What is Personality?
Our personality matter. A person is known or not known, it is only due to his or her personalities. If we are pleasant by personality, we can make other happy; if we are irritable and aggressive, only hostility results.
Our behaviors are determined by the traits which we inherit or learn as we grow. Personality traits are normal & prominent aspect of human behavior. Personality is defined as a deeply ingrained pattern of behavior & characters that include
1. The way we perceive the world i.e. the modes of perception
2. How we relate to & think about oneself and surrounding environment?
What is Personality Disorders?
The proverb "Excess of anything is bad" apply very well in defining personality disorder. Personality disorders results when the personality traits become excessive, abnormal, inflexible and maladaptive enough to cause significant social or occupational impairment or significant subjective distress. Personality disorders is characterized by
1. Enduring pattern of experience and behavior (cognition, affect, interpersonal functioning, impulse control) that remain
2. Cross-situationally stable i.e. Inflexible and that leads to
3. Impaired functioning & / or distress
Personality disorder is a common and chronic condition. Its prevalence is estimated between 10 - 20 % in the general population.
Its duration is expressed in decades.
Approximately one half of all psychiatric patients have personality disorder.
Persons with personality disorders refuse psychiatric help & deny their problems. Personality disorder is also a predisposing factor for other psychiatric disorders
It is because the symptoms of personality disorder are
2. Ego-syntonic (i.e. acceptable to the ego)
They do not feel anxiety about their maladaptive behavior.
They do not routinely acknowledge pain from what others perceive as their symptoms
What are the types of Personality Disorders ?
Personality disorders are grouped into three clusters based on descriptive similarities
Cluster A (These persons appear odd or eccentric)
Cluster B (These persons appear dramatic, emotional, or erratic)
Cluster C (These persons appear anxious or fearful)
What causes Personality Disorders?
Not only genes but also environmental factors, cultural factors, social factors & also recently anomalies of neurotransmitter and hormones plays a crucial role in determining our personality.
Monozygotic twins reared apart have nearly same personalities
Cluster A personality traits are more common in the biological relatives of patients with schizophrenia than among control groups
Among Cluster B personality groups, antisocial personality disorder is associated with alcohol use disorders; depression is common in family backgrounds of patients with borderline personality disorder; there exist a strong correlation between histrionic and somatization disorders
In Cluster C group, patients with avoidant personality often have high anxiety levels; obsessive-compulsive traits are more common in monozygotic twins than in dizygotic twins - they also show some signs of depression
Neurotransmitters also seem to play a role. 5-HIAA, a metabolite of serotonin is low in people who are impulsive and aggressive
1. Children with minimal brain damage are at risk for antisocial personality disorder
2. Link between fearful children raised by fearful mothers and avoidant personality disorder
3. Cultures that encourage aggression may contribute to paranoid and antisocial personality disorders
Paranoid Personality Disorder
Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts.
Such individuals are so much suspicious that they always think all other people are their enemies, plotting against them, conspiring or they can harm them or their family.
The prevalence of paranoid personality disorders is estimated at 0.5% to 2.5% of the general population, it's more common in males
The hallmarks of paranoid personality disorder are :
1. Suspicion & distrust of others' motives
2. Refusal to confide in others
3. Inability to collaborate with others
5. Inability to relax (they remain hyper vigilant)
7. Detachment & social isolation
8. Poor self - image
9. Sullenness, hostility, coldness & detachment
11. Anger, jealousy & envy
12. Bad temper, hyperactivity and irritability
13. Lack of social support systems
The specific cause of paranoid personality disorder is unknown. Its higher incidence in families with a schizophrenic member suggests a possible genetic influence. Some expert believe that the disorder result (at least partly) from negative childhood experiences & a threatening domestic atmosphere- for example, extreme unfounded rage or condescension by the parents, which can produce profound insecurity in the child
Paranoid personality disorder can be difficult to differentiate from pure delusional disorders or schizophrenia or other psychiatric conditions. Only by careful mental status evaluation, one can find the difference
1. Differentiated from delusional disorder by the absence of fixed delusions
2. Unlike schizophrenics, they have no hallucinations or formal thought disorder
3. Differ from borderlines because they are mostly incapable of overly involved, tumultuous relationships with others
4. No long history of antisocial activity
5. Schizoids are withdrawn & aloof and do not have paranoid ideation
Schizoid personality disorder
Person with schizoid personality lives alone and remain happy in their isolation, but at the cost of significant social and occupational impairment.
