Personality Disorders

This covers a wide range of behaviours that are not deemed ‘fit’ in other diagnostic categories. Those who suffer from these disorders have a hard time coping up with their lives. They also inflict distress to themselves and to others.

They have problems maintaining relationships and doing social cues. There is not one treatment that can cure these disorders. Very little studies have been done to confirm what causes these disorders as well. Approximately 10% of the population is affected by it.

A 'personality' disorder comes from a problem in the individual’s character. Their behaviour and attitude is at odds against what is normal. What is normal can be different across cultures but a diagnosis for the condition is done within the context of obligations, social expectations and rules in a community. There are many different kinds of personality disorders but somehow, all of them have the following characteristics:

  • Majority of the first symptoms begin showing at adolescent or late childhood and continue until adulthood.
  • Personality disorders for adolescents can be described as conduct disorders. But most of the conduct disorders do not lead to a personality disorder in adulthood.
  • An individual personality disorders have attitudes that cause a lot of problem for others and to themselves.
  • Patients with a personality disorder are inflexible or that they are narrow-minded and have bad coping mechanisms
  • These behaviours persist for a long time

Some other main points include:

  • Patients with a personality disorder fit at least two unlike criterion of personality disorder
  • Majority of the patients with a personality disorder should not be thought of as dangerous
  • Being dangerous is not exclusively linked with psychopathic or anti-social disorder
  • Patients with paranoid or borderline personality disorder have a higher risk of suicide and self mutilation
  • Patients with a personality disorder have many needs and weaknesses

Causes of Personality Disorders

Few studies were done to look into the exact causes of personality disorders. The most accepted explanation could be that the disorder comes from problems during the early childhood like abuse, trauma, neglect and inadequate parenting. Genetic and neurological factors like low amounts of serotonin and brain damage could also be reasons.

Someone with a personality disorder may also have mental health problems like panic disorders, anxiety, depression, self mutilation, eating disorders, substance abuse or bipolar disorder. There are not enough studies to support which of the conditions causes the other.

It is hard to properly diagnose personality disorders. This is because other mental health problems may be present alongside them. Personality disorders can also be misdiagnosed especially when the symptoms are similar to other syndromes like in the case of Asperger's syndrome and post-traumatic stress syndrome.

Classification of Personality Disorders

There are two classification systems for personality disorders. They are the following:

  • DSM classification system

The diagnostic criteria refer to traits or behaviours that are very characteristic of an individual’s current and long term performance since their early childhood. Personality disorders describe a pattern of traits or behaviours that could cause subjective distress or significant harm in occupational or social functioning.

  • ICD classification system

The diagnostic criteria includes a lot of conditions that indicates an individual’s characteristic and of their inner experience and behaviours that are significantly different from an accepted range and culturally expected.

Kinds of personality disorders

In the DSM system, three main categories or clusters are present for personality disorders:

Cluster A:

  • Paranoid Personality Disorder
  • Schizotypal Personality Disorder
  • Schizoid Personality Disorder

Cluster B:

  • Anti-social Personality Disorder
  • Narcissistic Personality Disorder
  • Histrionic Personality Disorder
  • Emotionally Unstable Personality Disorder

Cluster C:

  • Anxious Personality Disorder
  • Obsessive Compulsive Personality Disorder
  • Dependant Personality Disorder

Self management and treatment strategies

Currently, little is known if treatments can produce long term benefits for personality disorders. Not enough studies have been made to confirm these claims. Studies that were made suggest that personality disorders can be treated and can be managed, especially the mild and moderate forms. But the there is no single treatment that is efficient for all cases.

Personality disorders are hard to treat because most of them are lifelong, persistent attitudes. It is also because patients with personality disorders have other mental problems. If the treatment does not work for the patient, the patient is blamed for it rather than the service which does not fit the patient’s needs.

In UK, treatments for personality disorders can vary a lot, depending heavily on whether the patients are in an NHS setting, special hospital, an in-patient psychiatric unit, or at a prison system. It should be noted that a qualified staff, management support and therapeutic environments are needed to support such innovative treatments.

Medication

Treatments for short term benefits include anxiolytic or neuroleptic drugs that are given to treat severe stress. These drugs are taken for short periods of time. For long term treatments, these drugs are used to treat paranoia and shizotypal personality disorders. But it is also possible that the drugs are used to control risks and stress rather than giving long term benefit to the personality disorder.

Psychodynamic treatment

The treatment places emphasis on personality development and structure. It also aims to give valuable insight to people to allow them to know and understand their own feelings and find the best coping mechanisms. But this approach has had very limited success. It is likely to become less successful especially for those who have addiction or antisocial personality disorder.

Cognitive and behavioural therapy

Behavioural and cognitive have a variety of treatments like Cognitive Therapy, Interpersonal Psychotherapy, Dialectical Behaviour Therapy, and the Cognitive Analytic Therapy. Most of these approaches deal with the specific elements of thoughts, behaviour, feelings or attitude. These approaches do not claim that they treat the whole of the personality disorder. Studies have suggested that these approaches have short term benefits. A lot more studies have to be put in to confirm that they also have long term benefits.

Therapeutic Communities

Therapeutic Community (TC) involves living in the therapeutic community for a couple of months. Joining the therapy should be voluntary and the responsibility for the daily facilitation of the TC is usually shared between staff and the patients.The patients of the TC are urged to relate their feelings, especially what they feel about their co-patients’ behaviour. This exercise enables them to think about the effect of their behaviour to other people. But the results of this exercise are still under a lot of scrutiny.