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Mental Health Tips > Personality disorder

Personality disorder
(Special thanks to Dr. Mimi Wong of Institute of Mental Health, Castle Peak Hospital, for authoring this article)

The personality of a person represents his characteristics and attitude. Our personality is formed and will become more obvious when we have reached late adolescence. Everyone has a different personality; some personality makes us more popular while some may result in difficulties when relating to other people. If someone’s personality has persistently caused a lot of trouble in relating to others and in controlling his own emotion and behaviour, thus making the person and people around him suffer, this condition is referred as personality disorder in psychiatry.

Personality disorder is a real problem and patients with this disorder deserve help and treatment. If you notice yourself or someone around you have personality problem, it is important to seek help as early as possible.

 
1. What is personality disorder?
2. How common are personality disorders?
3. What are the causes of personality disorder?
4. What are the kinds of personality disorder?
5. What are the characteristics of different kinds of personality disorder?
6. How to investigate and make diagnosis for personality disorder?
7. What are the treatments for personality disorder? 8. Do personality disorders change with time?



1. What is personality disorder?

‘Personality’ refers to the collection of characteristics or traits that makes each of us an individual. These include the ways that we think, feel and behave. By our late teens, or early 20s, most of us have developed our own personality under the influence of genetic and environmental factors. We will have our own distinctive ways of thinking, feeling and behaving. It remains pretty much the same for the rest of our life. Parts of our personality may develop in a way that makes it difficult for us to control our feelings or behaviour, to keep relationships, get on with friends, family or people at work, and keep out of trouble. As a result, the person is distressed and find that he often upsets or harms other people, then he may have a personality disorder. It can be difficult to learn from experience and to change those traits. Having a personality disorder makes life difficult, so other mental health problems (such as depression, or drug and alcohol problems) are also common.

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2. How common are personality disorders?

According to a large survey in the United States, around one in ten persons in the community have a personality disorder. Many people with personality disorders were also suffering from other major mental disorders.

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3. What are the causes of personality disorder?

There is no definite answer but similar to other mental illnesses, it may be associated with a number of causes which include genetic factors and defects in the brain. Some people with antisocial personality disorder have very slight differences in the structure of their brains, and in the way some chemicals work in their brains. However, there is no brain scan or blood test for a personality disorder.

The upbringing of a person also plays a role. The chance that someone will develop personality disorder will increase if he has been physically or sexually abused in childhood. Relationship with parents is also important and may affect the ability to develop relationship with other people when they have grown up. Discipline which is too strict, too loss or inconsistent may have harmful effect on personality development of a child.

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4. What are the kinds of personality disorder?

Personality disorders can be divided into three groups, according to their emotional “flavor”. They are “Suspicious”, “Emotional and impulsive” and “Anxious” personality disorder. A person may have more than one type of personality disorder at the same time. For example, he may be suspicious and impulsive, these two personalities have brought him a lot of distress. As you read through the descriptions of each type, you may well recognise some aspects of your own personality. This doesn't necessarily mean that you have a personality disorder. Some of these characteristics may even be helpful in some areas of your life. For example, an optimal level of perfectionism makes us more serious at work. Histrionic trait improves the performance of an artist. Someone with narcissistic personality makes a better leader. However, if you do have a personality disorder, these aspects of your personality go to extreme. They may spoil your life, and often also the lives of those around you.

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5. What are the characteristics of different kinds of personality disorder?

A) 'Suspicious' type
It includes paranoid, schizoid and schizotypal personality disorders.

Someone with paranoid personality disorder is always suspicious and feels that other people are being nasty to him. He tends to hold grudges and it is common for them to lodge complaint against others. It may develop into a delusional disorder.

For schizoid personality disorder, the patient will be emotionally 'cold'. He doesn't like contact with other people and prefers his own company. He has a rich fantasy world and is not interested in any form of interaction with others.

Those with schizotypal personality disorder have eccentric behaviour and odd ideas. They may have inappropriate emotional reactions and can see or hear strange things. It is related to schizophrenia.

