Psychiatry-Online

Personality disorder

Synonyms

Paranoid Personality Disorder, Schizoid Personality Disorder, Dissocial Personality Disorder, Emotionally Unstable Personality Disorder, Histrionic Personality Disorder, Anankastic (Compulsive) Personality Disorder, Anxious Avoidant Personality Disorder, Asthenic (Dependent) Personality Disorder

Summary

The term “personality disorder” encompasses a wide spectrum of very different disorder patterns that are characterized by the particularly extreme expression of certain character traits or “peculiarities”. The decisive factor for classification as a disorder is not its presence, but rather the particularly strong expression of the personality traits, which often have a very stable effect over time and across situations. It is not always easy to decide to what extent such “eccentricity” of a person needs treatment, especially since the tolerance of different societies towards the “eccentricity” of their members is quite different.

An indication of the need for treatment of a personality disorder is e.g. B. an actual or perceived restriction of those affected in everyday life, work and social life.

Ultimately, there is no clarity about the frequency of personality disorders in the population, estimates vary between 6-23%.

Different psychotherapeutic methods are used for therapy, which in detail depends u. a. on the type of disorder present. Such psychotherapeutic treatment can take a long time, but in many cases it leads to a good reduction in symptoms or a good integration of the patient into their everyday life.

Digression - personality

When approaching the clinical picture of “personality disorder”, it is essential to first get an idea of the term “personality”.

A common definition sees personality as the sum of individual characteristics that make a person unique. In the context of personality psychology, there are various models that take this fact into account and try to grasp various aspects of personality and to generalize them for the purpose of manageability. An example of this is the concept of the “Big Five”, which assigns five main dimensions to the concept of personality, which to a certain extent represent scales between two endpoints. As part of psychological tests, answers to standardized questions are given scores on these scales, which when viewed as a whole provide conclusions about the personality structure of the test person. The five dimensions are:

Extroversion "sociable" - "reserved"
Compatibility "peaceable" - "contentious"
Conscientiousness "thorough" - "careless"
Neuroticism (emotional stability) "relaxed" - "sensitive"
Openness "creative" - "unimaginative"

Dimensions of personality, based on the concept of the "Big Five"

Definition of personality disorder

Personality disorders are exaggerated expressions of certain, in principle quite "natural", character traits. The extent of these characteristics is so intensified in personality disorders that a social impairment arises, and is so firmly anchored in the personality that voluntary influence is only possible to a limited extent. These rigid reaction patterns often occur in situations that are perceived as conflicting.

Different types of personality disorder

In the classification of the World Health Organization (WHO), the following disorders are highlighted within personality disorders in the narrower sense:

Paranoid personality disorder: Suspicious attitude, easily offended, inclination to interpret neutral or friendly actions of others as directed against oneself.
Schizoid personality disorder: Emotional coolness, inhibition of contact and aloof behavior, suspicious-ambivalent feelings towards others, tendency to "loneliness" up to isolation.
Dissocial personality disorder: Lack of understanding of social rules and norms, tendency to break them repeatedly. Selfishness, lack of guilt, often conflict with the law and inability to learn from it.
Emotionally unstable personality disorder: A distinction is made between an impulsive type and a borderline type (see borderline). In the impulsive type, difficulties in self-control, inability to criticize, and often violent behavior.
Histrionic Personality Disorder: Urgent need to be the center of attention; "Acting", dramatic behavior. Tendency to lie and exaggerate to attract attention.
Anankastic (compulsive) personality disorder: Perfectionistic task fulfillment, strict adherence to rules and norms, control tendencies and pedantry. Often also difficulties in expressing feelings, cool, controlled demeanor. Excessive conscientiousness can, depending on the situation, be assessed positively in working life, but it can also have a paralyzing effect (lack of efficiency). See obsessive-compulsive disorder
Anxious Avoidant Personality Disorder: Strong sensitivity to (real or suspected) criticism, fear of rejection, feelings of inferiority. In order to meet an increased need for security, some significant restrictions are accepted in everyday life (avoidance behavior). See anxiety disorder
Asthenic (dependent) personality disorder: feeling helpless and dependent on other people, inability to make decisions on your own. Tendency to indulge too much in order to avoid rejection.

In addition to the "extended circle" of personality disorders, the narcissistic (increased feeling of one's own importance, see also narcissism), the schizotypical (difficulties in social interaction, cranky-peculiar appearance; see also schizophrenia) and the passive-aggressive (excessive feeling of injustice, passive resistance to social demands) personality disorder. Finally, the classification of the World Health Organization contains the “combined personality disorder”, which combines features of different personality disorders without assigning the symptoms to a single personality disorder in the overall view.

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It is already apparent from the brief list above that areas of overlap exist between the individual personality disorders. Occasionally, personality disorders are therefore assigned to superordinate categories ("clusters") based on symptoms:

Quirky Behavior (Cluster A): Paranoid, Schizoid Personality Disorder
Emotional-dramatic behavior (cluster B): Dissocial, emotionally unstable, histrionic personality disorder
Fearful-avoidant behavior (cluster C): Fearful, anankastic, passive-aggressive, asthenic personality disorder

frequency

The incidence of personality disorders is increasing with 6-23% stated, a certain number of unreported cases is not unlikely due to the difficult availability. The most common personality disorders include dependent, antisocial, histrionic, and borderline personality disorder. The gender distribution is different for the individual types of personality disorders.

root cause

The cause of the development of personality disorders is not yet fully understood. Several factors seem to be important:

On the one hand, a genetic predisposition for the development of personality disorders based on z. B. twin studies proven.
Anomalies in early childhood development are also used to explain, since personality disorders can also be interpreted from certain points of view as misguided (conflict) learning processes that cause the disorder-typical rigid, inflexible reaction pattern to different situations.
Furthermore, minimal early childhood brain damage or abnormalities in the neurotransmitter balance of the brain seem to be the cause of the disturbances.

Symptoms

The symptoms are outlined under the respective disorders. It is characteristic of all personality disorders that it is less the presence than the expression and lack of flexibility of certain character traits that is striking.

Diagnosis

The diagnosis of a personality disorder requires a conscientious psychiatric-psychotherapeutic history-taking (evaluation).

Diagnostic criteria for establishing a diagnosis of a personality disorder are given in the current classification catalogs of the World Health Organization and the American Psychiatric Association.

therapy

For the therapy of personality disorders are mainly psychotherapeutic procedures applied, which in detail is u. a. Depends on the type of personality disorder. For use are z. B. psychoanalytic, depth psychological or behavioral methods. The goals here are to recognize inappropriate behavior patterns, to learn alternative strategies for solving conflictual situations and to improve adaptation to everyday life and the social environment.
It may also be accompanied by a treatment aimed at alleviating accompanying symptoms medical therapy take place, for example strong fears could be alleviated by anti-anxiety drugs.

forecast

Even if the therapy of personality disorders is protracted and requires a high level of commitment from both those affected and therapists, in many cases it is possible to enable patients to adapt well to the requirements of daily (professional) life. The success of a therapy is also significantly influenced by the type of disorder and the presence of other (accompanying) disorders such as drug use. It is ultimately unclear whether personality disorders are completely “curable” or whether a therapy only leads to an extensive suppression of symptoms.