Personality disorders

A personality disorder exists when the habits that constitute a personality are inflexible and damaging. Inflexible and maladaptive personality traits can cause significant impairment in social or occupational functioning or subjective distress. In some cases, one may not realize that they have a personality disorder because thier way of thinking and behaving seems natural. And they may blame others for the challenges they face. Personality disorders usually begin in the teenage years or early adulthood. There are many types of personality disorders. Some types may become less obvious throughout middle age.

It is not easy to distinguish the influence of personality from that of more transient states and situations. One source of confusion is social roles. Family therapists have suggested that some apparently individual characteristics are best thought of as features of the 'family system' - a result of relations among family members not attributable to any one of them. Certain situations seem almost designed to bring out behaviour that is easy to mistake for a personality trait. Famous experiments by Stanley Milgram show that most people can bring themselves to behave sadistically under the influence of a person claiming authority. According to some sceptics, the sullen compliance combined with deliberate dawdling identified as a feature of passive-aggressive personality is simply the way people act when they are under compulsion and resisting demands for adequate performance because they have little to gain from it. Historians and sociologists have described slaves and army privates as behaving this way.

Another complication is the influence of emotional states and mental illnesses. Anyone may seem utterly transformed by chronic depression or alcoholism. Professionals who did not take sufficient notice of this once spoke of the alcoholic personality. The difficulty of distinguishing personality traits from states of mind and the demands of social roles is so serious that a few researchers have even denied the existence of individual patterns that persist in every mood and social context.

In the first two editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-I and DSM-II), personality disorders were relegated to a secondary place along with a mixture of other conditions; symptom disorders had priority. The third edition (DSM-III), published in 1980, gave equal prominence to personality disorders for the first time. The diagnostic scheme was strongly criticized from the start and has already been revised once, in the new edition published in 1987 (DSM-III-R). It will certainly be revised further, but the main outlines drawn a decade ago remain. DSM-III-R still dominates the field and provides at least a starting point for many mental health professionals in their consideration of personality problems.

Types of personality disorders are grouped into three clusters, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional personality disorder. It's not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

Cluster A personality disorders:
1. Paranoid personality disorder - Pervasive distrust and suspicion of others and their motives; Unjustified belief that others are trying to harm or deceive you; Unjustified suspicion of the loyalty or trustworthiness of others; Hesitancy to confide in others due to unreasonable fear that others will use the information against you; Perception of innocent remarks or nonthreatening situations as personal insults or attacks; Angry or hostile reaction to perceived slights or insults; Tendency to hold grudges; Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful.

2. Schizoid personality disorder - Lack of interest in social or personal relationships, preferring to be alone; Limited range of emotional expression; Inability to take pleasure in most activities; Inability to pick up normal social cues; appearance of being cold or indifferent to others; Little or no interest in having sex with another person.

3. Schizotypal personality disorder - Peculiar dress, thinking, beliefs, speech or behavior; Odd perceptual experiences, such as hearing a voice whisper your name; Flat emotions or inappropriate emotional responses; Social anxiety and a lack of or discomfort with close relationships; Indifferent, inappropriate or suspicious response to others; "Magical thinking"; believing you can influence people and events with your thoughts; Belief that certain casual incidents or events have hidden messages meant only for you.

Cluster B personality disorders:
1. Antisocial personality disorder - Disregard for others' needs or feelings; Persistent lying, stealing, using aliases, conning others; Recurring problems with the law; Repeated violation of the rights of others; Aggressive, often violent behavior; Disregard for the safety of self or others; Impulsive behavior; Consistently irresponsible; Lack of remorse for behavior.

2. Borderline personality disorder - Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating; Unstable or fragile self-image; Unstable and intense relationships; Up and down moods, often as a reaction to interpersonal stress; Suicidal behavior or threats of self-injury; Intense fear of being alone or abandoned; Ongoing feelings of emptiness; Frequent, intense displays of anger; Stress-related paranoia that comes and goes.

3. Histrionic personality disorder - Constantly seeking attention; Excessively emotional, dramatic or sexually provocative to gain attention; Speaks dramatically with strong opinions, but few facts or details to back them up; Easily influenced by others; Shallow, rapidly changing emotions; Excessive concern with physical appearance; Thinks relationships with others are closer than they really are.

4. Narcissistic personality disorder - Belief that you're special and more important than others; Fantasies about power, success and attractiveness; Failure to recognize others' needs and feelings; Exaggeration of achievements or talents; Expectation of constant praise and admiration; Arrogance; Unreasonable expectations of favors and advantages, often taking advantage of others; Envy of others or belief that others envy you.

Cluster C personality disorders:
1. Avoidant personality disorder - Too sensitive to criticism or rejection; Feeling inadequate, inferior or unattractive; Avoidance of work activities that require interpersonal contact; Socially inhibited, timid and isolated, avoiding new activities or meeting strangers; Extreme shyness in social situations and personal relationships; Fear of disapproval, embarrassment or ridicule.

2. Dependent personality disorder - Excessive dependence on others and feeling the need to be taken care of; Submissive or clingy behavior toward others; Fear of having to provide self-care or fend for yourself if left alone; Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions; Difficulty starting or doing projects on your own due to lack of self-confidence; Difficulty disagreeing with others, fearing disapproval; Tolerance of poor or abusive treatment, even when other options are available; Urgent need to start a new relationship when a close one has ended.

3. Obsessive-compulsive personality disorder - Preoccupation with details, orderliness and rules; Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don't meet your own strict standards; Desire to be in control of people, tasks and situations, and inability to delegate tasks; Neglect of friends and enjoyable activities because of excessive commitment to work or a project; Inability to discard broken or worthless objects; Rigid and stubborn; Inflexible about morality, ethics or values; Tight, miserly control over budgeting and spending money.
Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, a type of anxiety disorder.