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. Although no statistics document the number of cases of personality disorder, these disorders are known to be widespread. Most patients with a personality disorder don't receive treatment; when they do, they're typically managed as outpatients.

For persons without a personality disorder, personality traits are patterns of thinking, reacting, and behaving that remain relatively consistent and stable over time. Persons with a personality disorder display more rigid and maladaptive thinking and reacting behaviors that often disrupt their personal, professional, and social lives.

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 characterized by unresponsiveness, overprotectiveness, or early separation.

Signs and symptoms

Each specific personality disorder produces characteristic signs and symptoms, which may vary among patients and within the same patient at different times. In general, the history of the patient with a personality disorder will reveal long-standing difficulties in interpersonal relationships, ranging from dependency to withdrawal, and in occupational functioning, with effects ranging from compulsive perfectionism to intentional sabotage.

The patient with a personality disorder may show any degree of self-confidence, ranging from no self-esteem to arrogance. Convinced that his behavior is normal, he avoids responsibility for its consequences, often resorting to projections and blame.

Diagnosis

There are no specific tests for personality disorders. Your doctor will ask you questions about your symptoms, personal history and emotional well-being, and may talk to friends and relatives about your behavior. A mental health professional will probably help make the diagnosis, and he or she also will evaluate whether you have other mental health or substance abuse problems.

Doctors regard the diagnosis of most personality disorders in adolescents as premature. That's because what appear to be signs or symptoms of personality disorders often disappear as adolescents grow older. However, signs and symptoms of antisocial personality disorder become evident before age 15.

Treatment

Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient's symptoms.

Drug therapy is ineffective but may be used to relieve acute anxiety and depression. Family and group therapy usually are effective.

Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment of borderline personality disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don't comply with extended therapeutic regimens; for such patients, outpatient therapy may be more useful.