Schizoid personality disorder is characterized primarily by a profound defect in the ability to form personal relationships or to respond to others in any meaningful and emotional way.
These individual displays a lifelong pattern of social withdrawal & their discomfort with human interaction is very apparent.
The prevalence of schizoid personality disorder within general population has been estimated at between 3 to 7.5%. It is diagnosed more frequently in men than women.
The core characteristics of schizoid personality disorder are mentioned below.
1. Emotional detachment
2. Inability to experience pleasure
3. Lack of strong emotions & little observable change in mood
4. Avoidance of activities that involve significant interpersonal contact
5. Little desire for or enjoyment of close relationships
6. No desire to be part of a family
7. Strong preference for solitary activities
8. Little or no interest in sexual experiences with another person
9. Lack of close friends or confidants other than immediate family members
10. Shyness, distrust & discomfort with intimacy
11. Feeling of superiority
14. Oversensitivity to slights
As with the other personality disorders, the exact cause of schizoid personality disorder is not known. Some researchers think it may be inherited.
Other possible causes may include:
1. A sustained history of isolation during infancy & childhood
2. Cold or grossly deficient early parenting
3. Parental modeling of interpersonal withdrawal, indifference and detachment
Schizotypal Personality Disorder
Among the cluster A group of personality disorders, schizotypal is more graver than paranoid and schizoid types.
Schizotypal personality disorder is marked by a pervasive pattern of social and interpersonal deficits, along with acute discomfort with others.
People with this disorder have odd thought & behavioral patterns.
It is prevalent in 3% of general population. Such persons not only lives in in isolation but lost in fantasy.
People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They generally don't understand how relationships form or the impact of their behavior on others. They may also misinterpret others' motivations and behaviors and develop significant distrust of others.
These problems may lead to severe anxiety and a tendency to turn inward in social situations, as the person with schizotypal personality disorder responds inappropriately to social cues and holds peculiar beliefs.
Schizotypal personality disorder typically is diagnosed in early adulthood and likely to endure, though symptoms may improve with age. Medications and therapy also may help.
Core features of Schizotypal people are enumerated below:
1. Odd or eccentric behavior or appearance
2. Inaccurate beliefs that other's behavior or environmental phenomena are meant to have an effect on the patient
3. Odd beliefs or magical thinking (such as thinking that one's thought or desires can influence the environment or cause events to occur)
4. Unusual perceptual experiences, including bodily illusions
5. Vague, circumstantial or stereotypical speech or thinking pattern
6. Unfounded suspicious of being followed, talked about, persecuted, or under surveillance
7. Inappropriate or constricted affect
8. Lack of close relationships other than immediate family members
9. Social isolation
10. Excessive social anxiety
11. A sense of feeling different and not fitting in with others easily
Schizotypal personality disorder may have a genetic basis. Family, twin and adoption studies show an increased risk of the condition in people with a family history of schizophrenia. Environmental factors (such as severe stress) may determine whether schizotypal personality disorder or schizophrenia manifests.
Dopamine Deviance: Some evidence suggests that patients with schizotypal personality disorder have poor regulation of dopamine pathways in the brain.
Psychological & Cognitive theories: psychological & cognitive explanations for schizotypal personality disorder focus on deficits inattention & information processing. These patients perform poorly on tests that assess continuous performance tasks, which require the ability to maintain attention on one object & to look at new stimuli selectively
Psychoanalytic theories: One proposes that patients with this disorder have ego boundary problems; the other, that these patients were raised by patients with inadequate parenting skills, poor communication skills & loose association of words
Antisocial Personality Disorder
The highlight of antisocial personality disorder is chronic antisocial behavior that violates other's rights or generally accepted social norms.
