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Personality Disorder
Tuesday, July 12, 2011
Personality Disorder

Overview
Personality disorders are long-term patterns of thoughts and behaviours that cause serious problems with relationships and work. People with personality disorders have difficulty dealing with everyday stresses and problems. They often have stormy relationships with other people. The exact cause of personality disorders is unknown. However, genes and childhood experiences may play a role.
Symptoms vary widely depending on the specific type of personality disorder. Treatment usually includes talk therapy and sometimes medicine.
A personality disorder is a type of mental illness in which you have trouble perceiving and relating to situations and to people — including yourself. There are many specific types of personality disorders.
In general, having a personality disorder means you have a rigid 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, 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 the challenges you face.
Symptoms
Symptoms vary widely depending on the type of personality disorder.
In general, personality disorders involve feelings, thoughts, and behaviours that do not adapt to a wide range of settings.
These patterns usually begin in adolescence and may lead to problems in social and work situations.
The severity of these conditions ranges from mild to severe.
General symptoms of a personality disorder
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
A person with antisocial personality disorder may:
·         Be able to act witty and charming
·         Be good at flattery and manipulating other people's emotions
·         Break the law repeatedly
·         Disregard the safety of self and others
·         Have problems with substance abuse
·         Lie, steal, and fight often
·         Not show guilt or remorse
·         Often be angry or arrogant
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. Untreated, personality disorders can cause significant problems in your life, and they may get worse without treatment.
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 behaviours 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. You may have a genetic vulnerability to developing a personality disorder and your life situation may trigger the actual development of a personality disorder.
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
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 behaviour 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 behaviour
·         Self-injury
·         Reckless behaviour
·         Risky sexual behaviour
·         Child abuse
·         Alcohol or substance abuse
·         Aggression or violence
·         Incarceration
·         Relationship difficulties
·         Social isolation
·         School and work problems
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 personality disorder symptoms from worsening.

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 are personality disorders characterized by odd, eccentric thinking or behaviour 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 behaviour
·         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 behaviour and include:
Antisocial (formerly called sociopathic) personality disorder
·         Disregard for others
·         Persistent lying or stealing
·         Recurring difficulties with the law
·         Repeatedly violating the rights of others
·         Aggressive, often violent behaviour
·         Disregard for the safety of self or others
Borderline personality disorder
·         Impulsive and risky behaviour
·         Volatile relationships
·         Unstable mood
·         Suicidal behaviour
·         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 personality disorders
These are personality disorders characterized by anxious, fearful thinking or behaviour 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



Antisocial Personality Disorder
Antisocial personality disorder is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. This behaviour is often criminal.
Causes
The causes of antisocial personality disorder are unknown. Genetic factors and child abuse are believed to contribute to the development of this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected. The condition is common in people who are in prison.
Fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality.
Some people believe that psychopathic personality (psychopathy) is the same disorder. Others
Treatment
Antisocial personality disorder is one of the most difficult personality disorders to treat. People with this condition rarely seek treatment on their own. They may only start therapy when required to by a court.
The effectiveness of treatment for antisocial personality disorder is not known. Treatments that show the person the negative consequences of illegal behaviour seem to hold the most promise.
Outlook (Prognosis)
Symptoms tend to peak during the late teenage years and early 20s. They sometimes improve on their own by a person's 40s.

Possible Complications
Complications can include imprisonment, drug abuse, violence, and suicide.

When to Contact a Medical Professional
Call for an appointment with a mental health professional if:
·         You have symptoms of antisocial personality disorder
·         Your child shows behaviours of this disorder
Alternative Names
Sociopathic personality; Sociopathy; Personality disorder – antisocial

Avoidant Personality Disorder
Avoidant personality disorder is a mental health condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection.
Causes
Personality disorders are lifelong patterns of behaviour that cause problems with work and relationships.
About 1% of the population has avoidant personality disorder. Both males and females have the condition equally. The cause is unknown.
Symptoms
People with avoidant personality disorder can't stop thinking about their own shortcomings. They form relationships with other people only if they believe they will not be rejected. Loss and rejection are so painful that these people will choose to be lonely rather than risk trying to connect with others.

Exams and Tests
A person with avoidant personality disorder may:
·         Be easily hurt when people criticize or disapprove of them
·         Hold back too much in intimate relationships
·         Be reluctant to become involved with people
·         Avoid activities or jobs that involve contact with others
·         Be shy in social situations out of fear of doing something wrong
·         Make potential difficulties seem worse than they are
·         Hold the view they are not good socially, not as good as other people, or unappealing
Treatment
Antidepressant medications can often make people less sensitive to rejection. However, talk therapy (psychotherapy) is considered to be the most effective treatment for this condition.
Psychodynamic psychotherapy, which helps patients understand their thoughts and feelings, and cognitive behavioural therapy (CBT), can help. A combination of medication and talk therapy may be more effective than either treatment alone.
Outlook (Prognosis)
People with this disorder may develop some ability to relate to others, and this can be improved with treatment.

