Dealing with Different Types of Personality Disorders
Deeply ingrained, maladaptive patterns of behavior; recognizable in adolescence or earlier; continuing throughout most of adult life; either the patient or others have to suffer; there is an adverse effect on the individual or society. They neither learn from past experience nor benefit from punishment.
Alternate personalities or "alters" may be created deal with those situations beyond his emotional control. Many times those "alter" are the result of profound abuse or a traumatic event in a person's life. Abuse may be rooted in childhood.
That's where you find the worries many people have — fear of speaking in public, of eating alone in restaurants, of giving presentations at work — listed as indications of potential mental disorders. Specifically, social phobia and avoidant personality disorder.
That's really disconcerting because shyness becomes almost indistinguishable from these disorders. By the 1990s you see social anxiety disorder named as the "disorder of the decade" in Psychology Today.
A study published recently in the open access journal BMC Psychiatry suggests that the way in which professional care workers respond emotionally to substance abuse patients with personality disorders depends on the type of disorder.
Birgitte Thylstrup and Morten Hesse of Aarhus University, Centre for Alcohol and Drug Research, in Copenhagen, Denmark, explain that while previous research has shown that antisocial and aggressive behavior in patients can affect how professionals manage them, no previous studies have investigated the distinction between the full range of different personality disorders and their effects on professional health care workers.
A single mental illness afflicts some 4 million Americans, between 1 percent and 2 percent of the population. It accounts for, or figures in, 20 percent of all psychiatric hospital admissions. More Americans have this illness than suffer from schizophrenia. A third of all young Americans who commit suicide first show symptoms of this illness.
More commonly diagnosed in:
- Age group 18-35 years.
- Male sex.
- Lower social class.
I. Personality disorders tend to become rather less disordered as the patient grows older.
II. Patients with antisocial personality disorders over the age of 45 present fewer problems of aggressive behavior than patients under the age of 45. However, their problems of personal relationships tend to persist.
Different types of personality disorder:
I. Affective personality disorder - 3 groups:
1. Depressive personality disorder— always low in spirits; persistently gloomy view of life; brood about misfortunes; worry unduly; strong sense of duty; little capacity for enjoyment.
2. Hyperthymic personality disorder— habitually cheerful and optimistic; striking zest for living; poor judgment; periods of irritability when aims frustrated.
3. Cyclothymic personality disorder— alternate between being low in spirits and being cheerful and optimistic; gloomy defeatist approach to life as mood changes from hyperthymic to depressive; reduced energy. The cause of cyclothymic disorder is unknown. Although the changes in mood are irregular and abrupt, the severity of the mood swings is far less extreme than that seen with bipolar disorder (manic depressive illness). In actual mania, a person may lose control over his or her behavior and go on spending binges, engage in highly risky sexual or drug-taking behavior, and become detached from reality.
Cyclothymic disorder may cause disruption in all areas of the person's life. Many individuals with this disorder are unable to succeed in their professional or personal lives as a result of their symptoms. A few who suffer primarily from hypomanic episodes are high achievers who work long hours and require little sleep. A person's ability to manage the symptoms of the disorder depends upon a number of personal, social, and cultural factors.
II. Anankastic personality disorder (obsessional personality disorder) —
Lack of adaptability to new situations; high moral standards; humorless approach to life; miserly; sensitivity to criticism; indecision; emotionally constricted.
III. Antisocial personality disorder (sociopathic or asocial personality disorder) — impulsive actions; lack of guilt; failure to make loving relationships; failure to learn from adverse experiences.
IV. Asthenic personality disorder (passive or dependent personality disorder)— weak-willed; unduly compliant; lack vigor; lack self-reliance; avoid responsibility; little capacity for enjoyment.
V. Avoidant personality disorder— hypersensitive to rejection; low self-esteem; unwillingness to enter into relationships; desire for acceptance.
VI. Borderline personality disorder— Borderline personality disorder (BPD), characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, afflicts approximately 2 percent of the general population and is a leading cause of suicide. It causes unstable relationships; undue anger variable moods; chronic boredom; doubts about personal identity; intolerance of being left alone; self-injury; impulsive behavior that is damaging to the person. Eight to 10 percent of individuals with this disorder take their own lives. Sufferers of BPD can't control their emotions, impulses and relationships. Many are unemployable. Of the men in prison, 12 percent have BPD, as do 28 percent of women inmates.
People with BPD usually suffer from other illnesses — depression and drug addiction, for instance — both mental and physical. A 30-year-old woman with BPD typically has the medical profile of a woman in her 60s, according to the alliance.
“A common misapprehension by family, friends and often by clinicians is that patients with borderline personality disorder are not likely to commit suicide since suicidal behavior is seen as a bid for attention, misjudged as not serious. The prevalence is more than 400 times higher than in the general population,” said John Oldham, MD, MS, senior vice president and chief of staff, The Menninger Clinic, and professor of psychiatry and executive vice chair, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine.
