Personality Disorders - refer to personality traits that are extreme or that

create so much difficulty in life as to be considered disabling. They are more severe than the negative personality traits that we all show at various times throughout our lives, or the "problem" people that we sometimes have to deal with at work. Personality disorders are medically defined as long-term, pervasive, inflexible patterns of thoughts and behaviors that are not well adapted or do not fit within the range of behavior considered normal. These patterns lead to significant difficulties in the ability to reason or interact with others or to behave appropriately. Subtypes:

Antisocial personality disorder Avoidant personality disorder Borderline personality disorder Dependent personality disorder Histrionic personality disorder Narcissistic personality disorder Obsessive-compulsive personality disorder Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder

Characteristics: Symptoms vary widely depending on the type of personality disorder. In general, personality disorders involve feelings, thoughts, and behaviors that do not adapt to a wide range of settings. These patterns usually begin in adolescence and may lead to problems in social and work situations. The severity of these conditions ranges from mild to severe. Etiology: The causes of personality disorders are unknown. However, many genetic and environmental factors are thought to play a role. The roots of personality disorder lie in both early life experiences and genetic (ie, inherited) factors. However, severe changes in personality may develop during later life because of the unique stresses experienced by older adults. Many older adults become overwhelmed by losses (eg, deaths among friends and loved ones), medical problems, and stresses that build up over time. This is especially true for people who are not able to cope well or do not have the personal, social, or financial resources to act as a cushion or buffer against these stresses. General Management: At first, people with these disorders usually do not seek treatment on their own. They tend to seek help once their behavior has caused severe problems in their relationships or work, or when they are diagnosed with another psychiatric problem, such as a mood or substance abuse disorder.

Although personality disorders take time to treat, there is increasing evidence that certain forms of talk therapy can help many people. In some cases, medications can be a useful addition to therapy.

Subtypes: There are many formally identified personality disorders, each with their own set of behaviors and symptoms. Many of these fall into three different categories or clusters: Cluster A: Odd or eccentric behavior Cluster B: Dramatic, emotional or erratic behavior Cluster C: Anxious or fearful behavior

1. Cluster A: a. Schizoid Personality Disorder - is a psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation. Symptoms: A person with schizoid personality disorder: Appears aloof and detached Avoids social activities that involve emotional intimacy with other people Does not want or enjoy close relationships, even with family members Etiology: The causes of schizoid personality disorder are unknown. This disorder may be related to schizophrenia and it shares many of the same risk factors. However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia. b. Paranoid Personality Disorder - is a psychiatric condition in which a person has a long-term distrust and suspicion of others, but does not have a full-blown psychotic disorder such as schizophrenia. Symptoms: People with paranoid personality disorder are highly suspicious of other people. As a result, people with this condition severely limit their social lives. They often feel that they are in danger, and look for evidence to support their suspicions. People with this disorder have trouble seeing that their distrustfulness is out of proportion to their environment. Common symptoms include: Concern that other people have hidden motives Expectation that they will be exploited by others Inability to work together with others Social isolation Detachment Hostility

Etiology: The causes of paranoid personality disorder are unknown. The disorder appears to be more common in families with psychotic disorders such as schizophrenia and delusional disorder, which suggests genes may be involved. However, environmental factors may play a role as well. The condition appears to be more common in men. c. Schizotypal Personality Disorder - is a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior. Symptoms: People with schizotypal personality disorder: May be very disturbed. Their odd behavior may look like that of people with schizophrenia. For example, they may also have unusual preoccupations and fears, such as fears of being monitored by government agencies. More commonly, however, people with schizotypal personality disorder behave oddly and have unusual beliefs (such as aliens). They cling to these beliefs so strongly that it prevents them from having relationships. People with schizotypal personality disorder feel upset by their difficulty in forming and keeping close relationships. This is different from people with schizoid personality disorder, who do not want to form relationships. Etiology: The exact cause is unknown. Genes are thought to be involved, because this condition is more common in relatives of schizophrenics. Schizotypal personality disorder should not be confused with schizophrenia. People with schizotypal personality disorder can have odd beliefs and behaviors, but they are not disconnected from reality and usually do not hallucinate. Hallucinations, delusions (fixed, false beliefs), and loss of touch with reality are hallmarks of psychosis. People with schizotypal personality disorder do not usually have psychotic symptoms. 2. Cluster B: a. Antisocial Personality Disorder - is a type of chronic mental illness in which a person's ways of thinking, perceiving situations and relating to others are abnormal and destructive. People with antisocial personality disorder typically have no regard for right and wrong. They may often violate the law and the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems.

