Personality is defined as “Enduring patterns of perceiving, relating to, and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts” Personality is a unique and long-term pattern of inner experience and outward behaviour. Personality tends to be consistent and is often described in terms of “traits”. These traits may be inherited, learned, or both. Personality is also flexible, allowing us to learn and adapt to new environments. Thus we can retrieve from it that “Personality refers to a distinctive set of traits, behaviour styles, and patterns that make up our character or individuality. How we perceive the world, our attitudes, thoughts, and feelings are all part of our personality. People with healthy personalities are able to cope with normal stresses and have no trouble forming relationships with family, friends, and co-workers.”But the same can behave in a haphazard manner if once control over itself is aberrated.
Personality Disorder
A personality disorder is characterized by stable patterns of thoughts, feelings, attitudes, or behaviours that cause significant distress or interfere with relationships or work. Those who struggle with a personality disorder have great difficulty dealing with other people. They tend to be inflexible, rigid, and unable to respond to the changes and demands of life. Although they feel that their behaviour patterns are “normal” or “right,” people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.
Recognizing a Personality Disorder and its causation
A personality disorder must fulfil several criteria. A deeply ingrained, inflexible pattern of relating, perceiving, and thinking serious enough to cause distress or impaired functioning is a personality disorder. Personality disorders are usually recognizable by adolescence or earlier, continue throughout adulthood, and become less obvious throughout middle age. Some experts believe that events occurring in early childhood exert a powerful influence upon behaviour later in life. Others indicate that people are genetically predisposed to personality disorders. In some cases, however, environmental facts may cause a person who is already genetically vulnerable to develop a personality disorder.
Main Features of PDs
-Extreme patterns of thinking, feeling, and behaving that deviate from a person’s culture
-Begin early in life and remain stable – not contextual or transient
-Inflexible and maladaptive
-Cause significant functional impairment and subjective distress
Classification of Personality disorder: Psychiatric syndromes and symptoms are complex phenomena that can potentially be conceptualized and assessed both categorically and dimensionally. Both the diagnostic and statistical manual of mental disorders and the international classification of disease systems rely extensively on a categorical approach, but also note the dimensional nature of syndromes and symptoms.
Categorical approach
A categorical approach to psychiatric disorders is frequently adopted in clinical practice because the presence or absence of a particular condition crucially informs treatment decisions.
Assumptions of the categorical approach
-Personality pathology is suited to be classified into discrete types or disorders
-These disorders group themselves into three clusters
-The diagnostic criteria naturally fall into the particular personality disorders to which they have been assigned
Advantages of Categorical System
-Ease in conceptualization and communication
-Familiarity
-Consistency with clinical decision making
Disadvantages of the Categorical Approach
-Complex and cumbersome
-Arbitrary cut-off points
-Loss of important information
Dimensional Approach
Given these kinds of difficulties raised by the categorical approach, many clinicians and researchers advocate the use of a dimensional approach to conceptualizing and assessing psychiatric syndromes and symptoms. Given that nature cannot easily be carved at her joints, one argument is that an understanding of the psychobiology of the psychiatric disorder requires an acceptance of the dimensional nature of symptoms. Dimensions can conceivably be used to record not only symptom profiles but also etiological contributors, including the full range of relevant types and extents.
Advantages of the Dimensional Model
-Resolution of a variety of classification dilemmas
-Retention of Information
-Flexibility
Disadvantages of the Dimensional Approach
-Lack of clinical utility and familiarity.
-Bottom line: not too many disadvantages and most researchers favour it – likely to be adopted in DSM-V
Types of Personality Disorders
The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual fifth edition (DSM-5) lists a number of personality disorders as diagnosable conditions for which people can seek treatment.
There are many formally identified personality disorders, each with their own set of behaviours and symptoms. Many of these fall into three different categories or clusters:
-Cluster A: Odd or eccentric behaviour
-Cluster B: Dramatic, emotional or erratic behaviour
-Cluster C: Anxious fearful behaviour
Cluster A:
-Schizoid Personality Disorder. Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker.
