Personality disorders

Personality disorder is a general term for a type of mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. There are many specific types of personality disorders.

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What is it?

Personality disorder is a general term for a type of mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. There are many specific types of personality disorders.

In general, having a personality disorder means you have a rigid and potentially self-destructive or self-denigrating pattern of thinking and behaving no matter what the situation. This leads to distress in your life or impairment of your ability to go about routine functions at work, school or social situations. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you, and you may blame others for your circumstances.

Symptoms

General symptoms of a personality disorder

General signs and symptoms that may indicate a personality disorder include:

  • Frequent mood swings
  • Stormy relationships
  • Social isolation
  • Angry outbursts
  • Suspicion and mistrust of others
  • Difficulty making friends
  • A need for instant gratification
  • Poor impulse control
  • Alcohol or substance abuse

Specific types of personality disorders

The specific types of personality disorders are grouped into three clusters based on similar characteristics and symptoms.

Cluster A. These are personality disorders characterized by odd, eccentric thinking or behavior and include:

Paranoid personality disorder

  • Distrust and suspicion of others
  • Believing that others are trying to harm you
  • Emotional detachment
  • Hostility

Schizoid personality disorder

  • Lack of interest in social relationships
  • Limited range of emotional expression
  • Inability to pick up normal social cues
  • Appearing dull or indifferent to others

Schizotypal personality disorder

  • Peculiar dress, thinking, beliefs or behavior
  • Perceptual alterations, such as those affecting touch
  • Discomfort in close relationships
  • Flat emotions or inappropriate emotional responses
  • Indifference to others
  • "Magical thinking" — believing you can influence people and events with your thoughts
  • Believing that messages are hidden for you in public speeches or displays

Cluster B. These are personality disorders characterized by dramatic, overly emotional thinking or behavior and include:

Antisocial (formerly, sociopathic) personality disorder

  • Disregard for others
  • Persistent lying or stealing
  • Recurring difficulties with the law
  • Repeatedly violating the rights of others
  • Aggressive, often violent behavior
  • Disregard for the safety of self or others

Borderline personality disorder

  • Impulsive and risky behavior
  • Volatile relationships
  • Unstable mood
  • Suicidal behavior
  • Fear of being alone

Histrionic personality disorder

  • Constantly seeking attention
  • Excessively emotional
  • Extreme sensitivity to others' approval
  • Unstable mood
  • Excessive concern with physical appearance

Narcissistic personality disorder

  • Believing that you're better than others
  • Fantasizing about power, success and attractiveness
  • Exaggerating your achievements or talents
  • Expecting constant praise and admiration
  • Failing to recognize other people's emotions and feelings

Cluster C. These are personality disorders characterized by anxious, fearful thinking or behavior and include:

Avoidant personality disorder

  • Hypersensitivity to criticism or rejection
  • Feeling inadequate
  • Social isolation
  • Extreme shyness in social situations
  • Timidity

Dependent personality disorder

  • Excessive dependence on others
  • Submissiveness toward others
  • A desire to be taken care of
  • Tolerance of poor or abusive treatment
  • Urgent need to start a new relationship when one has ended

Obsessive-compulsive personality disorder

  • Preoccupation with orderliness and rules
  • Extreme perfectionism
  • Desire to be in control of situations
  • Inability to discard broken or worthless objects
  • Inflexibility

Obsessive-compulsive personality disorder isn't the same as obsessive-compulsive disorder, a type of anxiety disorder.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors:

  • Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate.
  • Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some research suggests that you may have a genetic vulnerability to developing a personality disorder and that your life situation may trigger the actual development of a personality disorder.

Risk factors

Although the precise cause of personality disorders isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering personality disorders, including:

  • A family history of personality disorders or other mental illness
  • Verbal, physical or sexual abuse during childhood
  • An unstable or chaotic family life during childhood
  • Being diagnosed with childhood conduct disorder
  • Loss of parents through death or divorce during childhood

Personality disorders are common worldwide, affecting about 10 to 13 percent of people at some point during their life. Personality disorders often begin in childhood and last through adulthood. There's some reluctance to diagnose personality disorders in a child, though, because the patterns of behavior and thinking could simply reflect adolescent experimentation or temporary developmental phases.

Complications

Complications and problems that personality disorders may cause or be associated with include:

  • Depression
  • Anxiety
  • Eating disorders
  • Suicidal behavior
  • Self-injury
  • Reckless behavior
  • Risky sexual behavior
  • Child abuse
  • Alcohol or substance abuse
  • Aggression or violence
  • Incarceration
  • Relationship difficulties
  • Social isolation
  • School and work problems
  • Strained relationships with health care providers

Diagnosis

When doctors believe someone has a personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

  • Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
  • Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
  • Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings, relationships and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-injury or harming others.

Pinpointing which personality disorder you have

It sometimes can be difficult to determine which particular personality disorder or personality disorders you have. For one thing, some personality disorders share similar symptoms. Also, a diagnosis is often based largely on how you describe your symptoms and behavior, along with how your doctor interprets those symptoms and observes you behaving. Because of this, it can take some time and effort to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate treatment designed for your particular illness and situation.

Diagnostic criteria

The symptoms and clinical features for each personality disorder are detailed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

To be diagnosed with a particular personality disorder, you must meet the criteria for that disorder listed in the DSM. Each personality disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular personality disorder. Some people may not meet all of the criteria but may still have a personality disorder and need professional help to overcome or manage it. Also, it's not unusual to have more than one personality disorder at the same time.

Treatment & Management Strategies

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