PERSONALITY DISORDERS – An overview
Keywords: Personality Disorders, Mental Disorder, Paranoid, Schizoid, Anti-social, Histrionic, Narcissistic, Borderline, Avoidant, Obsessive-Compulsive, Psychotherapy
We humans are all unique. Different in the way we think, behave, react and act in situations and in our surroundings.
In simple terms, Personality can be understood as the way one normally or typically behaves.
Example, when exposed to stress some of us want to stay aloof from the rest of the world, others may be binge-eat to destress and few others may want to talk it out with someone.
So, we all have these traits of our personality which may appear weird or uncommon. Don’t we?
But, if we all have distinctive personality traits, is the presence of uncommon traits a disorder? If not, then when will someone be called as suffering from personality disorder(PD)
The answer is, Personality disorders result when these personality traits become abnormal, that is, become inflexible and maladaptive, and cause significant social or occupational impairment, or significant subjective distress.
Also, it has been observed that more often than not symptoms of more than one personality disorder are present in one person. In fact, it is now believed that the occurrence of mixed personality disorders is commoner than single personality disorder.
These disorders interfere with everyday life and contribute to significant suffering, functional limitations, or both. They are common and are frequently encountered in virtually all forms of health care. PDs are associated with an inferior quality of life (QoL), poor health, and premature mortality. The aetiology of PDs is complex and is influenced by genetic and environmental factors. The clinical expression varies between different PD types; the most common and core aspect is related to an inability to build and maintain healthy interpersonal relationships.(2)
Much of a modern classification of these disorders is based on the works of German psychiatrist Kurt Schneider, Who was one of the earliest researchers into what was then known as psychopathy and published a treatise on the study in 1923. Today, the DSM 5 contains 10 distinct personality disorders which are classified in three clusters namely, cluster A, cluster B, and cluster C.
Cluster A comprises disorder thought to be “odd and eccentric” and on a “schizophrenic continuum”. These include Paranoid, Schizoid and Schizotypal personality disorders.
Paranoid PD patients are reported to have excessive sensitiveness, tendency to persistently bear grudges, suspiciousness, excessive self importance.
The next disorder in cluster A is the Schizoid PD. This comprises emotional coldness, lack of pleasure from activities, limited capacity to express feelings towards others, indifference to praise or criticism, little interest in sexual experiences, preference for solitary activities and no close friends.
Last is the Schizotypal PD.
This disorder is characterised as a personality disorder under DSM-IV-TR but ICD-10 does not identify it as a personality disorder.
The behavior and features are quite similar to those seen in Schizophrenia.
Features like Inappropriate or constricted affect, odd, eccentric, or peculiar behaviour, poor rapport with others and social withdrawal, odd beliefs or magical thinking, suspiciousness or paranoid ideas.
All PD of cluster A are ego-syntonic. That is, a patient has a lack of insight and is unable to perceive his or her illness.
As a result, treating these PD is quite difficult as patients do not seek treatment of their own and also resent treatment.
Cluster B is a set of disorders considered “dramatic, emotional and erratic” and on a “psychopathic continuum”. These include Antisocial (or Dissocial), Histrionic, Narcissistic and Borderline (or Emotionally Unstable) personality disorder.
Antisocial or Dissocial PD, as the name suggests, has features like unconcerned for the feelings of others, gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations, incapacity to maintain enduring relationships, very low tolerance to frustration and a low threshold for discharge of aggression, incapacity to experience guilt and to profit from experience, particularly punishment, and marked proneness to blame others.
Persistent irritability and history of conduct disorder in childhood and adolescence is also seen in some cases.
Disorder is most commonly seen in males and many criminals and serial killers are in fact sufferers of anit-social PD. Patients don’t usually seek help unless pushed by legal authorities.
Next PD belonging to this cluster is the Histrionic PD. It is characterised by self-dramatisation and exaggerated expression of emotions, continual attention seeking attitude, inappropriate seductiveness, and over-concern with physical attractiveness.
There may also be other associated features like egocentricity, getting easily hurt, constant need for appreciation, and attempting to look charming and seductive.
This disorder is common among females and earlier it was thought to be associated or a predisposition to dissociative or conversion disorder.
A very important as well as well-known PD belonging to cluster B is the Narcissistic PD,
a new concept but it has gained popularity very quickly even among the common people. Ideas of grandiosity and inflated sense of self importance, preoccupation with fantasies of unlimited success, attention seeking, dramatic behaviour, needs constant praise, and is unable to face criticism, lack of empathy with others, with exploitative behaviour, shaky self-esteem, underlying sense of inferiority, easily depressed by minor events as some of the important features of narcissistic PD.
Perhaps the most studied of all PDs is the Borderline PD. The last PD from B cluster.
True to its name, in this personality disorder there is marked impulsivity and instability.
This is mainly known as emotionally unstable personality disorder. This disorder is further characterised by two types: impulsive type (impulsivity is the hallmark feature) and borderline type (emotional instability is the hallmark feature). The borderline type is more specifically referred to as borderline personality disorder. Well known characteristics of Borderline PD are anger outbursts, feeling of emptiness and boredom, attempts to self harm and suicidal gestures,there is instability in personal relationships, and impulsiveness.
Lastly, Cluster C has disorders considered “anxious and fearful” and characterised by “introversion”. These include Anxious (Avoidant), Dependent and Obsessive Compulsive (or Anankastic) personality disorders.
First PD in this group is an epitome of what is often called inferiority complex. It is Anxious (avoidant) PD. There is persistent and pervasive feelings of tension and apprehension, belief that one is socially inept, personally unappealing, or inferior to others, excessive preoccupation with being criticised or rejected in social situations, restrictions in lifestyle because of need to have physical security, and avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism or rejection.
Second is the Dependent PD.
This comprises of symptoms like allowing others to make decisions for them, subordination of one’s own needs to those of others and undue compliance with their wishes, unwillingness to make even reasonable demands on the people one depends on, feeling uncomfortable or helpless when alone, preoccupation with fears of being abandoned by a person with whom one has a close relationship, and limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.
Last of all PDs is the Obsessive compulsive PD. This is most commonly identified in males and is common in the premorbid personality of patients with obsessive compulsive disorder.
Sufferers of this PD have feelings of excessive doubt, preoccupation with details, perfectionism that interferes with task completion, excessive conscientiousness, excessive pedantry and adherence to social conventions, rigidity and stubbornness, unreasonable insistence that others submit to exactly their way of doing things.
Such patients usually have an insight and seek treatment on their own. Supportive therapy or group therapy is quite helpful.
PD can significantly disrupt the lives of both the affected person and those who care about that person. As already mentioned, most of these disorders affect the relationships of a patient. They may also cause significant morbidity in terms of work, studies etc. The fact that they are ego-syntonic only adds up to the trouble.
Nevertheless, PDs are a fascinating study and each PD has mysteries that still need to be unravelled.
About the Author
Dr. Sarah Malik
Currently pursuing MD ( part-2) in Psychiatry from Bakson Homeopathic Medical College and Hospital, U.P.
BHMS – Nehru Homeopathic Medical College and Hospital, DU.
Avid reader, blogger and passionate about mental health.
- Ahuja Neeraj. A short textbook of psychiatry.Jaypee Brothers Med Pub.7th ed;2011.
- Ups J Med Sci. 2018 Dec; 123(4): 194–204.Published online 2018 Dec 12. doi:10.1080/03009734.2018. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327594/#__ffn_sectitle
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