Be aware of personality disorders

by Harshani A. Pinnawala

Though most people are unaware of personality disorders, it does not mean that it is uncommon among us. This is the most increasing disorder worldwide which people pay less attention to. people keep growing and changing throughout their lives.Some people adjust their lives successfully in the life cycle and some are unable to do so.The people who are unable to adjust, go through a lot of difficulties. They may become patients at one point of time.

Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviour that the American Psychiatric Association (APA) defines as "an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the individual who exhibits it".

Based on the basis of similarities among disorders, it's grouped into three clusters. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B includes histrionic, narcissistic, antisocial and borderline personality disorders. Cluster C. includes avoidant, dependent and obsessive-compulsive personality disorders.

Patient with 'Paranoid Personality Disorder' have a pervasive suspiciousness and distrust of others. They tend to find mistakes in others instead of finding faults in themselves. They often doubt about the loyalty of friends. These patients are very hypersensitive. And they also commonly bear grudges, are unwilling to forgive perceived insults and slights, and quick to react with anger.

It's very important to know that paranoid personalities are not usually psychotic, and most of the time they are in clear contact with reality. Since these patients have pervasive suspiciousness and distrust of others, it may tend to have negative effect on interpersonal relationships.

Lack of expression

Patients with 'Schizoid Personality Disorder' usually show lack of interest in keeping social relationships. They do not keep good relationships with friends and relatives too. These patients lack expression in their feelings and try to maintain a distance from others.

They are known as loners and introverts. The majority do not take pleasure in many activities, including sexual activity.

They do appear indifferent to criticisms from others and even to praise. In short, patients with schizoid personality disorder fail to develop the need for love, belonging, approval from others or these qualities must have disappeared in the early stages of the development.

Patients with 'Schizotypal Personality Disorder' are excessively introverted and have pervasive social deficits. Also they do find difficulties in communication and behaviour. They often believe that they have magical powers and may engage in magical rituals. The prevalence of this disorder in the general population is estimated at about 3 percent.

Excessive attention-seeking behaviour and emotionality are the characteristics of patients with 'Histrionic Personality Disorder'. These patients tend to feel unappreciated if not the centre of attention, and their lively and dramatic styles ensure that they can charm others when it's necessary. In this case the patient's appearance and behaviour are of quite emotional and theoretical as well as sexually provocative and seductive. Their style of speech is dramatic and impressionistic, but also lack in details.

These kinds of patients are often highly suggestible and consider relationships to be closer than they are. Their sexual adjustment is usually poor and their interpersonal relationships are not in good terms since they try to control their partners. These patients are considered to be self-centred and over concerned about the approval of others.

The prevalence in the general population is estimated at 2 to 3 percent and this is more common in women than men.

Patients with 'Narcissistic Personality Disorder' show an exaggerated sense of self-importance, a pre-occupation with being admired, and a lack of empathy for the feelings of others.

Patients with 'Anti-Social Disorder' continually violate and show deceitful, aggressive, or anti-social behaviour without loyalty to anyone. These patients tend to be impulsive, irritable, and aggressive. According to many researchers this pattern of behaviour occurs since the age of 15, and before 15. Some patients with anti-social personalities have enough intelligence and social charm to devise and carry out elaborate schemes for conning a large number of people. This is a disorder which is more common in men than women, with a lifetime prevalence of about 3 percent in men and about 1 percent in women.

Patients with 'Borderline Personality Disorder' (BPD) show an impulsive and instable behaviour in interpersonal relationships, self-image and moods. This disorder has a long confusing history. People with BPD show serious disturbances in basic identity. They have highly unstable interpersonal relationships, self-image and moods. They tend to have a low tolerance for frustration and chronic feeling of emptiness. Therefore they prefer to be alone. Self-injurious behaviour and suicide attempts are often among them. BPD patients are usually aware of surroundings, they may relatively appear to be out of contact with reality and may experience delusions, hallucinations and paranoid beliefs.

Individuals who suffer from 'Avoidant Personality Disorder' have a pattern of extreme social inhibition and introversion leading to limited social relationships and social interactions. They fear criticism, but seek affection from others. They do not enjoy their aloneness. They tend to have low self-esteem and excessive self-consciousness. Several researches suggest that avoidant personality may be a biologically based disorder starting from infancy or childhood that is reinforced by environmental factors.

Extreme dependence

Individuals with 'Dependent Personality Disorder' show extreme dependence on other people, specially the need to be taken care of, which leads to a submissive behaviour. They feel uncomfortable in separations' and often try to be alone. These individuals do not get angry with other people due to the fear of losing their support. They lack self-confidence and are helpless even when they have good work skills and other competencies. These individuals function well when they are not on their own and they let others to take major decisions in their lives. They appear "selfless" and bland, because they feel that they don't have any right to express their feelings.

Perfectionism and an excessive concern with maintaining order are the two major characteristic in 'Obsessive Compulsive Personality Disorder' (OCPD). These individuals are very careful with what they do, as not to make mistakes, and they will check for possible mistakes. They hardly go for leisure activities and have difficulty in relaxing or doing anything for fun. These individuals have difficulty getting rid of old and worn out household items and are quite stingy or miserly.

There are two extra personality disorders which have been found recently. One is 'Passive Aggressive Personality Disorder'. This is a very controversial disorder. Individuals with this disorder show a pervasive pattern of passive resistance to demands in social or work situations. They do have a negative attitude towards everything. They complain of being misunderstood and unappreciated. And at the same time highly critical or scornful of authority.

The second category is 'Depressive Personality Disorder'. Here, individuals show a pattern of depressive behaviour that begins in early adulthood and is pervasive in nature.

Their mood is always unhappy and they tend to feel inadequate, worthless, or guilty.

Personality disorders may occur due to several reasons. It can be due to biological factors, psychological factors and socio-cultural factors. Personality traits are heritable and there is evidence for genetic contributions to certain personality disorders. But at the same time we need to keep it in mind that none of the personality disorders is heritable and none can be understood properly from a biological perspective.

'Early learning experiences' play a major role in personality disorders. Several studies suggest that abuse and neglect in childhood may be related to the development of certain personality disorders. Nature of stress also plays a major role here.

Having many personality disorders makes it harder to treat the patients. This may be due to difficulties establishing good therapeutic relationships with their therapist and patients, which tend to terminate prematurely. And also they seldom come to the attention of mental hospitals or clinics.

Some may participate in rehabilitation programs in penal institutions, but it rarely changed them. Even if more or better therapeutic facilities were available, effective treatment would still be a challenging task. And also patients find it unable to trust, to feel as others do, to learn from experience, and to accept responsibility for one's actions.

In addition, the therapist may believe that the patient may attempt to manipulate them, and that the information provided about the patient's life is not exactly true and incorrect.Cognitive-Behaviour therapists have developed multifaceted techniques that appear to offer some promise of more effective treatment.

The common targets of cognitive-behaviour treatment includes improving social skills, increasing self-control, increasing social perspective-taking, increasing self-critical thinking, victim awareness, anger management, changing anti-social attitudes, curing drug addiction, reducing contacts with anti-social peers, improving positive interactions with nonanti-social peers, interpersonal problem solving and improving vocational competencies.

The writer holds a BA and MSc in Psychology, Bangalore University.