Personality disorders are characterized by a skewed perception of the world and problematic relations with others and self. “Personality disorder” is not a diagnosis in and of itself but simply a category that several psychiatric conditions fall under. Those with personality disorders tend to have an inflexible and ineffective reaction to the world and have difficulty adjusting to everyday changes or demands. People with personality disorders believe their behavior is appropriate, view the world in a one-dimensional fashion and find social participation difficult or impossible.
Personality disorders are diagnosed through close observation by a trained medical professional. Personality disorders are identified by a maladaptive pattern towards dealing with life that is deep-rooted and has led to excessive stress or sub-par functioning. This is evident through the patient’s thoughts, feelings and behavior. Personality disorders usually become evident during adolescence and persist as an adult usually becoming less noticeable throughout middle age. It is common for someone who is diagnosed with a personality disorder to exhibit traits of at least one other personality disorder.
Some of the particular symptoms of personality disorders as a whole are:
- Frequent mood swings
- Turbulent relationships
- Social isolation
- Lack of trust and a suspicion of others
- Difficulty initiating relationships
- A preoccupation with instant gratification
- Impulse control deficiency
- Alcohol or drug abuse
Many attribute personality disorders to a traumatic childhood experience. Others believe personality disorders occur because of a genetic predisposition. Most consider it to be a combination of both of these factors; both genes and childhood events lead to the formation of a personality disorder.
Some factors which may heighten the risk for developing a personality disorder include:
- A family history of personality disorders or mental illness in general
- Abuse during childhood
- Neglect during childhood
- An unsteady or chaotic household during childhood
- A diagnosis of Childhood Conduct Disorder
- Loss of parents during childhood either through death or traumatic divorce
Some co-occurring disorders or difficulties that coincide with personality disorders are:
- Eating Disorders
- Suicidal ideation or behavior
- Reckless behavior
- Unsafe sexual practices
- Child abuse
- Alcohol or drug abuse
- Hostility or violent acts
- Relationship troubles
- Social isolation
- Academic or occupational difficulties
Personality disorders are split up into three sub-categories or “clusters”. Cluster A consists of personality disorders that involve bizarre or eccentric behavior. Schizoid Personality Disorder, Paranoid Personality Disorder, and Schizotypal Personality Disorder are the mental conditions that are contained in this cluster.
Those with Schizoid Personality Disorder are introverted, favor isolation, and are unsociable. They tend to be preoccupied by their own thoughts and feelings and dread intimacy. Those that suffer from this disorder spend much time deep in thought and have trouble taking action.
Individuals with Paranoid Personality Disorder perceive others actions as belittling or aggressive. They tend to have extreme difficulty trusting or forgiving others. People with this disorder often erupt with anger and rationalize their behavior with the belief that others are fake or disloyal. Paranoid Personalities often live ultra-private lives, experience jealousy and may give the impression of being emotionally distant or extremely solemn.
People who have Schizotypal Personality Disorder tend to have strange or eccentric habits of behavior and dressing. They have a far-fetched and bizarre thought process and experience paranoid delusions. Those diagnosed with this disorder have difficulty obtaining closeness with others and feel severe anxiety when confronted with a social situation. They may not react at all during a conversation or they may talk to themselves or respond inappropriately. “Magical thinking” is a characteristic that is attributed to this disorder and this involves beliefs such as being able to prophesize the future or read minds.
Personality disorders that fall under Cluster B are characterized by intense emotional or erratic behavior. Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality Disorder are the specific diagnoses that are described within this cluster.
Those with Antisocial Personality Disorder act outside the typical social norms. They tend to be impulsive, reckless, and appear to have a blunted affect. Many experience trouble with the law, engage in chaotic behavior, and have hostile or even violent relationships. They are highly insensitive to others feelings and are shameless with all their actions. Antisocial Personalities are vulnerable to addiction because of drugs ability to temporarily relieve tension.
