Personality Disorders

From Drug Rehab Wiki

Contents 1 What Are Personality Disorders? 2 Types of Personality Disorders 3 Symptoms 4 Causes 4.1 Nature factors 4.2 Nurture factors 4.3 Risk factors 5 Descriptions of Personality Disorders 5.1 Cluster A 5.2 Cluster B 5.3 Cluster C 6 Problems Associated with Personality Disorders 7 Treatment for Personality Disorders 7.1 Psychotherapy 7.2 Medication 7.3 Hospitalization 8 Conclusions

What Are Personality Disorders?

Personality disorders are complex and challenging psychiatric disorders. The term “personality disorder” refers to a condition that involves a dysfunctional, inflexible and chronic way of interacting with, thinking about and perceiving oneself and one’s environment. When a person has a personality disorder it affects how he thinks, feels and behaves. In order to qualify for a diagnosis of a personality disorder, it must cause the person distress or significantly impair his or her functioning in important areas of life.

A personality disorder affects every area of the person’s life. In other words, it doesn’t just manifest in certain situations. It typically affects most if not all aspects of the person’s life, including relationships, work, school and social situations. In many cases, the person doesn’t even realize he or she has a personality disorder, and may, in fact, blame others for problems that are a direct result of the disorder.

Personality disorders often begin to develop in childhood, although the traits may not be evident until adolescence and must be apparent by early adulthood. While children or adolescents may be diagnosed with a personality disorder in some cases, the symptoms must be present for at least one year and must not be due to a developmental phase or due to another psychiatric disorder. Antisocial personality disorder, however, cannot be diagnosed prior to the age of 18.

Types of Personality Disorders

Currently there are 10 different personality disorders. They are as follows:

• Paranoid Personality Disorder

• Schizoid Personality Disorder

• Schizotypal Personality Disorder

• Antisocial Personality Disorder

• Borderline Personality Disorder

• Histrionic Personality Disorder

• Narcissistic Personality Disorder

• Avoidant Personality Disorder

• Dependent Personality Disorder

• Obsessive-Compulsive Personality Disorder

It is possible for a person to actually have more than one personality disorder. Some individuals exhibit traits of two or more personality disorders, and meet the general criteria for a personality disorder, but don’t meet all the criteria for a specific one. Also, some people meet the general criteria for a personality disorder, but none of the ten categories applies to them. When either of these situations occurs they are given a diagnosis of “Personality Disorder Not Otherwise Specified”.

Because the traits are deeply ingrained and rigid, individuals with personality disorders are difficult to treat. In fact, the majority of health insurance plans will not pay for psychiatric treatment of personality disorders. In order for treatment to be effective, it generally needs to be intensive and long term, which makes treatment very expensive. Some insurance companies will pay for certain types of treatment for borderline personality disorder, but will rarely cover treatment for any of the other nine personality disorders. Unfortunately, this issue causes statistics on personality disorders to be skewed, as healthcare providers are reluctant to put a personality disorder as a primary diagnosis, knowing that insurance coverage may be denied as a result.

Also, due to the very nature of most personality disorders, individuals who have them often do not seek treatment. It is much more common for a spouse or family member to seek help in dealing with the person or to attempt to get the personality-disordered individual to get help, as living with someone with a personality disorder can be very challenging, frustrating and even exasperating. The one main exception to this is borderline personality disorder. Individuals with this disorder frequently seek help and make up a significant percentage of patients in both inpatient and outpatient psychiatric settings.

Symptoms

While the specific traits for each personality disorder differ, there are some general symptoms that may be a sign that a person has a personality disorder. These symptoms include:

• Rocky interpersonal relationships

• Difficulties making or keeping friends

• Moodiness

• Substance abuse

• Social withdrawal or isolation

• Poor impulse control

• Paranoia or difficulties trusting others

• Inability to delay gratification

• Excessive displays of emotion

Causes

A person’s personality starts to form very early in childhood. Various factors play a role in personality development, which fall into either the category of “nature” or “nurture”.

Nature factors

Genetics play a role in the type of temperament a person has. Temperament pertains to a person’s disposition, which influences personality development. For example, some people are predisposed to being shy or introverted, while some are more inclined to be extraverts.

Nurture factors

Nurture factors include things such as one’s environment while growing up, different events that are experienced, and one’s relationship with primary caregivers. Experiences such as being abused, loved, neglected, spoiled, or abandoned all impact personality development.

