Personality disorders

A personality disorder may be diagnosed when the person's personality traits '. reflect persistent patterns of self-or other-perception and behaviour, are inflexible and maladaptive, cause significant functional impairment or subjective distress, and are markedly abnormal for the person's culture.' (Reid & Wise 1995).

Most personality disorders are recognisable to others by the time that the sufferer reaches adolescence or early adulthood but the traits may not be recognised by themselves as symptoms. They may only become troublesome after a significant life change which causes them to become more exaggerated. Theories as to why personality disorders occur vary dependant upon the modality of the therapist, but it appears that both genetics and environment have a place in their creation.

In many personality disorders, there are degrees of severity of symptoms displayed and a person may show several signs of, e.g. obsessive-compulsive disorder, without it reaching the level of requiring treatment. It is also possible for someone to display features of more than one personality disorder, again, with varying degrees of incapacitation.

It can be helpful to make three groups of the various types of personality disorders, as defined for the DSM IV.

• Paranoid, schizoid and schizotypal _ eccentric behaviour
• Antisocial, borderline, histrionic and narcissitic - impulsive/dramatic behaviour
• Avoidant, dependant and obsessive-compulsive - anxious/fearful behaviour

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When examining each of these disorders on a little more detail, it is important to remember that many people can display some of these traits, without being categorised as someone who has a personality disorder and diagnosis can only be made by a trained professional.

Paranoid

• Suspicious of others
• Reluctant to confide in others
• Persistently bears grudges and is hypersensitive
• Suspects, without foundation, the infidelity of their partner
• Reads hidden meanings/ threats into benign events
• Quick to attack or counterattack

Schizoid

• Detached and indifferent to other's praise or criticism
• Doesn't enjoy or want close relationships, even with family
• Little interest in sexual experience
• Shows emotional coldness/flatness
• Prefers solitary activities
• Generally reclusive

Schizotypal

• Has odd beliefs/ perceptions
• Magical thinking or bizarre fantasies
• Excessive social anxiety that doesn't diminish with familiarity
• Lacks close friends
• Has a paranoid or suspicious ideation
• Behaviour and appearance may be odd and eccentric

Antisocial

• Fails to conform to social norms with respect to the law
• Has a reckless regard for safety of self or others
• Lacks remorse
• Is overly impulsive and fails to plan ahead
• Is deceitful, indicated by repeated lying, use of aliases or conning others
• Is irritable and aggressive and repeatedly initiates fights

Borderline

• Recurrent suicidal or self mutilating behaviour
• Has a pattern of intense and unstable relationships
• Impulsivity in at least two self damaging areas
• Inappropriate/ intense displays of anger
• Marked mood instability, often out of touch with reality
• Frantically avoids real or imagined abandonment

Histrionic

• Inappropriate sexually seductive or provocative behaviour
• Is self dramatic, self centred and vain with exaggerated displays of emotion
• Considers relationships to be more intimate than they are
• Uncomfortable in situations where they are not the centre of attention
• Easily influenced
• Has an impressionistic style of speech that lacks detail

Narcisstic

• Believes that they are special and unique
• Preoccupied with fantasies of power and success
• Requires excessive admiration and special treatment or compliance
• Takes advantage of others to exploit their own means
• Lacks empathy
• Shows arrogant behaviours or attitudes

Avoidant

• Avoids activities that involve significant personal contact
• Unwilling to get involved with others unless certain of being liked
• Preoccupied with being criticised or rejected
• Views self as inept, unappealing or inferior
• Is restrained in intimate relationships for fear of being ridiculed
• Often lonely and suffering from low self esteem

Dependant

• Has difficulty making everyday decisions without excessive amounts of advice
• Needs others to assume responsibility for their life
• Fearful of being alone as doesn't feel capable of looking after themselves
• Will form new relationships as soon as one ends
• Difficulty initiating things by themselves
• Will go to excessive lengths to obtain support from others

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Obsessive-compulsive

• Is preoccupied with trivial details so that the point of the activity is lost
• Is an extreme perfectionist which interferes with completing tasks
• Overconscientious, scrupulous and inflexible on ethics, values or morals
• Miserly towards self and others
• Reluctant to delegate
• Unable to discard worthless objects

As stated earlier, diagnosis of a personality disorder should be made by a professional therapist. If symptoms are causing the person or their family and friends any problems, therapy and/or medication may be advised. Other areas that should not be overlooked are the introduction of specialist diets and testing for food allergies/intolerances, which can also cause a wide range of psychological problems.

References:

Reid, W.H. & Wise, M.G. (1995) DSM-IV Training Guide (4th ed) New York : Brunner/Mazel Inc (p279).

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