Personality Disorders

Personality Disorders

The way a person thinks, feels, and behaves that makes them different from other people is known as personality. Influenced by experiences, environment (surroundings, life situations) and inherited characteristics, an individual’s personality generally stays the same over time. A deviation of a person’s normal personality from the expectations of culture, causing distress or problems functioning, while lasting over time is known as a personality disorder. This pattern usually begins in the late teens and early 20s. Without treatment, personality disorders can be long-lasting. In India, prevalence rates of 0.3-1.6% were found with rates being higher in certain populations such as university students, criminals, patients with substance use disorders, etc.

What are the types of personality disorders and their symptoms?

Personality disorders are divided into certain types such as:

Group A personality disorders – Consistently dysfunctional pattern of thinking and behaviour that reflects suspicion or lack of interest in others. These could be: Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder.

Group B personality disorders: Consistently dysfunctional pattern of being dramatic, overly emotional thinking or unpredictable behaviour. These are: Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder, Antisocial personality disorder.

Group C personality disorders: Consistently dysfunctional pattern of anxious thinking or behaviour. Disorders are: Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder.

Each disorder may have different symptoms. Following are the common personality disorders and their symptoms:

Borderline Personality Disorder (BPD): Feeling any emotions very intensely is characteristic of BPD and it is difficult to establishing a stable emotional baseline. Symptoms include:

  • Extreme fear of abandonment
  • Black and white thinking about people (Love them or hate them attitude)
    Unclear self-view
  • Exhibiting dangerous behaviours including reckless driving, etc.
    Harming self
  • Sudden episodes of intense emotion, irritability, anxiety, anger, shame, and guilt
  • Feeling of emptiness
  • Relationship difficulties
  • Inability to deal with stress.

Narcissistic personality disorder (NPD): Personality disorder having a grand sense of themselves, needing a lot of admiration. People with NPD are very sensitive and are unable to take criticism easily. Symptoms include:

  • Inflated sense of importance
  • Entitlement to people’s time and attention
  • Extreme attention seeking and admiration seeking behaviour
  • Superiority complex
  • Associate with people who are equally “superior”
  • Monopolizing conversations
  • Looking down on people considered “inferior”
  • Expecting people to say yes to everything you ask
  • No empathy with others (putting yourself in other people’s shoes)
  • Easily jealous
  • Needs the best material things
  • Fantasizes about success
  • Easily getting upset when others don’t match their expectations
  • Insecure secretly
  • Feeling angry when ignored
  • Difficulty accepting other people’s success
  • Maintaining relationships and friendships is difficult

Treatment for NPD usually includes therapy.

Obsessive-compulsive personality disorder (OCPD):

The symptoms of this disorder include:

  • Rigidly rule following
  • Require things in supremely orderly fashion to function normally
  • Unwillingness to delegate tasks
  • Micromanaging in every task given to others
  • Feeling a there is particular way to do things, and everyone should always do them that way
  • Fixating on lists and on small details while missing the main point of the project
  • Perfectionist and hence, unable to finish tasks or projects
  • Being extremely frugal
  • Hoarding tendencies
  • Excessive dedication to work, affecting your social life

What are the causes and risk factors of personality disorders?

Personality disorders may be caused by genetics and the environment’s affect is vital in shaping this disorder. The risk factors for personality disorders are:

Specific personality traits such as trying to avoid harm, or a strong need for seeking out new activities for an adrenaline rush and also includes poor impulse control.

Early life experiences such as an unstable, unpredictable, unsupportive home environment or a history of trauma from physical neglect or abuse, emotional neglect or abuse, or sexual abuse.

How can any personality disorder be diagnosed?

Finding out about a personality disorder may involve:

  • – A physical exam
  • – A mental health evaluation
  • – Comparing symptoms to standard guidelines (Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) published by the American Psychiatric Association.)
  • – Neuropsychological testing

What are the treatment options for personality disorders?

The treatment depends best on the personality disorder, its seriousness, and the life situation. Treatment may be continued for months or years. A team of doctor along with a specialist may be recommended as follows:

  • Psychiatrist.
  • Psychologist or another therapist.
  • Psychiatric nurse.
  • Pharmacist.
  • Social worker.

Dialectical behavioural therapy (DBT): Psychotherapy form (talk therapy) is the mainstream way to treat personality disorders along with medicines. The focus of the therapy is to treat dangerous behaviour that affects the quality of life of a person or may lead to suicide. Weekly one-on-one sessions with a therapist is a part of the treatment and may last for about a year.

Modules on the therapy include:

  • Emotion control
  • Distress handling.
  • Increasing mindfulness
  • Effectively relating with other people.

The effectiveness of therapy has been proven in adolescents and adults but, it should be a certified DBT group.

Medicines: There aren’t any approved medicines by the FDA to treat personality disorders specifically, but several types of psychiatric medicines may be administered to manage the symptoms. These are – antidepressants, mood stabilizers, antipsychotic medications and antianxiety medications.

Hospital and residential treatment programs:

Serious personality disorder may need to stay in a hospital for mental health care. This may be done when in immediate danger of harming themselves or someone else. A day hospital program, residential program or an outpatient treatment may be recommended when the patient becomes stable in the hospital.

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