Personality refers to enduring patterns of thinking and behavior that define the person and distinguish him or her from other people. I like to think of it as what makes you you. The general definition of personality disorder presented in DSM-IV-TR emphasizes the duration of the pattern and the social impairment associated with the traits in question.

My personality is different….is it a disorder? The concept of social dysfunction plays an important role in the definition of personality disorders. Obviously everyone is different. If the personality characteristics identified in DSM-IV-TR criterion sets interfere with the person’s ability to get along with other people and perform social roles, they become more than just a collection of eccentric traits or peculiar habits.

Symptoms:

Social Motivation

Motives (either conscious or unconscious) describe the way that the person would like things to be, and they help to explain why people behave in a particular fashion. I think of motivation as that “thing” inside that makes you tic. Two of the most important motives in understanding human personality are affiliation (the desire for close relationships with other people) and power ( the desire for impact, prestige, or dominance). Many of the symptoms of personality disorders can be described in terms of maladaptive variations concerning affiliation and power.

Cognitive Perspectives Regarding Self and Others

One central issue involves our image of ourselves. Is the self-image stable? Is self-esteem maintained by external (money, fame, approval from others) validation?

Temperament and Personality Traits

Temperament and personality traits describe how they behave. Temperament refers to a person’s most basic, characteristic styles of relating to the world, especially those styles that are evident during the first year of life.
Temperament and personality are measured by activity level and emotional reactivity.

Context and Personality

Differences may not be evident in all situations. Social circumstances frequently determine whether a specific pattern of behavior will be assigned a positive or negative meaning by other people. What seems aggressive in one situation may be a normal response in another.

The Personality Disorder Clusters

Diagnosis Cluster A (odd and eccentric people)

Paranoid Personality Disorder

These individuals have a pervasive tendency to be inappropriately suspicious of others’ motive and behaviors. They have the expectation of being harmed and are completely inflexible in their views and expectations. Imagine trying to live everyday suspecting everyone of harming you.

Schizoid Personality Disorder

Such individuals display pervasive patterns of indifference to other people, coupled with a diminished range of emotional experience and expression.

Schizotypal PD

This diagnosis centers around peculiar behaviors rather than emotional restriction. These individuals have perceptual and cognitive disturbances; however, they are not psychotic or out of touch with reality. People with SPD frequently met the criteria for additional Axis II disorders. There is considerable overlap with Cluster A and avoidant PD and with borderline PD.

Causes

This PD is genetically related to schizophrenia. First degree relatives of schizophrenic patients are considerably more likely than people in the general population to exhibit symptoms of schizotypal PD. The prevalence rates for paranoid and avoidant PD also tend to be higher among relatives of schizophrenic patients.

Treatment

Because of the ego-syntonic nature of personality disorders treating them is difficult. They do not tend to seek treatment and when they do, they usually quit early. Comorbidity complicates treatment even more. Treatment is seldom aimed at problem behaviors that are associated with only one type of PD, therefore efficacy of treatment is difficult to evaluate.

Cluster B (often appear dramatic, emotional, and/or erratic)

Antisocial Personality Disorder

These individuals show a persistent pattern of irresponsible and antisocial behavior that begins during childhood or adolescence. They are impulsive and reckless. They lack conscience or superego. ASP is the most thoroughly studied PD over a longer period of time than any other PD. Psychopathy and ASP are two different attempts to define the same disorder. However, they are different and do not identify the same people. They are no longer used interchangeably. Diagnosis of ASPD requires the presence of conduct disorder prior to the age of 15. At least three out of seven signs of irresponsible and antisocial behavior after the age of 15. Psychopathology Checklist (PCL) developed by Robert Hare is used.

Causes

Adoption studies have showed that the highest rates of antisocial behavior is determined by an interaction between genetic factors and adverse environment. People raised in more difficult adoptive homes were more likely to engage in various types of aggressive and antisocial behaviors as children and as adults.

Psychological Factors
Investigations have attempted to explain several characteristic features of psychopathy—such as lack of anxiety, impulsivity, and failure to learn from experience. There are two primary hypotheses to explain the poor performance of psychopaths on these tasks. Cleckley’s argument: psychopaths are emotionally impoverished. Psychopaths have difficulty shifting or reallocating their attention to consider the possible negative consequences of their behavior. They fail to inhibit inappropriate behavior because they are less able than other people to stop and consider the meaning of important signals that their behavior might lead to punishment.