Possible Complications
Without treatment, a person with avoidant personality disorder may become resigned to a life of near or total isolation. They may go on to develop a second psychiatric disorder such as substance abuse or a mood disorder such as depression.

When to Contact a Medical Professional
See your health care provider or a psychiatrist if shyness or fear of rejection overwhelms your ability to function in life and relationships.

Alternative Names
Personality disorder – avoidant

Borderline Personality Disorder
Borderline personality disorder is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others.
These inner experiences often cause them to take impulsive actions and have chaotic relationships.
Causes
The causes of borderline personality disorder (BPD) are unknown. Genetic, family, and social factors are thought to play roles.
Risk factors for BPD include:
·         Abandonment in childhood or adolescence
·         Disrupted family life
·         Poor communication in the family
·         Sexual abuse
This personality disorder tends to occur more often in women and among hospitalized psychiatric patients.
Symptoms
People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly.
People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships.
Other symptoms of BPD include:
·         Fear of being abandoned
·         Feelings of emptiness and boredom
·         Frequent displays of inappropriate anger
·         Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting
·         Intolerance of being alone
·         Repeated crises and acts of self-injury, such as wrist cutting or overdosing
Exams and Tests
Like other personality disorders, BPD is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment
Many types of individual talk therapy, such as dialectical behavioural therapy (DBT), can successfully treat BPD. In addition, group therapy can help change self-destructive behaviours.
In some cases, medications can help level mood swings and treat depression or other disorders that may occur with this condition.
Outlook (Prognosis)
The outlook depends on how severe the condition is and whether the person is willing to accept help. With long-term talk therapy, the person will often gradually improve.

Possible Complications
·         Depression
·         Drug abuse
·         Problems with work, family, and social relationships
·         Suicide attempts and actual suicide
Alternative Names
Personality disorder – borderline

Dependent Personality Disorder
Dependent personality disorder is a long-term (chronic) condition in which people depend too much on others to meet their emotional and physical needs.
Causes
Dependent personality disorder usually begins in childhood. The causes of this disorder are unknown. It is one of the most common personality disorders, and is equally common in men and women.

Symptoms
People with this disorder do not trust their own ability to make decisions. They may be very upset by separation and loss. They may go to great lengths, even suffering abuse, to stay in a relationship.
Symptoms of dependent personality disorder may include:
·         Avoiding being alone
·         Avoiding personal responsibility
·         Becoming easily hurt by criticism or disapproval
·         Becoming overly focused on fears of being abandoned
·         Becoming very passive in relationships
·         Feeling very upset or helpless when relationships end
·         Having difficulty making decisions without support from others
·         Having problems expressing disagreements with others
Exams and Tests
Like other personality disorders, dependent personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment
Talk therapy (psychotherapy) is considered to be the most effective treatment for gradually helping people with this condition make more independent choices in life. Medication may help treat other conditions, such as anxiety or depression.

Outlook (Prognosis)
Improvements are usually seen only with long-term therapy.
Possible Complications
·         Alcohol or drug abuse
·         Depression
·         Increased likelihood of physical, emotional, or sexual abuse
Alternative Names
Personality disorder – dependent

Histrionic Personality Disorder
Histrionic personality disorder is a condition in which people act in a very emotional and dramatic way that draws attention to them.
Causes
The cause of this disorder is unknown. Both genes and early childhood events are thought to contribute. It occurs more often in women than in men, although it may be diagnosed more often in women because attention-seeking and sexual forwardness are less socially acceptable for women.
Histrionic personality disorder usually begins in early adulthood.
Symptoms
People with this disorder are usually able to function at a high level and can be successful socially and at work.
Symptoms include:
·         Acting or looking overly seductive
·         Being easily influenced by other people
·         Being overly concerned with their looks
·         Being overly dramatic and emotional
·         Being overly sensitive to criticism or disapproval
·         Believing that relationships are more intimate than they actually are
·         Blaming failure or disappointment on others
·         Constantly seeking reassurance or approval
·         Having a low tolerance for frustration or delayed gratification
·         Needing to be the centre of attention (self-centeredness)
·         Quickly changing emotions, which may seem shallow to others
Exams and Tests
The health care provider can diagnose histrionic personality disorder by looking at your:
·         Behaviour
·         History
·         Overall appearance
·         Psychological evaluation
Like other personality disorders, histrionic personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.
Treatment
People with this condition often seek treatment when they experience depression or anxiety from failed romantic relationships or other conflicts with people. Medication may help the symptoms, but talk therapy (psychotherapy) is the best treatment for the condition itself.

