Personality Disorders Diagnosis

  • Diagnosis

    People with personality disorders have inflexible behaviors that interfere with their ability to function in society.

    Personality is a combination of lasting emotional and behavioral traits. Usually a person's personality is established by the end of adolescence, and persists throughout adult life. People with personality disorders—an estimated 9% to 10% of the population—have extremely rigid behavioral patterns. Their rigid behavior impairs their ability to function or get along with others, and causes them emotional distress. People with personality disorders are said to regard their behavior as being right and normal despite distressing feedback from others. People with a personality disorder often believe that other people are responsible for their problems.

    There are three types of recognized personality disorders: odd-eccentric, dramatic, and anxious-fearful. People with odd-eccentric personality disorders tend to withdraw socially and detach themselves from others. They are often suspicious, distrustful, and uncomfortable with close relationships. This group includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

    People with dramatic personality disorders are emotionally intense and unstable, and exhibit impulsiveness, irritability, and aggression. They are manipulative, demanding, and self-centered in their relationships with others. Although they often lack the ability to empathize with others' concerns, they are very sensitive to slights and withdrawal of attention, and often respond with anger, anxiety, or depression that is disproportionate to the situation. Histrionic, narcissistic, antisocial,and borderline personality disorders all fall into this category.

    People with anxious-fearful type personality disorders have overwhelming fear of rejection or social disapproval. They usually deal with these concerns through avoidance, submission, or by being very self-controlled or inhibited. Avoidant, dependent, and obsessive-compulsive personality disorders fall into this category.

    Little is understood about the causes of personality disorders. Some disorders may beheritable. Temperamental factors in childhood may also be associated with personality disorders as an adult. Certain personality disorders may occur because of temperamental differences between a child and the parents. Education, moral teachings, life experiences, and adolescent socialization may also play a role. None of these possibilities, however, have been proven in scientific studies. Other factors such as physical, verbal, and sexual abuse, neglect, loss or separation during childhood, and brain abnormalities have also been cited as possible causes for personality disorders.

    Although most personality disorders appear during the teenage years, others can appear later in life as a result of physical damage to the brain, psychiatric illness, or extreme stress.

    Symptoms of personality disorder depend on the specific disorder present Table 01.

    Table 1.  Classification of Personality Disorders

    Personality disorder Features
    Odd-eccentric cluster
    Paranoid personality disorder Defensive, suspicious, distrustful, secretive, oversensitive
    Schizoid personality disorder Shy, introverted, detached, solitary, avoids interactions with others
    Schizotypal personality disorder Cognitive and perceptual distortions, tangential and circumstantial thinking, odd beliefs, suspicious, paranoid ideation, uncomfortable with social interaction
    Dramatic cluster
    Histrionic personality disorder Manipulative, seductive, provocative, excessively emotional, displays attention-seeking behavior
    Narcissistic personality disorder Self-centered, exaggerated sense of self-importance, demands attention
    Borderline personality disorder The most impaired of the dramatic cluster; affectively labile, impulsive, manipulative, sensitive to rejection, lacks self-control, may self-mutilate or attempt suicide, has highly unstable and intensive relationships
    Antisocial personality disorder Lacks empathy and remorse, disregards social norms including the law, is unable to control impulses and behavior, fails to learn from experience
    Anxious-fearful cluster
    Avoidant personality disorder Shy, lacks self-esteem, fears criticism and rejection, displays prominent social anxiety
    Dependent personality disorder Passive, defers to others, lacks confidence and self-esteem, avoids responsibility
    Obsessive-compulsive personality disorder Perfectionist, workaholic, unable to relax and enjoy spontaneous pleasures, excessively inhibited emotionally, preoccupied with issues of control over affect, thought, and action

    Paranoid personality disorder is characterized by suspiciousness and a distrust of others. A paranoid person often finds signs of insult, threat, or injury in others' most benign statements and acts. Paranoids are often secretive and mistrustful, and think that people are talking about them, staring, or laughing at them. They can respond to these feelings with anger or even aggression.

