Personality Disorders

Definition:
Personality disorders are defined by the American Psychiatric Association (APA) as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”. These patterns, as noted, are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e., the patterns are consistent with the ego integrity of the individual), and therefore, perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to the beginning of adulthood, and, in rare instances, early adolescence.

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This definition allows significant deviance from societal norms, such as conscientious objection to a social regime, to be classified as a mental disorder. In the former Soviet Union and elsewhere this has been used to justify treatment of political dissidents as though they were psychologically disturbed.

Personality disorders are also defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10) which is published by the World Health Organization. Personality disorders are categorized in ICD-10 Chapter V: Mental and behavioural disorders, specifically under Mental and behavioral disorders: 28F60-F69.29 Disorders of adult personailty and behavior. It is seeking to develop an international diagnostic system. The ICD-10 has been structured in part to mesh the DSM’s multiaxial system and diagnostic formats.

Whether you’re sociable, reserved, funny or forthright, everyone who knows you would likely list the same traits when describing your personality. These characteristics are the combined product of your heredity and early life experience, and they are fixed by the time you reach adulthood.

People with personality disorders have traits that cause them to feel and behave in socially distressing ways, which often limit their ability to function in relationships and at work. Depending on the disorder, their personalities are generally described in more-negative terms: dramatic, clingy, antisocial or obsessive. As many as 15 percent of U.S. adults have one or more personality disorders.

Among the 10 conditions that are considered personality disorders, some have very little in common. Doctors typically group the personality disorders that have shared characteristics into one of three clusters:

*Cluster A includes personality disorders marked by odd, eccentric behavior, including paranoid, schizoid and schizotypal personality disorders.

*Cluster B personality disorders are those defined by dramatic, emotional behavior, including histrionic, narcissistic, antisocial and borderline personality disorders.

*Cluster C personality disorders are characterized by anxious, fearful behavior and include obsessive-compulsive, avoidant and dependent personality disorders.

It is a condition characterized by impulsive actions, mood instability, and chaotic relationships.There’s no cure for these conditions, but therapy and medication can help. The symptoms of some personality disorders also may improve with age.

Signs and symptoms:
People with personality disorders commonly experience conflict and instability in many aspects of their lives, and most believe others are responsible for their problems.

Signs and symptoms of cluster A (odd, eccentric) personality disorders may include:

Paranoid personality disorder
*Belief that others are lying, cheating, exploiting or trying to harm you
*Perception of hidden, malicious meaning in benign comments
*Inability to work collaboratively with others
*Emotional detachment
*Hostility toward others

Schizoid personality disorder:
*Fantasizing
*Extreme introversion
*Emotional distance, even from family members
*Fixation on your own thoughts and feeling
*Emotional detachment

Schizotypal personality disorder
*Indifference to and withdrawal from others
“Magical thinking” — the idea that you can influence people and events with your thoughts
*Odd, elaborate style of dressing, speaking and interacting with others
*Belief that messages are hidden for you in public speeches and displays
*Suspicious or paranoid ideas

Signs and symptoms of cluster B (dramatic, emotional) personality disorders may include:

Histrionic personality disorder
*Excessive sensitivity to others’ approval
*Attention-grabbing, often sexually provocative clothing and behavior
*Excessive concern with your physical appearance
*False sense of intimacy with others
*Constant, sudden emotional shifts

Narcissistic personality disorder
*Inflated sense of — and preoccupation with — your importance, achievements and talents
*Constant attention-grabbing and admiration-seeking behavior
Inability to empathize with others
*Excessive anger or shame in response to criticism
*Manipulation of others to further your own desires


Antisocial (formerly, sociopathic) personality disorder

*Chronic irresponsibility and unreliability
*Lack of regard for the law and for others’ rights
*Persistent lying and stealing
*Aggressive, often violent behavior
*Lack of remorse for hurting others
*Lack of concern for the safety of yourself and others
Borderline personality disorder
*Difficulty controlling emotions or impulses
*Frequent, dramatic changes in mood, opinions and plans
*Stormy relationships involving frequent, intense anger and possibly physical fights
*Fear of being alone despite a tendency to push people away
*Feeling of emptiness inside
*Suicide attempts or self-mutilation

Signs and symptoms of cluster C (anxious, fearful) personality disorders may include:

Avoidant personality disorder
*Hypersensitivity to criticism or rejection
*Self-imposed social isolation
*Extreme shyness in social situations, though you strongly desire close relationships
Dependent personality disorder
*Excessive dependence on others to meet your physical and emotional needs
*Tolerance of poor, even abusive treatment in order to stay in relationships
*Unwillingness to independently voice opinions, make decisions or initiate activities
*Intense fear of being alone
*Urgent need to start a new relationship when one has ended
Obsessive-compulsive personality disorder
Excessive concern with order, rules, schedules and lists
Perfectionism, often so pronounced that you can’t complete tasks because your standards are impossible to meet

*Inability to throw out even broken, worthless objects

*Inability to share responsibility with others

*Inflexibility about the “right” ethics, ideas and methods

*Compulsive devotion to work at the expense of recreation and relationships

*Financial stinginess
*Discomfort with emotions and aspects of personal relationships that you can’t control

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, an anxiety disorder that shares some symptoms but is more extreme and disabling.