Borderline Personality Disorder is characterized by instability in relationships, behavior, mood, and self-image. Turbulent interpersonal relationships, extreme mood swings, transitory self-image, and self-destructive behavior are all symptoms of borderline personality disorder. Those suffering from Borderline Personality Disorder experience a problematic sense of self and view the world in a black and white fashion by either idolizing or demonizing others, ignoring a middle ground. Borderline personalities build an intense liking for someone which turns to hatred over a relatively insignificant occurrence interpreted as being disrespectful. They tend to become very codependent of others on account of a deep seeded fear of abandonment. Suicidal behavior or ideation may be employed by those with Borderline to gain attention or control others. Impulsivity, consistently feeling bored or empty, and episodes of extreme anger are also characteristics of this disorder. Borderline tends to occur more in females than males.
Histrionic Personality Disorder consists of one being overemotional and compulsively seeking attention. They are at a near constant need for approval and are overly flirtatious. They may be capable of successfully functioning socially and vocationally. Histrionics tend to have above average social skills but use these abilities for manipulation. They may initiate relationships only to abruptly end them when it becomes too attached. It is somewhat similar to Borderline in that they swing between idealizing and devaluing their relationship partner. Histrionic tend to enjoy excitement and become bored easily which may lead to job loss or putting themselves in dangerous situations.
Individuals with Narcissistic Personality Disorder have a grandiose image of their own importance, seek attention excessively, and are consumed by delusions of infinite success. They are over-sensitive to failure or judgment and may suffer from hypochondria. Their self-image may fluctuate rapidly between a superiority complex and insecurity. In addition, Narcissists may take advantage of their interpersonal relationships.
Anxious and fearful personality disorders are listed in Cluster C. These include Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive-Compulsive Personality Disorder.
Those with Avoidant Personality Disorder may be extremely sensitive to criticism or rejection and avoid involvement with others unless acceptance is guaranteed. Social anxiety and bashfulness are experienced by Avoidant Personalities which leads to an avoidance of occupations that require social contact. They carry great fear of saying the wrong thing, are nervous that they will blush or cry, and are hyper-vigilant and dramatically effected by perceived disapproval from others.
Dependent Personality Disorder is characterized by submissive and dependent behavior, relying on others for decision making. They require constant validation and are hyper-sensitive to rejection. They might have nervous breakdowns following a commencement of a relationship. Dependents lack the confidence necessary for independence and necessitate assistance even in relatively menial tasks.
Obsessive-Compulsive Personality Disorder is not one in the same with Obsessive-Compulsive Disorder, which is an anxiety disorder. Obsessive-Compulsive Personalities aspire to be perfect. They tend to take on many responsibilities; however, they are never happy with their current achievements. Obsessive-Compulsives are reliable, organized, and precise; however, this rigidness causes them to have trouble adjusting to life’s changes. They are overly cautious, intently calculating the risks and rewards of every decision, which makes completing tasks challenging. When Obsessive-Compulsive Personalities cannot control the outcome of circumstances, they may experience loneliness or helplessness.
When symptoms of these disorders occur for a prolonged period of time and interfere with day to day functioning, an assessment from a licensed mental health professional is recommended. Therapeutic options available for those with personality disorders are psychotherapy and medication. Psychotherapy may be carried out on an individual basis, in groups, or with the family. This treatment option’s goal is to assist the patient in recognizing the unconscious struggles that are feeding or producing the particular disorder. It also attempts to give the patient flexibility and to moderate the patterns that hinder a well-adjusted lifestyle.
Psychotherapy for those with personality disorders can give the patient a better sense of how his or hers conduct affects others. It can also help with the decision making process and improve the patient’s interpersonal relationships.
Medications that have been applied successfully for the treatment of personality disorders include antidepressants, mood-stabilizers, anxiolytics, and anti-psychotics. Antidepressants may be helpful for depression, anger, impulsivity, irritability or hopelessness. Mood stabilizers can assist in the prevention of mood swings, provide impulse control, and lower aggressiveness. Anxiolytics reduce anxiety or hostility and treat insomnia. These should be used under close medical supervision because of their tendency to increase impulsivity. Anti-psychotics also known as neuroleptics may give the patient a better grasp of reality for those suffering from psychotic symptoms and in some cases they may reduce anxiety or manage anger.
For severe cases of personality disorders, hospitalization may be required. This is typically necessary when one is incapacitated or is a threat to themself or others. Hospitalization may consist of around the clock inpatient care or residential treatment which provides a secure living space.