Personality disorders – types, symptoms, diagnosis, treatment

Personality disorders (PD) are a very widespread mental condition around the world associated with lifelong social and occupational disabilities, shortened life expectancy, and high social and health care costs. Read about the types of personality disorders and how they can be treated.

In its most basic personality, personality is the distinctive patterns of thoughts, feelings, and behaviors that make a person unique. Personality is believed to emerge from within the individual and remain fairly consistent throughout life.

While there are many different definitions of personality, most focus on behavioral patterns and traits that can help predict and explain a person’s behavior.

Explanations about personality can focus on a variety of influences, from genetic explanations of personality traits to the role of environment and experience in shaping an individual’s personality.

Personality characteristics

So what exactly is personality? The traits and patterns of thinking and emotions play an important role, as well as the following basic personality traits:

1. cohesion: There is generally recognizable order and regularity in behavior. Basically people behave the same or similar in different situations,
2. psychological and physiological factors: personality is a psychological construct, but research suggests that it is also influenced by biological processes and needs,
3. behavior and actions: personality not only influences how we move and react in our environment, but also causes us to act in a certain way,
4. impressions: personality manifests itself not only in behavior. It can also be seen in our thoughts, feelings, close relationships, and other social interactions.

The effects of personality disorders, as with any mental disorder, can be diagnosed when they inhibit a person’s ability to function in everyday life. Treatment may include dialectical behavior therapy, long-term psychotherapy, and drug therapy. There is evidence that people with personality disorders can live a normal life and become more able to manage their symptoms with appropriate treatment.

There is no clear cause for personality disorders, but it is widely accepted that both genetic inheritance and early attachment problems are to blame. Other environmental factors besides attachment may also work, but this is not clear.

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Types of personality disorders

W DSM-5 there are thirteen diagnosable personality disorders. They are divided into three categories or “clusters” of disorders with similar symptoms in people suffering from personality disorders.

Cluster A includes:

1. paranoid personality disorder,
2. schizoid personality disorder,
3. schizotypal personality disorder,

Cluster B includes:

1. antisocial personality disorder,
2. borderline personality disorder,
3. histrionic personality disorder,
4. narcissistic personality disorder,

Cluster C includes:

1. avoidant personality,
2. dependent personality disorder,
3. obsessive-compulsive personality disorder.

W DSM-5 for personality disorders, personality disorders due to another disease state, other specified personality disorder, and other unspecified personality disorder are also included.

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Paranoid personality disorder

Paranoid personality disorder (PPD) is a difficult mental health condition defined by distrust and suspicion so intense that it interferes with thought patterns, behavior, and daily functioning. A person with PPD may feel very distrustful of others, always guarding against signs that someone is trying to threaten, bully or cheat them. No matter how unfounded their beliefs are, they can repeatedly challenge the faithfulness, integrity, or trustworthiness of others. When they perceive that they are being persecuted, rejected or disregarded, they will likely respond with outbursts of anger by controlling their behavior or blaming others.

The fearful, distrustful perceptions that accompany PPD can make it very difficult to form and maintain close relationships, affecting a person’s ability to function at home, work, and school. If you have a loved one with a paranoid personality disorder, you may feel frustrated by their distorted view of the world, exhausted by their constant accusations, or overwhelmed by their hostility and stubbornness. They may appear to be able to find and exaggerate the negative aspects of any situation or conversation.

Professional treatment can help a person with paranoid personality disorder to cope with symptoms and improve daily functioning. However, due to the very nature of the disorder, most people with PPD do not seek help. As for them, their fears are well-founded, and any attempt to change their mindset only confirms their suspicion that people somehow “want to get them.”

Common symptoms of PPD include:

1. suspecting without justification that others are trying to use, harm or cheat them,
2. obsession with the lack of loyalty or trustworthiness of family, friends and acquaintances
3. refusing to confide in people for fear that any information they disclose will be used against them, which often leads them to isolate themselves from others.
4. interpreting hidden, malicious meanings in innocent gestures, events or conversations,
5. being overly sensitive to perceived insults, criticism or disregard, reacting quickly to judgment and holding a grudge,
6. reacting to imaginary attacks on their nature with anger, hostility or control behavior,
7. he repeatedly groundlessly suspected his partner or spouse of infidelity.

