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What is a personality disorder?
Personality traits are patterns of perceiving, thinking about, relating and interacting with people. These traits contribute to how a person is perceived by others in all types of interaction, whether it is social, at work or in personal relationships. Everybody has a personality trait. A Personality Disorder is when these personality traits are inflexible, maladaptive, and cause significant impairment to a persons functioning (eg in relationships, at work etc). Personality Disorders cause significant distress to the person and affect their cognition (thinking), and emotion (eg. sadness, elation, anger). This pattern of maladaptive personality traits are stable and long lasting, they apply to a wide range of social and personal situations and cannot be explained by the differences in beliefs and behaviours found in different cultures. Personality Disorders can often be traced back to early adulthood or adolescence and are often diagnosed in early adulthood. They tend to become less obvious through middle age, mainly because people are able to function well by having acquired good coping mechanisms. Cluster A: Individuals in this cluster often appear odd or eccentric. This includes the Paranoid, Schizoid and Schizotypal Personality Disorders. Cluster B: Individuals in this cluster appear dramatic, emotional or erratic. This includes the Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders. Cluster C: Individuals in this cluster often appear anxious or fearful. This includes the Avoidant, Dependent and Obsessive-compulsive Personality Disorders.
Cluster A Paranoid Personality Disorder (PPD) Paranoid personality disorder is marked by distrust and suspiciousness of others, such that their motives are always questioned and interpreted as ill will or malicious. In people with PPD, the excessive suspiciousness and hostility, often leads to arguments because of which they may be difficult to get along with. Due to their lack of trust in others, these individuals have a great need to be self sufficient, and to have a high degree of control over those around them. Following are some specific characteristics of PPD. Suspiciousness - People with PPD believe that others will exploit, harm or deceive them. Often based on little or no evidence they speculate that others are plotting against them. Doubts about loyalty of friends - They are preoccupied with doubts about the loyalty and trustworthiness of their friends and associates. They have difficulty in relationships as they often feel as if another person has deeply and irreversibly injured them. They believe that if they were in trouble, their friends will either attack or ignore them. If a friend displays a gesture of loyalty, the person with PPD is so amazed that they cannot trust or believe it. Confiding - Individuals with this disorder are reluctant confiding in anyone, or in disclosing personal information. They believe that the information will be used against them. Hidden meanings - They are constantly on the lookout for hostile intentions, because of which they often read hidden meaning into events, or remarks made by people. Compliments are often misinterpreted eg. a compliment by a boss on a project well done could be interpreted as the boss implying or pushing for better performance next time. Grudges -Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults and injuries that they think they have received, and so hostile feelings towards others persist for a very long time. Counterattack ¡V These individuals are also quick to counterattack with anger over suspicions of attack to their reputation or character. Partner faithfulness - They may constantly suspect their spouse or partner of being unfaithful. They tend to want maintaining complete control of intimate relationships. To avoid being betrayed, they may constantly question and challenge the actions and intentions of their spouse eg If buying milk from the corner store normally takes 15 minutes but took the partner 20 minutes on a particular occasion, he/she may be obliged to account for the extra 5 minutes.
Schizoid Personality Disorder (SPD) The main feature of SPD is detachment from and a lack of interest in social relationships and activities. Because of this people with SPD often lack social skills and close friends. Their ability to work may also be impaired, though they may do well when they work under social isolation. They may also display only a limited range of emotions and expression. More specific characteristics of SPD are as follows: Relationships - People with SPD tend to lack an interest in developing close relationships such as that of being part of a family or social group. Solitary activities -They prefer to spend time by themselves rather than with other people. Consequently they choose hobbies and activities (eg. painting, drawing) that do not involve interaction with others. Lack of interest in sexual experiences -They show little, if any interest in sexual experiences with another person. Pleasure - They tend to experience little pleasure in any activities, and rarely claim to have experienced strong emotions such as anger or joy Friendships - People with SPD tend to have no close friends, except possibly a first degree relative. Indifferent to opinion of others - They appear not to be bothered by what others think of them, their criticism or approval. Emotional coldness - People with SPD appear to be self-absorbed, they often have a ¡¥bland¡¦ expression on their face and rarely respond by way of facial expressions such as smiles or nods. This often leads to people interpreting them as being cold and lacking emotion. Schizotypal Personality Disorder (STPD) People with STPD experience difficulties in social situations and relationships and have extreme difficulties in forming close relationships. They may also experience difficulties in their ability to think