A lot of clients I see are diagnosed with Axis I disorders like Schizophrenia, Major Depression and Bipolar Disorder when in actuality, they are suffering from a Personality Disorder. Personality Disorders are rarely discussed because they ultimately cannot be medicated and require long term psychotherapy. Insurance companies do not cover them and, at least where I live, the county mental health authority does not treat them. So in order for people with Personality Disorders to get any help, they are mislabeled as one of the "Big Three" (Schizophrenia, Bipolar Disorder or Major Depression) - disorders which are covered by most systems. I think this is a great disservice to patients and clients. People have a right to know what is really going on with them and what the proper treatment provided. What are Personality Disorders?
We come to know people by their personalities, the way they think, feel and behave. Most Personality Disorders begin in childhood as problems in personal developoment, peak in adolescence, progress through adulthood and may lessen in severity with middle age. These traits persist throughout life and affect every aspect of day to day behavior.
Personality Disorders are pervasive, chronic, rigid and deeply ingrained behaviors which are maladaptive, dysfunctional and/or self-destructive. Personality Disorders affect the ways in which a person relates to others, perceives the world and people around them, experiences and expresses emotions and behaves. They can affect every area of a person's life; work, school, family and social relationships and can be serious enough to canse distress or impair the person's ability to function. They affect the way a person relates, perceives, thinks, feels and behaves regardless of the situation.
Some of the symptoms of a Personality Disorder are:
- Disturbances in self-image
- Impaired ways of perceiving themselves, others, and the world
- Inability to cope with everyday stresses and problems
- Blaming others for their problems
- Frequent conflicts with other people
- Extreme, dramatic or highly unstable mood swings
- Social isolation
- Suspicion and mistrust of others
- Difficulty establishing and/or maintaining relationships
- A need for instant gratification
- Poor impulse control
- Alcohol or substance abuse
Severity
Any Personality Disorder exists on a continuum from mild to severe. People with mild symptoms may lead fairly normal lives and merely be considered a bit "odd" or "moody" or "overly dramatic" by friends and family. Under stress or pressure their symptoms may increase or become severe enough to impair various areas of their lives, but decrease when the stress or pressure has been resolved.
People with more severe symptoms may require frequent psychiatric hospitalizations, may be placed on psychiatric medications and may fail to be able to function in most areas of their lives. They may be unable to work, to maintain stable relationships, to interact appropriately with others or to maintain adequate housing. (Research has shown that in the homeless population up to 70% have a Personality Disorder. The prevalence of Personality Disorders in the general population is about 10%.)
Some Personality Disorders are less well tolerated than others by society and individuals. Borderline Personality Disorder and Antisocial Personality Disorder being two of the most common examples. These two disorders are also good examples of gender differences. Men are must more likely to be diagnosed as Antisocial while women are more likely to be diagnosed Borderline. Some Personality Disorders are less tolerated in one gender than another, for example Dependent men or Antisocial women. Environmental factors may enable one person to thrive with a Personality Disorder while another person with the same Personality Disorder flounders. An Antisocial male from an affluent family may become the CEO of a company while an Antisocial male from a poor family will go to prison. However, sometimes even money and education will not protect the former from joining the latter as we have seen in recent years. Some individuals with a Personality Disorder may choose careers that accomodate their symptoms. The overdramatization of Histrionic Personality Disorder may be used to develop a successful acting career. However, personal relationships and interactions will continue to be strained by the manifestation of the symptoms as we often read in the tabloids.
Age of Onset
The symtpoms of Personality Disorder may be seen as early as childhood. They often peak in adolescence, continue throughout adulthood and may decrease during middle age.
Causes
No one factor has been shown to cause Personality Disorders. It is believed that they are caused by a combination of family environment, the type of personality with which you were born and the type of social development you experienced while growing up. There may also be genetic and biological factors which influence who develops a Personality Disorder.
Risk Factors
Treatment
Psychotherapy, or counseling, is the treatment of choice for personality disorders. Therapy can help you learn more about the condition, recognize patterns of behavior that are causing problems and learn healthy ways to manage the symptoms. Therapy is usually for the individual, but can also include group, family or couples therapy to help the people around you learn how to live with the disorder as well and to work on interpersonal interactions.
Medications may be prescribed by a psychiatrist or other medical doctor to help relieve symptoms of personality disorders, especially problems with perceptions or anxiety, but should be used in conjunction with psychotherapy.
Diagnostic Criteria
There are 10 different types of personality disorders. They are grouped in 3 different "clusters" as shown below.
Cluster A (odd or eccentric disorders)- Paranoid Personality
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive Compulsive Disorder
You can read the Diagnostic Criteria for Personality Disorders in General or view the diagnostic criteria for specific Personality Disorders below: (listed alphabetically)
1. Antisocial Personality Disorder
2. Avoidant Personality Disorder
3. Borderline Personality Disorder
4. Dependent Personality Disorder
5. Histrionic Personality Disorder
6. Narcissistic Personality Disorder
7. Obsessive Compulsive Personality Disorder
8. Paranoid Personality Disorder
9. Schizoid Personality Disorder
10. Schizotypal Personality Disorder