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Personality Disorders

A Personality Disorder is characterized by a specific set of symptoms that affect normal attitudes and decisions, and result in compromised social interaction and problems at work, home and school. These disorders create inflexible patterns of thought, feeling and behavior that can cause significant distress to patients and to friends and family. Personality disorders are pervasive and chronic and they exist on a continuum from mild to severe. Patients with a personality disorder exhibit distinctive psychological features, including altered self-image, an inappropriate or distorted range of emotion, and inaccurate perception of others, and of the world in general. They may have problems with impulse control or express emotion in unusual ways. Research defines ten separate Personality Disorders in three ‘clusters’ as follows:

Cluster A includes Paranoid Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personality Disorder.

Cluster B includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality Disorder.

Cluster C includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder. For more detailed information on each of these disorders, see the related title article.

There is another category of Personality Disorders, called Personality Disorders Not Otherwise Specified. This category is used to define any patient with disturbed personality function that does not meet the criteria for specific Personality Disorders as defined above, but which disorder causes distress or significant compromise in one or more areas of life.

There are many potential causes of personality disorders, including environmental factors in childhood, upbringing, personality, social development, hereditary and biological factors. Personality Disorders often appear for the first time during times of stress. Patients with a severe personality disorder are at significant risk for hypochondriasis, alcohol and/or drug abuse, or violent or self-destructive behaviors.

What are the symptoms?

Cluster A (eccentric personality disorders) may appear peculiar and show signs of disorder in early adulthood: Paranoid – interprets actions of others as threatening, is distrustful and suspicious of everyone. Schizoid – detached from social interaction, narrow range of emotional expression, few friends, indifferent to praise or criticism. Schizotypal – distortion of thought or perception, peculiar behavior, events and objects have unusual significant to patient, inappropriate or constricted emotional reactions

Cluster B (dramatic personality disorders) may be intense, unstable, with distorted self-perception or impulsive behavior: Antisocial – legal problems and arrest, lying, deceit, impulsiveness, aggression, fighting, assault, lack of remorse. Borderline – instability in relationships, starting in early adulthood, frantic about abandonment, dramatic shifts in mood, anxiety, irritability, impulsiveness in sex, driving, eating, shifting self-image and values. Histrionic – attention seeking, overreacts, shallow, inappropriate and seductive behavior, rapidly shifting emotions, dramatic speech and affect. Narcissistic – grandiose view of self, lack of empathy for others, concerned with power, success, beauty, brilliance, believes he/she is special, inflated sense of self-importance, arrogant, requires admiration.

Cluster C (anxious personality disorders) anxious, fearful, symptoms appear in early adulthood: Avoidant - feels inadequate, overly sensitive to criticism, inhibited, fear of ridicule and rejection. Dependent – passive, clinging, fears separation, needs others to assume responsibility for them, finds it hard to disagree with others, excessive attempts to gain support from others, dislikes being alone. Obsessive-Compulsive - preoccupied with order, perfection, control, concerned with rules, lists, details, unable to meet self-inflicted standards, inflexible, stingy spending style, stubborn

How is it diagnosed and treated?

Doctors will perform medical and mental health evaluation to rule out other illness or disease.

For specific information on diagnosing and treating each of the major Personality Disorders, see the related title article. A high-level summary appears below:

Cluster A: Paranoid –suspicious, distant, cold, believes all motives are hostile, angry. Schizoid – introverted, withdrawn, solitary, cold, like to speculate and daydream. Schizotypal – isolated, detached, odd thinking, perception and communication.

Cluster B: Antisocial –.exploitive, steals, fights, does not care about others’ property or feelings, deceitful, lies. Borderline – may seek help for depression, substance abuse or eating disorder, lonely, unstable self-image, mood, behavior and relationships, needs inordinate amount of care and support, mood shifts and changes in view of world and self, fears abandonment, Histrionic – may seem childish and dramatic, conscious of appearance, seeks sympathetic or erotic attention from others, relationships are shallow and transient. Narcissistic –.needs to be admired, feels superior, shows no empathy toward others feelings or situation, overly dramatic, inappropriate sexual discussion and behavior, wants recognition in spite of underachievement.

Cluster C Avoidant - hypersensitive to rejection, fear of starting relationships or projects Dependent – surrenders responsibility to others, lacks confidence, does not like to be alone, can’t make decisions, Obsessive-Compulsive - orderly, conscientious, reliable, inflexible, obsessed with counting, organization, dislikes changes in routine.

For treatment of specific disorders, see the related title article.

A summary of treatment modalities can include:

• Group Therapy
• Psychotherapy
• Family Therapy
• Self-Help Groups
• Psychodynamic Therapy
• Dialectical Therapy (DBT)
• Interpersonal Therapy (IPT)
• Cognitive Behavioral Therapy (CBT)
• Medication as appropriate to treat secondary disorders such as depression, anxiety, psychosis, etc.

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