and perceive, and may also display unusual behaviour. Only a small number of people with STPD ever develop full-fledged schizophrenia. A large proportion of people (30-50%) with STPD however, may also suffer from a depressive disorder, which occasionally may cause the person to develop suicidal tendencies. Some of the main characteristics of STPD are: Incorrect interpretations ¡V casual incidents and external events may have a particular and unusual meaning to the person with STPD. Superstitious and odd beliefs - Preoccupation with paranormal phenomena that are outside the norms of their subculture. Special Powers - they may believe that they possess special powers, for example, the ability to sense events before they happen or to read others thoughts. Perceptual alterations may also be present eg. sensing that another person is present or hearing a voice murmur his or her name. Vague speech ¡V the person with STPD may speak in a manner that is overly concrete and abstract. Though they use words and concepts in unusual ways, they are still generally coherent. Paranoid & Suspicious ¡V these individuals tend to be suspicious of others around them, for example, they may believe that their colleagues are constantly trying to degrade their reputation with the boss. Interaction with others ¡V these individuals usually are not able to negotiate all social /interpersonal cues, so often interact with others in an inappropriate, stiff or constricted fashion. Odd - people with STPD tend to be considered odd because of their unusual mannerism and dress. Relationships ¡V though these individuals may suggest unhappiness at the lack of relationships, their behaviour often suggests a decreased desire for intimate contact. Therefore, they usually have no or few close friends other than a first-degree relative. Social Situations ¡V these individuals tend to be anxious in social situations. They prefer keeping to themselves because they feel that they are ¡¥different¡¦ from others, and just do not ¡¥fit in¡¦. In social situations their anxiety does not decrease with time or familiarity with people. This is generally because their anxiety tends to be related to suspiciousness regarding others¡¦ motivations. Cluster B Antisocial Personality Disorder (APD) The main feature of antisocial personality disorder (APD) is a pattern of complete disregard for the rights of others. It also involves deceit and manipulation. This personality disorder begins in childhood or early adulthood and continues into adulthood. APD was previously known as ¡¥psychopathy¡¦ and ¡¥sociopathy¡¦. For a diagnosis of APD to be made, the individual must be at least 18 years in age, and have had a history of some symptoms of ¡¥Conduct Disorder¡¦ before age 15. The behaviours characteristic of conduct disorder fall into the following characteristics: aggression to people and animals; destruction of property; deceitfulness or theft; serious violation of rules. The main characteristics of antisocial personality disorder are: Unlawful behaviour - A failure to conform to social norms with resect to lawful behaviour. Persons with APD may repeatedly be involved in actions that are grounds for arrest eg. destroying property, harassing others, stealing, or pursuing illegal occupations. Deceitful - They tend to have disregard for the wishes, rights and feelings of others. They may also frequently be deceitful and manipulative in order to gain personal profit or pleasure (eg to obtain money, sex or power). They may repeatedly lie, con others or malinger. Impulsive Behaviour - Because of a failure to plan ahead they may have a tendency for impulsive behaviour. Decisions may be made on the spur of the moment, without forethought, and without consideration to consequences to self or others. This may lead to sudden changes of jobs, residences or relationships. Irritability & Aggressiveness - Individuals with APD tend to be irritable and aggressive, and may repeatedly get involved in physical fights or assault. Reckless Behaviour - Individuals with APD may display a disregard for safety of themselves or others. This can be displayed by reckless driving behaviour (recurrent speeding, driving while intoxicated, multiple accidents); involvement in high at risk sexual behaviour; neglect or failing to care for a child in a way that puts the child in danger. Irresponsible Behaviour - These individuals may also tend to be consistently and extremely irresponsible. Behaviour that is indicative of this may include irresponsible work behaviour, for example long periods of unemployment despite several job opportunities, abandonment of jobs without plan for getting another, repeated absences from work that are not explained. Financial irresponsibility may include acts such as defaulting on debts and failing to provide child support. Lack of Remorse - Individuals with APD show little remorse for the consequences of their acts. They tend to provide superficial excuses for their actions of having hurt, mistreated or stolen from someone (eg. ¡¥they deserved it¡¦). They may blame the victims of their actions for being foolish, helpless or deserving their fate. They generally fail to correct their wrong actions, or to apologise or show remorse for their behaviour.
Borderline Personality (BPD) Borderline Personality Disorder (BPD) is marked by a pattern of unstable relationships, mood, self-image and impulsivity. Relationships - People with BPD experience difficulties in relationships, they may at one instant idealise a person, and in the next moment completely devalue them. They go to extreme lengths to avoid rejection or abandonment -- these threats of rejection may be real or imagined. They may believe that this ¡¥abandonment¡¦ by others is because they are in some way ¡¥bad¡¦. Because of this constant fear, these individuals are extremely sensitive to separation and unavoidable changes in plans (eg. Friend running late or doctor cancelling appointment).
