INTRODUCTION

Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individuals personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A persons 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.

A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school.

In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face. Personality disorders usually begin in the teenage years or early adulthood. There are many types of personality disorders. Some types may become less obvious throughout middle age.

TYPES AND SYMPTOMS OF PERSONALITY DISORDERS

Cluster A personality disorders

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

  Pervasive distrust and suspicion of others and their motives

  Unjustified belief that others are trying to harm or deceive you

  Unjustified suspicion of the loyalty or trustworthiness of others

  Hesitancy to confide in others due to unreasonable fear that others will use the information against you

  Perception of innocent remarks or nonthreatening situations as personal insults or attacks

  Angry or hostile reaction to perceived slights or insults

  Tendency to hold grudges

  Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

  Lack of interest in social or personal relationships, preferring to be alone

  Limited range of emotional expression

  Inability to take pleasure in most activities

  Inability to pick up normal social cues

  Appearance of being cold or indifferent to others

  Little or no interest in having sex with another person

  Peculiar dress, thinking, beliefs, speech or behavior

  Odd perceptual experiences, such as hearing a voice whisper your name

  Flat emotions or inappropriate emotional responses

  Social anxiety and a lack of or discomfort with close relationships

  Indifferent, inappropriate or suspicious response to others

  "Magical thinking" believing you can influence people and events with your thoughts

  Belief that certain casual incidents or events have hidden messages meant only for you

Cluster B personality disorders

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

  Disregard for others' needs or feelings

  Persistent lying, stealing, using aliases, conning others

  Recurring problems with the law

  Repeated violation of the rights of others

  Aggressive, often violent behavior

  Disregard for the safety of self or others

  Impulsive behavior

  Consistently irresponsible

  Lack of remorse for behavior

  Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating

  Unstable or fragile self-image

  Unstable and intense relationships

  Up and down moods, often as a reaction to interpersonal stress

  Suicidal behavior or threats of self-injury

  Intense fear of being alone or abandoned

  Ongoing feelings of emptiness

  Frequent, intense displays of anger

  Stress-related paranoia that comes and goes

  Constantly seeking attention

  Excessively emotional, dramatic or sexually provocative to gain attention

  Speaks dramatically with strong opinions, but few facts or details to back them up

  Easily influenced by others

  Shallow, rapidly changing emotions

  Excessive concern with physical appearance

  Thinks relationships with others are closer than they really are

  Belief that you're special and more important than others

  Fantasies about power, success and attractiveness

  Failure to recognize others' needs and feelings

  Exaggeration of achievements or talents

  Expectation of constant praise and admiration

  Arrogance

  Unreasonable expectations of favors and advantages, often taking advantage of others

  Envy of others or belief that others envy you

Cluster C personality disorders

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

  Too sensitive to criticism or rejection

  Feeling inadequate, inferior or unattractive

  Avoidance of work activities that require interpersonal contact

  Socially inhibited, timid and isolated, avoiding new activities or meeting strangers

  Extreme shyness in social situations and personal relationships

  Fear of disapproval, embarrassment or ridicule

  Excessive dependence on others and feeling the need to be taken care of

  Submissive or clingy behavior toward others

  Fear of having to provide self-care or fend for yourself if left alone

  Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions

  Difficulty starting or doing projects on your own due to lack of self-confidence

  Difficulty disagreeing with others, fearing disapproval

  Tolerance of poor or abusive treatment, even when other options are available

  Urgent need to start a new relationship when a close one has ended

  Preoccupation with details, orderliness and rules

  Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don't meet your own strict standards

  Desire to be in control of people, tasks and situations, and inability to delegate tasks

  Neglect of friends and enjoyable activities because of excessive commitment to work or a project

  Inability to discard broken or worthless objects

  Rigid and stubborn

  Inflexible about morality, ethics or values

  Tight, miserly control over budgeting and spending money

CAUSES

Environment and social circumstances

The environment and social circumstances we grow up in and the quality of care we receive can affect the way our personality develops. You may experience difficulties associated with personality disorders if you've experienced:

         an unstable or chaotic family life, such as living with a parent who is an alcoholic or who struggles to manage a mental health problem

         little or no support from your caregiver this may be especially hard if you've experienced a traumatic event or situation

         a lack of support or bad experiences during your school life, peer group or wider community, such as bullying or exclusion

         poverty or discrimination

         some form of dislocation, such as migration from abroad.

 

Genetic factors

Personality is very complex and researchers currently don't know much about what makes up our personalities and to what extent genes play a part in this.

Some elements of our personality are likely to be genetic. We are born with different temperaments for example, babies vary in how active they are, their attention span and how they adapt to change.

While some experts believe genetic inheritance may play a part in the development of personality disorder, others point out that it is difficult to know whether similarities in temperament and behaviour have been handed down the generations genetically or through the behaviour children were modelled as they grew up. More research needs to be done in this area.

Early life experiences

Our experiences growing up can affect our personality in later life. If you had a difficult childhood, you might have developed certain beliefs about the way people think or act and how relationships work. This can lead to developing certain strategies for coping which may have been necessary when you were a child, but which aren't always helpful in your adult life.

If you have been given a personality disorder diagnosis you are more likely than most people to have experienced difficult or traumatic experiences growing up, such as:

         neglect

         losing a parent or experiencing a sudden bereavement

         emotional, physical or sexual abuse

         being involved in major incidents or accidents

         often feeling afraid, upset, unsupported or invalidated.

Not everyone who experiences a traumatic situation will develop these problems however. Your unique reactions, as well as the consistency and quality of support and care you received, will make a difference.

Similarly, not everyone who develops a personality disorder will have had a traumatic experience.

DIAGNOSIS

If your doctor suspects you have a personality disorder, a diagnosis may be determined by:

         Physical exam. The doctor may do a physical exam and ask in-depth questions about your health. In some cases, your symptoms may be linked to an underlying physical health problem. Your evaluation may include lab tests and a screening test for alcohol and drugs.

         Psychiatric evaluation. This includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may be helpful.

         Diagnostic criteria in the DSM-5. Your doctor may compare your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

TREATMENT

The treatment that's best for you depends on your particular personality disorder, its severity and your life situation. Often, a team approach is needed to make sure all of your psychiatric, medical and social needs are met. Because personality disorders are long-standing, treatment may require months or years.

Psychotherapy

Psychotherapy, also called talk therapy, is the main way to treat personality disorders. During psychotherapy with a mental health professional, you can learn about your condition and talk about your moods, feelings, thoughts and behaviors. You can learn to cope with stress and manage your disorder.

Psychotherapy may be provided in individual sessions, group therapy, or sessions that include family or even friends. There are several types of psychotherapy your mental health professional can determine which one is best for you. You may also receive social skills training. During this training you can use the insight and knowledge you gain to learn healthy ways to manage your symptoms and reduce behaviors that interfere with your functioning and relationships.

Family therapy provides support and education to families dealing with a family member who has a personality disorder.

Medications

There are no medications specifically approved by the Food and Drug Administration (FDA) to treat personality disorders. However, several types of psychiatric medications may help with various personality disorder symptoms.

         Antidepressants. Antidepressants may be useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness, which may be associated with personality disorders.

         Mood stabilizers. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.

         Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms include losing touch with reality (psychosis) or in some cases if you have anxiety or anger problems.

         Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior, so they're avoided in certain types of personality disorders.

Hospital and residential treatment programs

In some cases, a personality disorder may be so severe that you need to be admitted to a hospital for psychiatric care. This is generally recommended only when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else.

After you become stable in the hospital, your doctor may recommend a day hospital program, residential program or outpatient treatment.