    People with schizoid personality disorder show little emotion, and appear to be detached from interpersonal relationships. People with schizoid disorder are often the “loners” of society, occupying solitary jobs and generally avoiding interactions whenever possible. Despite the similar name, these people do not have the thought disorders (hallucinations, delusions, etc.) seen in schizophrenia.

    Characteristics of schizotypal personality disorder include discomfort in social relations and tendency toward idiosyncratic thinking. Unlike other disorders in the odd-eccentric cluster, however, this disorder can manifest with thought disorders similar to those of schizophrenia. However, those with schizotypal disorders do not become schizophrenic over time.

    Histrionic personality disorder is characterized by an excessively emotional and attention-seeking style of interacting with others. People with histrionic personality disorder try to command attention though manipulation, seduction, and provocation. Their relationships tend to be mostly self-serving and shallow.

    People with narcissistic personality disorder have an extreme need for attention coupled with an overblown sense of entitlement. Narcissistic individuals have an inflated sense of importance and little appreciation for the thoughts and needs of others.

    Borderline personality disorder is the most severe of the dramatic cluster of personality disorders. People with borderline personality disorder have a well-established pattern of instability in personal relationships (which are often stormy and intense), self-image, and emotional tone. They are also very impulsive and self-damaging in their actions. They quickly shift their view of the world, themselves, and others from one extreme to another, and are seldom neutral.

    People with antisocial personality disorder have no regard for the rights and feelings of others. Antisocial personality disorder is often associated with criminality. People with antisocial personality disorder tolerate frustration poorly, which can cause them to become hostile or violent. They also exhibit a complete lack of remorse for the problems they cause others.

    People with avoidant personality disorder are often described as “painfully shy”. A person with avoidant personality disorder feels inadequate, and has a deep fear of rejection or ridicule that causes them to avoid relationships. Unlike the schizoid, the avoidant patient very much desires a close relationship, but is afraid of disapproval. Anxiety in social situations is common, and can lead to social phobia.

    Those with a dependent personality disorder have fears of rejection and abandonment. Dependent individuals also have an unrealistic fear of being unable to care for themselves, and will submit themselves to others who will take care of them. If this relationship is threatened, the dependent shows signs of severe anxiety. Dependent individuals avoid responsibility and are “born followers”.

    People with obsessive-compulsive personality disorder are reliable, dependable, and orderly, but often cannot successfully adapt to change. Obsessive-compulsive disorder patients tend be overly cautious, and analyze all aspects of a problem. This excessive caution can lead to “paralysis by analysis” in decision-making.

    Many personality disorders run in families; however, whether this occurs as a result of genetics or learned behavior is still a subject of debate.

    Gender plays a role in one's likelihood of having a particular personality disorder. Certain personality disorders (such as antisocial personality disorder) are more frequent in males, whereas others (such as borderline, histrionic, and dependent personality disorders) are seen more often in women.

    Your doctor will take a careful history to make sure that your symptoms are due to a personality disorder, and not another underlying problem. Your doctor will ask about the nature and duration of your symptoms. The doctor will also ask about childhood experiences, personality characteristics of your parents, and any difficulty you have had at work, at home, or in other settings that could have occurred as a result of your behavior. Your doctor will also want to know if you use drugs, or if you have any other co-existing conditions such as depression or eating disorders, the presence of which can make a diagnosis more difficult.

    Your doctor will look for evidence of self-harming behavior during the physical exam. Around half of female patients with bulimia also have personality disorders. In addition, about 9% to28% of people who commit suicide have personality disorders. Therefore, evidence that you have tried to harm yourself will provide further clues about the likelihood that you have a personality disorder.

    Some experts feel that noticing the symptoms in the early stages during childhood or adolescence and getting into therapy immediately may help lessen the course and severity of personality disorders; however, this possibility has not yet been proven in scientific studies.

  • Prevention and Screening

    Some experts feel that noticing the symptoms in the early stages during childhood or adolescence and getting into therapy immediately may help lessen the course and severity of personality disorders; however, this possibility has not yet been proven in scientific studies.

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