And people with antisocial personality disorder may not be able to fulfill responsibilities to family, work or school. Antisocial personality disorder is sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder. Symptoms: Disregard for right and wrong Persistent lying or deceit Using charm or wit to manipulate others Recurring difficulties with the law Repeatedly violating the rights of others Child abuse or neglect Intimidation of others Aggressive or violent behavior Lack of remorse about harming others Impulsive behavior Agitation Poor or abusive relationships Irresponsible work behavior Have problems with substance abuse Etiology: The causes of antisocial personality disorder are unknown. Genetic factors and child abuse are believed to contribute to the development of this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected. The condition is common in people who are in prison. Fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality. Some people believe that psychopathic personality (psychopathy) is the same disorder. Others believe that psychopathic personality is a similar but more severe disorder. b. Borderline Personality Disorder - is a condition in which people have longterm patterns of unstable or turbulent emotions, such as feelings about themselves and others. These inner experiences often cause them to take impulsive actions and have chaotic relationships. Symptoms: People with Borderline Personality Disorder (BPD) are often uncertain about their identity. As a result, their interests and values may change rapidly. People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked

up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships. Other symptoms of BPD include: Fear of being abandoned Feelings of emptiness and boredom Frequent displays of inappropriate anger Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting Intolerance of being alone Repeated crises and acts of self-injury, such as wrist cutting or overdosing

Etiology: The causes of BPD are unknown. Genetic, family, and social factors are thought to play roles. Risk factors for BPD include: Abandonment in childhood or adolescence Disrupted family life Poor communication in the family Sexual abuse This personality disorder tends to occur more often in women and among hospitalized psychiatric patients. c. Narcissistic Personality Disorder - is a condition in which people have an inflated sense of self-importance and an extreme preoccupation with themselves. Symptoms: A person with narcissistic personality disorder may: React to criticism with rage, shame, or humiliation Take advantage of other people to achieve his or her own goals Have excessive feelings of self-importance Exaggerate achievements and talents Be preoccupied with fantasies of success, power, beauty, intelligence, or ideal love Have unreasonable expectations of favorable treatment Need constant attention and admiration Disregard the feelings of others, and have little ability to feel empathy Have obsessive self-interest Pursue mainly selfish goals Etiology: The causes of this disorder are unknown. An overly sensitive personality and parenting problems may affect the development of this disorder.

d. Histrionic Personality Disorder - is a condition in which people act in a very emotional and dramatic way that draws attention to themselves. Symptoms: People with this disorder are usually able to function at a high level and can be successful socially and at work. Symptoms include: Acting or looking overly seductive Being easily influenced by other people Being overly concerned with their looks Being overly dramatic and emotional Being overly sensitive to criticism or disapproval Believing that relationships are more intimate than they actually are Blaming failure or disappointment on others Constantly seeking reassurance or approval Having a low tolerance for frustration or delayed gratification Needing to be the center of attention (self-centeredness) Quickly changing emotions, which may seem shallow to others Etiology: The cause of this disorder is unknown. Both genes and early childhood events are thought to contribute. It occurs more often in women than in men, although it may be diagnosed more often in women because attention-seeking and sexual forwardness are less socially acceptable for women. 3. Cluster C: a. Avoidant Personality Disorder - is a mental health condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection. Symptoms: People with avoidant personality disorder are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these individuals will choose to be lonely rather than risk trying to connect with others. Hypersensitivity to rejection/criticism Self-imposed social isolation Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships Avoids physical contact because it has been associated with an unpleasant or painful stimulus Avoids interpersonal relationships Feelings of inadequacy Severe low self-esteem

Mistrust of others Highly self-conscious Feeling inferior to others Utilizes fantasy as a form of escapism and to interrupt painful thoughts

Etiology: Apart from the above, other causes of Avoidant Personality Disorder (AvPD) are not clearly defined, and may be influenced by a combination of social, genetic, and psychological factors. The disorder may be related to temperamental factors that are inherited. Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterized by behavioral inhibition, including features of being shy, fearful, and withdrawn in new situations. These inherited characteristics may give an individual a genetic predisposition towards AvPD. Childhood emotional neglect and peer group rejection are both associated with an increased risk for the development of AvPD. b. Dependent Personality Disorder - is a long-term (chronic) condition in which people depend too much on others to meet their emotional and physical needs. Symptoms: People with this disorder do not trust their own ability to make decisions. They may be very upset by separation and loss. They may go to great lengths, even suffering abuse, to stay in a relationship. Symptoms of dependent personality disorder may include: Avoiding being alone Avoiding personal responsibility Becoming easily hurt by criticism or disapproval Becoming overly focused on fears of being abandoned Becoming very passive in relationships Feeling very upset or helpless when relationships end Having difficulty making decisions without support from others Having problems expressing disagreements with others Etiology: Dependent personality disorder usually begins in childhood. The causes of this disorder are unknown. It is one of the most common personality disorders, and is equally common in men and women. c. Obsessive-Compulsive Personality Disorder (OCPD) - is a condition in which a person is preoccupied with rules, orderliness, and control. Symptoms:

OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct. People with both OCPD and OCD tend to be high achievers and feel a sense of urgency about their actions. They may become very upset if other people interfere with their rigid routines. They may not be able to express their anger directly. Instead, people with OCPD experience feelings that they consider more appropriate, like anxiety or frustration. A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person's ability to complete tasks, because their standards are so rigid. People with this disorder may emotionally withdraw when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships. Some of the other signs of obsessive-compulsive personality disorder include: Excess devotion to work Inability to throw things away, even when the objects have no value Lack of flexibility Lack of generosity Not wanting to allow other people to do things Not willing to show affection Preoccupation with details, rules, and lists Etiology: Obsessive-compulsive personality disorder tends to occur in families, so genes may be involved. A person's childhood and environment may also play roles. This condition can affect both men and women, but it most often occurs in men.