Personality disorders

Overview
A personality disorder is an enduring pattern of thinking, perceiving, reacting and relating differently than what's considered appropriate in a given culture. The pattern becomes so rigid and maladaptive that it causes distress or impairs personal relationships and the ability to work or complete daily tasks.
Those who have a personality disorder usually do not see the need for therapy and are commonly referred to therapy by loved ones or friends. Other symptoms such as depression, anxiety or substance abuse are often the precursor to seeking therapy.

Personality disorders usually develop in adolescence or young adulthood with traits that are always present, affect many areas of the person's life, and cause impaired functioning.

There are three categories of personality disorders, called clusters. Cluster A disorders are characterized by odd or eccentric behavior. Cluster B disorders are characterized by dramatic or erratic behavior. Cluster C disorders are marked by anxious or inhibited behavior.

I. Cluster A personality disorders

Paranoid personality disorder
People who have paranoid personality disorder tend to be suspicious and read malevolent motives into innocent or trivial behavior. They may be cold, distant and angry in relationships, especially if they feel suspicions have been confirmed. People who have this disorder often feel they've been deeply and irreversibly injured by others, even if there's no objective evidence of harm. They tend to persistently bear grudges or may even take legal action against others. They may be reluctant to confide in anyone for fear that information may be used against them. For the same reason, they may refuse to answer personal questions. They tend to work better in relative isolation, and may be attracted to cults or tightly knit groups that share their paranoid belief systems.

Schizoid personality disorder
Schizoid personality disorder is characterized by a pattern of detachment from social relationships and a restricted range of emotional expression. People who have schizoid personality disorder may appear indifferent to close relationships or the criticism or approval of others. They may not respond appropriately to social cues or appear to derive satisfaction from being part of a family or social group. People who have this disorder tend to be introverted, absorbed in their own thoughts or daydreams, cold, distant and afraid of intimacy.

Schizotypal personality disorder
Like schizoid personality disorder, people who have schizotypal personality disorder may be cold, distant and afraid of intimacy. In addition, they may develop oddities of thinking, perception and communication, such as:

magical thinking (holding irrational or superstitious beliefs that certain behaviors will offer protection from danger)
ideas of reference (for example, thinking that people on television or the radio are referring to or directly addressing him or her)
paranoia
preoccupation with paranormal phenomena outside cultural norms (for example, telepathy, clairvoyance or a sixth sense)
dressing peculiarly or having an otherwise odd appearance
II. Cluster B personality disorders

Antisocial personality disorder
Antisocial personality disorder is characterized by callous disregard for the rights and feelings of others. People who have antisocial personality disorder often exploit others for material gain or personal gratification and rationalize their behavior. They typically feel little or no remorse for hurting others, and have little or no empathy for others. They tend to be impulsive and unable to adequately consider consequences of their actions. They're consistently extremely irresponsible. Unlike people who have borderline personality disorder, people who have antisocial personality disorder often direct anger at others rather than themselves.

People who have antisocial personality disorder often engage in behaviors such as:

infidelity
promiscuity
criminal behavior
physical assaults, including domestic abuse and child abuse
substance abuse
occupational failure (such as significant periods of unemployment despite available job opportunities)
frequent relocation
Borderline personality disorder
Borderline personality disorder is characterized by unstable self-image, mood, behavior, and relationships, as well as considerable impulsivity. People who have this disorder often feel that they were deprived or uncared for as children and, therefore, tend to feel empty, angry or entitled to nurturing as an adult. They may make frantic efforts to avoid real or imagined abandonment.

People who have borderline personality disorder may misinterpret boundary enforcement as rejection or even as an attack. They may not tolerate being alone, feeling a constant need to be surrounded by people. They may vacillate between idealizing and defaming others -- they're seldom neutral. They may also experience potentially dramatic shifts in mood that are often expressed through intense angry outbursts. The anger is often self-destructive or self-directed. They may have a pattern of undermining themselves just as a goal is about to be realized.