Outlook (Prognosis)
Histrionic personality disorder can improve with psychotherapy and sometimes medications. If left untreated, it can cause conflict in people's personal life and prevent them from reaching their potential in their work life.


Possible Complications
Histrionic personality disorder may affect your social or romantic relationships, or your ability to cope with losses or failures. You may go through many job changes as you become easily bored and have trouble dealing with frustration.
Because you tend to crave new things and excitement, you may put yourself in risky situations. All of these factors may lead to a greater risk of depression.
When to Contact a Medical Professional
Call your health care provider if you think you may have symptoms of histrionic personality disorder. It is important to call if this condition is affecting your sense of well-being, relationships, or ability to keep a job.

Prevention
Mental health treatment may help you learn better ways of understanding and dealing with your needs.

Narcissistic Personality Disorder
Narcissistic personality disorder is a condition in which people have an inflated sense of self-importance and an extreme preoccupation with themselves.
Causes
The causes of this disorder are unknown. An overly sensitive personality and parenting problems may affect the development of this disorder.

Symptoms
A person with narcissistic personality disorder may:
·         React to criticism with rage, shame, or humiliation
·         Take advantage of other people to achieve his or her own goals
·         Have excessive feelings of self-importance
·         Exaggerate achievements and talents
·         Be preoccupied with fantasies of success, power, beauty, intelligence, or ideal love
·         Have unreasonable expectations of favourable treatment
·         Need constant attention and admiration
·         Disregard the feelings of others, and have little ability to feel empathy
·         Have obsessive self-interest
·         Pursue mainly selfish goals
Exams and Tests
Like other personality disorders, narcissistic personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment
Psychotherapy (for example, talk therapy) may help the affected person relate to other people in a more positive and compassionate way.

Outlook (Prognosis)
The outcome depends on the severity of the disorder.
Possible Complications
·         Alcohol or other drug dependence
·         Relationship, work, and family problems

Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder (OCPD) is a condition in which a person is preoccupied with rules, orderliness, and control.
Causes
Obsessive-compulsive personality disorder tends to occur in families, so genes may be involved. A person's childhood and environment may also play roles.
This condition can affect both men and women, but it most often occurs in men.
Symptoms
OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.
People with both OCPD and OCD tend to be high achievers and feel a sense of urgency about their actions. They may become very upset if other people interfere with their rigid routines. They may not be able to express their anger directly. Instead, people with OCPD experience feelings that they consider more appropriate, like anxiety or frustration.
A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person's ability to complete tasks, because their standards are so rigid.
People with this disorder may emotionally withdraw when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships.
Some of the other signs of obsessive-compulsive personality disorder include:
·         Excess devotion to work
·         Inability to throw things away, even when the objects have no value
·         Lack of flexibility
·         Lack of generosity
·         Not wanting to allow other people to do things
·         Not willing to show affection
·         Preoccupation with details, rules, and lists
Exams and Tests
OCPD can be diagnosed by an experienced mental health professional (psychiatrist or psychologist) with an evaluation. Psychological tests that may help diagnose this condition include:
·         The Structured Clinical Interview for DSM IV Disorders (SCID II)
·         The Schedule for Non-Adaptive and Adaptive Personality (SNAP)
Treatment
Medications such as selective serotonin reuptake inhibitors (for example, Prozac) may help reduce some of the anxiety and depression from this disorder.
However, talk therapy (psychotherapy) is thought to be the most effective treatment for this condition.
·         Psychodynamic psychotherapy helps patients understand their thoughts and feelings.
·         Cognitive-behavioural therapy (CBT) can also help.
In some cases, medications combined with talk therapy may be more effective than either treatment alone.
Outlook (Prognosis)
The outlook for people with obsessive-compulsive personality disorder tends to be better than that for other personality disorders. The rigidness and control of OCPD may prevent many of the complications such as drug abuse, which are common in other personality disorders.
However, the social isolation and difficulty handling anger that are common with this illness may lead to feelings of depression and anxiety later in life.
Possible Complications
·         Anxiety
·         Depression
·         Difficulty moving forward in career situations
·         Relationship difficulties
When to Contact a Medical Professional
Call for an appointment with your health care provider if perfectionism is interfering with your job or relationships.

