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Mental health: personality disorders

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Mental Health

Mental health: personality disorders

Our personality is the distinctive set of traits, behaviours, attitudes, thoughts and feelings that make up our character and shape how we perceive the world. 

A healthy personality is flexible enough to adapt to change and to behave differently between different situations - for example, between talking to your friends and talking to someone you are trying to invite on a date.

 

Personality disorders are defined as "enduring patterns of inner experience and behaviour" that are sufficiently rigid and deep-seated to cause serious problems in a person's life. This is often complicated further when the person believes they don't have a problem and that any issues lie with everyone around them. 

 

Causes of personality disorders

Like most mental illnesses, we do not know exactly what causes a personality disorder. Some experts argue it is a post-traumatic response to early childhood events such as abuse. Others argue that there are genetic predispositions and that a personality disorder can be inherited.

 

We also know that some personality disorders (such as antisocial personality disorder) are common in men, while others (such as borderline personality disorder) are more common in women, and it seems clear that different disorders have different contributing factors.

 

A brain injury will not directly cause a personality disorder, but it will generally increase the likelihood of a personality disorder or other mental illness emerging when there is a predisposition. 

 

Diagnosis of personality disorders

Personality disorders usually emerge in late adolescence or early adulthood. To meet the diagnosis of personality disorder, problematic behaviours must appear in two or more of the following areas:

  • Perception and interpretation of self and other people
  • Intensity and duration of feelings and their appropriateness to situations
  • Relationships with others
  • Ability to control impulses.

 

List of personality disorders

The DSM-IV-TR lists ten personality disorders, grouped into three clusters. 

Cluster A (odd or eccentric disorders)

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder.

 

Cluster B (dramatic, emotional, or erratic disorders)

  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder.

 

Cluster C (anxious or fearful disorders)

  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive-compulsive personality disorder (not the same as Obsessive-compulsive disorder).

 

 Prognosis for personality disorders

The prognosis of personality disorders is difficult to assess. While these disorders are chronic in nature, gradual improvements with work are definitely seen. While it is difficult for anyone to change major aspects of their personality, the symptoms of these disorders can be reduced in both number and intensity. Long term treatment is almost always required as is a very strong commitment to change.

 

Treatment for personality disorders

The range of possible treatments for personality disorders is wide and growing, and the specific treatment which may be useful depends upon the specific disorder.

 

Cognitive therapies are used to assist the individual with a personality disorder to change the patterns of behaviour and cognition that are causing distress or impairment in any aspect of their life. Common treatments include cognitive behaviour therapy, psychodynamic psychotherapy and dialectical behaviour therapy. DBT was specifically designed for adults with a diagnosis of Borderline Personality Disorder, however many now regard it as best practice treatment for all personality disorders.

 

Medications may be used to alleviate symptoms of the disorder, or conditions such as anxiety, impulsive behaviour or distorted thinking that may be associated with particular disorders or that may have arisen during the individual's life and be interfering with treatment of the disorder, but medications cannot 'cure' a personality disorder and therapy is usually seen as the cornerstone of treatment.

References and further information

 

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