In this essay we will discuss about personality disorders.
Prevalence of personality disorder is general population is about 5-10%. In ICD-10, personality disorders are listed in section on ‘Disorders of Adult Personality and Behaviour’ DSM-IV classifies Personality Disorders into group of clusters (A, B and C) as given in Table 24.1.
Essay # 1. Cluster A (Odd & Eccentric):
The odd or eccentric group includes he paranoid, schizoid and Schizotypal personality disorders.
Affected individuals use the following defense mechanisms and may have a tendency towards psychotic thinking:
Projection involves attributing to another person, thoughts or feelings of one’s own that are unacceptable, such as prejudice, excessive fault-finding and paranoia.
Fantasy is the creation of an imaginary life with Somatization disorder is associated with histrionic which the patient deals with loneliness.
Paranoia is thinking of being prosecuted, vulnerability to cognitive disorganization when stressed.
Essay # 2. Cluster B (Dramatic, Emotional Eccentric):
The dramatic, emotional and erratic group includes histrionic, narcissistic, antisocial and borderline personality disorders. Mood disorders are common in cluster B and may be the chief complaint.
Somatization disorder is associated with histrionic personality disorders:
Affected individuals tend to use the following defense mechanisms:
Dissociation involves the ‘forgetting’ of unpleasant feeling and associations.
The patient disavows a thought, feeling or wish but is unaware of doing so.
The patient divides individuals into all good and all bad and cannot experience an ambivalent relationship, often seen in borderline personalities.
d) Acting out:
Acting out involves actual motor expression of a thought or feeling that is intolerable to the patient. It is not associated with any particular anxiety.
Essay # 3. Cluster C (Anxious & Fearful):
The anxious and fearful group includes avoidant, dependent, compulsive personality disorders.
(i) Affected individuals use the following defense mechanisms:
It occurs when an unacceptable feeling, act or idea is separated from the associated emotion.
Passive aggression occurs when resistance is indirect and often turned against the self.
Hypochondriasis is often present in patients with personality disorders, particularly in dependent, passive aggressive patients.
(ii) Twin studies have demonstrated some genetic factors in the development of cluster C personality disorders (especially compulsive personality disorder). The diagnostic criteria, epidemiology, complications, differential diagnosis and treatment is given in Tables 24.1 and Table 24.2
Michael W. Adamowicz, LICSW Dec 6, 2013 Updated Nov 2, 2015
Personality Disorder Definition
Since everyone has a personality, but not everyone has a personality disorder, these disorders are considered a variant form of normal, healthy personality.
- However, the most significant and defining feature of personality disorders is the negative effect these disorders have on interpersonal relationships.
- People with personality disorders tend to respond to differing situations and demands with a characteristically rigid constellation of thoughts, feelings, and behavior.
- This inflexibility and difficulty in forming nuanced responses represents the primary difference between healthy and disordered personalities.
The diagnosis of personality disorders is often very complex as these disorders frequently co-occur with each other and with other psychiatric categories of disorders. The current diagnostic system of the DSM-5 (APA, 2013) relies upon a categorical approach that outlines the following criteria to meet a personality disorder diagnosis:
- Significant impairments in interpersonal functioning and self-identity that are relatively consistent across time and situations.
- The impairments have no discernable cause outside of the individual's personality trait domains, like psychological or head trauma, sociological/cultural environment and are not due to the effects of using a substance.