The term personality disorder encompasses a variety of different mental disorders in which the affected person may deviate greatly from “normal” patterns of behavior. Often, patients’ actions and thoughts seem inappropriate to the situation and inappropriate to healthy people. Typical forms of personality disorder are paranoid personality disorder and schizophrenia. However, the latter is classified as a psychotic disorder.
What is a personality disorder?
The development of a personality disorder is considered to be conditioned in a complex interaction of family and social interactions and genetic predispositions. In psychology and medicine, the term personality disorder refers to a group of mental illnesses that begin in childhood or adolescence and are characterized by deviant patterns of experience and behavior described as rigid and inflexible, especially in situations that are conflictual for the person. As a result, the affected person’s ability to function and perform is always impaired, sometimes considerably, in the personal and social spheres, and sometimes also in the professional sphere. Personality disorders are subdivided in clinical psychology and psychiatry according to the ICD-10 and DSM-IV diagnostic systems into subtypes defined by characteristic features, although overlaps and thus combined personality disorders are common.
Causes
There is no universally accepted definition of the causes of personality disorders. The development of a personality disorder is considered to be conditioned in a complex interplay of family and social interactions and genetic predispositions. The psychosocial aspects in the development of personality disorders are evaluated differently by the individual psychotherapeutic schools. While depth psychology sees the causes in childhood disorders such as a problematic social environment (e.g. parental home) or early psychotraumas, psychoanalysis focuses on individual psychological aspects of personality development. Behavioral medicine takes a different approach, seeing personality disorders as the result of the reinforcement of behavioral foundations laid in childhood or adolescence through operant conditioning (solidification of behavioral patterns through positive or negative reinforcement, for example, by the social environment) and model learning (solidification of general behavior through learning from a specific example). This theory forms the basis for the treatment methods of behavior therapy, which has gained increasing importance over classical psychotherapeutic methods due to proven successes in the treatment of personality disorders, including in particular the so-called borderline personality disorder.
Diseases with this symptom
- Schizophrenia
- Dissocial personality disorder
- Narcissism
- Alzheimer’s disease
- Brain tumor
- Multiple personality disorder
- Borderline Syndrome
- Paranoid schizophrenia
- Munchausen Syndrome
Complications
Personality disorders may be associated with other mental disorders. However, the frequency of such concomitant disorders (comorbidities) differs depending on the personality disorder present. About 50 percent of individuals who have an eating disorder have a concurrent personality disorder. Anxiety disorders are particularly common in obsessive-compulsive personality disorder. A common complication is depressive disorders such as dysthymia and (major) depression. Their core features are loss of pleasure and interest and depressed mood. Dysthymia is, in a sense, a weaker but longer-lasting form of depression. At the same time, however, more severe depressive episodes are also possible. People with a personality disorder also have an increased risk of suicide, which also varies among different personality disorders. For example, people suffering from borderline personality disorder have a suicide risk of around ten percent. In addition, if the personality disorder is accompanied by [[[Self-injurious behavior|self-injurious behavior]], various physical complications are conceivable. These include blood loss, inflammation of wounds, and damage to affected nerves or muscles.Injuries and scars can further lead to stigmatization and exclusion of the affected person. Social difficulties are also possible as a result of a personality disorder. Complications at work and relationship problems are possible, as are financial difficulties. Such factors may, in turn, have a negative impact on the personality disorder, exacerbating it or contributing to its perpetuation.
When should you see a doctor?
Personality disorder can lead to various complications and should therefore always be treated by a doctor. In many cases, however, the affected person does not realize that he or she is suffering from a personality disorder. For this reason, the help of friends and family is important in getting the affected person into treatment. In severe cases, treatment in a closed clinic may also be necessary. A doctor should generally be consulted if the personality disorder causes discomfort in life and in everyday life. This includes above all a social withdrawal and an aggressive basic attitude of the patient towards other people and activities. Likewise, perceptual disturbances, headaches, and insomnia may indicate a personality disorder and must be treated. A doctor must also be consulted if the personality disorder causes inferiority complexes or suicidal thoughts. Both of these symptoms can greatly threaten life and should be treated. If the personality disorder occurs after the use of alcohol or other drugs, a doctor may be seen if the use cannot be stopped. In this case, withdrawal is usually necessary.