This disorder predisposes a person toward criminal behavior. In the general population, the prevalence of antisocial personality disorder is about 2% to 3%.
Roughly one-half of people with this disorder have a history of arrest.
It affects three to four times as many males than females.
Antisocial personality disorder is a type of chronic mental condition in which a person's ways of thinking, perceiving situations and relating to others are dysfunctional — and destructive.
People with antisocial personality disorder typically have no regard for right and wrong and often disregard the rights, wishes and feelings of others.
Those with antisocial personality disorder tend to antagonize, manipulate or treat others either harshly or with callous indifference.
They may often violate the law, landing in frequent trouble, yet they show no guilt or remorse.
They may lie, behave violently or impulsively, and have problems with drug and alcohol use.
These characteristics typically make people with antisocial personality disorder unable to fulfill responsibilities related to family, work or school.
Core features of antisocial personality disorder is enumerated below:
1. A long-standing pattern of disregarding other's right & society's values
2. Repeatedly performing unlawful acts
3. Reckless disregard for his own or others' safety
5. Lack of remorse
6. Consistent irresponsibility
7. Power-seeking behavior
8. Destructive tendencies
9. Impulsivity & failure to plan ahead
10. Superficial charm
11. Manipulative nature
12. Inflated, arrogant self-appraisal
13. Irritability & aggressiveness
14. Inability to maintain close personal or sexual relationships
15. Disconnection between feelings & behaviors
16. Substance abuse
2. Biological factors (poor serotonin regulation in certain brain regions, reduced autonomic activity, abnormalities in the pre-frontal brain systems) leads to decrease behavioral inhibition, low arousal, poor fear conditioning and decision-making deficits seen in patients with antisocial personality disorder
3. Attention deficit hyperactivity disorder
4. Large families & Low socioeconomic status
5. Transient friendships
6. Social isolation
7. Neglectful or unstable parenting
8. Childhood physical or sexual abuse
9. Substance abuse
Borderline Personality Disorder
A disorder of poor regulation of emotions, borderline personality disorder is marked by a pattern of instability in interpersonal relationships, mood, behavior and self-image. Although people with this disorder may experience it in various ways, most find it hard to distinguish reality from their own misperceptions of the world. Their emotions overwhelm their cognitive functioning, creating many conflicts with others
The prevalence of borderline personality disorder affects 2% to 3% of the general population, about 11% of psychiatric outpatients, & nearly 20% of psychiatric inpatients
It's three times more common in females than in males.
Borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness.
With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone.
Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.
signs & symptoms of borderline personality disorder fall into four main
1. Unstable relationships
2. Unstable self-image
3. Unstable emotions
Symptoms are more acute when the patient feels isolated & without social support.
Assessment findings may include:
1. A pattern of unstable and intense interpersonal relationships
2. Splitting (viewing others as either extremely good or extremely bad)
3. Intense fear of abandonment, as displayed in clinging & distancing maneuvers
4. Rapidly shifting attitudes about friends & loved ones
5. Desperate attempts to maintain relationships
6. Unstable perceptions of relationships
7. Manipulation, as in pitting people against one another
8. Limited coping skills
9. Dissociation (separating objects from their emotional significance)
10. Transient, stress-related paranoid ideation or severe dissociative symptoms
11. Inability to develop a healthy sense of oneself
12. Uncertainty about major issues, such as self-image, identity, life goals, sexual orientation, values, career choices or types of friends
13. Imitative behavior
14. Rapid, dramatic mood swings, from euphoria to intense anxiety to rage, within hours or days
15. Acting out of feelings instead of expressing them appropriately or verbally
16. Inappropriate, intense anger or difficulty controlling anger
17. Chronic feelings of emptiness
18. Unpredictable self-damaging behavior, such as driving dangerously, gambling, sexual promiscuity, overeating, spending & abusing substances
19. Self-destructive behavior, such as physical fights, recurrent accidents, self-mutilation and suicidal gesture
What predisposes to borderline?
