeup of an individual or past experiences (from childhood and growing up) that influence their mental makeup in later years. However, personality disorders can be gauged if they affect at least two of the following patterns of thought:

  • Emotional response
  • Thoughts on self and others
  • Degree of empathy towards others
  • Control over self

Diagnosis of personality disorders

Various manuals on psychiatry and psychotherapy may be considered to diagnose mental health conditions like personality disorders as they do not show up on any imaging tests. One such manual is the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5 (into its fifth edition, published by the American Psychiatric Association) which doctors and mental health practitioners frequently refer to for guidance.

Read more: Bipolar disorder

Personality disorders have different criteria—the doctor/therapist asks questions based on these reference points to make an accurate diagnosis. However, the behaviours and feelings characteristic of a personality disorder must be consistent across various aspects of life to be considered an affliction or diagnosis. Meaning the patient must feel and behave in ways characteristic of a personality disorder at all times, and not just in some situations.

Read more: Delusional disorder

Certain other tests that may be ordered to diagnose a personality disorder include tests for alcohol or drugs in your bloodstream, and whether any underlying medical condition is aggravating the patient's mental symptoms.

Personality disorders treatment

There are different treatment options for personality disorders, depending on the degree of the condition as well as the symptoms.

Personality disorders develop over time and can take months, sometimes years of treatment. The doctor may advise you to visit a clinical psychiatrist for an accurate evaluation and to recommend the future course of action based on your condition. A therapist could be recommended for counselling and therapy sessions, along with medications if any.

Read more: Yoga for mental health

In mild cases, a few rounds of counselling sessions could be helpful and lead you towards the path of recovery, or can even be handled by your usual doctor.

Psychotherapy or talk therapy is a one-on-one or group interaction with a therapist which allows the patient to discuss the condition and the problems they have been experiencing along with the signs of their affliction. The therapist advises the patient on the actions or suggestions which can help the patient cope with their symptoms better and prevent them from affecting their life in an extreme way.

If you find social situations to be daunting or awkward, you may also receive training to develop adequate social skills to be able to communicate with other people in a healthy manner. In some cases, family members of the patient can also be included in the therapy to be made aware of the patient's condition and the kind of support they need from their loved ones.

Certain psychiatric medications used for different mental health conditions can also be prescribed depending on the condition of the patient. Medications include antidepressants, mood stabilisers or medicines to control your anxiety, or even sleep medication.

Read more: Depression

In some rare cases of extreme episodes, hospitalisation is required to make the patient return to a stable state of mind in psychiatric care. This becomes a necessity when a patient is in danger of harming oneself or someone else, or does not have anyone else looking after them.



References

  1. National Health Service [Internet]. UK; Personality disorder.
  2. Mental Health America [Internet]. Alexandria, VA, USA. Personality Disorder.
  3. Gupta S and Mattoo SK. Personality disorders: Prevalence and demography at a psychiatric outpatient in North India. International Journal of Social Psychiatry. 2012 Dec; 58 (2): 146-152.
  4. Hartocollis L. The Making of Multiple Personality Disorder: A Social Constructionist View. Clinical Social Work Journal. 1998; 26: 159–176.

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