Personality Disorders
What Are They?
Personality Disorders are enduring and inflexible patterns of relating, perceiving, and thinking about oneself and one's surroundings that hinder the establishment of stable and satisfying relationships. These disorders typically begin to manifest during adolescence and may persist or worsen in adulthood. They can stabilize or even decrease in intensity in later years.
It's important to view Personality Disorders as adaptive ways of coping with one's environment. Often, they don't result from functional deficits but rather from an effort to adapt and restore balance with others and oneself, even if the results are negative.
What Types Exist?
Some authors group Personality Disorders based on their primary characteristics. While some types share more eccentric features, there are others with more dramatic/erratic characteristics and others with more anxious features. Below are descriptions of distinct Personality Disorders according to their marked characteristics, with each of them being a complex diagnosis with many nuances:
Paranoid Personality Disorder: A pattern of suspicion and distrust that leads to interpreting others' motives as malevolent.
Schizoid Personality Disorder: A pattern of social relationship detachment and restricted emotional expression.
Schizotypal Personality Disorder: A pattern of acute discomfort in close relationships that may include cognitive distortions and eccentricities in behavior.
Antisocial Personality Disorder: A pattern of disregard and violation of others' rights, typically involving difficulties in impulse control and learning from past experiences.
Borderline Personality Disorder: A pattern of instability in interpersonal relationships, self-image, and affects, including marked impulsivity.
Histrionic Personality Disorder: A pattern of excessive emotionality and the need for attention.
Narcissistic Personality Disorder: A pattern of an inflated sense of grandiosity, the need for admiration, and a lack of empathy.
Avoidant Personality Disorder: A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
Dependent Personality Disorder: A pattern of submissive behavior associated with an excessive need for others to take care of oneself.
Obsessive-Compulsive Personality Disorder: A pattern of extreme concern about order, perfection, and control.
How Do They Manifest?
Personality Disorders are diagnosed when the pattern of inflexible thinking, emotion, relationship, and impulse control is enduring, persistent, and occurs in many personal and social situations. Intense and significant distress is also a diagnostic criterion, negatively affecting social functioning (social isolation, inability to form relationships, exaggerated behaviors in relating to others), occupational functioning (work performance begins to suffer due to this type of functioning), among other areas of life.
It's natural for people with these difficulties to feel judged or looked at differently by others since they deviate from social expectations and conventions, often with significant distress associated.
Many individuals with Personality Disorders use compensatory strategies to deal with their emotions and suffering. These strategies include behaviors to alleviate psychological distress, such as substance use, dysregulated patterns in relating to others (excessive isolation or excessive closeness), self-harm, compulsive rituals, and aggressive or manipulative communication styles.
What Are the Possible Causes and Risk Factors?
Dysfunctional family relationships, abuse, or neglect (both physical and emotional), and a lack of defined rules and boundaries tend to lead to traits of Personality Disorders. In addition to the environmental and relational aspects, neurobiological and hereditary factors play a role in the development of certain Personality Disorders, such as Obsessive-Compulsive or Borderline Personality Disorders.
Can They Be Associated with Other Disorders?
Personality Disorders tend to be associated with other disorders or symptoms. For example, for certain disorders like Paranoid and Schizoid, exposure to stress can trigger the manifestation of psychotic episodes. Some Personality Disorders may appear as precursors to other disorders such as Schizophrenia or Delusional Disorder. The presence of a Personality Disorder increases the risk of developing other disorders such as Major Depressive Disorder and Anxiety Disorder. The development of secondary disorders, especially eating and substance use disorders, which are based on an individual's attempt to compensate or cope with the effects of their Personality Disorder, is not uncommon. Overlapping different Personality Disorders with each other is also quite common.
What Is the Prevalence?
The prevalence of Personality Disorders varies by cultural and ethnic background. Studies suggest an incidence of 10% to 13% of Personality Disorders in the general population, with a slightly higher prevalence in urban areas, single individuals, and the unemployed, and lower prevalence in the elderly population. Dependent Personality Disorder is the most common and tends to be more prevalent in women, which may be due to a higher demand for help in managing this disorder among women.
How Can Psychotherapy Help?
The characteristics associated with Personality Disorders differ in their stability and potential for change. While personality traits are relatively stable, there are several aspects associated with Personality Disorders that are amenable to change through psychotherapeutic support, such as:
- Symptom manifestations
- Interpersonal patterns
- Maladaptive thinking patterns
- Attitudes toward oneself, including self-esteem
In addition to modifying some of the more malleable aspects, psychotherapy can help individuals adapt to their more stable and structural characteristics. This may involve attenuating extreme expressions of problematic traits and promoting healthier alternatives for expression.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association.
Barlow, D. H, (2007). Clinical Handbook of Psychological Disorders. (4th Ed) A Step-by-Step Treatment Manual. New York: Guilford.
J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed.). (2005). New York: Oxford University Press.
Livesley, W. J., Dimaggio, G., & Clarkin, J. F. (Eds.). (2016). Integrated treatment for personality disorder: A modular approach. The Guilford Press.
Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (2004). Personality Disorders in Modern Life (2nd ed.). Hoboken, NJ: Wiley.
Norcross, J. C. (Ed.). (2011). Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd ed.). New York: Oxford University Press.