Treatment
People with ASPD seldom seek professional mental health services unless mandated by the legal system. Even when they do seek treatment, it rarely helps. The high rate of alcoholism and other forms of substance dependence complicates planning and evaluating treatment programs.

Borderline Personality Disorder

These individuals show a pervasive pattern of instability in mood and interpersonal relationships. They find it very difficult to be alone and have rapid mood shifts with anger and mood disturbances. BPD is one of the most disabling, and most frequently treated forms of PD. Otto Kernberg (1967, 1975) suggests that BPD refers to a set of personality features or deficiencies that can be found in individuals with various disorders.

Common features/abnormal behaviors of BPD

Splitting is when an individual sees people as entirely good or entirely bad. They are often paranoid, schizoid, cyclothymic, and have little impulse control.

Treatment

BPD conditions are the most difficult to treat. Between 1/2 to 2/3 of all patients with BPD discontinue treatment prematurely. Marsha Linehan developed Dialectical Behavioral Therapy (DBT). This therapy emphasizes the individual learning to be more comfortable with strong emotions. Another emphasis is that the therapist accept the patient and his or her negative behaviors. Women treated with DBT tend to drop out of treatment at a lower rate, and they tend to experience more improvement than women in control groups. Medication is frequently used along with therapy. Psychiatrists employ the entire spectrum of psychoactive medication with DBT patients, from antipsychotics and antidepressants to lithium and anticonvulsants. They throw mud at a wall and see what sticks.

Histrionic Personality Disorder

They display a pervasive pattern of emotionality and attention-seeking behavior. They seem emotionally shallow and have a tendency of making inappropriate exaggerations. They are also very manipulative.

Narcissistic Personality Disorder

They have a pervasive pattern of grandiosity, need for admiration, and inability to empathize with others. They also have a greatly exaggerated sense of self-importance.

Cluster C (often seem anxious and fearful)

Avoidant Personality Disorder

They have a pervasive pattern of social discomfort, fear of negative evaluation, and timidity. However, they want to be liked, but they are easily hurt by even minimal signs of disapproval.

Dependent Personality Disorder

They show a pervasive pattern of submissive and clinging behaviors and are afraid of separating from other people on whom they are dependent. They assume a submissive role in relationships with other people and require an extraordinary level of reassurance and support. These individuals often cling to others who will take care of them. Those with DPD are at risk for depression. People who are dependent, or sociotropic, may be particularly likely to become depressed if they experience a stressful event that is interpersonal in nature.

Symptoms

Two underlying components: Preference for affiliation & fear of criticism. Both reflect a lack of self-confidence and includes actions aimed at eliciting help from others. DPD overlaps with borderline PD

Causes

Little research on the etiology of DPD. However, overprotective, authoritarian parents are likely to foster development of dependency. Insecurely or anxiously attached children are likely to become dependent.

Treatment

Virtually no literature on the outcome of treatment for DPD. These individuals usually enter therapy for other reasons, such as depression, anxiety or substance use disorder. Cognitive therapy is often the therapy of choice.  Psychopharmacology is typically not used.

Obsessive Compulsive Personality Disorder

They have a pervasive pattern of orderliness, perfectionism, and mental and interpersonal inflexibility, at the expense of flexibility, openness, and efficiency. They are preoccupied with details and rules with a need for control and lack of tolerance for uncertainty.

Frequency

The overall lifetime prevalence for having at least one personality disorder varies between 10% and 14%. Highest prevalence rates are for OCPD, ASP, and Avoidant PD. Low rates for narcissistic PD may be due to the individual simply not seeking treatment and assuming everything is fine.

Gender Differences

The overall prevalence of personality disorders is approximately equal in men and women. However, antisocial personality disorder is a little lopsided ( 5% reported for men and 1% for women).

Gender Bias and Diagnosis

Critics contend that the definitions of some categories are based on sex role stereotypes and therefore, are inherently sexist.

Stability of Personality Disorders over Time

Temporal stability is one of the most important assumptions about personality disorders. The long-term prognosis is less optimistic for schizotypal and schizoid personality disorders. People with these diagnoses are likely to remain socially isolated and occupationally impaired.

Culture and Personality

Personality disorders may be more closely tied to cultural expectations than any other kind of mental disorder.
Much more information is needed before we can be confident that the DSM-IV-TR system for describing personality disorders is valid in other societies.

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