Alternative Names
Personality disorder - obsessive-compulsive

Paranoid Personality Disorder
Paranoid personality disorder is a psychiatric condition in which a person has a long-term distrust and suspicion of others, but does not have a full-blown psychotic disorder such as schizophrenia.
Causes
The causes of paranoid personality disorder are unknown. The disorder appears to be more common in families with psychotic disorders such as schizophrenia and delusional disorder, which suggests genes, may be involved. However, environmental factors may play a role, as well. The condition appears to be more common in men.

Symptoms
People with paranoid personality disorder are highly suspicious of other people. As a result, people with this condition severely limit their social lives.
They often feel that they are in danger, and look for evidence to support their suspicions. People with this disorder have trouble seeing that their distrustfulness is out of proportion to their environment.
Common symptoms include:
·         Concern that other people have hidden motives
·         Expectation that they will be exploited by others
·         Inability to work together with others
·         Social isolation
·         Detachment
·         Hostility
Exams and Tests
Like other personality disorders, paranoid personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment
Treatment is difficult because people with this condition are often very suspicious of doctors. If treatment is accepted, talk therapy and medications can often be effective.

Outlook (Prognosis)
The outlook usually depends on whether the person is willing to accept help. Therapy and medications can reduce paranoia and limit its impact on the person's daily functioning.
Possible Complications
·         Extreme social isolation
·         Interference with work
When to Contact a Medical Professional
If suspicions are interfering with your relationships or work, contact a health care provider or mental health professional.

Alternative Names
Personality disorder – paranoid

Schizoid Personality Disorder
Schizoid personality disorder is a psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation.
Causes
The causes of schizoid personality disorder are unknown. This disorder may be related to schizophrenia and it shares many of the same risk factors.
However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia.
Symptoms
A person with schizoid personality disorder:
·         Appears aloof and detached
·         Avoids social activities that involve emotional intimacy with other people
·         Does not want or enjoy close relationships, even with family members
Exams and Tests
Like other personality disorders, schizoid personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment
People with this disorder rarely seek treatment, and little is known about which treatments work. Talk therapy may not be effective, because people with schizoid personality disorder have difficulty relating well to others.
However, one approach that appears to help is to put fewer demands for emotional closeness or intimacy on the person with this condition.
People with schizoid personality disorder often do better in relationships that do not focus on emotional closeness. They are better at handling relationships that focus only on recreation, work, or intellectual activities and expectations.
Outlook (Prognosis)
Schizoid personality disorder is a long-term (chronic) illness that usually does not improve much over time. Social isolation often prevents the person from seeking the help or support that might improve the outcome.
Limiting emotional intimacy may help people with this condition make and keep connections with other people.
Alternative Names
Personality disorder – schizoid


Schizotypal Personality Disorder
Schizotypal personality disorder is a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behaviour.
Causes
The exact cause is unknown. Genes are thought to be involved, because this condition is more common in relatives of schizophrenics.
Schizotypal personality disorder should not be confused with schizophrenia. People with schizotypal personality disorder can have odd beliefs and behaviours, but they are not disconnected from reality and usually do not hallucinate.
Hallucinations, delusions (fixed, false beliefs), and loss of touch with reality are hallmarks of psychosis. People with schizotypal personality disorder do not usually have psychotic symptoms.
Between 30% and 50% of people with schizotypal personality disorder also have a major depressive disorder.A second personality disorder, such as paranoid personality disorder, is also common with this condition.
Symptoms
People with schizotypal personality disorder may be very disturbed. Their odd behaviour may look like that of people with schizophrenia. For example, they may also have unusual preoccupations and fears, such as fears of being monitored by government agencies.
More commonly, however, people with schizotypal personality disorder behave oddly and have unusual beliefs (such as aliens). They cling to these beliefs so strongly that it prevents them from having relationships.
People with schizotypal personality disorder feel upset by their difficulty in forming and keeping close relationships. This is different from people with schizoid personality disorder, who do not want to form relationships.
Exams and Tests
Some of the common signs of schizotypal personality disorder include the following:
·         Discomfort in social situations
·         Inappropriate displays of feelings
·         No close friends
·         Odd behaviour or appearance
·         Odd beliefs, fantasies, or preoccupations
·         Odd speech
Treatment
Some people may be helped by antipsychotic medications. Talk therapy (psychotherapy) is a big part of treatment. Social skills training can help some people cope with social situations.

Outlook (Prognosis)
Schizotypal personality disorder is usually a long-term (chronic) illness. The outcome of treatment varies based on the severity of the disorder.
Possible Complications
·         Poor social skills
·         Lack of interpersonal relationships
When to Contact a Medical Professional
Talk to your health care provider or mental health professional if:
·         You have trouble forming and keeping relationships due to unusual beliefs
·         You suspect that your child may have this problem
Prevention
There is no known prevention. Awareness of risk, such as a family history of schizophrenia, may allow early diagnosis.



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