-Paranoid Personality Disorder. The essential feature for this type of personality disorder is interpreting the actions of others as deliberately threatening or demeaning. People with paranoid personality disorder are untrusting, unforgiving, and prone to angry or aggressive outbursts without justification because they perceive others as unfaithful, disloyal, condescending or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious.
-Schizotypal Personality Disorder. A pattern of peculiarities best describes those with a schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of “magical thinking” by saying they can see into the future or read other people’s minds.
Cluster B:
-Antisocial Personality Disorder. People with antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behaviour. These individuals are impulsive, irresponsible, and callous. Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behaviour, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behaviour on others. These people ware at high risk for substance abuse, especially alcoholism since it helps them to relieve tension, irritability and boredom.
-Borderline Personality Disorder. People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behaviour, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterize the person with a borderline personality disorder. These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes, viewing others as either “all good” or “all bad.” A person with borderline personality may form an intense personal attachment with someone only to quickly dissolve it over a perceived slight. Fears of abandonment may lead to excessive dependency on others. Self-mutilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of boredom or emptiness, and bouts of intense inappropriate anger are other traits of this disorder, which is more common among females.
-Narcissistic Personality Disorder. People with narcissistic personality have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.
Cluster C:
-Avoidant Personality Disorder. Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are fearful of saying something considered foolish by others; worry they will blush or cry in front of others and are very hurt by any disapproval by others. People with an avoidant personality disorder may have no close relationships outside of their family circle, although they would like to, and are upset at their inability to relate well to others.
-Dependent Personality Disorder. People with a dependent personality disorder may exhibit a pattern of dependent and submissive behaviour, relying on others to make decisions for them. They require excessive reassurance and advice and are easily hurt by criticism or disapproval. They feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends. They have a strong fear of rejection. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males.
-Obsessive-Compulsive Personality Disorder. Compulsive personalities are conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances. People with compulsive personality are highly cautious, weigh all aspects of a problem, and pay attention to every detail, making it difficult for them to make decisions and complete tasks. When their feelings are not under strict control, events are unpredictable, or they must rely on others, compulsive personalities often feel a sense of isolation and helplessness.
Treatment of the Personality Disorder
Unlike with mood disorders such as clinical depression and bipolar disorder, there are remarkably few studies on how to effectively treat personality disorders. And In general, many experts believe that personality disorders are difficult to treat because they are, by definition, long-standing patterns of personality.
The National Alliance on Mental Illness (NAMI) lists several types of psychotherapy that may be useful for treating personality disorders:
-Dialectical behaviour therapy (DBT), which teaches coping skills and strategies for dealing with urges related to self-harm and suicide, regulating emotions, and improving relationships.
-Cognitive behaviour therapy (CBT). The goal of CBT as stated by NAMI is “to recognize negative thoughts and learn effective coping strategies.”
-Mentalization-based therapy (MBT) teaches people to notice internal states and to develop empathy for others.
Conclusion: Personality disorders are a diagnostic category of psychiatric disorders that affect approximately 10% of the population (Torgersen, 2005). Since everyone has a personality, but not everyone has a personality disorder, these disorders are considered a variant form of a normal, healthy personality. This group of disorders is characterized by problematic thinking patterns, problems with emotional regulation, and difficulty achieving a balance between spontaneity and impulse control. However, the most significant and defining feature of personality disorders is the negative effect these disorders have on interpersonal relationships. In conclusion, recent technological advancements and improvements to diagnostic methodologies have enabled researchers to study personality and personality disorders as never before. As a result, we now have a much greater understanding of these disorders. Furthermore, this research has facilitated the development of several highly effective treatments for personality disorders that are evidenced-based. As research continues, these treatment approaches will be further refined. Therefore, we can state with confidence there is hope and relief for people affected by these disorders, including their family members and loved ones.
Reference:
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5). American Psychiatric Association. (2013).
- Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. 2007. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553-564.
- http://www.nmha.org/go/information/get-info/personality-disorders
