What is personality disorder?
Someone may be described as having a 'personality disorder' if their personal characteristics cause regular and long term problems in the way they cope with life, interact with other people and in the way in which they can respond emotionally.
Each of us has characteristics which influence the way we think, feel and behave and makes us a unique individual.
It's possible that some people with these disorders never come into contact with the psychiatrist. Those who are given a diagnosis of personality disorder may feel, perhaps understandably, that they are being blamed or criticised or that they are somehow responsible for their problems.
What are the types of personality disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a guide to diagnosis, divides personality disorders into three clusters:
Cluster A - Odd/eccentric paranoid: schizoid, schizotypal
Cluster B - Dramatic/erratic antisocial: borderline, histrionic, and narcissistic
Cluster C - Anxious/inhibited dependent: avoidant, obsessive-compulsive.
As well as these there is the controversial label of dangerous severe personality disorder (DSPD) but this is not recognised in clinical terms.
What causes personality disorders?
Like other psychiatric illnesses, it is thought that personality disorders are caused by a number of factors. These include parental upbringing in childhood, personality, social development as well as genetic and biological factors.
There is a
body of research which shows that the vast majority of patients with
personality disorders were abused as children. 75% of people diagnosed with
borderline personality disorder have experienced physical or sexual abuse.
Abuse can come in the form of physical, sexual or just not being parented
properly. These findings are predominantly from western countries.
There is a
growing amount of research that indicates that personality disorders can be
What are common manifestations of personality disorders?
One needs to understand that personality disorder is a chronic maladaptive style of dealing with stressful situation. So, it is unlikely to be acute in nature. However, due to difficult or different style of relating with others, these people are more likely to become depressed or anxious while dealing with stressful situation.
Given that every individual is unique, more than often, features of 2 or more personality disorder occur together in an individual.
Some of the commonly observed manifestations are-
- Oversuspicious, reading too much into a situation and becoming paranoid
- Emotionally cold, indifferent to social interaction, chronic aloofness
- Odd or eccentric style of thinking, dressing. Superstitious, undue belief into witchcrafts, pseudo philosophical
- Chronically depressed, over possessive, feeling suicidal when facing difficult situation,
- Frequent anger outburst
- Difficulty controlling emotions
- Not having due regard for others, frequent lying, manipulating others
- Relating oneself with great people and not doing anything
- Socially anxious
- Not able to take decisions
These people are usually labelled as ‘odd person/social misfit’, or ‘angry/manipulative/self-boasting/emotionally blackmailing’ or ‘shy/anxious/dependent’.
Because the personality keeps on developing since childhood, it is not advisable to label the person as ‘personality disorder’ till age 18.
It is a very stigmatising diagnosis to be given. So the doctor should be overcautious in giving the diagnosis.
How people with personality disorder are assessed?
It is said that one becomes what he/she experiences in their life. So the personality attributes are to some extent gets consolidated with varied life experience. As the individual grows up, he tries to confirm his belief system so that there is no major conflict in his thinking pattern and way of relating to others. For example, a child who has been frequently criticized by his father/mother may start believing that he is worthless and not to be loved or cared. This might make him withdraw from playing or mixing with others. As a result, he may not learn how to socialize with others. When attending a school, that boy is more than likely to be criticized by his classmates/peers which may further confirm his belief system. It is possible that as an adult he may be socially avoidant, shy, timid, lacking in self-confidence. In order to confirm his belief this man might prefer not to dress well or do a ‘blue collar job’ despite having good academic performance. This will serve the purpose of avoiding people who he might believe will criticise him.
Thus the assessment for personality disorders is time consuming. It not only requires diagnosis but a sound formulation(why this person has become like this). For this to occur, information from various sources is needed. Once the case is understood, attempts should be made to identify the key problematic area rather than changing the personality itselfi.e the goal of the treatment should be to make the person more adaptable to his situation. For example, a shy person might have problem asserting others or a dependent person may struggle to make decision himself/herself.
The role of psychiatrist is extremely important in assessment and management.
The treatment requires plenty of time and effort from patient and family members.
What kinds of problems occur because of personality problems?
One need to understand that personality plays a major role in individual’s success. For example, even if one is academically bright but very shy, he may not be well accepted by friends or peers. His relationship with wife and children may suffer.
Common problems noted are difficulty with relationships, not able to achieve as per the talent, use of alcohol and tobacco to cope with interpersonal problems, chronic anger to avoid getting confronted to their weaknesses.
These people are more prone to develop psychological/psychiatric disorders.
What are the treatments available?
These are primarily psychological treatment. However, medication is also helpful to some extent.
Psychological treatment is guided by individual case formulation. Some of the techniques employed are anger management, role playing, empathy training, limit setting, problem solving, assertiveness training, mindfulness based techniques and cognitive analytic methods.