I'm Suhani, a 16 year old with an interest in psychiatry.
What are personality disorders?
Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings and life situations) and inherited characteristics.
A person’s personality typically stays the same over time. A ‘personality disorder’ is a way of thinking, feeling and behaving that deviates from the expectations of the culture and causes distress or problems functioning, lasting over time.
Types and Symptoms
Personality disorders can be of many types. They are mainly divided into three ‘clusters’ based on similar characteristics and symptoms. Many people who show signs and symptoms of one personality disorder also usually show signs of at least one other personality disorder. For a person to be diagnosed with a personality disorder, it is not necessary for all signs and symptoms of that disorder to be present.
The three clusters with their symptoms are given below-
Cluster A (odd thinking and eccentric behaviour) consists of three types of personality disorders, namely
1. Paranoid personality disorder
Pervasive distrust and suspicion of others and their motives
Unjustified belief that others are trying to harm or deceive you
Unjustified suspicion of the loyalty or trustworthiness of others
Hesitancy to confide in others due to unreasonable fear that others will use the information against you
Perception of innocent remarks or nonthreatening situations as personal insults or attacks
Angry or hostile reaction to perceived slights or insults
Tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
2. Schizoid personality disorder
Lack of interest in social or personal relationships, preferring to be alone
Limited range of emotional expression
Inability to take pleasure in most activities
Inability to pick up normal social cues
Appearance of being cold or indifferent to others
Little or no interest in having sex with another person
2. Schizotypal personality disorder
Peculiar dressing, thinking, beliefs, speech or behaviour
Odd perceptual experiences, such as hearing a voice whisper your name
Flat emotions or inappropriate emotional responses
Social anxiety and a lack of or discomfort with close relationships
Indifferent, inappropriate or suspicious response to others
"Magical thinking" — believing you can influence people and events with your thoughts
Belief that certain casual incidents or events have hidden messages meant only for you
Cluster B (dramatic and erratic behaviour) contains four types, they are
1. Antisocial personality disorder
Disregard for others' needs or feelings
Persistent lying, stealing, using aliases, conning others
Recurring problems with the law
Repeated violation of the rights of others
Aggressive, often violent behaviour
Disregard for the safety of self or others
Impulsive behaviour
Consistently irresponsible
Lack of remorse for behaviour
2. Borderline personality disorder
Impulsive and risky behaviour, such as having unsafe sex, gambling or binge eating
Unstable or fragile self-image
Unstable and intense relationships
Up and down moods, often as a reaction to interpersonal stress
Suicidal behaviour or threats of self-injury
Intense fear of being alone or abandoned
Ongoing feelings of emptiness
Frequent, intense displays of anger
Stress-related paranoia that comes and goes
3. Histrionic personality disorder
Constantly seeking attention
Excessively emotional, dramatic or sexually provocative to gain attention
Speaks dramatically with strong opinions, but few facts or details to back them up
Easily influenced by others
Shallow, rapidly changing emotions
Excessive concern with physical appearance
Thinks relationships with others are closer than they really are
4. Narcissistic personality disorder
Belief that you're special and more important than others
Fantasies about power, success and attractiveness
Failure to recognize others' needs and feelings
Exaggeration of achievements or talents
Expectation of constant praise and admiration
Arrogance
Unreasonable expectations of favours and advantages, often taking advantage of others
Envy of others or belief that others envy you
Cluster C (severe anxiety and fear) consists of 3 types of personality disorders, which are
1. Avoidant personality disorder
Too sensitive to criticism or rejection
Feeling inadequate, inferior or unattractive
Avoidance of work activities that require interpersonal contact
Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
Extreme shyness in social situations and personal relationships
Fear of disapproval, embarrassment or ridicule
2. Dependent personality disorder
Excessive dependence on others and feeling the need to be taken care of
Submissive or clingy behaviour toward others
Fear of having to provide self-care or fend for yourself if left alone
Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
Difficulty starting or doing projects on your own due to lack of self-confidence
Difficulty disagreeing with others, fearing disapproval
Tolerance of poor or abusive treatment, even when other options are available
Urgent need to start a new relationship when a close one has ended
3. Obsessive compulsive disorder
Preoccupation with details, orderliness and rules
Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don't meet your own strict standards
Desire to be in control of people, tasks and situations, and inability to delegate tasks
Neglect of friends and enjoyable activities because of excessive commitment to work or a project
Inability to discard broken or worthless objects
Rigid and stubborn
Inflexible about morality, ethics or values
Tight, miserly control over budgeting and spending money
Causes
There can be various reasons for an individual to develop one or more personality disorders at different stages in life. The main causes for having personality disorders are:
Genetics. Researchers have now begun to identify certain genetic factors that may lead to the development of certain personality disorders.
Childhood trauma. Findings from one of the largest studies on personality disorders offer clues about the links between childhood trauma and the prevalence of personality disorders. For instance, it was found that individuals diagnosed with Borderline personality disorders had high rates of childhood sexual trauma.
Verbal Abuse. Verbal abuse can also be linked to the appearance of personality disorders. Children who were abused verbally were found to be three times as likely to have borderline, paranoid, narcissistic and obsessive-compulsive personality disorders.
Treatment
Best treatment for an individual having personality disorders depends not only on the type and severity of the disorder but also on the life situation of the individual. Often, a team approach is required to make sure the patient’s medical, psychological and social needs are met. Due to the long standing nature of personality disorders, treatment may often take months or even years.
Psychotherapy, also called talk therapy is the main way to treat personality disorders. During psychotherapy with a mental health professional, the affected person may learn about their condition and talk freely about their moods, feelings, thoughts and behaviours. The individual can learn to cope with stress and manage their disorder. Along with psychotherapy, certain psychiatric medications may help in managing personality disorders. Usually the medications given are:
Antidepressants
Mood stabilizers
Antipsychotic medications, and
Anti-anxiety medications
In some cases, the personality disorder may be so severe that the individual may require to be admitted to a hospital for Psychiatric care. However, this is only recommended when the individual cannot care for themselves or is in danger of direct harm to themselves or others.
If you suspect that you or someone you know may be having a personality disorder then do reach out to a mental health professional at the earliest.
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