Personality Disorders

Overview


Definition

What is a Personality?

A personality consists of enduring patterns of perceiving, relating to, and thinking about the environment and oneself, that are exhibited across numerous social and personal contexts. It is a set of stable, predictable emotional and behavioral traits.

What is a Personality Disorder?

An enduring pattern of inner experience and behavior that markedly deviates from the expectations of the individual's culture. It must be inflexible and pervasive, stable (tracing back at least to adolescence or early adulthood), and result in clinically significant distress or functional impairment.

Not better explained as a manifestation of another mental disorder, or attributable to the effects of a substance or medical condition.

Criteria (2 or more):

  1. Altered cognition (trouble perceiving and interpreting self, other people, or events)

  2. Altered affectivity (range, intensivity, lability, and appopriateness of emotional response)

  3. Changes in interpersonal functioning

  4. Impaired impulse control

Personality disorders are egosyntonic (not perceived by the individual to be disruptive). Behavior, values, feelings, needs, goals, and ideal self-image are in perceived to be perfect harmony. This means that these individuals have little insight into there being a problem, even when things are actually out of balance.

Types

The DSM-V includes 10 personality disorders grouped into 3 clusters based on descriptive similarities.

Clusters:

  1. Cluster A ("MAD")

    1. Familial association with psychotic disorders

  2. Cluster B ("BAD")

    1. Familial association with mood disorders

  3. Cluster C ("SAD")

    1. Familial association with anxiety disorders

Cluster A Disorders

"Odd/eccentric":

  • Schizotypal Personality - unusual thoughts, perceptions, and behaviors

  • Schizoid Personality - prefers to be a loner, detached, unemotional

  • Paranoid Personality - suspicious, distrustful, hypervigilant

Cluster B Disorders

"Dramatic/erratic":

  • Histrionic Personality - superficial, theatrical, attention-seeking

  • Borderline Personality - chaotic relationships, abandonment fears, labile mood, impulsivity, inner emptiness, self-harm

  • Narcissistic Personality - grandiosity, lack of empathy

  • Antisocial Personality - disregard and violation of the rights of others

Cluster C Disorders

"Anxious/fearful":

  • Avoidant Personality - avoidance due to fears of criticism and rejection

  • Dependent Personality - submissive, clingy, needs to be taken care of

  • Obsessive Compulsive Personality - rigid, controlling, perfectionistic

Management

Approach to Management:

  1. Align with the patient (let patients feel trusted and secured)

  2. Check countertransference

  3. Establish goals of treatment

  4. Introduce idea of psychotherapy (usually most helpful)

    1. Psychodynamic psychotherapy is intended to help the patient change by transforming an ego-syntonic to an ego-dystonic state by helping identify and address the manner in which a personality style is maladaptive.

  5. Consider adjunctive pharmacotherapy (as last resort) for target symptoms

    1. Used to treat biological dimensions of personality that may respond to medication (e.g. aggression, impulsivity, anxiety, depression, and psychosis)

Distinctions

Unlike dependent personality disorder, the sense of inadequacy experienced by individuals with avoidant personality disorder leads them to avoid, rather than seek out, close relationships.

Individuals with borderline personality disorder and dependent personality disorder fear abandonment. However, in BPD, this fear is accompanied by emotional reactivity, anger, splitting, and dangerous impulsivity (including suicidal threats or acts), rather than clinging and submissive behavior.

Theories of Personality

  • Sigmund Freud believed that personality traits were the product of fixation at particular stages of psychosexual development.

  • Wilhelm Reich suggested that personality arose from the particular pattern of defense mechanisms (unconscious mental processes the ego uses to resolve conflict and thereby reduce anxiety and stress).

Resources