A person’s personality is a fixed repertoire of traits and behaviors that persists throughout life. Personality may change subtly, for example, in response to emerging new social roles, but its basis, developed in the process of maturation, remains the same. Appear during childhood and adolescence inadequate conditions for development, healthy relationships with caregivers, or some traumatic events occur, then personality disorders can arise. These disorders make the woman affected by them not function properly in society, often being destructive to herself as well as those around her. Where do personality disorders come from? How can they be diagnosed? What are the effective treatments for personality disorders?
Personality disorders – what are they?
Personalitydisorders refer to a person’s dysfunctional character traits – his way of forming relationships with others, patterns of behavior and general functioning in society. Personality disorders are also linked to the way a person perceives himself and others. They hinder school, family and work life and are associated with the patient’s perceived suffering associated with these areas of life. Often, due to unhealthy behavior patterns, a person with a personality disorder is unable to educate and develop in any area of life.
There is no single behavioral model for a person with a personality disorder. Depending on the type of disorder present in a person, problems with particular areas of life may occur in varying degrees of severity. Unlike healthy people, a person with a personality disorder does not show behavioral flexibility in various social situations, and his limited, rigid behavioral repertoire, different from the standard accepted in a given culture, often makes such a person perceived by others as hostile and alien.
What distinguishes personality disorders from other mental problems is their permanent nature. Personality disorders do not come in the form of isolated crises that have a beginning and an end, but are part of the person who struggles with them. Personality disorders can often be said to have been around “forever,” as they are formed during childhood or adolescence. Due to their permanent nature, personality disorders are not easy to diagnose and treat, but with properly conducted therapy, such as schema therapy, unfavorable behavioral patterns can be replaced with healthy counterparts and thus improve the patient’s quality of life.
Causes of personality disorders
The causes of personality disorders are divided into genetic and psychosocial factors. They appear in late childhood, adolescence or early adulthood, but researchers identify their causes in the process of socialization in childhood.
Personality disorders can contribute to the onset of personality disorders:
- unhealthy family relationships
- neglect or rejection by caregivers
- lack of a sense of security
- lack of assimilation of social norms and rules for functioning in various social roles
The onset of personality disorders can also be influenced by school upbringing. A factor that is also slightly responsible for the onset of social disorders is an individual’s temperament.
It is worth remembering that not everyone in whom the above-mentioned unfavorable socialization processes take place will develop personality disorders. Any such person in the process of maturation may also manifest constructive ways of coping with the difficulties encountered in life, which is why the diagnosis of personality disorders usually appears only in adulthood.
Diagnosis of personality disorders-symptoms
There is no single set of symptoms characteristic of personality disorders, and there are no specific symptoms of personality disorders. These disorders are divided into several types, each of which is diagnosed based on different guidelines. It is worth knowing that a single person can have several types of personality disorders at once. Below we briefly describe each type of personality disorder, along with a brief indication of the most important symptoms. Remember, however, that a diagnosis of personality disorders cannot be made on your own, as only a specialist can make a diagnosis based on a detailed examination of the patient.
Personality disorders of what type? Borderline personality, dependent personality
Personality disorders are divided into 10 types and described in detail in the ICD-10 classification created by the World Health Organization. This classification is used to diagnose all diseases. There is also the DSM-5 classification, which focuses only on diagnosing mental problems.
Types of personality disorders according to the ICD-10 classification
- Paranoid personality – suspiciousness, belief in conspiracy theories, hypersensitivity about oneself, distrust. A person with this personality disorder is certain that others want to take advantage of him and harm him.
- Schizoid personality – loners, unable to form social relationships, perceived as cold and withdrawn. Often relationships are indifferent to these people, they also show no interest in sexual contact with others, and are not sensitive to criticism or praise from others.
- Antisocial (dissocial) personality – lack of anxiety and learning from experienced punishment. In the case of dissocial personality, there is a disregard for social norms and the feelings of others. People with this disorder, do not feel shame, have no sense of guilt, do not take responsibility for their own behavior. They may be accompanied by destructive and aggressive actions.
- Emotionally unstable personality. In the impulsive subtype, the main features are emotional instability, explosiveness, lack of control over one’s own behavior along with a hostile attitude toward others. In the borderline subtype (borderline or borderline personality type), among others: inconsistency of one’s own identity, unstable relationships with others, avoidance of rejection at all costs, frequent, jealousy and intense mood changes.
- Histronic personality – theatricality of gestures and speech, constant attention seeking and need to be the center of attention, forming shallow relationships, excessive focus on appearance. People with this type of personality disorder often provoke with extreme opinions or inappropriate sexuality in order to be the center of attention.