Causes:
Personality disorders are chronic patterns of behavior that impair relationships and work. The cause of borderline personality disorder (BPD) is unknown. People with BPD are impulsive in areas that have a potential for self-harm, such as drug use, drinking, and other risk-taking behaviors.

A combination of personal history and biology appears to play a role in most personality disorders. Genetics play a significant — but not necessarily singular — role in the development of schizotypal, schizoid and paranoid personality disorders, which all are more common in families with a history of schizophrenia. Heredity also contributes to the development of obsessive-compulsive personality disorder.

A family history of antisocial personality disorder increases your risk of developing the condition, but childhood trauma also has considerable influence. Children with an alcoholic parent, or who have an abusive or chaotic home life, are at increased risk of developing antisocial personality disorder.

Sexual abuse is a common risk factor for borderline personality disorder. People with borderline personality disorder who report sexual abuse at a younger age — younger than 13 years old — are also more likely to have post-traumatic stress disorder. Heredity and childhood head injuries also may influence the development of this disorder.

The causes of narcissistic, histrionic, avoidant and dependent personality disorders have been minimally studied and aren’t yet well understood.
Risk factors:
More women than men develop borderline personality disorder. But men are much more likely than women to have antisocial personality disorder and obsessive-compulsive personality disorder.

Other risk factors for personality disorders include:

*A history of childhood verbal, physical or sexual abuse
*A family history of schizophrenia
*A family history of personality disorders
*A childhood head injury
*An unstable family life
Diagnosis:
Personality disorders are diagnosed based on psychological evaluation and the history and severity of the symptoms.
There are no specific tests for personality disorders. Your doctor will ask you questions about your symptoms, personal history and emotional well-being, and may talk to friends and relatives about your behavior. A mental health professional will probably help make the diagnosis, and he or she will also evaluate whether you have other mental health or substance abuse problems.

Doctors regard the diagnosis of most personality disorders in adolescents as premature. That’s because what appear to be signs or symptoms of personality disorders often disappear as adolescents grow older. However, signs and symptoms of antisocial personality disorder become evident before age 15.

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Complications:
People with personality disorders are at significantly increased risk of:

*Social isolation.
An inability to forge and maintain healthy relationships, lack of desire for closeness, or extreme shyness may cause those with personality disorders to be socially disconnected.

*Suicide. The risk of self-inflicted injury and suicide is highest among people with cluster B personality disorders, such as borderline personality disorder.

*Substance abuse. Those with cluster B personality disorders are at especially increased risk of alcohol and drug addiction.
Depression, anxiety and eating disorders. People with all types of personality disorders are at increased risk of developing other psychiatric problems.

*Self-destructive behavior. People with borderline personality disorder are particularly at risk of engaging in dangerous behaviors, such as risky sex and gambling. Those with dependent personality disorder — who may tolerate mistreatment in order to stay in a relationship — are at increased risk of physical, emotional and sexual abuse.

*Violence and homicide. Aggressive behavior is a significant risk among those with paranoid and antisocial personality disorders.

*Incarceration. People with antisocial personality disorder are at increased risk of committing serious crimes. The condition is common among prisoners.

The intensity of the symptoms of personality disorders may change over time. The symptoms of cluster A and cluster B personality disorders may become less severe later in life. Those with cluster C personality disorders often experience worsening symptoms as they age.
Treatment:
A number of barriers make personality disorders among the most challenging mental health conditions to treat. People with these conditions are likely to have difficulty opening up to or retaining closeness with therapists. Perceived criticism may cause them to react angrily and break off therapy. Those who seek treatment on their own and who are motivated to stick with therapy over many years are the most likely to succeed.

Treatment for most personality disorders is with a combination of therapy and medications.

Therapy
Types of therapy that can help people with personality disorders include:

*Psychodynamic psychotherapy. This approach entails talking about your condition and related issues with a mental health professional. Psychotherapy can help people with personality disorders recognize how they’re responsible for the turmoil in their lives and learn healthier ways of reacting to people and problems. Individual, group and family therapy can all be helpful.

*Cognitive behavior therapy. This form of psychological treatment involves actively retraining the way you think about problems, which in turn improves your emotions and behaviors.

*Dialectical behavior therapy. This type of cognitive behavior therapy focuses on coping skills — learning how to take better control of behaviors and emotions with techniques such as mindfulness, which helps you observe your feelings without reacting. It is most often used to treat borderline personality disorder. Doctors are studying the effectiveness of this type of therapy with all types of personality disorders.

Medications:
People with personality disorders often experience serious mental and emotional strain, causing additional mental health problems, such as depression, phobia and panic. Medications may help alleviate these related conditions, but they can’t cure the underlying disorder. Therapy aimed at building new coping mechanisms must be the cornerstone of treatment.