Despite being one of the most common personality disorders, paranoid personality disorder can be difficult to spot until symptoms change from mild to more severe. After all, most of us have behaved in a distrustful, suspicious or hostile way at some point in our lives without a diagnosis of PPD.

Spotting the symptoms of a paranoid personality disorder can be even more complicated as it often coexists with another mental health problem such as anxiety disorder (often social anxiety disorder), obsessive compulsive disorder (OCD), substance abuse or depression.

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Schizoid personality disorder

Schizoid personality disorder (SPD) is a chronic and pervasive disease characterized by social isolation and a sense of indifference to other people. Those who live with this disorder are often described as distant or withdrawn and tend to avoid social situations that require interaction with other people.

DSM-5 defines schizoid personality disorder as “a pervasive pattern of social and interpersonal deficits, characterized by acute discomfort and limited ability to form close relationships, as well as cognitive or perceptual distortions and eccentric behavior, beginning in early adulthood and the present. in different contexts ”.

They find it difficult to express their emotions and lack the will to establish close personal relationships. This type of personality disorder is believed to be relatively rare and affects more men than women. People with schizoid personality disorder are also at risk of becoming depressed.

People with schizoid personality disorder typically experience:

1. preoccupation with introspection and fantasy,
2. feeling indifferent to praise and affirmation, as well as criticism or rejection
3. separation from other people,
4. little or no desire to establish close relationships with others,
5. indifference to social norms and expectations,
6. rare participation in activities for fun or pleasure,
7. not enjoying social or family relationships,
8. often described as cold, uninterested, withdrawn and aloof.

The disorder is often first noticed in childhood and is usually seen in early adulthood. The symptoms of the disorder can affect many areas of life, including family relationships, school and work.

People with schizoid personality disorder are often described by others as aloof and cold. Those with this disorder may prefer loneliness, but some may also experience loneliness and social isolation as a result.

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Schizotypal personality disorder

Unlike schizoid personality disorder, in which individuals are “separated” in their relationships, schizotypal individuals exhibit eccentric behavior and display distortions and discomfort in their social relationships.

The signs of schizotypal personality disorder include three main components. The first is the reduced ability to form close relationships, which can cause a person severe discomfort. The second is experiencing distortions in thinking or perceiving events. The third is eccentric behavior.

In younger people, schizotypal personality disorder may first manifest as problems with attention, social anxiety, or an interest in playing or working alone. Children can struggle with teasing or bullying, which can further increase social anxiety. To receive a diagnosis, a person must experience these symptoms before reaching early adulthood.

The person must also have experienced five of the following symptoms:

1. no close friends from outside the immediate family,
2. eccentric or unusual beliefs or manners
3. belief in superpowers (i.e. telepathy) or superstition,
4. excessive social anxiety related to paranoid anxiety,
5. paranoid thoughts or doubts about the loyalty of others
6. interpreting harmless events as having personal significance
7. dressing in a neglected or strange way
8. sensing the presence of an absent person,
9. strange or chaotic speech patterns
10. flat or limited emotional reactions.

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Aspocial personality disorder

Asocial (antisocial) personality disorder (ASPD) is a condition characterized by a lack of empathy and respect for other people. People who have antisocial personality disorder have little or no respect for good or bad. They antagonize and are often insensitive. People with this disorder may lie, engage in aggressive or violent behavior, and participate in criminal activities.

People with asocial personality disorder:

1. may begin to show symptoms in childhood; such behavior may include setting fire, animal cruelty and crime issues,
2. often have legal problems resulting from non-compliance with social norms and lack of concern for the rights of others,
3. they often act impulsively and do not take into account the consequences of their actions,
4. show aggression and irritability which often lead to physical violence,
5. have difficulty feeling empathy,
6. shows no remorse for inappropriate behavior,
7. they often have bad or abusive relationships with others and are more likely to abuse or neglect their children
8. they often lie and deceive others for personal gain.

The above-mentioned features often lead to serious difficulties in many areas of life. At its core, the inability to consider other people’s thoughts, feelings, and motivations can lead to a harmful disregard for others.

In adulthood, this disorder can be destructive for both the person living with it and the people who come into contact with it. People with antisocial personality disorder are more likely to engage in risky behaviors, dangerous activities, and criminal acts. 1 People with this disorder are often described as having no conscience and feel no regret or remorse over their harmful actions.

