Personality disorders

Definition

Personality disorder is a general term for a type of mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. There are many specific types of personality disorders.

In general, having a personality disorder means you have a rigid and potentially self-destructive or self-denigrating pattern of thinking and behaving no matter what the situation. This leads to distress in your life or impairment of your ability to go about routine functions at work, school or social situations. 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 your circumstances.

Symptoms

General symptoms of a personality disorder
General signs and symptoms that may indicate a personality disorder include:

·         Frequent mood swings

·         Stormy relationships

·         Social isolation

·         Angry outbursts

·         Suspicion and mistrust of others

·         Difficulty making friends

·         A need for instant gratification

·         Poor impulse control

·         Alcohol or substance abuse

Specific types of personality disorders
The specific types of personality disorders are grouped into three clusters based on similar characteristics and symptoms.

Cluster A. These are personality disorders characterized by odd, eccentric thinking or behavior and include:

Paranoid personality disorder

·         Distrust and suspicion of others

·         Believing that others are trying to harm you

·         Emotional detachment

·         Hostility

Schizoid personality disorder

·         Lack of interest in social relationships

·         Limited range of emotional expression

·         Inability to pick up normal social cues

·         Appearing dull or indifferent to others

Schizotypal personality disorder

·         Peculiar dress, thinking, beliefs or behavior

·         Perceptual alterations, such as those affecting touch

·         Discomfort in close relationships

·         Flat emotions or inappropriate emotional responses

·         Indifference to others

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

·         Believing that messages are hidden for you in public speeches or displays

Cluster B. These are personality disorders characterized by dramatic, overly emotional thinking or behavior and include:

Antisocial (formerly, sociopathic) personality disorder

·         Disregard for others

·         Persistent lying or stealing

·         Recurring difficulties with the law

·         Repeatedly violating the rights of others

·         Aggressive, often violent behavior

·         Disregard for the safety of self or others

Borderline personality disorder

·         Impulsive and risky behavior

·         Volatile relationships

·         Unstable mood

·         Suicidal behavior

·         Fear of being alone

Histrionic personality disorder

·         Constantly seeking attention

·         Excessively emotional

·         Extreme sensitivity to others' approval

·         Unstable mood

·         Excessive concern with physical appearance

Narcissistic personality disorder

·         Believing that you're better than others

·         Fantasizing about power, success and attractiveness

·         Exaggerating your achievements or talents

·         Expecting constant praise and admiration

·         Failing to recognize other people's emotions and feelings

Cluster C. These are personality disorders characterized by anxious, fearful thinking or behavior and include:

Avoidant personality disorder

·         Hypersensitivity to criticism or rejection

·         Feeling inadequate

·         Social isolation

·         Extreme shyness in social situations

·         Timidity

Dependent personality disorder

·         Excessive dependence on others

·         Submissiveness toward others

·         A desire to be taken care of

·         Tolerance of poor or abusive treatment

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

Obsessive-compulsive personality disorder

·         Preoccupation with orderliness and rules

·         Extreme perfectionism

·         Desire to be in control of situations

·         Inability to discard broken or worthless objects

·         Inflexibility

Obsessive-compulsive personality disorder isn't the same as obsessive-compulsive disorder, a type of anxiety disorder.

When to see a doctor
If you have any signs or symptoms of a personality disorder, see your doctor, mental health provider or other health care professional. If untreated, personality disorders can cause significant problems in your life, and they may get worse.

Helping a loved one
If you have a loved one who you think may have symptoms of a personality disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors:

·         Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate.

·         Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some research suggests that you may have a genetic vulnerability to developing a personality disorder and that your life situation may trigger the actual development of a personality disorder.

Risk factors

Although the precise cause of personality disorders isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering personality disorders, including:

·         A family history of personality disorders or other mental illness

·         Verbal, physical or sexual abuse during childhood

·         An unstable or chaotic family life during childhood

·         Being diagnosed with childhood conduct disorder

·         Loss of parents through death or divorce during childhood

Personality disorders are common worldwide, affecting about 10 to 13 percent of people at some point during their life. Personality disorders often begin in childhood and last through adulthood. There's some reluctance to diagnose personality disorders in a child, though, because the patterns of behavior and thinking could simply reflect adolescent experimentation or temporary developmental phases.

Complications

Complications and problems that personality disorders may cause or be associated with include:

·         Depression

·         Anxiety

·         Eating disorders

·         Suicidal behavior

·         Self-injury

·         Reckless behavior

·         Risky sexual behavior

·         Child abuse

·         Alcohol or substance abuse

·         Aggression or violence

·         Incarceration

·         Relationship difficulties

·         Social isolation

·         School and work problems

·         Strained relationships with health care providers

Preparing for your appointment

In some cases, a health care provider or other professional may ask you about your mood, thoughts or behavior. Your doctor may bring it up during a routine medical appointment if you seem to be sad, agitated or angry, for instance. Or you may decide to schedule an appointment with your family doctor or general practitioner to talk about your concerns.

In either case, because personality disorders often require specialized care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment. In other cases, you may seek out a mental health provider on your own first.

What you can do
Being an active participant in your care can help your efforts to manage your personality disorder. One way to do this is by preparing for your appointment. This may be especially important when you have a personality disorder that tends to create antagonistic relationships with medical professionals. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These may include:

·         What type of personality disorder might I have?

·         Why can't I get over a personality disorder on my own?

·         How do you treat my type of personality disorder?

·         Will psychotherapy help?

·         Are there medications that might help?

·         How long will treatment take?

