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Personality Disorders


Personality refers to a distinctive set of behavior style, patterns, and traits that make up our character or individuality. Our perception of the world along with our attitudes, thoughts, and feelings are all part of our personality. People with healthy personalities are able to cope with normal stresses and do not have difficulty forming relationships with family, friends, and co-workers.

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 and shaped through an interaction of your genetic makeup and the environment you grew up in.  The aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook (temperament) is your genetic makeup.  The surroundings you grew up in, events that occurred, and relationships with family members and others would be your environment.  It includes such things as the type of parenting you had (whether loving or abusive).


Personality disorders are thought to be caused by a combination of these genetic and environmental influences. You may have a genetic vulnerability to developing a personality disorder and your life situation may trigger the actual development of a personality disorder. Personality disorders often begin in childhood and last through adulthood. There’s 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.


A personality disorder is a type of mental illness in which an individual has trouble perceiving and relating to situations and to people, including themselves. There are many specific types of personality disorders. In general, having a personality disorder means an individual has a rigid, inflexible, and unhealthy pattern of thinking and behaving no matter what the situation. This leads to significant problems and limitations in relationships, social encounters, work, and school. In some cases, the individual may not realize that they have a personality disorder because their way of thinking and behaving seems natural to them, and they may blame others for the challenges they face. Although they feel that their behavior patterns are “normal” or “right,” people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.


Personality Disorder symptoms 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. Many people with one diagnosed personality disorder also have signs and symptoms of at least one additional personality disorder.


Cluster A Personality Disorders

These personality disorders characterized by odd, eccentric thinking or behavior include:


Paranoid Personality Disorder


The essential feature for this type of personality disorder is interpreting the actions of others as deliberately threatening or demeaning. People with paranoid personality disorder are untrusting, unforgiving, and prone to angry or aggressive outbursts without justification because they perceive others as unfaithful, disloyal, condescending or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious.


•    Distrust and suspicion of others
•    Believing that others are trying to harm you
•    Emotional detachment
•    Hostility


Schizoid Personality Disorder


Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker.


•    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


A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of “magical thinking” by saying they can see into the future or read other people’s minds.


•    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 Personality Disorders

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


Antisocial (formerly called Sociopathic) Personality Disorder: People with antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behavior, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behavior on others. These people  are at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom.


•    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: People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behavior, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterize the person with borderline personality disorder. These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes, viewing others as either “all good” or “all bad.” A person with borderline personality may form an intense personal attachment with someone only to quickly dissolve it over a perceived slight. Fears of abandonment may lead to an excessive dependency on others. Self-mutilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of boredom or emptiness, and bouts of intense inappropriate anger are other traits of this disorder, which is more common among females.


•    Impulsive and risky behavior
•    Volatile relationships
•    Unstable mood
•    Suicidal behavior
•    Fear of being alone


Histrionic Personality Disorder: Histrionic personality disorder is characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive behavior, usually beginning in early adulthood. These individuals are lively, dramatic, vivacious, enthusiastic, and flirtatious.


•    Constantly seeking attention
•    Excessively emotional
•    Extreme sensitivity to others’ approval
•    Unstable mood
•    Excessive concern with physical appearance


Narcissistic Personality Disorder:  People with narcissistic personality have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.


•    Believing they are better than others
•    Fantasizing about power, success and attractiveness
•    Exaggerating achievements or talents
•    Expecting constant praise and admiration
•    Failing to recognize other people’s emotions and feelings


Cluster C Personality Disorders

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


Avoidant Personality Disorder: Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are fearful of saying something considered foolish by others; worry they will blush or cry in front of others; and are very hurt by any disapproval by others. People with avoidant personality disorder may have no close relationships outside of their family circle, although they would like to, and are upset at their inability to relate well to others.


•    Hypersensitivity to criticism or rejection
•    Feeling inadequate
•    Social isolation
•    Extreme shyness in social situations
•    Timidity


Dependent Personality Disorder: People with dependent personality disorder may exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They require excessive reassurance and advice, and are easily hurt by criticism or disapproval. They feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends. They have a strong fear of rejection. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males.


•    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: Compulsive personalities are conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances. People with compulsive personality are highly cautious, weigh all aspects of a problem, and pay attention to every detail, making it difficult for them to make decisions and complete tasks. When their feelings are not under strict control, events are unpredictable, or they must rely on others, compulsive personalities often feel a sense of isolation and helplessness.


•    Preoccupation with orderliness and rules
•    Extreme perfectionism
•    Desire to be in control of situations
•    Inability to discard broken or worthless objects
•    Inflexibility


*Note: Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, a type of anxiety disorder.


When these characteristics are carried to an extreme, when they endure over time and when they interfere with healthy functioning, a diagnostic evaluation with a licensed physician or mental health professional is recommended.


Risk Factors

Although the precise cause of personality disorders isn’t known, certain factors seem to increase the risk of developing or triggering personality disorders, including:


•    A family history of personality disorders or other mental illness
•    Low socioeconomic status
•    Verbal, physical or sexual abuse during childhood
•    Neglect during childhood
•    An unstable or chaotic family life during childhood
•    Being diagnosed with childhood conduct disorder
•    Loss of parents through death or traumatic divorce during childhood


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


Treatment of the Personality Disorder
There are many types of help available for the different personality disorders. Treatment may include individual, group, or family psychotherapy. Medications, prescribed by a patient’s physician, may also be helpful in relieving some of the symptoms of personality disorders, including problems with anxiety and perceptions.
Psychotherapy for patients with personality disorders focuses on helping them see the unconscious conflicts that are contributing to or causing their symptoms. It also helps people become more flexible and is aimed at reducing the behavior patterns that interfere with everyday living.


In psychotherapy, people with personality disorders can better recognize the effects of their behavior on others. Behavior and cognitive therapies focus on resolving symptoms or traits that are characteristic of the disorder, such as the inability to make important life decisions or the inability to initiate relationships.


There is Hope

The more you learn about personality disorders the more you will understand that they are illnesses, with causes and treatments. People can improve with proper care. By seeking out information you can recognize the signs and symptoms of a personality disorder and help yourself or someone you know live a healthier more fulfilling life.
Untreated, personality disorders can cause significant problems in your life, and they may get worse without treatment.  Please contact your local mental health professional for more information about treatment options.


Other Resources
National Mental Health Consumer Self-Help Clearinghouse

National Mental Health Information Center

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