The Causes, Signs, and Treatment of Personality Disorders
Personality disorders have been around since the beginning of time. There are many different types of personality disorders and it has only been in more recent times in history that we have begun to understand what personality disorders really are and why they happen. There are many different types of disorders and what causes them is still up for debate. The diagnosis of these disorders is very difficult and treating them is almost equally as tough.
The DSM-IV gives these generic criteria for personality disorders:
· A lasting pattern of behavior and inner experience that markedly deviates from norms of the patient’s culture.
· This pattern is fixed and affects many personal and social situations
· The pattern causes clinically important distress or impairs work, social, or personal functioning
· This stable pattern has lasted a long time, with roots in adolescence or young adulthood
· The pattern isn’t better explained by another mental disorder
· It isn’t directly caused by a general medical condition or by the use of substances, including medications (Morrison 461)
Personality disorders are grouped into three clusters A, B, and C. Cluster A contains disorders such as paranoid, schizoid (a lack of interest in social relationships), and schizotypal (a need for social isolation). Cluster B contains antisocial, borderline (a prolonged disturbance of personality function), histrionic (excessive emotionality and attention-seeking), and narcissistic (egotism). Cluster C contains avoidant, dependent, and obsessive-compulsive. People with Cluster A personality disorders can be described as withdrawn, cold, suspicious, or irrational. People with the Cluster B disorders tend to be dramatic, emotional, and attention-seeking with their moods being labile and often shallow. People with the Cluster C disorders tend to be anxious and tense, and are often over controlled (Morrison 458-459). Many people have some form of one or many of these and continue to live normal lives. Why some need treatment while others don’t is still a mystery.
What causes personality disorders is still a debatable subject although most people accept that they are the combination of three factors. These factors are biological, psychological and cognitive-behavioral (Gazzaniga, Heatherton, Halpern 626). The biological factors begin with the fetus. Evidence has shown that some mental disorders arise from prenatal problems such as malnutrition, exposure to toxins, and maternal illness (Gazzaniga, Heatherton, Halpern 626). The psychological aspect focuses on two main areas. The first, the family-systems model, proposes that an individual’s behavior has to be looked at in a social context, particularly within the family. The second area of focus is the sociocultural model which takes in to account the individuals interaction between other individuals and their culture (Gazzaniga, Heatherton, Halpern 626-627). Finally the cognitive-behavioral factor proposes that mental disorders are a result of classical and operant conditioning. The idea behind this theory is that thoughts can become distorted and produce maladaptive behaviors and emotions (Gazzaniga, Heatherton, Halpern 628). There are however, other factors in what cause personality disorders.
Sex also plays a role in personality disorders. Some disorders are more common for males and others for females. For example, dependence on alcohol and/or drugs, antisocial personality disorders, and childhood attention-deficit/hyperactivity disorders are twice as likely to happen to males than females (Gazzaniga, Heatherton, Halpern628). Likewise, anorexia is 10 times more likely to affect females and panic disorders are twice as likely. Some disorders such as schizophrenia (characterized by abnormalities in perception or expression of reality) and bipolar disorder are equal for both males and females (Gazzaniga, Heatherton, Halpern 628). Once one is diagnosed with a personality disorder, treatment, the most difficult part of therapy, begins.
When diagnosing personality disorders, a therapist must use the Axis I and Axis II system. For this, Axis I is reserved for clinical disorders, including major mental disorders, and learning disorders. Axis II is for personality disorders and mental retardation (Morrison 4-5). This presents a problem in the diagnosis of personality disorders. Axis II disorders are often overlooked but they are sometimes also over diagnosed. Borderline Personality Disorder is an example of an Axis II disorder that is almost always over diagnosed. Some, Antisocial Personality Disorder, carry a poor prognosis. To top all of that off most, if not all, personality disorders are hard to treat (Morrison 462).
There are however several different methods of treating personality disorders. One method is day treatment. Day treatment, day hospital, day care, and all other forms of partial hospitalization, can be helpful because they do not require inpatient care but provide a person with more intensive treatment than is possible on an outpatient basis (Magnavita 357). There are differences within these treatments too. Day treatment is different from day hospital and day care in that it gives emphasis to the treatment and rehabilitation of patients. Treatment is usually concerned with optimal recovery and tries to alleviate (remove) symptoms from patients. Day hospital programs are concerned with the treatment of acute illness. Day hospitals are appropriate for those who would otherwise be treated as inpatients. Day care programs are concerned with maintaining patients with chronic mental disorders. Rehabilitation and adjustment expectations are modest and treatment usually only has a minor role in the programs (Magnavita 357).
Another method of treatment is long-term therapy. However, long-term therapy is very difficult to do because as Thomas R. Lynch, PhD, assistant professor of psychology at Duke University and the Duke University Medical Center says, "[People with] personality disorders exhibit chronic, pervasive problems getting along with people in all kinds of different contexts, and this includes therapists." Because of this, people with disorders often don’t seek treatment, and those who do usually drop out (Dingfelder par. 4). One example of this is people with borderline personality disorder.
Borderline Personality Disorder (BPD) is one of the most common personality disorders around. The DSM-IV has this to say about BPD:
“Patients with Borderline Personality Disorder sustain a pattern of instability throughout their adult lives. The often appear to be in a crisis of mood, behavior, or interpersonal relationships. Many feel empty and bored; they attach themselves strongly to others, and then become intensely angry or hostile when they believe that they are being ignored or mistreated by those they depend on. They may impulsively try to harm or mutilate themselves; these actions are expressions of anger, cries for help, or attempts to numb themselves to their emotional pain. Although borderline patients may experiences brief psychotic episodes, these episodes resolve so quickly that they are seldom confused with psychoses like Schizophrenia. Intense and rapid mood swings, impulsivity, and unstable interpersonal relationships make it difficult for borderline patients to achieve their full potential socially, at work, or in school.”(Morrison 478-479)
It goes on to state that BPD runs in families and that these people are truly miserable and in some cases (up to 10%) complete suicide (Morrison 479). BPD is the most commonly treated disorder; however people who seek help quit their therapy sessions about 70% of the time (Dingfelder par. 4). Another problem with treating those with BPD is while the individuals can be quick to open to therapists, they can also be even quicker and shutting down. These individuals also often want approval and even the smallest amount of provocation can trigger abusive and violent behavior towards those trying to help them (Dingfelder par. 7).
Personality disorders come in many different ways and forms happening to both men and women and in some cases are passed through generations in families. They appear in a person seemingly without any reason but yet they are one of the more difficult things for a therapist to diagnose and treat. Personality disorders do not have to be life-crippling if the individual does not want them to be. There are different treatment options for those suffering from them depending on how long or intense those individuals want treatment.