VII. Explosive personality disorder— instability of mood with outbursts of anger and violence; no other difficulties in relationships (cf. antisocial personality disorder).
vIII. Histrionic personality disorder— self-dramatization; a self- importance; preoccupation with fantasies of unlimited success, power and intellectual brilliance; attention demanding but show little warm feeling in return; exploitative but do not give favors in return.
IX. Paranoid personality disorder— strong sense of self-importance; suspicious; hypersensitive; cold affect; argumentative and stubborn.
X. Passive-aggressive personality disorder— passive resistance to demands for adequate performance; stubborn; inefficient.
XI. Schizoid personality disorder— introspective; prone to engage in an inner world of fantasy rather than take action; lack of emotional warmth and rapport; self-sufficient and detached; aloof and humorless; incapable of expressing tenderness or affection; shy; often eccentric; insensitive; ill-at-ease in company.
XII. Schizotypal personality disorder— superstitious ideas; an interest in telepathy and clairvoyance; unrealistic (magical) thinking; odd forms of speech.
xiii) Dissociative identity disorder (DID): A psychiatric disorder called dissociative identity disorder (DID) or, as it was known earlier, multiple personality disorder (MPD). This disorder has been recorded in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The prevalence of this disease is still hard to determine even as psychiatrists across the globe are trying to solve this aberration. What is worse is that the causes of DID are yet to be ascertained, but it is theoretically linked with overwhelming stress, insufficient childhood nurturing and abuse and the innate ability to dissociate memories or experiences from consciousness.
xiv) Narcissistic Personality Disorder: It is a very real problem. Why is it that so many of our military, political, educational, religious and manufacturing leaders have the same scenarios being played out (uncontrollable subconscious)? It doesn't matter what you're doing, because the guy with NPD will always take advantage.
NPD is a rare disorder, beginning in childhood. The cause is not understood, and there is some disagreement regarding environmental vs. biological causation. People with narcissistic personalities, in spite of their thoughts and behaviors, unconsciously feel inferior and inadequate. Narcissistic personality disorders are often caused by poor parenting and a dysfunctional childhood. The parents of a narcissist either overly spoiled or pampered the child or they were overly harsh and abusive. Either extreme may cause a child to develop a narcissistic personality.
99% of subjects clinically diagnosed with NPD are men, it is largely unknown in women" NNPD is often characterized by grandiose behavior, due to the subject’s belief that they are "special", or "favored by God". They lack empathy for others in general, creating difficult social interactions and the inability to bond appropriately in personal relationships. Treatment is difficult, and outcome statistics are poor, as subjects do not see themselves as having a problem."
- Short-term-anxiolytic drugs or neuroleptics may be given for short periods at times of unusual stress.
- Long-term- neuroleptics may be helpful in paranoid and schizotypal personality disorders.
II. Social— supervision and support are often beneficial. This can be given by a doctor, social worker or psychiatric nurse.
III. Psychological— for the majority, psychotherapy is not indicated. Group psychotherapy is more helpful than individual psychotherapy. Confrontative psychotherapy is more helpful than interpretative psychotherapy. Psychotherapy is least likely to help people with antisocial personality disorders, although some are helped by large group psychotherapy in the form of a therapeutic community-in such a unit, the patients meet several times a day for group discussions, in which each person's behavior and feelings are examined by the other group members.
IV. General measure:
- The treatment plan aims to bring about limited changes in the patient's circumstances, so that he has less contact with situations that provoke his personality.
- Admission to hospital should be avoided whenever possible, but may be necessary for short periods of crisis.
As yet, there is no medication approved for the treatment of BPD, but specific counseling therapies and techniques have proved effective.
In recent decades, the deadly sins have been transformed into personal afflictions. That is why the invention of ‘eco-sin’ represents such a remarkable development in modern society. It is its successful rehabilitation of the idea of human guilt that makes eco-sin so attractive to the Vatican and other religions. The old deadly sins tend to be looked upon as personality disorders that require treatment, rather than transgressions that deserve punishment.
“The patient with antisocial personality disorder tends to be manipulative and aggressive. It is natural for staff members to react to such behavior with some negative reactions, and this is not a sign of unprofessional conduct”, says Morten Hesse. “On the other hand, the patient with avoidant personality disorder is often cautious and appears vulnerable and needy. In that context, many clinicians feel that they can be useful to the patient, and feel secure in their role as treatment providers.”
Treatment usually needs to be compelled, is long term (several years), and often requires both a mental health professional with special expertise in treating narcissistic personalities and another person or institution that has the power to require that the narcissistic person completes treatment. Treatment is usually best done in group therapy with other individuals who have narcissistic personality problems.
The idea that the emotional reactions of a professional to his or her patient may play an important part in psychotherapeutic treatment dates back to the work of Sigmund Freud. He coined the term ‘countertransferance’ to describe the observation that a patient’s influence on the analyst’s unconscious feelings may interfere with the patient’s treatment.