The precise causes of borderline personality disorder are unknown, but several theories are being investigated. Because it's five time more common in first-degree relatives of people who have it, researchers suspect genetic may play a role.
Biological factors may involve:
1. Dysfunction in the brain's limbic system or frontal lobe
2. Decreased serotonin activity
3. Increased activity in alpha-2-noradrenergic receptors
Early losses & abuse like prolonged separation from their parents, other major losses early in life and physical, sexual, or emotional abuse or neglect seem to be more common in patients with this disorder than in the general population
Histrionic Personality Disorder
This disorder is characterized by colorful, dramatic and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance from others.
The prevalence of the disorder is thought to be about 2 to 3%; it is more common in women than in men,
Assessment of a patient with histrionic personality disorder may reveal:
1. Constant craving for attention, stimulation and excitement
2. Intense affect
3. Shallow, rapidly shifting expression of emotions
4. Flirting and seductive behavior
5. Overinvestment in appearance
6. Exaggerated, vague speech
10. Suggestibility and impressionability
11. Egocentricity, self-indulgence and lack of consideration for others
12. Intolerance of frustration, disappointment and delayed gratification
13. Somatic (physical) preoccupations and symptoms
14. Angry outbursts and tantrums
15. Sudden enraged, despairing or fearful states
16. Intense anger toward people viewed as withholding
17. Troublesome, manipulative behavior
18. Intolerance of being alone
19. Suppression or denial of internal distress, weakness, depression or hostility
20. Dread of growing old
21. Demanding and manipulative nature
22. Use of alcohol or drugs to quickly alter negative feelings
24. Suicidal gestures and threats
The cause of histrionic personality disorder is not known. A genetic component may be involved, as hysterical traits are more common in relatives of those with this disorder. However, little research has been done on the biological origins of this disorder.
Childhood events may come into play as well
Psychoanalytic theories focus on seductive & authoritarian attitudes by fathers of these patients
Narcissistic Personality Disorder
Persons with narcissistic personality disorder have an exaggerated sense of self-worth. They lack empathy & are hypersensitive to the evaluation of others. They believe that they have the absolute right to receive special consideration & that their desire is justification for possessing whatever they seek.
Narcissistic personality disorder is found in less than 1% of the general population. It affects about three times as many males as females.
People with narcissistic personality disorder often display snobbish, disdainful, or patronizing attitudes. For example, an individual with this disorder may complain about a clumsy waiter's "rudeness" or "stupidity" or conclude a medical evaluation with a condescending evaluation of the physician.
1. Arrogance or haughtiness
3. Unreasonable expectations of favorable treatment
4. Grandiose sense of self-importance
5. Exaggeration of achievements & talents
6. Preoccupation with fantasies of success, power, beauty, brilliance or ideal love
7. Manipulative behavior
8. Constant desire for attention & admiration
9. Lack of empathy
10. Lack of concern over whom he offends
11. Taking advantage of others to achieve his own goals
12. Rage, shame or humiliation in response to criticism
Love thyself, hate thyself theory holds that patients with this disorder have an ambivalent self-perception: an idealized (or over idealized) view of the self coexists with deep feelings of inferiority
The exact cause of narcissistic personality disorder is unknown
A psychodynamic theory proposes that it arises when a child's basic needs go unmet & a low self-esteem, develops. Thus, the grandiose image is an effort to cover feelings of inferiority. According to this theory, the patient received little encouragement and support from his parents during childhood and tends to internalize the process by looking for these feelings within himself
Avoidant Personality Disorder
Avoidant personality disorder is marked by feelings of inadequacy, extreme social anxiety, social withdrawal, & hypersensitivity to other's opinions. People with this disorder have low self-esteem & poor self-confidence. They dwell on the negative & have difficulty viewing situations and interactions objectively.
The prevalence of the disorder in the general population is between 0.5 & 1%; it appears to be equally common in men & women.
