Personality disorders are described as patterns of thinking, perceiving, reacting and relating that cause significant distress or functional impairment by the DSM V. There are many varieties of personality disorders that can show different symptoms, they are all caused by a combination of environmental and genetic factors. While there are possibilities that gradually it can decrease with age there are some traits that remain persistent.
These disorders exist when the traits start with daily functioning such as work and interpersonal relationships. Usually, they seek treatment to help with their traits rather than their own feelings. The symptoms become pronounced during late adolescence or early adulthood. Traits and symptoms may resolve with time, but the symptoms vary. There are 10 types of personality disorders that can be organized into 3 clusters, most patients meet the criteria for more than one.
While there is no distinction in terms of socioeconomic class, race or sex about 10% of the general population have some kind of personality disorder.
Odd or eccentric disorders (Cluster A):
Paranoid: mistrust and suspicion
Schizoid: Disinterest in others
Schizotypal: Eccentric ideas and behavior
Dramatic, emotional or erratic disorders (Cluster B)
Antisocial: Social irresponsibility, disregard for others, deceitfulness and manipulation of others for personal gain
Borderline: Inner emptiness, unstable relationships and emotional dysregulation
Histrionic: Attention seeking and excessive emotionality
Narcissistic: Self-grandiosity, need for admiration and lack of empathy
Anxious or fearful disorders (Cluster C)
Avoidant: Avoidance of interpersonal contact due to rejection sensitivity
Dependent: Submissiveness and a need to be taken care of
Obsessive-compulsive: Perfectionism, rigidity, and stubbornness
While the full causes of personality disorders are not fully understood, it is well known that both genetic and environmental factors play a part. The levels heritability is about 50% which is similar or higher than most psychiatric disorders. While these genetic markers make people more vulnerable to these conditions, environmental factors and experiences may trigger the development of a personality disorder.
There have been studies to show the association between childhood trauma such as verbal abuse causes up to 3 times more likely to have a personality disorder. In some cases, early problems such as violence in the family, disobedience and temper tantrums can be an indicator. While there is no brain scan or blood test that can diagnose a personality disorder, there might be slight differences in the structure and how some chemicals work in the brain.
While all these factors are underlying there can be a few things to actually trigger the disorder, these might be:
Anxiety or depression
Using a lot of drugs or alcohol
Loss of a loved one
Personality disorders displays problems with:
Interpersonal functioning problems: unable to maintain or develop close relationships and/or being insensitive to others. There might be a problem with setting the boundary between themselves and others, while their self-esteem is disproportionally high or low.
Self-Identity problems: while there could be problems with their self-image and inconsistent in appearance, values and goals.
Impluse and risky behaviour: this could be things such as gambling, unsafe sex
Unstable and intense relationships
Suicidal behaviour or threats of self-injury
Connecting with other people including friends and colleagues
These symptoms often are exacerbated by stress.
Personality disorders exist when traits begin to interfere with certain areas, and these are accessed to determine if they have a disorder. These areas of function include work, feelings/emotions, self-identity, relationships, behaviour/ impulse control and awareness of reality. If there is interference in any of these areas then a licenced medical professional will do a variety of tests to rule out any physical symptoms.
This medical professional will then in turn refer you to a mental health specialist such as a psychiatrist of psychologist, who will use interview and assessment tools to evaluate for a personality disorder.
According to the DSM-5, generally the diagnosis of a personality disorder includes long-term marked deviation from cultural expectations that leads to significant distress or impairment in at least two of these areas:
The way you perceive and interpret yourself, other people and events
The appropriateness of your emotional responses
How well you function when dealing with other people and in relationships
Whether you can control your impulses
Many personality disorders share similar symptoms, and more than one type might be present. Depression, anxiety or substance abuse might impair the diagnosis as well. It is important to determine the diagnosis in order to get the best course of treatment.
While there is no set treatment, symptoms are treatable, and psychotherapy is the main form. Psychotherapy focuses on changing patterns of thinking and teaching new behaviour patterns, as well as learning coping skills. Different kinds of therapy include:
CBT (cognitive behavioural therapy): helps understand how your thoughts and actions affect how you feel
DBT (dialectical behavioural therapy): individual and group sessions to manage difficult feelings, make positive changes in your life and coping skills.
MBT (mentalisation-based therapy): understand and reflect on your thoughts and feeling and those of other people. This helps with relationships and controlling impulses.
CAT (cognitive affective therapy): building a trusting relationship with your
While medication is not used to specifically to treat personality disorders, they can help the comorbid disorders. Certain medications can help alleviate symptoms, such as:
Antidepressants: helps with associated symptoms of personality disorders like depressed mood, impulsivity and hopelessness
Mood stabilizers: can help even out mood swings, reduce aggression and irritability
Antipsychotics: helpful with symptoms that make you lose touch with reality
Anti-anxiety: can help reduce anxiety or insomnia but can also have the side effect of increasing impulsivity so avoided for certain disorders.
The main aim for treatment of personality disorders:
Modify problematic personality traits
Decrease maladaptive and socially undesirable behaviours
Enable patients to understand that their problems are theirs
While having a treatment plan is extremely important, there are other coping strategies that are helpful to people with personality disorders, such as:
Avoid drugs and alcohol specifically when on medication already
Join a support group of others with personality disorders
Relaxation and stress management techniques such as meditation
Avoid isolation and stay connected with friends and family
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association, 2013.