Medications that may offer support during therapy include:

*Antidepressants.
Doctors commonly prescribe selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), nefazodone, and escitalopram (Lexapro), or the related antidepressant venlafaxine (Effexor) to help relieve depression and anxiety in people with personality disorders. Less often, monoamine oxidase inhibitors such as phenelzine (Nardil) and tranylcypromine (Parnate) may be used.

*Anticonvulsants. These medications may help suppress impulsive and aggressive behavior. Your doctor may prescribe carbamazepine (Carbatrol, Tegretol) or valproic acid (Depakote). Your doctor may also prescribe topiramate (Topamax), an anticonvulsant that’s being studied as an aid in managing impulse-control problems.

*Antipsychotics. People with borderline and schizotypal personality disorders are at risk of losing touch with reality. Antipsychotic medications such as risperidone (Risperdal) and olanzapine (Zyprexa) can help improve distorted thinking. For severe behavior problems, doctors may prescribe haloperidol (Haldol).

*Other medications. Doctors sometimes prescribe anti-anxiety medications such as alprazolam (Xanax) and clonazepam (Klonopin) and mood stabilizers such as lithium (Eskalith, Lithobid) to relieve symptoms associated with personality disorders.

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Alternative therapies:
Some alternative therapies for PTSD include:

*Spiritual/religious counseling. Because traumatic experiences often affect patients’ spiritual views and beliefs, counseling with a trusted religious or spiritual advisor may be part of a treatment plan. A growing number of pastoral counselors in the major Christian and Jewish bodies have advanced credentials in trauma therapy.

*Yoga and various forms of bodyworkare often recommended as ways of releasing physical tension or muscle soreness caused by anxiety or hypervigilance.

*Martial arts training can be helpful in restoring the patient’s sense of personal effectiveness and safety. Some martial arts programs, such as Model Mugging, are designed especially for survivors of rape and other violent crimes.

*Art therapy, journaling, dance therapy, and creative writing groups offer safe outlets for the strong emotions that follow traumatic experiences.

Recent controversial therapies:
Since the mid-1980s, several controversial methods of treatment for PTSD have been introduced. Some have been developed by mainstream medical researchers while others are derived from various forms of alternative medicine.

They include:

*Eye Movement Desensitization and Reprocessing. This is a technique in which the patient reimagines the trauma while focusing visually on movements of the therapist’s finger. It is claimed that the movements of the patient’s eyes reprogram the brain and allow emotional healing.


*Tapas Acupressure Technique (TAT).TAT was derived from traditional Chinese medicine (TCM), and its practitioners maintain that a large number of acupuncture meridians enter the brain at certain points on the face, especially around the eyes. Pressure on these points is thought to release traumatic stress.

*Thought Field Therapy. This therapy combines the acupuncture meridians of TCM with analysis of the patient’s voice over the telephone. The therapist then provides an individualized treatment for the patient.

*Traumatic Incident Reduction. This is a technique in which the patient treats the trauma like a videotape and “runs through” it repeatedly with the therapist until all negative emotions have been discharged.

*Emotional Freedom Techniques (EFT). EFT is similar to TAT in that it uses the body’s acupuncture meridians, but it emphasizes the body’s entire “energy field” rather than just the face.

*Counting Technique. Developed by a physician, this treatment consists of a preparation phase, a counting phase in which the therapist counts from 1 to 100 while the patient reimagines the trauma, and a review phase. Like Traumatic Incident Reduction, it is intended to reduce the patient’s hyperarousal.

Prognosis:
Trauma survivors who receive critical incident stress debriefing as soon as possible after the event have the best prognosis for full recovery. For patients who develop full-blown PTSD, a combination of peer-group meetings and individual psychotherapy are often effective. Treatment may require several years, however, and the patient is likely to experience relapses.

There are no studies of untreated PTSD, but long-term studies of patients with delayed-reaction PTSD or delayed diagnosis of the disorder indicate that treatment of patients in these groups is much more difficult and complicated.

In some patients, PTSD becomes a chronic mental disorder that can persist for decades, or the remainder of the patient’s life. Patients with chronic PTSD often have a cyclical history of symptom remissions and relapses. This group has the poorest prognosis for recovery; some patients do not respond to any of the currently available treatments for PTSD.

Prevention:
Some forms of trauma, such as natural disasters and accidents, can never be completely eliminated from human life. Traumas caused by human intention would require major social changes to reduce their frequency and severity, but given the increasing prevalence of PTSD around the world, these long-term changes are worth the effort. In the short term, educating people—particularly those in the helping professions—about the signs of critical incident stress may prevent some cases of exposure to trauma from developing into full-blown PTSD.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=2
http://en.wikipedia.org/wiki/Personality_disorder
http://www.nlm.nih.gov/medlineplus/ency/article/000935.htm
http://www.minddisorders.com/Ob-Ps/Post-traumatic-stress-disorder.html

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