A patient with avoidant personality disorder may exhibit or report:
1. Shyness, timidity and social withdrawal
2. Behavior or appearance that's meant to drive others away (which give him a sense of control) over talkativeness
3. Constant mistrust or worry of others
4. Testing of others' sincerity
5. Difficulty starting and maintaining relationships
7. Rejection of people who don't live up his impossibly high standards
8. Limited emotional expression
9. Tenseness and anxiety
10. Low self-esteem
11. Feelings of being unworthy of successful relationships
14. Reluctance to take personal risks or engage in new activities
15. Frequent escapes into fantasy, such as by excessive reading, watching TV, or daydreaming
Avoidant personality disorder most likely results from a combination of genetic, biological, environmental and other factors - although the evidence for genetic and biological causes is weak
From a psychodynamic view, the disorder has been attributed to an overly critical parental style.
Avoidant personality disorder is closely linked to temperament. Studies of children under age 2 found that some have an apparently inborn tendency to withdraw from new situation or people. In fact, roughly 10% of toddlers are habitually fearful and withdrawn when exposed to new people & situation. Some evidence suggests that a timid temperament in infancy may predispose a person to developing avoidant personality disorder later in life.
Information overload: The inherited tendency to be shy may result from overstimulation or an excess of incoming information. The patient can't cope with the excess information and withdraws in defense. Inability to cope with the information overload may stem from a low autonomic arousal threshold.
Low threshold, greater response: Research suggests that in people with this disorder, certain structures in the brain's limbic system may have a lower threshold of arousal and a more pronounced response when activated.
Some expert believe that significant environmental influences during childhood, such as rejections or peers, leads to the full development of avoidant personality disorder
Dependent Personality Disorder
Dependent personality disorder is characterized by "a pervasive and excessive need to be taken care of that leads to submissive & clinging behavior & fear of separation.
In the general population, its prevalence is about 1.5%; it affects slightly more females than males.
Assessment findings in a patient with dependent personality disorder may include:
2. Self-effacing, apologetic manner
3. Low self-esteem
4. Lack of self-confidence
5. Lack of initiative
6. Incompetence & a need for constant assistance
7. Intense, unremitting need to be loved in a stable long term relationship that goes through minimal change
8. Anxiety & insecurity, especially when deprived of a significant relationship
9. Feelings of inferiority & unworthiness
10. Hypersensitivity to criticism
11. In females, little needs to overtly control or compete with others
12. Demanding behavior
13. Use of cajolery, bribery, promises to change and even threats to maintain key relationships
14. Fear and anxiety over losing a relationship or being alone
15. Dependence on a number of people, any one of whom could substitute for the other
16. Difficulty making everyday decisions without advice and reassurance
17. Avoidance of change and new situations
18. Exaggerated fear of losing support and approval
According to some expert, authoritarian or overprotective parenting may lead to high levels of dependency. These parenting styles may cause the child to believe that she can't function without other's guidance
The exact cause of dependent personality disorder is not known. Because it tends to run in families, it may involve a genetic component
Possible contributing factors may include:
Orthodox family system that discourages outside relationships
Childhood physical or sexual abuse
Way to maintain relationships is to give in to others' demand
Obsessive Compulsive Personality Disorder
Individual with obsessive-compulsive personality disorder are very serious & strict and have difficulty expressing emotions. They are overly disciplined, perfectionist and preoccupied with rules. They are inflexible about the way in which things must be done & have a devotion to productivity to the exclusion of personal pleasure.
The prevalence of the disorder in the general population is 1.5%; two time more common in males than in females.
A patient with obsessive-compulsive personality disorder may describe his symptoms in a logical way, attaching little emotion to any physical discomfort.
Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
1. Behavioral, emotional and cognitive rigidity
3. Severe self-criticism
5. Controlling manner
6. Difficulty expressing tender feelings
7. Poor sense of humor
8. Cool, distant, formal manner
9. Emotional constriction
10. Excessive discipline
11. Aggression, competitiveness, & impatience
12. Bouts of intense anger when things stray from the patient's expectation
13. Difficulty incorporating new information into his life
14. Psychosomatic complaints
16. Sexual dysfunction
17. Chronic sense of time pressure & inability to relax
18. Indirect expression of anger despite an apparent undercurrent of hostility
19. Hoarding of memory and other possessions
20. Preoccupation with orderliness, neatness and cleanliness
21. Discuss about morality, ethics or values
22. Signs and symptoms of depression
23. Physical complaints (commonly stemming from overwork)
Genetic and developmental factors may play a role in the development of this disorder.