- Avoidant (anxiety) personality – is manifested by an unwillingness to enter into close relationships with other people. People with this type of disorder are hypersensitive about themselves and take criticism and rejection badly. They live in constant tension, focus on ensuring their own safety, and feel unattractive in every area of life.
- Dependent personality – is characterized by excessive submissiveness and passivity. Such a person willingly gives responsibility for his life to others, avoids risk and rejection, and maintains social relationships at all costs, even at the expense of his needs.
- Obsessive-compulsive personality – excessive attachment to rules, perfectionism in every area of life, inability to express emotions, often stinginess. Such people are unable to experience spontaneous joy, and are unable to adapt flexibly to change.
Personality disorders according to the DSM-5 classification
The DSM, an abbreviated word for“Diagnostic and Statistical Manual of Mental Disorders,” is a system for classifying and diagnosing various types of mental disorders. The DSM is developed by the American Psychiatric Association and serves as an important tool for mental health professionals to diagnose and treat patients.
The basic classification categories (groups of personality disorders) in the DSM-5 are:
- Neurocognitive disorders, includes disorders such as Alzheimer’s disease and others associated with cognitive impairment.
- Psychotic disorders, includesschizophrenia, schizoaffective disorder, substance-related psychotic disorders and others.
- Mood disorders, includes depression, CHAD bipolar disorder, substance-related mood disorders and others.
- Anxiety disorders, includes disorders such as generalized anxiety disorder, social phobias, obsessive-compulsive dis order and many others.
- Obsessive-compulsive and related disorders, focuses on obsessive-compulsive disorders such as obsessive-compulsive disorder, movement body disorder and others.
- Somatization and somatic symptom disorders, deals with disorders in which somatic symptoms play a large role, such as somatization disorder and hypochondria.
- Substance use disorders, includes psychoactive substance addiction and other substance use problems.
- Eating and related disorders, refers to disorders such as anorexia, bulimia, compulsive overeating dis order and others.
- Sleep and substance abuse disorders, focuses on sleep problems such as insomnia, substance-related sleep disorders and others.
- Sexual disorders, includes disorders such as erectile dysfunction, sexual desire disorders, orgasmic dis orders and more.
- Dissociative disorders, refers to disorders related to cognitive splitting, such as dissociative amnesia, dissociative identity disorder and others.
The aforementioned classification also includes unspecified disorders and mixed personality disorders. Meanwhile, the DSM-5 classification divides personality disorders into 3 groups:
- Group A – eccentricity and non-relationality. This group includes paranoid and schizoid personalities.
- Group B – disorders based on intense and turbulent emotions. Here we list antisocial personality , histronic personality , narcissistic personality and borderline disorder.
- Group C – a category based on lack of relationships, anxiety and stress avoidance. This group includes dependent personality, avoidant type personalities and obsessive-compulsive personality.
The latest ICD-11 classification
The main intent of the ICD-11 is to systematize a comprehensive listing of mental disorders while facilitating the diagnosis process. ICD-11 abandons a classification based on 10 types for personality disorders. The key change in the new classification system is primarily to focus the diagnostic process on identifying the presence of a disorder and its severity. According to the new criteria, an impaired behavioral pattern, co-occurring with difficulties in personal, occupational and social functioning, should be present for at least two years in order to be diagnosed.
The latest ICD – 11 classification changes the way we think about personality disorders, the severity of severity is assessed – from mild to severe.
| Mild personality disorder | Moderate personality disorders | Severe personality disorders |
| Impaired in only some areas of personality functioning, e.g., problems with self-direction in the absence of problems with self-consistency and stability. | Disorder affects some areas of personality functioning e.g. identity, self-esteem. | There is severe dysfunction of the self, no sense of who one is, high vacillation or rigidity. Often contempt for oneself. |
| There are problems in some social relationships and/or professional roles. | There are clear problems in most interpersonal relationships. | Problems in interpersonal functioning seriously affect virtually all relationships. |
| Usually not associated with significant harm to self or others. | Sometimes involves harm to self or others. | Often involves harm to self or others. |
| Specific personality disorder symptoms tend to be mild in severity | Specific personality disorder symptoms are generally of moderate severity. | Specific personality disorder symptoms are severe affecting most, if not all, areas of personality functioning. |
Who diagnoses personality disorders?