·         What can I do to help myself?

·         Are there any brochures or other printed material that I can take home with me?

·         What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask, don't hesitate to ask questions at any time during your appointment if you don't understand something.

What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts, behavior and urges. You may be asked such questions as:

·         When did you first notice symptoms?

·         How is your daily life affected by your symptoms?

·         What other treatment, if any, have you had?

·         What have you tried on your own to feel better or control your symptoms?

·         What things make you feel worse?

·         Have family or friends commented on your mood or behavior?

·         Have any relatives had a mental illness?

·         What do you hope to gain from treatment?

·         What medications or over-the-counter herbs and supplements do you take?

Tests and diagnosis

When doctors believe someone has a personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

·         Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.

·         Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.

·         Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings, relationships and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-injury or harming others.

Pinpointing which personality disorder you have
It sometimes can be difficult to determine which particular personality disorder or personality disorders you have. For one thing, some personality disorders share similar symptoms. Also, a diagnosis is often based largely on how you describe your symptoms and behavior, along with how your doctor interprets those symptoms and observes you behaving. Because of this, it can take some time and effort to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate treatment designed for your particular illness and situation.

Diagnostic criteria
The symptoms and clinical features for each personality disorder are detailed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

To be diagnosed with a particular personality disorder, you must meet the criteria for that disorder listed in the DSM. Each personality disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular personality disorder. Some people may not meet all of the criteria but may still have a personality disorder and need professional help to overcome or manage it. Also, it's not unusual to have more than one personality disorder at the same time.

Treatments and drugs

The treatment that's best for you depends on your particular personality disorder, its severity and your life situation. Often, a team approach is appropriate to make sure all of your psychiatric, medical and social needs are met. Because personality disorders tend to be chronic and can sometimes last much of your adult life, you may need long-term treatment.

Treatment teams
The team involved in treatment may include your:

·         Family or primary care doctor

·         Psychiatrist

·         Psychotherapist

·         Pharmacist

·         Family members

·         Social workers

If you have mild symptoms that are well controlled, you may need treatment from only your family doctor, a psychiatrist or a therapist. If possible, find medical and mental health providers with experience in treating personality disorders.

Treatment options
Several treatments are available for personality disorders. They include

·         Psychotherapy

·         Medications

·         Hospitalization

Psychotherapy. Psychotherapy is the main way to treat personality disorders. Psychotherapy is a general term for the process of treating personality disorders by talking about your condition and related issues with a mental health provider. During psychotherapy, you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy ways to manage your symptoms.

Types of psychotherapy used to treat personality disorders may include:

·         Cognitive behavioral therapy. This combines features of both cognitive and behavior therapies to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.

·         Dialectical behavior therapy. This is a type of cognitive behavioral therapy whose primary objective is to teach behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others.

·         Psychodynamic psychotherapy. This is based on the theories of psychoanalysis and focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life.

·         Psychoeducation. This teaches you — and sometimes family and friends — about your illness, including treatments, coping strategies and problem-solving skills.

Psychotherapy may be provided in individual sessions, in group therapy or in sessions that include family or even friends. The type of psychotherapy that's right for you depends on your individual situation.

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

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

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

·         Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.

·         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.

Hospitalization and residential treatment programs. In some cases, a personality disorder may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.

Participating in your own care. Try to be an active participant in your treatment. Working together, you and your doctor or therapist can decide which treatment options may be best for your situation, depending on your type of personality disorder, your symptoms and their severity, your personal preferences, insurance coverage, affordability, treatment side effects, and other factors. In some cases, a personality disorder may be so severe that a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making.

Lifestyle and home remedies

You can do some things for yourself that build on your professional treatment plan. Along with professional treatment, consider following these lifestyle and self-care steps for personality disorders:

·         Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going.

·         Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.

·         Learn about your condition. Education about your condition can empower you and motivate you to stick to your treatment plan.

·         Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends in watching for warning signs.

·         Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of physical activity that you enjoy.

·         Avoid drugs and alcohol. Alcohol and illicit drugs can worsen personality disorder symptoms or interact with medications.

·         Get routine medical care. Don't neglect checkups or skip visits to your family doctor, especially if you aren't feeling well. You may have a new health problem that needs to be addressed, or you may be experiencing side effects of medication.

Coping and support

Coping with a personality disorder can be challenging. Having a personality disorder makes it hard to engage in the behavior and activities that may help you feel better. Talk to your doctor or therapist about improving your coping skills, and consider these tips:

·         Simplify your life. Cut back on obligations when possible, and set reasonable schedules for goals.

·         Write in a journal to express pain, anger, fear or other emotions.

·         Read reputable self-help books and consider talking about them to your doctor or therapist.

·         Don't become isolated. Try to participate in normal activities and get together with family or friends regularly.

·         Take care of yourself by eating a healthy diet and getting sufficient sleep.

·         Join a support group for people with your type of personality disorder so that you can connect to others facing similar challenges.

·         Stay focused on your goals. Recovery from a personality disorder is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals.

·         Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.

·         Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.

·         Time your big decisions. Don't make important decisions when you're in the depths of a personality disorder since you may not be thinking clearly.

Prevention

There's no sure way to prevent personality disorders. Trying to identify those most at risk, such as children living with neglect or abuse, and offering early intervention may help. Taking steps to control your stress, increase your resilience and boost low self-esteem also may offer benefits. Getting appropriate treatment early, and sticking with it for the long term, may prevent symptoms from worsening.


By Mayo Clinic Staff
Sept. 11, 2008

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