Self Image - These individuals demonstrate an unstable sense of self. They may suddenly change their goals or values in life, jobs or career aspirations, sexual identity, friends etc. Often there is a pattern of ¡¥giving up¡¦ the moment a goal or achievement is about to be reached eg. dropping out of school just before graduation, or breaking a relationship that is progressing well). Impulsivity - especially actions that are potentially self-damaging eg. Gambling, spending money irresponsibly, binge eating, substance abuse, unsafe sex and reckless driving. These individuals may also present recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour (eg cutting or burning). Instability ¡V these individuals experience long periods of feelings of anger, panic or despair. These emotions are a reflection of the amount of stress the person is constantly feeling. When a caregiver/ family/ relative/lover is seen to be uncaring, abandoning and neglectful towards the person, then there may be displays of extreme sarcasm, bitterness or verbal outbursts. This is often followed by feelings of guilt and shame. They may also experience feelings of emptiness.
Histrionic Personality Disorder (HPD) The major characteristic of histrionic personality disorder is excessive emotionality and attention-seeking behaviour. Other characteristics are as follows: Centre of Attention - Individuals with HPD feel the need to always be the centre of attention, otherwise they may feel uncomfortable or unappreciated. Because of their enthusiasm and charm, they generally tend to draw attention onto themselves. When the attention begins to wear away, these individuals may do something dramatic such as create a scene to draw focus back onto themselves. Inappropriate Sexual Behaviour - the individual with HPD often displays inappropriate sexually provocative or seductive behaviour. This type of behaviour is not only directed toward people to whom the person with HPD has a sexual or romantic interest, but generally towards a wide range of people in a wide range of situations. Emotion - Their emotional expression may keep changing and appear to be shallow. Physical Appearance - these individuals, in an attempt to impress others, tend to spend excessive amount of time and energy onto their clothes and grooming. They may hint for compliments on their appearance by others and may get excessively upset by a critical comment on their looks or dressing. Speech - their speech tends to be extremely dramatic, but, vague and lacking in detail. For example, they may claim that a certain person is a ¡¥wonderful human being¡¦, but be unable to provide examples of those person¡¦s good qualities, or the reason why they believe this person to be such an extremely good person. Self-dramatisation - Individuals with HPD may display an exaggerated expression of emotion and self-dramatisation, for example, they may embrace casual acquaintances with extreme zeal. Such public displays of emotion may embarrass friends and acquaintances, and may also cause tensions in the relationship because their dramatic emotions tend to switch on and off too quickly, and thereby may come across as being fake. Highly Suggestible -Individuals with HPD are easily influenced by opinions and feelings of others (especially strong authority figures) and current fads. Relationships - they may also have a tendency to consider relationships more close than they actually are eg. the person with HPD may call physicians they have met once or twice, under professional circumstances by their first name.
Narcissistic Personality Disorder (NPD) The major features of narcissistic personality disorder is a pattern of grandiosity, need for admiration and lack of empathy. These characteristics are present in a variety of different contexts and usually begin in early adulthood. Other characteristics are: Grandiosity ¡V these individuals have a grand sense of self-importance, they overly overestimate their abilities and accomplishments, because of which may come across as being boastful and pretentious. They assume that others place the same sort of value into their accomplishments as they do on themselves. Further, while there in an exaggerated sense of self-accomplishments there may also be a lack of acknowledgment or devaluation of contribution of others.