A twin and adoption study suggests that it runs in families
Psychodynamic theories view the patient as needing control as a defense against feelings of powerlessness or shame
Passive-Aggressive Personality Disorder (A research type)
This disorder is characterized by a pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations that begins by early adulthood and occurs in a variety of contexts.
People with passive-aggressive behavior express their negative feelings subtly through their actions instead of handling them directly. This creates a separation between what they say and what they do.
Core manifestation or features of these individual include:
1. Feels cheated and unappreciated
2. Passively resists fulfilling routine social and occupational tasks
3. Complains of being misunderstood and unappreciated by others
5. Unreasonably criticizes and scorns authority
6. Expresses envy and resentment toward those apparently more fortunate
7. Voices exaggerated and persistent complaints of personal misfortune.
8. Alternates between hostile defiance and remorse
Contradictory parental attitude and behavior are implicated in the predisposing to passive-aggressive personality disorder. Through this type of environment, children learn to control their anger for fear of provoking parental withdrawal and not receiving love and support -even on an inconsistent basis. Overtly the child appears polite & undemanding; hostility and inefficiency are manifested only covertly and indirectly.
How to manage people with problematic personalities?
Our aim always remains to lessen the inflexibility of the maladaptive traits and reducing their interference with everyday functioning and meaningful relationship. Selection of intervention is generally based on the area of greatest dysfunction, such as cognitive, affect, behavior or interpersonal relations.
Interpersonal psychotherapy (a time-limited treatment that encourages the patient to regain control of mood and functioning typically lasting 12-16 weeks. IPT is based on the principle that there is a relationship between the way people communicate and interact with others and their mental health.) may be particularly appropriate because personality disorders largely reflect problems in interpersonal style. Long-term psychotherapy attempts to understand and modify the maladjusted behaviors, cognition and affects of clients with personality disorders that dominate their personal lives.
The core element of treatment is the establishment of an empathic therapist-client relationship, based on collaboration.
Interpersonal psychotherapy is suggested for clients with paranoid, schizoid, schizotypal, borderline, dependent, narcissistic personality disorders (guided discovery in which the therapist functions as a role model for the client).
The treatment of choice for individuals with histrionic personality disorder has been psychoanalytical psychotherapy. Treatment focuses on the unconscious motivation for seeking total satisfaction from others and for being unable to commit oneself to a stable, meaningful relationship.
Supportive group psychotherapy is especially appropriate for individuals with antisocial personality disorder, who respond more adaptively to homogeneous supportive groups that emphasize the development of social skills. It greatly helps in allaying social anxiety in these people.
Feedback from peers plays a beneficial role in reinforcing desirable behavior in persons with personality abnormalities.
Social skills training, cognitive strategies and assertiveness training program teaches clients alternative ways to deal with frustration.
Pharmacotherapy (Medications for personality disorders)
Medications are only short term solution to personality problems. Drugs have little or no effect in the treatment of the disorder itself, although some symptomatic relief can be achieved.
Antipsychotic medications are helpful in the treatment of psychotic decompensation experienced by clients with paranoid, schizotypal and borderline personality disorder. Antipsychotic have resulted in improvement in illusions, ideas of reference, paranoid thinking, anxiety and hostility in some clients.
The selective serotonin reuptake inhibitors (SSRIs)have been successful in decreasing impulsivity and self-destructive acts in the client's personality disorder.
Lithium carbonate and propranolol may be useful for the violent episodes observed in the clients with antisocial personality disorder
Anxiolytics are useful for clients with avoidant personality disorder.
Contact us if you or your beloved one is suffering from personality disorders. These disorders are not going to kill you, but leads to constant problems and impairment in social and occupational life and familial relationship.