Chapter Notes: Personality Disorders

Introduction

Personality is the unique way an individual interacts with their environment, shaped by an internal organization that influences how they behave. 

Personality Traits

•  Personality can be described using five main traits, remembered by the acronym OCEAN: 
  • Openness to experience: This trait shows a person's curiosity and eagerness to try new things. Individuals high in this trait might enjoy adventurous activities like: 
    • Skydiving
    • Bungee jumping
    • Gambling
  • Conscientiousness: This reflects how organized, disciplined, and responsible a person is. 
  • Extraversion: This trait indicates how social and talkative a person is, as well as their preference for being with others rather than alone. 
  • Agreeableness: This trait shows how compassionate and cooperative a person is, along with their trusting and helpful nature. 
  • Neuroticism: This indicates how likely a person is to feel negative emotions. It also relates to their emotional stability. 
•  When a person's traits lead to behavior that is different from social norms and causes unhappiness or problems, they may be diagnosed with a personality disorder. 
•  A personality disorder is characterized by unusual behaviors and feelings that significantly disrupt daily life. 
•  The occurrence of personality disorders is about 10-20% in the general population. 
•  Symptoms typically start during adolescence or early adulthood and can remain consistent throughout life. Many people see improvements by around 40 years old, which means they may overcome unhealthy behavior patterns. 
•  Individuals with personality disorders often view their behavior as normal or acceptable, making them less likely to seek help. 
•  The DSM-5 categorizes personality disorders into three main groups or clusters. 

Cluster A Personality Disorders

Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

• Paranoid Personality Disorder
  • Characteristics: Individuals with paranoid personality disorder exhibit intense suspicion and distrust towards others. They are often hypersensitive and may react with anger easily. These individuals tend to see themselves as very significant and may be prone to believing in conspiracy theories.
  • Treatment: The primary treatment is psychotherapy. Medications such as benzodiazepines and antipsychotics may be prescribed to help manage agitation and paranoia.
• Schizoid Personality Disorder
  • Characteristics: People with schizoid personality disorder are often detached from social relationships and prefer solitary activities. They exhibit emotional coldness and have limited reactions to praise or criticism. These individuals may appear self-absorbed, lost in their thoughts, and show little interest in sexual activities.
  • Treatment: Treatment primarily involves psychotherapy. In some cases, medications such as antipsychotics, antidepressants, and benzodiazepines may be used.
• Schizotypal Personality Disorder
  • Characteristics: Schizotypal personality disorder is characterised by peculiar thinking and communication patterns. Individuals may hold unusual beliefs or engage in magical thinking, such as superstitions or beliefs in telepathy. Their thoughts may be filled with fears and fantasies, and they often communicate in ways that others find difficult to understand. These individuals frequently feel isolated and may appear odd or eccentric to others. During periods of severe stress, they may experience brief psychotic symptoms.
  • Treatment: The main treatment is psychotherapy. Medications like antipsychotics, antidepressants, and benzodiazepines may be used in certain cases.

Note: Cluster A personality disorders, especially schizotypal personality disorder, are considered to be on a "schizophrenia continuum." This means they exist between typical behaviour and schizophrenia.

Cluster B Personality Disorders

Cluster B personality disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. People with these disorders often have difficulty regulating their emotions and behaviors, which can lead to significant problems in their relationships and daily functioning. The following are the specific disorders included in Cluster B:

• Histrionic Personality Disorder
  • Individuals with Histrionic Personality Disorder are highly emotional and seek to be the center of attention.
  • They often exaggerate situations to make them seem more significant than they are.
  • Their behavior may be sexually provocative, using their appearance to draw attention.
  • Treatment typically involves psychotherapy, and medications like antidepressants may be used in some cases.
• Narcissistic Personality Disorder
  • People with Narcissistic Personality Disorder have an inflated sense of self and believe they are unique or special.
  • They often indulge in fantasies of success and seek constant admiration from others.
  • Criticism can provoke anger or indifference in them.
  • They have fragile self-esteem and may become depressed when rejected.
  • Treatment usually involves psychotherapy, with antidepressants sometimes prescribed.
• Antisocial Personality Disorder
  • Individuals with Antisocial Personality Disorder ignore the rights of others and often engage in illegal activities.
  • Their behaviors may include theft, lying, truancy, and deceit.
  • They typically feel no remorse for their actions and may also have substance use issues.
  • Treatment generally involves psychotherapy, and medications like carbamazepine and beta-blockers may be used.
• Borderline Personality Disorder
  • Individuals with Borderline Personality Disorder experience severe emotional instability and frequent mood swings.
  • They may suddenly feel angry, anxious, or frustrated without clear triggers.
  • Their relationships are often intense and unstable, swinging between extreme closeness and hostility.
  • They may engage in self-harm or substance abuse as a way to cope with emotional pain.
  • Impulsive behaviors such as reckless spending or risky sexual behavior are common.
  • They often see people in black-and-white terms, viewing others as either all good or all bad.
  • Treatment typically involves psychotherapy, especially dialectical behavior therapy (DBT), and medications like antipsychotics, antidepressants, and mood stabilizers may be prescribed.

