Personality Disorders
Overview
Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A person’s personality typically stays the same over time. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.
Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning. Without treatment, personality disorders can be long-lasting. Personality disorders affect at least two of these areas:
- Way of thinking about oneself and others
- Way of responding emotionally
- Way of relating to other people
- Way of controlling one’s behavior
Types of Personality Disorders
There are 10 specific types of personality disorders:
A pattern of preoccupation with orderliness, perfection and control. A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values. (This is NOT the same as Obsessive Compulsive Disorder.)
A pattern of extreme shyness, feelings of inadequacy and extreme sensitivity to criticism. People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.
A pattern of needing to be taken care of and submissive and clingy behavior. People with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.
A pattern of being suspicious of others and seeing them as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them.
A pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety.
A pattern of excessive emotion and attention seeking. People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions.
A pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness.
A pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.
A pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively.
Being detached from social relationships and expressing little emotion. A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others.
Diagnosis
Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. Diagnosis is typically made in individuals 18 or older. People under 18 years old are typically not diagnosed with personality disorders because their personalities are still developing. Some people with personality disorders may not recognize a problem. Also, people may have more than one personality disorder.
Treatment
Determination of the best treatment to someone depends on the type of the personality disorder and its severity. Since personality disorders usually last for a long time, the treatment process could also take months or years. Psychotherapy is the main form of treatment for personality disorders.
Psychotherapy
Certain types of psychotherapy are effective for treating personality disorders. During psychotherapy, an individual can gain insight and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings and behaviors. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances.
Commonly used types of psychotherapy include:
- Dialectical behavior therapy
- Cognitive behavioral therapy
- Psychodynamic therapy
- Group therapy
- Psychoeducation (teaching the individual and family members about the illness, treatment and ways of coping)
Medications
There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be helpful in treating some symptoms.
People with personality disorders often have a hard time taking responsibility for their feelings and behaviors. They sometimes even blame others for their problems. However, each of them is suffering and is aware that their life is not going well. Approaching a friend about her painful feelings or the frustrations and disappointments in her life, and offering to listen, might be a way to help her consider treatment. If you have had a successful experience in therapy, share that with your friend, even if it wasn’t necessarily for “personality problems” (an off-putting term for many people). Most people with personality disorders enter treatment with another problem, such as depression, anxiety, substance abuse, a job loss, a romantic break-up, etc. The challenge is to get your friend “in the door,” so to speak, not to commit to long-term treatment at the beginning.
Some theories of personality disorder view it as developmental delay, which a person may be able to grow out of. Studies show that a fair number of children and early adolescents report signs and symptoms consistent with a personality disorder. For many, these symptoms decrease over time. Children with more symptoms are at greater risk for being diagnosed with a personality disorder in early adulthood. So, on the one hand, it could be argued that time will address many personality problems. On the other hand, if a young person is at risk for a serious mental disorder that may have devastating effects, then early intervention and prevention should be recommended. Currently, this approach appears to be gaining steam. Clinics and therapists are increasingly recognizing and developing treatment interventions for personality disorder symptoms in children and adolescents.
A person can receive more than one personality disorder diagnosis. People who are diagnosed with a personality disorder most often qualify for more than one diagnosis. A person with a severe personality disorder might meet the criteria for four, five or even more disorders! In practice, clinicians usually recognize that meeting more criteria for personality disorders means more severe disorder.