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Personality Disorders

Defined as individual traits that reflect chronic, inflexible, and maladaptive patterns of behavior, personality disorders cause social discomfort and impair social and occupational functioning. These behaviors aren't due to a mental disorder, substance abuse, or a medical condition.

Although no statistics exist to quantify personality disorders, they are, nevertheless, widespread. Most patients with personality disorders don't receive treatment; when they do, they're typically managed as outpatients.

Personality disorders fall on Axis II of the DSM-IV classification system. Personality notations are appropriate and useful for all patients and help provide a fuller picture of the patient and a more accurate diagnosis. For example, many features that are characteristic of personality disorders are apparent during an episode of another mental disorder (such as a major depressive episode in a patient with compulsive
personality features).

The prognosis is variable. Personality disorders typically have an onset before or during adolescence and early adulthood and persist throughout adult life.

Causes

Only recently have personality disorders been categorized in detail, and research continues to identify their causes.

Various theories attempt to explain the origin of personality disorders. Biological theories hold that these disorders may stem from chromosomal and neuronal abnormalities or head trauma. Social theories hold that the disorders reflect learned responses, having much to do with reinforcement, modeling, and aversive stimuli as contributing factors. Psychodynamic theories hold that personality disorders reflect deficiencies in ego and superego development and are related to poor mother-child relationships that are fraught with unresponsiveness, over protectiveness, or early separation.

Complications

The patient's maladaptive behavior often leads to social and occupational impairment. Personality disorders also increase the risk of developing mood disturbances, such as anxiety and depression, as well as psychoactive substance use disorders.

Treatment

Personality disorders are difficult to treat. Treatment depends on the patient's symptoms but requires a trusting relationship in which the therapist can use a direct approach.

Traditionally, long-term psychotherapy was used to treat patients with personality disorders. Because of the biological implications, clusters may be treated with drugs to relieve specific symptoms. Patients with cluster A personality disorders benefit from antidepressants and low-dose antipsychotic medications. Anticonvulsant mood-stabilizing agents and monoamine oxidase inhibitors may be used on cluster B patients who show marked mood reactivity, behavioral drug control, or rejection hypersensitivity. Cluster C patients may be treated with anti-anxiety agents or drugs used to treat Axis I anxiety disorders. Positive effects may be subtle at first, and it may take time for the patient to see beneficial effects.

Diagnostic criteria

A patient with one personality disorder may meet the diagnostic criteria for another disorder. Pinpointing a diagnosis and developing an effective treatment plan is especially challenging for this reason.

Prevention

The most effective preventive strategy for personality disorders is early identification and treatment of children at risk. High-risk groups include abused children, children from troubled families, children with close relatives diagnosed with personality disorders, children of substance abusers, and children who grow up in cults or political extremist groups.


 

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