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Borderline personality disorder

Borderline personality disorder is a mental illness that seriously affects a person’s ability to regulate emotions. This loss of emotional control can increase impulsiveness, affect how a person thinks about themselves, and negatively affect their relationships with others. Effective treatments are available for the symptoms of borderline personality disorder.

People with borderline personality disorder may experience intense mood swings and feel uncertain about how they see themselves. Their feelings for others can change quickly, from extreme closeness to extreme dislike. These changing feelings can lead to unstable relationships and emotional pain.

People with borderline personality disorder also tend to take things to the extreme, such as all-good or all-bad. Their interests and values ​​can change quickly, they can act impulsively or recklessly.

Other signs or symptoms may include:

1. efforts to avoid actual or perceived abandonment, such as getting into relationships – or ending them just as quickly
2. a pattern of intense and unstable relationships with family, friends and loved ones,
3. distorted and unstable self-image or sense of self
4. impulsive and often dangerous behaviors such as spending money, unsafe sex, substance abuse, reckless driving and binge eating.
5. self-harming behavior,
6. Repeated thoughts of suicidal behavior or threats
7. intense and highly fluctuating moods, with episodes lasting from several hours to several days,
8. chronic feeling of emptiness,
9. inappropriate, intense anger or problems with controlling anger
10. feelings of dissociation, such as feeling cut off from yourself, seeing yourself from the outside, or feeling unreal.

Not everyone with borderline personality disorder may experience all of these symptoms. The severity, frequency and duration of symptoms depend on the person and their disease.

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Histrionic personality disorder

Histrionic personality disorder (HPD) is a mental health condition characterized by intense, unstable emotions and a distorted self-image. The word “histrionic” means “dramatic or theatrical.”

For people with histrionic personality disorder, their self-esteem depends on the approval of others and is not based on genuine self-esteem. They have an overwhelming desire to be noticed and often act dramatically or inappropriately to get attention. People with histrionic personality disorder often don’t realize that their behavior and way of thinking can be problematic towards others.

The main feature of histrionic personality disorder is the display of excessive, superficial emotionality and sexuality in order to attract attention.

A person with histrionic personality disorder can:

1. feel underappreciated or depressed when not in the spotlight
2. feel rapidly changing and shallow emotions,
3. be persistently charming and flirty,
4. overly concerned about physical appearance,
5. use your physical appearance to get attention by wearing brightly colored clothes or by excessively revealing your body
6. use socially unacceptable sexual behavior towards other people,
7. speak radically and express strong opinions, but with a few facts or details to support your views
8. be naive and easily influenced by others, especially people she admires,
9. have difficulty maintaining relationships, they often appear false or shallow in their interactions with others
10. need immediate gratification very easy to be bored or frustrated
11. is constantly looking for encouragement or approval.

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Narcissistic personality disorder

A narcissistic personality disorder characterized by great self-thoughts and a great need for admiration comes from the Greek mythological character Narcissus. This figure admired his reflection in the puddle so much that he fell and drowned.

These individuals are visible across the spectrum of society – introverts, extroverts, loners, social butterflies, model citizens, and anti-social individuals. They lack empathy and are sensitive to any suggestions that they are not extraordinary. As with all personality disorders, these people often experience other problems: depression, anxiety, substance abuse, suicide, and self-harm.

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Avoidant personality disorder

Avoidant Personality Disorder (AVPD) is a persistent pattern of behavior associated with social rejection, feelings of inadequacy, and a sensitivity to rejection that causes problems in work situations and relationships.

This disorder is characterized by extreme shyness and sensitivity to criticism from others. AVPD is often associated with other mental health conditions such as anxiety disorders, in particular social anxiety disorder. People with the disorder exhibit a pattern of avoidance because of a fear of rejection or disapproval, which is extremely painful for them. The disorder affects about 2,5% of the population, with roughly the same number of men and women.