Most experts believe that a combination of factors contribute to the development of personality disorders. While a person may be predisposed to developing a personality disorder, the things he or she experiences while growing up determine whether or not a personality disorder actually develops.

Risk factors

Research over the years on the development of psychiatric disorders suggests that particular elements contribute to the risk of a person developing a personality disorder. These risk factors include:

• The presence of personality disorders or other types of psychiatric disorders in one’s family background

• A history of sexual, physical or verbal abuse as a child

• A childhood environment that was chaotic, unpredictable, and / or unstable

• Losing one’s parents as a child, usually due to divorce or death

• A childhood diagnosis of conduct disorder

Descriptions of Personality Disorders

The ten different personality disorders are divided into three clusters. These clusters are based on the similarities they share. Cluster A is comprised of the paranoid, schizoid and schizotypal personality disorders. Individuals with these disorders think and act in odd and eccentric ways.

Cluster A

• Paranoid Personality Disorder – individuals with this disorder have an unfounded suspicion that other people are hurting them, deceiving them, or taking advantage of them in some way. They constantly doubt, without good reason, the loyalty and trustworthiness of friends and associates. They fear that if they disclose personal information to others, it will be used against them. They perceive casual or innocent remarks by others and benign events as having hidden meanings that are hurtful or degrading. They often think others are attacking their character and get angry or retaliate in response. They continually hold grudges and often suspect their partners of cheating, even if there’s nothing to justify their suspicion.

• Schizoid Personality Disorder – people with this disorder have little interest in socializing with others or developing close relationships, even with family members. They rarely have any interest in sex. They generally prefer solo activities, and enjoy few, if any, activities. They are seemingly unaffected by praise or criticism, and tend to be cold and detached, showing little emotion.

• Schizotypal Personality Disorder – individuals with this disorder are very odd and eccentric in their manner of dress, speech, beliefs and thinking, and behaviors. They lack social skills and are uncomfortable in social situations and relationships. They have strange beliefs or magical thinking, such as believing they can read other’s thoughts. They are paranoid and suspicious, and are very anxious in social situations, even with people they know. They display either inappropriate emotion or no emotion at all. They often have strange perceptual experiences, such as hearing their name whispered. They rarely have close friends.

Cluster B

Individuals with cluster B personality disorders are dramatic, erratic, or emotional. This cluster includes the antisocial, borderline, histrionic, and narcissistic personality disorders.

• Antisocial Personality Disorder – this disorder is characterized by a lack of regard for and frequent violation of the rights and feelings of others. People with this disorder are often deceitful and con others for fun or profit. They feel they are above the law, and often end up in legal trouble as a result. They are very impulsive, and don’t care if they do things which put themselves or others in harm’s way. They are often irritable and aggressive, getting into frequent physical altercations. They tend to be very irresponsible, failing to hold down a job or pay money they owe. They rationalize their bad behavior, blaming others and showing no remorse when they hurt others.

• Borderline Personality Disorder – individuals with this disorder have relationships which are rock, intense and volatile. They often perceive themselves as bad or evil, and chronically feel empty inside. They are very moody, switching from one mood to the next very quickly. They are highly impulsive and frequently engage in high risk, self-destructive behaviors, such as unprotected sex, reckless driving, substance abuse or binge eating. They have an intense fear of abandonment and will do frantic things in an attempt to prevent someone from leaving them. Many people with this disorder engage in acts of self-mutilation, such as cutting or burning themselves when they are distressed. Suicide threats and attempts are common with this disorder.

• Histrionic Personality Disorder – people with this disorder have an intense need for attention and approval. They don’t like situations in which they are not the center of attention, and use their physical appearance to get others to notice them. They are very dramatic, displaying exaggerated but shallow emotion. They are very provocative or sexually seductive when they interact with others. They are easily influenced and very suggestible. They regard their relationships as having much more depth and intimacy than they actually do.

• Narcissistic Personality Disorder – individuals with this disorder have an inflated opinion of themselves. They regard themselves as superior to others, and expect excessive admiration and praise. They treat people as objects that exist only for their benefit or pleasure, and often take advantage of others. They have little or no genuine regard for people’s feelings, and lack empathy. They tend to blame others for any problems, as they see themselves without fault. They fantasize often about having unlimited power, success, beauty, brilliance, or perfect love. Narcissists are often haughty and arrogant.