Cluster C Personality Disorders

Cluster C personality disorders are characterized by anxious and fearful behaviors. Here are the specific disorders within this cluster:

• Avoidant Personality Disorder
  • Individuals with avoidant personality disorder are extremely sensitive to rejection.
  • They have a strong fear of criticism or rejection in social situations, leading them to be socially withdrawn.
  • They tend to avoid relationships unless they are assured of uncritical acceptance.
  • In the ICD-10, this disorder is referred to as anxious personality disorder.
  • Management of avoidant personality disorder often involves psychotherapy, and medications such as beta blockers and SSRIs can also be helpful.
• Dependent Personality Disorder
  • Individuals with dependent personality disorder rely heavily on others for making even everyday decisions.
  • Major life decisions are often made by someone else, as they seek excessive amounts of advice and reassurance.
  • They struggle to express disagreement due to the fear of losing support and often feel uncomfortable and helpless when alone.
  • Management typically includes psychotherapy, with medications like benzodiazepines and SSRIs for symptom relief.
• Obsessive-Compulsive Personality Disorder
  • Individuals with obsessive-compulsive personality disorder are preoccupied with rules and regulations, placing excessive importance on details and exhibiting perfectionist tendencies.
  • This perfectionism can hinder their ability to complete tasks, as they are inflexible and demand compliance from others.
  • They are highly dedicated to work, often at the expense of leisure activities, and tend to be serious with a lack of humour.
  • In the ICD-10, this disorder is referred to as anankastic personality disorder.
  • Management usually involves psychotherapy.

Type A and B Personality

•  Another way to categorize personality is through Type A and Type B personalities. 
• Type A personality is known for traits such as: 
  • Competitiveness
  • Time urgency
  • Hostility
  • Anger
•  People with Type A personality are often: 
  • Ambitious
  • Impatient
  • Hardworking workaholics
•  Many studies have indicated that Type A personality, particularly the traits of hostility and anger, can increase the risk of coronary heart disease. 
•  In contrast, those with a Type B personality tend to be: 
  • Easygoing
  • Relaxed
  • Less focused on competition and more on enjoyment
•  Recent research has introduced a new personality type called Type D personality. 
• Type D personality is defined by: 
  • Negative affectivity (the tendency to feel negative emotions)
  • Social inhibition (the tendency to hold back emotions)
•  Individuals with Type D personality may also be at a higher risk for developing coronary heart disease. 

Impulse Control Disorders

Impulse control disorders are characterized by overwhelming urges or temptations to engage in behaviors that can be harmful to oneself or others. Individuals with these disorders often describe their urges as a build-up of tension and excitement that leads to specific actions. Acting on these impulses provides a temporary sense of relief and satisfaction, but it is usually followed by feelings of guilt or regret.

Types of Impulse Control Disorders

• Pyromania: Involves the repeated and intentional act of setting fires.
• Kleptomania: Entails stealing items that are not needed for personal use and do not hold significant value.
• Intermittent Explosive Disorder: Characterized by sudden and aggressive outbursts that result in serious harm to others or property damage.
• Pathological Gambling: Involves frequent gambling that leads to financial difficulties and significant problems in relationships.
• Trichotillomania: Involves the compulsive act of pulling out one's own hair.
• Others: 
  • Oniomania or compulsive buying: Recurrent episodes of buying or shopping despite the buying behavior causing significant monetary and socio-occupational distress.