 Your personality is the distinctive set of traits,
behaviour styles and patterns that make up your character and individuality.
How you perceive the world, your attitudes and thoughts and feelings are all
part of your personality.
A healthy personality is flexible enough to adapt to
change and to behave differently between different situations – for example,
between talking to your friends and talking to someone you are trying to invite
on a date.
Personality disorders are a group of mental
disturbances defined by the text revision to the fourth edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) as "enduring pattern[s] of
inner experience and behavior" that are sufficiently rigid and deep-seated
to bring a person into repeated conflicts with his or her social and
occupational  Environment. DSM-IV-TR specifies that these dysfunctional
patterns must be regarded as non-conforming or deviant by the person's culture,
and cause significant emotional pain and/or difficulties in relationships and
occupational performance. In addition, the patient usually sees the disorder as
being consistent with his or her self image (ego-syntonic) and may blame
others.
Description
To meet the diagnosis of personality
disorder, which is sometimes called character disorder, problematic behaviours
must appear in two or more of the following areas:
- Perception and interpretation
of the self and other people
- Intensity and duration of
feelings and their appropriateness to situations
- Relationships with others
- Ability to control impulses
Personality disorders have their onset in
late adolescence or early adulthood.
General diagnostic criteria
Diagnosis of a personality disorder must
satisfy these following general criteria, in addition to the specific criteria for
each individual personality disorder:
- Experience and behaviour that deviates markedly from the
expectations of the individual's culture. This pattern is manifested in two (or
more) of the following areas:
- Cognition (perception and
interpretation of self, others and events)
- Affect (the range, intensity,
lability, and appropriateness of emotional response)
- Interpersonal functioning
- Impulse control
- The enduring pattern is inflexible and pervasive across a broad
range of personal and social situations.
- The enduring pattern leads to clinically significant distress or
Impairment in social, occupational, or other important areas of functioning.
- The pattern is stable and of long duration and its onset can be
traced back at least to adolescence or early adulthood.
- The enduring pattern is not better accounted for as a manifestation
or consequence of another mental disorder.
- The enduring pattern is not due to the direct physiological effects
of a substance or a general medical condition such as head injury.
People under 18 years old who fit the
criteria of a personality disorder are usually not diagnosed with such a
disorder, although they may be diagnosed with a related disorder. In order to
diagnose an individual under the age of 18 with a personality disorder,
symptoms must be present for at least one year. Antisocial Personality Disorder,
by definition, cannot be diagnosed at all in persons under 18. Under that age,
they are often diagnosed with a Conduct Disorder and in order to be diagnosed
with Antisocial Personality Disorder they must have displayed evidence of a
Conduct Disorder before the age of 15.
List of personality disorders defined in the DSM
The DSM-IV-TR lists ten personality
disorders, grouped into three clusters. The DSM also contains a category for behavioural
patterns that do not match these ten disorders, but nevertheless exhibit
characteristics of a personality disorder. This category is labelled
Personality Disorder NOS (Not Otherwise Specified).
Cluster
A (odd or eccentric disorders)
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality
disorder
Cluster B
(dramatic, emotional, or erratic disorders)
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality
disorder
Cluster C
(anxious or fearful disorders)
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive
personality disorder (not the same as Obsessive-compulsive disorder)
The prognosis of personality disorders is difficult
to assess. While these disorders are chronic in nature, gradual improvements
with work are definitely seen. While it is difficult for anyone to change major
aspects of their personality, the symptoms of these disorders can be reduced in
both number and intensity. Long term treatment is almost always required
as is a very strong commitment to change.
Causes of personality disorders
Like most mental illnesses, we do not know
what causes personality disorders. Some experts argue that the patterns of
behaviour and inflexibility that characterise a personality disorder are a
post-traumatic response to early childhood events, such as abuse. Others argue
that there are genetic predispositions and that a personality disorder can be
inherited. We also know that some personality disorders (such as antisocial
personality disorder) are common in men, while others (such as borderline
personality disorder) are more common in women, and it seems clear that
different disorders have different contributing factors.
It is likely that any individual
personality disorder arose out of life events acting upon predispositions,
however we still do not know all the details and it is unwise to make any
assumptions.
Treatments for personality disorders
The range of possible treatments for
personality disorders is wide and growing, and the specific treatment which may
be useful depends upon the specific disorder.
Cognitive (‘talk’) therapies are used to
assist the individual with a personality disorder to change the patterns of
behaviour and cognition that are causing distress or impairment in any aspect
of their life. Common treatments include cognitive behaviour therapy (CBT),
psychodynamic psychotherapy and dialectical behaviour therapy (DBT). DBT was
specifically designed for adults with a diagnosis of Borderline Personality
Disorder, however is now the recognised best practice treatment for the whole range
of personality disorders.
Medications may be used to alleviate
symptoms of the disorder, or conditions such as Anxiety, impulsive behaviour or
distorted thinking that may be associated with particular disorders or that may
have arisen during the individual’s life and be interfering with treatment of
the disorder, but medications cannot ‘cure’ a personality disorder and therapy
must be the cornerstone of treatment.
Further Information
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Personality Disorders