Treatment and therapy
For personality disorders, psychotherapeutic methods are the treatment methods primarily indicated. There are, as already mentioned, on the one hand the possibility of depth-psychological and psychoanalytical treatment methods and on the other hand the behavior-therapeutic methods. An accompanying drug treatment with antidepressants or antipsychotics can be useful, in case of a comorbid depression it is even indicated. The treatment of personality disorders places very high demands on the therapist and, depending on the type of personality disorder, is often fraught with complications such as suicidality, self-injurious behavior, substance abuse, or even violence and delinquency. In addition, comorbidity with depression is common, and rarely with psychotic disorders. Personality disorder takes a long time to treat, and it is doubtful that personality disorder can be completely cured with available treatment methods. While successes have been demonstrated, even in cases where a personality disorder could not have been diagnosed after treatment, it is not possible to speak of a complete cure of a personality disorder.
Outlook and prognosis
A personality disorder represents a very serious disorder of the psyche and must always be treated by a physician or by a psychologist. Therefore, no universal prediction can be made as to whether or not a personality disorder can be cured. These chances of success depend heavily on the personal characteristics of the person affected. Without treatment, the personality disorder will usually not disappear on its own. It often develops even further and becomes stronger and stronger. The affected person withdraws more and more and socially excludes himself. Severe depression, sleep disturbances and aggressive behavior occur. A loss of reality also occurs relatively frequently. In the worst case, the personality disorder can be so severe that it leads to suicide. Treatment usually takes place with medication and by a psychologist. At the psychologist’s office, the main goal is to determine the reasons for the personality disorder. It can also occur after an accident, which caused damage to the brain. In these cases, treatment is very limited. The quality of life decreases with the personality disorder. In most cases, therapy leads to success and can contain the personality disorder to a large extent. However, it can resurface when unpleasant situations arise for the patient.
Prevent
Since the first signs of a personality disorder often manifest themselves in childhood or adolescence, treatment by a child and adolescent psychotherapist, for example, should already begin here. In many cases, the development of a personality disorder in adulthood can be prevented or at least mitigated. However, there is no prevention in the true sense of the word, since the causes are not (yet) sufficiently understood. However, it can be assumed that if personal development in childhood and adolescence is as undisturbed as possible without too many harmful influences, a personality disorder will tend not to develop.
Aftercare
Once a patient with a personality disorder has been treated as an inpatient in a clinic, doctors and therapists often recommend subsequent outpatient treatment. A clinic may offer its own aftercare services for patients, which may include, for example, discussion groups, psychoeducation, and/or individual sessions with a therapist or psychiatrist. The aim of such services is often to support the patient on his way back to everyday life and gradually become more independent. Through everyday life, relationship conflicts that are typical of a personality disorder can become topical again. In some cases, therapists therefore include relatives in the treatment by inviting them to one or more sessions if the patient agrees. In outpatient therapy, patients often work long-term on how to manage their daily lives to reduce stressors and better manage their personality disorder. After the final conclusion of outpatient psychotherapy, people with a personality disorder can continue to use what they have learned in therapy. Because treatment is usually highly individualized, follow-up care cannot be readily generalized either. With the support of their therapists, many patients develop strategies tailored to them personally for dealing with relapses or crisis situations.
Here’s what you can do yourself
In many cases, everyday life with a personality disorder leads to tension with roommates, family or friends. For this reason, it is helpful to inform close people about the mental illness. Talking openly about wishes and needs helps others to respond appropriately. This also applies to dealing with the illness. A clear structure can help in everyday life. However, it depends on the type of personality disorder and any other mental health problems: Someone who tends to be obsessive may just benefit from learning to let go. A job or hobbies usually have a stabilizing effect and are a good way to practically help oneself with personality disorders. Those who are overwhelmed with a full job can also explore internship or volunteer opportunities. It may be possible to obtain a funded measure that supports such efforts, for example, as part of vocational rehabilitation or as a measure of the employment office. Since personality disorders are often associated with a high risk of suicide, it makes sense to take appropriate safety measures in everyday life. It is especially important to recognize early warning signs. These warning signs can be different for each person – therapy can help identify them individually. In addition, it is often useful to involve a confidant and ask for help in time, as soon as suicidal thoughts arise.