B) 'Emotional and impulsive' type
It includes antisocial, borderline, histrionic and narcissistic personality disorders.

Someone with antisocial personality disorder doesn't care about the feelings of others and he is unable to learn from his mistakes. His impulsiveness, low frustration tolerance and aggressiveness largely increase his chance of committing crimes. Therefore it is commonly found in the prison population.

Someone with borderline personality disorder feels empty and feels bad about himself. He makes relationships quickly, but easily loses them. He has difficulty controlling his emotions and often harms himself. When stressed, he may hear noises or voices. It presents like a mood disorder as well as a psychotic disorder, therefore it is difficult to classify it in the past. It receives the name of borderline because it seems to lie between the borders of two disorders.

A person with histrionic personality disorder shows strong emotions which changes quickly. He is self-centered and tends to over-dramatise events. He worries a lot about his appearance and craves new things and excitement.

For narcissistic personality, the person has a strong sense of own self-importance. He dreams of unlimited success and power. He tends to exploit others.

C) 'Anxious' type.
It includes obsessive-compulsive, avoidant and dependent personality disorder. These patients will have a higher chance to develop anxiety disorders.

Someone with obsessive-compulsive personality disorder worries and doubts a lot. He is a perfectionist whom always needs to check that he has not made any mistake. He often has high moral standards and requires people around him to follow his standards. This causes distress to others.

For avoidant personality disorder, the person is very anxious and feels insecure and inferior. He is extremely sensitive to criticism. He is not only shy. He would hide away from social interaction unless he is sure that he will be accepted.

A person with dependent personality disorder has to rely on others to make their own decisions. He find it hard to continue his life if he is left on his own, therefore he will do what other people want him to do. He easily feels abandoned by others.

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6. How to investigate and make diagnosis for personality disorder?

Accurately diagnosing someone with personality disorder is not an easy task as the psychiatrist needs to get hold of a lot of information about the life history of the patient. From the history, the psychiatrist has to confirm that the patient is having problem with human relationships, at work and with the society as a result of his personality and to identify that such pattern keeps on repeating. Information from those who have known the patient for more than ten years is particularly helpful in making the diagnosis. Other records like criminal records and job records which indicated frequent change of jobs are also helpful in identifying the problems encountered by the patient as a result of the personality disorder.

Other than clinical assessment performed by the psychiatrist, some personality assessment tools can be used to facilitate confirmation of the type of personality disorder.

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7. What are the treatments for personality disorder?

Treatments for people with personality disorders include psychological treatment and medication treatment. Psychological treatment involves talking and listening. It changes the core beliefs and unhelpful patterns of thinking of the patient. It also improves the patient’s problem solving skills and ability to control emotions. It may be performed individually or in groups. Group therapy has the advantage of training the social skills of the patient. For medications, low dose of antipsychotic drugs can help to reduce suspiciousness. Antidepressants can help with the mood and emotional difficulties. Mood stabilisers can reduce impulsiveness and aggressiveness.

These medications and treatments also help if someone with a personality disorder develops depression or schizophrenia.

Most patients can be treated in the community. Admission to hospital usually happens only as a last resort (e.g. when a person with borderline personality disorder is harming himself badly) and for a short time.

People with personality disorders are more likely to have other problems, e.g. drug or alcohol abuse, co-occurring mental illnesses, relationship problem with family and partners, and financial difficulties. These problems worsen the situation of the person, therefore, support to people with personality disorder should be comprehensive and persistent.

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8. Do personality disorders change with time?

Yes. There is evidence that they tend to improve slowly with age. Antisocial behaviour and impulsiveness seem to reduce in your 30s and 40s.

However, it sometimes works in the opposite direction. For example, schizotypal personality disorder can develop into the mental illness schizophrenia.

Websites with relevant information / Reference

The Royal College of Psychiatrists
The National Institute of Mental Health
National Institute for Health and Clinical Excellence guidelines

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