INTRODUCTION

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.

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.

• Paranoid personality disorder: 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.

ü Pervasive distrust and suspicion of others and their motives

ü Unjustified belief that others are trying to harm or deceive you

ü Unjustified suspicion of the loyalty or trustworthiness of others

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

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

ü Angry or hostile reaction to perceived slights or insults

ü Tendency to hold grudges

ü Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

• Schizoid personality disorder: 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.

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

ü Limited range of emotional expression

ü Inability to take pleasure in most activities

ü Inability to pick up normal social cues

ü Appearance of being cold or indifferent to others

ü Little or no interest in having sex with another person

• Schizotypal personality disorder: 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.

ü Peculiar dress, thinking, beliefs, speech or behavior

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

ü Flat emotions or inappropriate emotional responses

ü Social anxiety and a lack of or discomfort with close relationships

ü Indifferent, inappropriate or suspicious response to others

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

ü 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.

• Antisocial personality disorder: 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.

ü Disregard for others' needs or feelings

ü Persistent lying, stealing, using aliases, conning others

ü Recurring problems with the law

ü Repeated violation of the rights of others

ü Aggressive, often violent behavior

ü Disregard for the safety of self or others

ü Impulsive behavior

ü Consistently irresponsible

ü Lack of remorse for behavior

• Borderline personality disorder: 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.

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

ü Unstable or fragile self-image

ü Unstable and intense relationships

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

ü Suicidal behavior or threats of self-injury

ü Intense fear of being alone or abandoned

ü Ongoing feelings of emptiness

ü Frequent, intense displays of anger

ü Stress-related paranoia that comes and goes

• Histrionic personality disorder: 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.

ü Constantly seeking attention

ü Excessively emotional, dramatic or sexually provocative to gain attention

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

ü Easily influenced by others

ü Shallow, rapidly changing emotions

ü Excessive concern with physical appearance

ü Thinks relationships with others are closer than they really are

• Narcissistic personality disorder: 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.

ü Belief that you're special and more important than others

ü Fantasies about power, success and attractiveness

ü Failure to recognize others' needs and feelings

ü Exaggeration of achievements or talents

ü Expectation of constant praise and admiration

ü Arrogance

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

ü 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.

• Avoidant personality 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.

ü Too sensitive to criticism or rejection

ü Feeling inadequate, inferior or unattractive

ü Avoidance of work activities that require interpersonal contact

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

ü Extreme shyness in social situations and personal relationships

ü Fear of disapproval, embarrassment or ridicule

• Dependent personality disorder: 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.

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

ü Submissive or clingy behavior toward others

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

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

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

ü Difficulty disagreeing with others, fearing disapproval

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

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

• Obsessive-compulsive personality disorder: 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.)

ü Preoccupation with details, orderliness and rules

ü 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

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

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

ü Inability to discard broken or worthless objects

ü Rigid and stubborn

ü Inflexible about morality, ethics or values

ü 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.