Special ¡V these individuals may believe that they are special and unique, on par with other famous or privileged people. They expect other people to recognise their superiority and uniqueness. They may wish to only associate with other such ¡¥unique¡¦ and ¡¥gifted¡¦ people, and may believe that they can only truly be understood by them. An example of this is that they may insist on the ¡¥top¡¦ most doctor treating them. Admiration ¡V individuals with NPD generally require excessive admiration. They tend to have low self-esteem, and are constantly preoccupied with how they are regarded by others. They may ¡¥fish¡¦ for compliments. Favourable Treatment ¡V these individuals assume that they are entitled to special treatment eg. these individuals may assume that they do not have to wait in line, and are furious when they feel that they have not been catered for. Exploitive ¡V the expectation that their work is more important and the general lack of sensitivity to the needs and wants of others may result in the sometimes unconscious exploitation of others. For example, these individuals may require great dedication from others; they may overwork the workers without consideration for the impact on their lives. They may form friendships and romantic relationships with those whom they are likely to benefit from in some way. Lack of Empathy ¡V individuals with NPD generally have a lack of empathy towards others, they have difficulty recognising the desires and feelings of others eg. they may boast of their good health to someone who is sick. Envious- these individuals are often envious of others or believe that others are envious of them. They may feel that they deserve others success or possessions, and may harshly belittle others contributions, especially when they receive praise from others. Arrogant ¡V Snobbish or arrogant behaviours often characterise individuals with NPD. Cluster C Avoidant Personality Disorder (AVPD) The major features of avoidant personality disorder is a pattern of restraining or avoiding social interactions, feelings of inadequacy and extra sensitivity to negative evaluation by others. Other specific characteristics of individuals with AVPD are: Avoidance ¡V individuals with AVPD tend to avoid work or school activities that involve high levels of contact with other people. This is mainly because of fears of criticism, disapproval or rejection by others. Friends ¡V these individuals avoid meeting new people or making new friends unless they are sure of being liked and accepted by the people concerned. These individuals will not join group activities unless they are assured of high levels of support. Relationships ¡V these individuals will only engage in relationships when there is assurance of complete uncritical acceptance. They may still be extremely mindful of their words and actions, and withhold their intimate feelings due to fear of ridicule, exposure and shame. Preoccupation ¡V people with AVPD tend to be preoccupied with detecting criticism or rejection in social situations. The slightest disapproving gesture by others can cause extreme hurt in people with AVPD. Social Situations ¡V though these individuals desire to be actively involved in social situations, their feelings of inadequacy and their low self-esteem, especially in new situations, prevent them from being so. Therefore they tend to be quite, shy and ¡¥invisible¡¦ in social situations, preferring not to say much at all for fear of being seen as being ¡¥wrong¡¦ by others. Self Esteem ¡V they may have extreme doubts about their social competence and personal appeal, they may also view themselves as being inferior to others. New Activities - because of the possibility of embarrassment, individuals with AVPD tend to avoid new activities and opt for the certainty and security available in activities that they are use to. As can be imagined, this has a very restricting effect on their lifestyle. Dependent Personality Disorder (DPD) Dependent personality disorder (DPD) is marked by an excessive need to be taken care of which leads to clinging behaviour and fears of separation. The dependent behaviours are intended to bring forth care giving from others, and are based on the perception of the person with DPD that he/she cannot function without the help of others. Decisions ¡V individuals with DPD have extreme difficulty making everyday decisions, such as what to wear to work, and often need excessive amounts of advice and reassurance from others. Passive - these individuals tend to allow other people (normally one person) to take initiative and make decisions for their lives. For example, a person with DPD may rely on his/her parent or spouse for making decisions on where they should live, what sort of job they should have and whom they should befriend. Disagreement ¡V Because of fear of losing support, these individuals have great difficulty expressing disagreement on any issue, especially towards the person they are dependent on. They would rather agree to things they believe to be wrong rather than disagreeing and losing the guidance of the person they are dependant on. They tend not to express anger towards others, and especially those whose nurturance they require. Working Independently ¡V individuals with DPD experience difficulty in initiating projects or working on their own. Their lack of self-confidence convinces them that others can do the tasks better than they can. They are able to function adequately when there is assurance that someone else is supervising their work. However they are mindful of not appearing too competent, for fear of losing support. Volunteering ¡V to ensure that they receive the support they desire, individuals with DPD are often willing to go to excessive lengths to satisfy others demands. They may even volunteer for unpleasant tasks, or tasks that are unreasonable, if they believe that, them doing those tasks would bring the care they need. Fear of being alone ¡V because of fears of not being able to care for their own self, these individuals feel uncomfortable being alone. They may be found with other more ¡¥important¡¦ people, doing activities that they are not themselves directly involved in or even interested in being involved in. End to relationships ¡V when a relationship ends, such as a break up with a lover or death of a caregiver, the person with DPD, frantically, often indiscriminately seeks another person to become attached to and receive care from. Preoccupation ¡V these individuals tend to have unrealistic, excessive fears of being left to care for themselves. They may be occupied by fears of abandonment by their caregiver when there are no reasonable grounds or evidence for this. Obsessive Compulsive Personality Disorder (OPD)