People who have borderline personality disorder often engage in impulsive behaviors, such as:

gambling
spending money irresponsibly
binge eating
substance abuse
unsafe sex
reckless driving
self-mutilation (such as burning or cutting themselves)
placing unwarranted 911 calls
Histrionic personality disorder
Histrionic personality disorder is characterized by a pattern of excessive emotionality and attention-seeking behavior. Unlike narcissistic personality disorder, people who have histrionic personality disorder seek attention even if it means being thought of as weak or fragile. They feel uncomfortable and unappreciated when they're not the center of attention. They often evoke sympathy or erotic attention from others, but the relationships tend to be shallow and transient.

Narcissistic personality disorder
Narcissistic personality disorder is characterized by exaggerated feelings of superiority, importance and power, as well as the need to be admired by others. Perhaps surprisingly, people who have this disorder are often disinclined to achieve those goals for which they would be admired, however. They may become enraged or depressed when they're not admired. They often lack empathy for others, have fragile self-esteem, and tend to be preoccupied by what others think of them.

III. Cluster C personality disorders

Avoidant personality disorder
Avoidant personality disorder is characterized by hypersensitivity to rejection and fear of starting anything new, such as employment or a relationship, due to fear of failure or disappointing results. People who have this disorder are often preoccupied with being criticized or rejected in social situations. They may assume other people are critical and disapproving until they pass stringent tests to the contrary. People who have avoidant personality disorder consciously desire affection and acceptance and are distressed by their inability to relate comfortably to others. They react to rejection with withdrawal.

Dependent personality disorder
Dependent personality disorder is characterized by an extreme degree of reliance on others. People who have this disorder surrender responsibility for major areas of their lives to others. They often have submissive or clinging behaviors. They may go to excessive lengths to obtain emotional nurturing and support from others. For example, they may volunteer for unpleasant tasks, submit themselves to unreasonable demands, or tolerate abuse. They often lack self-confidence and are insecure about their ability to take care of themselves. They value the feelings and concerns of others over their own, fear losing support or approval, and fail to voice their feelings and needs for fear of offending others.

Obsessive-compulsive personality disorder
Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, conscientiousness and reliability, as well as an inflexibility to adapt and change. People who have obsessive-compulsive personality disorder attempt to maintain a sense of control through excessive attention to rules, procedures, trivial details, lists, forms or schedules. They often have difficulty making decisions, are prone to repeatedly checking for possible mistakes, and derive little satisfaction from achievements due to their anxiety. They tend to become entangled in minute details and have difficulty completing projects. They are reluctant to delegate tasks to others. People who have obsessive-compulsive personality disorder sometimes engage in "pack rat" behavior, having difficulty discarding worn-out or worthless objects with no sentimental value. This disorder differs from obsessive-compulsive disorder (OCD). The hoarding is less extreme, and true obsessions or compulsions are not present.


Causes
Personality disorder traits usually emerge in early adulthood. They may become evident or exaggerated during stressful life situations, such as relationship difficulties or a job loss. Some personality disorder traits may stabilize or ease with age.
Although the exact causes of personality disorders are unknown, a variety of genetic, environmental and developmental factors are thought to play a role. For example:

Cluster A personality disorders are thought to be associated with a family history of schizophrenia.

Paranoid personality disorder tends to occur more frequently in families with a schizophrenic member.

Schizoid personality disorder may be more likely to occur in relatives of people who have schizophrenia or schizotypal personality disorder. People who have schizotypal personality disorder are believed to have a mutated gene that causes schizophrenia.

Borderline personality disorder is thought to be related to biological, social and psychological factors. Many people with borderline personality disorder report a history of abuse, neglect or separation as young children. In fact, according to the National Institute of Mental Health, 40 to 71 percent of people who have borderline personality disorder report having been sexually abused.

Treatment
A variety of treatments for personality disorders are supported by current research. For example, psychotherapy, behavioral therapy or medications to target symptoms such as depression or anxiety can be effective. Response to treatment is often slow, however, and improvement often takes one year of therapy or more. A person must be persistent and motivated for therapy to succeed.
Other types of therapy can be helpful complements to a treatment plan as well. Group therapy can be helpful for interpersonal problems associated with personality disorders. Couple's therapy can be helpful for those who are in intimate relationships. Family therapy can be helpful for disruptions in family relationships related to personality disorders. Education for individuals and families can be helpful in understanding and coping with the emotions and behaviors related to the personality disorder. Learning about and practicing appropriate boundaries can also be helpful.