Causes and risk factors
There are several types of personality disorders each having distinctive causative factors. However, generally causes include combination of genetic and environmental influences. Environmental factors like abuse in childhood, childhood full of physical and verbal abuse, anger outburst in family members, repeated exposure to such type of domestic violence, alcoholic parents, divorce of parents, people in prison, children brought up in orphanage. Various types of personality disorders are – antisocial personality disorder , avoidant personality disorder, borderline personality disorder, histrionic personality disorder, multiple personality disorder or dissociative identity disorder, narcissist personality disorder, obsessive compulsive disorder, paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, Explosive personality disorder .
Clinical presentation
Each type of personality disorder presents differently as follows.
Antisocial personality disorder-A person with Anti social personality disorder presents with failure to follow social norms by breaking laws repeatedly, irresponsible work behaviour, and impulsivity. Repeated physical fights and assaults, unnecessary risk-taking, creating violence, lack of empathy for others and lack of remorse about harming others.
Avoidant personality disorder – A person with this disorder has a lifelong pattern of feeling extremely shy, inadequate, and sensitive to rejection. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. Is preoccupied with being criticized or rejected in social situations.
Borderline personality disorder – it is characterized by instability in moods, behaviour, and relationships. Inappropriate, intense anger or problems controlling anger. Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality. Extreme reactions including panic, depression, rage, or frantic actions to abandonment, whether real or perceived. A pattern of intense and stormy relationships with family, friends, and loved ones, Impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. Recurring suicidal behaviours or threats or self-harming behaviour, such as cutting.
Histrionic personality disorder – where a person has pattern of excessive emotions and attention-seeking behaviour. Patient is uncomfortable in situations in which he or she is not the centre of attention, sexually seductive or provocative behaviour, displays rapidly shifting and shallow expression of emotions, draw attention to themselves, has a style of speech that is excessively impressionistic and lacking in detail, shows self-dramatization, theatricality, and exaggerated expression of emotion.
Multiple personality disorder or dissociative identity disorder – mental process which produces lack of connection in person’s thoughts, actions, emotions and sense of identity. It is characterised by presence of two or more identities or split personalities. Each different identity has its own age, sex, race, posture, gesture and distinct way of talking. As the personality reveals itself it controls the individual’s behaviour. It is known as ‘switching’.
Narcissist personality disorder – characterised by feeling of grandiosity, need for admiration, and lack of empathy towards others. grandiose sense of self importance , excessive boasting, need for recognition; preoccupied with fantasies such as power, brilliance, beauty, ideal love; believing that he or she is superior and special and should interact with similar people; need for excessive admiration, proud, haughty, arrogant, rude; lacks empathy ; expectation of favourable treatment from others; takes advantage of others, will exploit others to achieve his goal.
Obsessive compulsive disorder- condition where one keeps repeating obsessive [Obsessions are involuntary, uncontrollable thoughts, images, or impulses that occur repeatedly in your mind and you can’t stop them] and Compulsory [Compulsions are behaviours that you feel driven to act out repeatedly] action involuntarily and is unable to resist that action. Obsessive thoughts such as the person washes his/her hand again and again; takes precautions for everything; counting and listing things very often even when not required. Compulsive actions like excessive double-checking of things, such as locks, switches etc.; counting, repeating certain words, spending a lot of time washing or cleaning etc.
Paranoid personality disorder – a person behaves very differently and over suspicious towards others. Becoming detached or socially isolated, being argumentative and defensive, having trouble seeing own problems, having trouble relaxing; being hypersensitive to criticism, having trouble working with others, being quick to become angry and hostile, believing that others have hidden motives or are out to harm you, doubting the loyalty of others.
Schizoid personality disorder – characterized by a longstanding behavioural pattern of detachment from social relationships. These people are socially and emotionally withdrawn. They have difficulty in expressing any type of emotion. These people prefer solitary activities and may even choose professions in which minimal social interaction is necessary. They try and avoid situations where they need to come into contact with plenty of people. They do not marry. They seem dull and indifferent. These people remain unaffected by praise or criticism. Their independence is extremely important to them.
Schizotypal personality disorder – characterized by social isolation, anxiety in social situations, oddness of behaviour and unconventional beliefs. People with this disorder are extremely uncomfortable in maintaining close relationships with people. They have few or no friends. Excessive social anxiety. Unusual beliefs, paranoid ideas, hypersensitivity they have Odd dressing sense. They show eccentric patterns of speech.
Explosive personality disorder – is a behavioural disorder characterized by episodes of aggressive, impulsive, violent behaviour which is disproportionate to the given situation resulting in damage to an individual or property. Failure to resist the aggressive impulses. Aggressive behaviour out of proportion to the triggering factor. Aggressive episode lasting for less than 30mins. Feelings subside quickly, followed by regret or embarrassment. Episodes of aggression occurs in cluster or there will be non-aggression phases lasting for weeks or months.
Investigation
Medical history by the patient and psychological evaluation by the psychiatrist or psychotherapist helps in diagnosis.
Treatment
Psychotherapy is required for treating personality disorders. It involves cognitive behavioural therapy, which teaches anger management techniques, relaxation techniques to combat personality disorders. Medications like anti depressants, anti anxiety drugs, anti convulsants, mood stabilizers help in treatment of the disease. Treating other accompanying psychological diseases contribute further to the treatment.
Other Modes of treatment
The other modes of treatment can also be effective in treating personality disorders.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating personality disorders.