Cluster C

The personality disorders in cluster C are characterized by anxiety and fearfulness. This cluster includes the avoidant, dependent, and obsessive-compulsive personality disorders.

• Avoidant Personality Disorder – individuals with this disorder are highly sensitive to any type of rejection or criticism. They tend to isolate and have extreme feelings of inadequacy. In social settings, they are very shy and as a result, will go out of their way to avoid uncomfortable interactions with others unless they are certain they will be accepted and liked. They perceive themselves as unappealing, inferior, and lacking social skills. They rarely take personal risks or try new things due to fear of embarrassment. It is difficult for them to get close to people because they are afraid they will be ridiculed or shamed.

• Dependent Personality Disorder – people with this disorder are very needy, clingy, dependent and submissive. They have a difficult time making decisions on their own and constantly seek reassurance. They rarely disagree with others out of fear of disapproval. They feel very helpless when alone, so they quickly seek out a new relationship if the one they are in ends. They will do whatever it takes, even if unpleasant, to get others to support and nurture them. They need someone else to handle the major aspects of their life, and have an extreme fear that they can’t manage on their own.

• Obsessive-compulsive Personality Disorder – this disorder is not to be confused with the anxiety disorder known as obsessive-compulsive disorder (OCD). However, some individuals with OCD also have this personality disorder. People with this disorder are very stubborn, inflexible, and preoccupied with rules, details, lists and orderliness. They are so perfectionistic that they often don’t finish a project because it doesn’t meet their excessively high standards. They are often controlling, demanding that others do things their way. They are often highly devoted to work. They are miserly when it comes to money, and have a difficult time discarding worn-out or useless objects.

Problems Associated with Personality Disorders

Individuals with personality disorders often have a lot of problems in their lives as a direct result of their disorder. These may include:

• Marital problems or divorce

• Relationship problems

• Difficulties at work or school

• Job loss

• Difficulties with health care providers

• Increased risk of suicide

• Depression or anxiety

• Substance abuse

• Problems with the law / incarceration

• Reckless behavior

• Aggressive behavior

• Social isolation

Treatment for Personality Disorders

As mentioned earlier, due to the fact that personality disorders, by nature, are deeply ingrained and inflexible, they are notoriously difficult to treat. Treatment is often unsuccessful, but the options include psychotherapy, medication and hospitalization.

Psychotherapy

The primary treatment indicated for personality disorders is psychotherapy. However, most experts agree that in order for psychotherapy to make a significant and effective impact, it usually needs to be intensive and long-term. This is very expensive, and thus health insurance rarely covers the treatment of personality disorders, with the occasional exception of borderline personality disorder. Unfortunately, many people cannot afford weekly (or sometimes twice weekly for personality disorders) psychotherapy if they are paying out of pocket.

The types of psychotherapy typically used to treat personality disorders are:

• Psychodynamic psychotherapy

• Cognitive behavioral therapy

• Dialectical behavior therapy (initially developed for borderline personality disorder, but also used for other disorders). It should be noted that dialectical behavior therapy has been shown to be one of the most effective treatments for borderline personality disorder.

• Transference-focused psychotherapy (also developed initially for the treatment of borderline personality disorder)

Medication

Medication alone is not typically indicated for the treatment of personality disorders. However, it is often used to treat symptoms associated with some of the personality disorders, such as anxiety or moodiness. Medication may help reduce associated symptoms, but it will not effectively impact the personality disorder itself. The types of medications often used are antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers.

Hospitalization

In severe cases, hospitalization may be required for someone with a personality disorder. Usually the primary reason for hospitalization is to keep the person from harming himself or someone else. Individuals with borderline personality disorder make up approximately 20% of inpatient psychiatric populations due to their frequent suicidality and self-mutilation. Of all the personality disorders, borderlines are the most likely to require hospitalization.

Conclusions

Personality disorders affect a significant percentage of the population, even though many are never diagnosed. Borderline personality disorder alone is estimated to affect at least 2% of adults in the U.S. Prisons are filled with individuals who have antisocial personality disorder. Paranoid, schizoid and schizotypal personality disorders are sometimes a precursor to schizophrenia.

Personality disorders are complex and challenging, and cause significant problems for both the individual with the disorder, as well as those around them. If treatment is sought, it is recommended that it be with a mental health professional that specializes in the treatment of personality disorders.