Preoccupation - these individuals tend to maintain a sense of control to the extent that the major point to any activity is lost, mainly due to extreme attention to rules, trivial details and schedules. They may be excessively careful, thus repetitious, which may lead to delays. Time is also poorly allocated, and generally the more important tasks are left to the last moment. Perfectionism - The extreme attention to detail and the self imposed high standards cause significant distress in these individuals. In an attempt to make a project absolutely perfect, often the project may never in fact get finished. Work ¡V Individuals with OPD tend to be devoted to work and productivity. This is often at the expense of leisure activities and friendships. They may feel that they do not have time to relax or go on a holiday. On those rare occasions that a person with OPD goes on a holiday, they may take some work along with them so that they do not ¡¥waste time¡¦. They tend to spend excessive amounts of time on household chores such as cleaning. When they do spend time with friends, it is likely to be in a formally organized activity such as sport. They may also view hobbies and recreational activities as serious tasks requiring careful organization and hard work to master. Ethics & Morality ¡V these individuals tend to be excessively conscientious and inflexible about matters of morality, ethics or values. They may force themselves and others to follow rigid moral principles and very strict standards of performance. They may be overly critical of their mistakes; they also tend to have great obedience towards authority and tend to literally abide by rules and regulations. They tend not to believe in ¡¥rule bending¡¦ for any circumstances. Discarding Objects ¡V individuals with OPD have great difficulty discarding worn out, worthless items (even those with no sentimental value). They tend to regard discarding objects as ¡¥wasteful¡¦ because of the attitude ¡¥ you never know when you would need the item¡¦. ¡¥My Way¡¦ ¡V these individuals are reluctant to delegate tasks unless people conform exactly to his/her way of doing things. They tend to give out extremely detailed instructions on how things should be done, and insists that his/her way is the only way to do things eg there is only one way to wash dishes. They may even reject offers of help on a task, even if they are behind schedule, because he/she may believe that no one else can do the task right. Money ¡V Individuals with OPD tend to be stingy, and often live in a standard far below what they can afford. This is because of their attitude that spending should be tightly controlled to allow for and accommodate future catastrophes. Stubbornness ¡V these individuals are characterised by rigidity and stubbornness. They tend to be overly concerned about doing things the one correct way, so much so, that they are unwilling to accommodate changes or consider others ideas. Friends and colleagues may become frustrated at their stubbornness to compromise, even when it is obvious that it is in his/her best interests to do so. The reason behind their single mindedness tends to be the ¡¥principle¡¦ of a given thing. What is Obsessive Compulsive Disorder (OCD) ? OCD is the fourth most commonly occurring psychiatric disorder after substance abuse, major depression and phobias. OCD can affect anyone regardless of class, culture, sex, status or level of intelligence. On average OCD affects 2-3% of the Australian population (Robins et al, 1984). That means that about 450, 000 Australians will suffer from OCD during some stage of their lives.
What Causes Personality Disorders?No single factor can explain the development of personality disorders. However there are some contributing factors. There is evidence suggesting that events occurring in early childhood exert a strong influence upon behaviour in later life. Of those people with personality disorders, a substantial proportion has experienced some form of abuse (physical, sexual, neglect) as children. Research suggests that some people may be genetically predisposed to a personality disorder. Instigators such as stress or specific traumatic events may trigger personality disorders in those that are genetically predisposed to it.
Treatment Psychotherapy - This may be in the form of individual, group or family psychotherapy. This counselling approach focuses on internal experiences and conflicts. It also helps address inflexible behaviour patterns that may maybe interfering with everyday living. People are often also taught better coping mechanisms for their emotions such as anger. Behaviour and cognitive therapies focus on resolving some of the symptoms of personality disorders, such as how to initiate and maintain relationships. Because of the nature of this type of treatment, marked improvements with therapy can take time, sometimes month¡¦s, even years. Those with insight and realisation of their problems, tend to be more successful in treatment. Medication may be prescribed by a physician to help relieve some of the symptoms of personality disorders such as problems with anxiety, depression or perception. Therefore antidepressant, antianxiety and antipsychotic medication may be prescribed. They are not however, intended to take the place of psychotherapy. Personality disorders are usually diagnosed in early adulthood, a period of great instability. There are more episodes of impulsivity, unstable mood, and greater use of mental health services. The risk of suicide is also greatest in these young adult years. This risk gradually decreases with increasing age and during their 30s and 40s most individuals with this disorder attain greater stability in their relationships, careers and other areas of their life. WHERE TO GO FOR HELP ƒË General Practitioner - for referral to a psychiatrist ƒË Psychologist, contact the Australian Psychological Association on 1800 333 497. ƒË Sane Australia: 1800 688 382 - for information/referral ƒË Association for Relatives and Friends of the Mentally Ill (ARAFMI): 24hr phone service and support groups for families and relatives of the mentally ill.(02) 9805 1883/ 1800 655 198- 24 hours ƒË Carers NSW: 1800 242 636 - Respite, support. ƒË Mental Health Information Service (for services in your area) on 02 9816 5688 or 1800 674 200 (country NSW) Reference 1) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 1995, American Psychiatric Association. Disclaimer
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