The following is a list of common symptoms associated with avoidance personality disorder:

1. the need to be liked,
2. anhedonia (no fun in class)
3. anxiety about saying or doing the wrong thing
4. anxiety in social situations,
5. avoiding conflicts (being a “people’s pleaser”),
6. avoiding interactions at work,
7. avoiding intimate relationships or sharing intimate feelings
8. avoiding making decisions,
9. avoiding situations because of fear of rejection,
10. avoiding social situations or events,
11. easily hurt by criticism or disapproval,
12. extreme self-awareness,
13. inability to initiate social contact,
14. attitude full of tension,
15. feeling of inadequacy,
16. hypersensitivity to negative assessment,
17. lack of assertiveness,
18. lack of trust in others,
19. poor self-esteem,
20. misinterpretation of neutral as negative situations,
21. no close friends / no social network,
22. self-isolation,
23. social inhibition,
24. unwilling to take risks or try new things
25. seeing oneself as socially inept or inferior,
26. alert to signs of disapproval or rejection.

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Dependent personality disorder

Dependent personality disorder is characterized by a high need for care, an inability to be alone, submissive, a strong fear of rejection (sometimes called rejection-sensitive dysphoria), and attachment. People with this disorder are easily hurt by criticism and go to great lengths to please others indiscriminately.

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Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder is characterized by a pervasive preoccupation with order, perfectionism, and control (with no room for flexibility) that ultimately slow down or interfere with the completion of a task. The diagnosis is based on clinical criteria. Treatment is provided with psychodynamic psychotherapy, cognitive behavioral therapy, and selective serotonin reuptake inhibitors (SSRIs).

Symptoms of obsessive-compulsive personality disorder may diminish even after 1 year, but their persistence (i.e. remission and relapse rates) is less pronounced in the long term.

In people with obsessive-compulsive personality disorder, preoccupation with order, perfectionism, and self-and situational control interferes with flexibility, effectiveness, and openness.

To maintain a sense of control, these individuals focus on rules, finest details, procedures, schedules, and lists. As a result, you lose the focal point of your project or activity. These people double-check errors and pay close attention to details. They don’t use their time well and often leave the most important tasks for the last. Their preoccupation with the details and making sure everything is perfect can delay completion endlessly. They are not aware of how their behavior affects their colleagues. By focusing on one task, they may be neglecting all other aspects of their lives.

Because they want everything done a certain way, they have difficulty delegating tasks and collaborating with others. While working with others, they can make detailed lists of how to get the job done and get frustrated when a coworker suggests an alternative. They can decline help even if they are late.

People with Obsessive Compulsive Personality Disorder are overly dedicated to work and productivity; their sacrifice is not motivated by financial necessity. As a result, leisure activities and relationships are neglected. They may think they don’t have time to relax or go out with friends; they may put off their vacation for so long that this does not happen, or they may feel they need to take their job with them so as not to waste time. Time spent with friends, when this occurs, usually involves a formally organized activity (e.g. sports). Hobbies and leisure activities are considered important tasks requiring organization and hard work to master; the goal is perfection.

Expressing your feelings is also tightly controlled. People with this personality disorder may relate to others in a formal, rigid or serious manner. They often only talk when they think of the perfect thing to say. They may be focused on logic and intellect and may not tolerate emotional or expressive behavior.

People with this personality disorder can be overzealous, picky, and rigid about morals, ethics, and values. They have strict moral standards for themselves and others and are severely self-critical. They are rigidly obedient to the authorities and insist on strict adherence to the rules, with no exceptions for extenuating circumstances.

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Personality disorder due to another medical condition

This category refers to social, interpersonal and / or occupational disabilities caused by personality problems that are clearly caused by a medical condition.

While it is generally accepted that personality disorders have, at least in part, a genetic basis, personality changes are not uncommon among people with brain trauma, stroke, or head trauma. This is sometimes referred to as acquired brain injury. This is especially important if the frontal or temporal lobes are damaged.

The well-known case of Phineas Gage is an example of this. Gage, a railwayman in 1848, sustained a brain injury when an accidental explosion pierced his skull with iron. Surprisingly, the severe frontal lobe damage didn’t kill Phineas Gage, but left him with a personality change that lasted for the rest of his life. This case initiated an understanding of the effects of brain damage on personality.

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Other specified personality disorder and unspecified personality disorder

Many mental health classifications are diagnosed as “Not Otherwise Specified” (NOS). NOS diagnoses exist for situations where the patient’s symptoms appear to be consistent with the overall diagnosis (e.g., anxiety) but do not meet specific criteria for the disorder. In other words, in the clinician’s opinion, there was sufficient evidence for a general disorder, but not enough for a specific disorder in this category.