Personality disorders are usually diagnosed by qualified specialists in psychiatry, clinical psychology or psychotherapy. The diagnosis of a personality disorder is made by a psychologist, psychotherapist or psychiatrist, often in collaboration with a psychologist, based on a detailed medical history. At the outset, it is necessary to exclude other diseases and disorders, including somatic diseases such as brain damage that can give similar mental symptoms. Sometimes relatives are also interviewed to diagnose the patient. Diagnostic interviews psychological tests are also used helpfully in making the diagnosis
MMPI diagnostic tool for personality disorders
MMPI stands for“Minnesota Multiphasic Personality Inventory.” It is one of the most popular and widely used psychological tests that is used to assess personality and identify various aspects of psychopathology in patients. The MMPI is a diagnostic tool that assesses a number of different aspects of personality, such as emotional traits, social behavior, anxiety levels, depression levels, obsessiveness, hypochondria and many others.
Treatment of personality disorders. How can personality disorders be treated?
The treatment of personality disorders is tailored to the individual patient and the severity of his symptoms. The most commonly used method of treatment is psychotherapy in a stream that is appropriately matched to the patient. In the case of severe symptoms, such as anxiety, the doctor may also temporarily implement pharmacological treatment, but the main axis of work on the problem is psychotherapy. Pharmacotherapy, however, is not enough in the treatment of personality disorders, there are no drugs that treat personality disorders, giving long-term effects after stopping taking them.
The goal of working with personality disorders is to implement healthy and supportive behavior patterns and learn to control one’s reactions, thereby increasing emotional stability. In some cases, social skills training and other forms of group therapy are also recommended for personality disorders.
Treatment of personality disorders is not easy, but is possible with the development of an appropriate therapeutic relationship and patient commitment. Often, patients do not come to a specialist with a personality disorder problem, but only when there is a clear mental crisis, for example, in the form of depression, so treatment may involve several conditions at once and thus its duration may be prolonged. Often in such a case, the start of psychotherapy is possible only after the patient’s symptoms have been stabilized with medication.
Treatment of personality disorders in cognitive-behavioral therapy (CTB)
Cognitive-behavioral therapy (CBT) is a therapeutic approach that focuses on changing a patient’s thoughts, beliefs and behaviors to improve emotional and psychological functioning. The therapy should be tailored to what personality disorder the patient is struggling with and whether it is accompanied by other psychological problems. This type of therapy is based on active measurement of the problem and a clear structure of action. It is focused on solving the patient’s problem. It also emphasizes psychoeducation, so that the person with the disorder understands exactly where the problem lies and how it can be eliminated.
During therapy, the patient learns to identify negative beliefs and then replace them with correct, healthier forms. Central to this type of therapy are homework assignments, or work to be done between meetings with the therapist. They allow the patient to confront the information learned in the office with everyday life and consolidate positive ways of dealing with difficulties.
Treatment of personality disorders in schema therapy
Schema therapy is a therapeutic approach developed by Jeffrey Young that focuses on working with established thought and emotional patterns that affect a patient’s functioning. Schema therapy is particularly effective in treating personality disorders, which are often associated with deeply ingrained thought and emotional patterns. Schemas are patterns of thoughts, behaviors and felt emotions learned through the process of socialization. Schemas are not a bad thing, as long as they are healthy patterns. In personality disorders, however, many maladaptive schemas develop, which can be healed, thanks to schema therapy. Schemas are activated by emotional states and are independent of each other. Depending on the emotions felt in a given situation, one may “activate“ a different mode within oneself in response to the same event.
Schema therapy is based on the assumption that although there has been a change in response to external stimuli – a change in the behavior of the person being treated – this does not mean that a change has also occurred in that person’s emotions. Accordingly, schema therapy also focuses on the emotional layer of the disturbed person and the causes of the disorder. Although it is a fairly new method of psychotherapy, its origin can be found in the well-studied cognitive-behavioral therapy and Gestalt therapy.
Schema therapy will especially help people with narcissistic, histrionic and borderline personality disorders. It will allow the patient’s emotional needs to be met, thereby interrupting the re-creation of maladaptive patterns. An important factor facilitating the achievement of goals in schema therapy is the therapeutic relationship. A person who reaches for schema therapy in personality disorders, has the chance to learn to form healthy, deep and stable relationships with others, control his reactions and meet his emotional needs independently.
You can free yourself from personality disorders
It’s not easy to fight a personality disorder, but it’s worth the work and free yourself from its symptoms as soon as possible. By choosing to work on yourself with a therapist, you are assured that you will be professionally guided through every stage of psychotherapy, even the most difficult ones, and thus increase your chances for a healthy, happy life in the future. Psychotherapy will allow you to successfully part with harmful ways of acting due to personality disorders and develop new and better patterns of behavior. Remember that at any age you can successfully fight for your well-being!
Bibliography:
R. Davis, L. Escovar (2005) “Personality disorders in the modern world”
J.Morrison (2016) “DSM-5 without secrets. A practical guide for clinicians”
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1908-3#Tab4