The latter two classifications relate to situations where a clinician has identified a personality disorder, but the criteria are not met for any particular personality disorder. The two options differ only in determining why the symptoms do not correspond to a specific disorder (in the case of a specific personality disorder) or in not giving a cause for an unspecified personality disorder.

Personality disorders – diagnosis

Overall, people with personality disorders rarely seek treatment until the disorder begins to significantly interfere with or otherwise affect their lives.

So, while it can be difficult, it’s important to take the first step and talk to your doctor.

After you spend some time talking to your GP, they will refer you to a mental health professional who is qualified to diagnose and treat people with this condition. A diagnosis of a personality disorder is made after talking to you about what you are experiencing, especially about your level of personal functioning and personality traits that may suggest a specific personality disorder.

For this reason, it is important for the mental health professional to get a complete, honest picture of the difficulties you have encountered, both from you and from your family / whānau or others who know you well.

In order to be diagnosed as a personality disorder, your behavioral pattern will cause significant stress or difficulties in personal, social, spiritual, cultural and / or work situations.

Personality disorders – treatment

Treatment of personality disorders is carried out with the help of psychotherapy, which includes individual psychotherapy and group therapy. Therapy is more effective when people are seeking treatment and are motivated to change.

Medications can help relieve symptoms of stress, such as depression and anxiety, and control some personality traits, such as aggression. However, drugs cannot cure a personality disorder.

Personality disorders can be particularly difficult to treat, so it’s important to choose a therapist who is experienced and non-judgmental and who can understand a person’s self-image, areas of sensitivity, and normal coping.

General principles of treating personality disorders

Though individual treatments vary depending on the type of personality disorder.

Reducing immediate stress such as anxiety and depression is the first goal of treatment. Reducing distress makes it easier to treat a personality disorder. First, therapists help people identify the causes of anxiety. Then they think about how to mitigate it. Therapists provide strategies to help a person recover from very unpleasant situations or relationships (called psychosocial support). These strategies may include caring for and support from family members, friends, neighbors, healthcare professionals, and more. Medicines for anxiety or depression can relieve these symptoms. When medications are used, they are best used in low doses and for a limited time.

Helping people understand that their problems are internal is crucial because people with personality disorders may not see the problem with their own behavior. Doctors try to help people understand when their behavior is inappropriate and has harmful consequences. By establishing a collaborative, respectful doctor-patient relationship, physicians can help people become more self-aware and recognize their socially undesirable, inappropriate behavior. Doctors can also help people realize that changes in their behavior and perceptions of themselves and others take time and effort.

Maladaptive and undesirable behaviors (such as recklessness, social isolation, lack of assertiveness, and temperamental outbursts) must be dealt with quickly to minimize permanent damage to work and relationships. Sometimes doctors have to set boundaries of behavior in their office. For example, doctors may tell people that shouting and threats are making a session difficult. If the behavior is extreme – for example, if people are reckless, socially isolating, have outbursts of anger, or are self-destructive – they may need treatment in a day hospital or nursing home.

Dialectical behavioral therapy is also recommended for the treatment of personality disorders. It is a comprehensive cognitive-behavioral treatment for the symptoms of borderline personality disorder and many other difficult-to-treat mental and psychiatric disorders. It is especially effective in managing and reducing suicidal and parasamicidal behavior, self-destructive behavior, anger, impulsiveness, interpersonal problems, and emotional dysregulation. Combines cognitive-behavioral techniques and Zen mindfulness practices with a dialectical philosophy of change perceived as a synthesis of opposites. It offers a comprehensive behavioral analysis of disturbed functioning and practical skills training specifically designed to increase personal and interpersonal efficiency, emotional stability and overall mastery of one’s own behavior.

Psychopharmacological treatment – direct intervention at the biological level of the functioning of the brain and nervous system. Each patient undergoes a comprehensive psychiatric evaluation and, if appropriate, receives psychotropic medications prescribed to treat specific symptoms of his / her mental state. Each patient’s pharmacotherapy is carefully monitored by a psychiatrist and psychiatric residents and is integrated into ongoing psychotherapy.

Mindfulness and meditation training – specialized approach to self-transformation using Buddhist meditation techniques and Buddhist psychology of consciousness.