Personality disorders - list, symptoms, causes, treatment

Overview of personality disorders

Personality disorders are a mental illness in which the behavior, character traits and other characteristics of the personality structure deviate drastically from the norm. Those affected are trapped in certain patterns of thinking and behavior that they can barely break. The disturbances can manifest themselves in many ways. The behavior of persons suffering from a personality disorder is often perceived by others as strange, eccentric, paranoid, dramatic, narcissistic, moody, compulsive, or insecure. Here are the most important things in brief:

• definition: A personality disorder is a series of different mental illnesses in which sufferers suffer from disturbances of experience and behavior.
• diseases: Disease patterns include paranoid, schizoid, histrionic, narcissistic, emotionally unstable, dissocial, self-conscious, dependent, and compulsive personality disorder.
• symptoms: Certain personality traits are so pronounced that sufferers constantly suffer from the effects of their behavior or are severely limited in their quality of life and achievement of their goals.
• causes: The exact causes are considered insufficiently understood. Experts agree that the combination of genetic predisposition and psychological stress caused by environmental factors such as early childhood events is a cause.
• diagnosis: The diagnosis is usually made by a psychiatrist or psychotherapist according to given criteria of the ICD-10 and the DSM classification.
• therapy: Psychotherapeutic procedures such as cognitive behavioral therapy, depth psychological psychotherapy and analytic psychotherapy are increasingly being used. Psychiatric drugs are occasionally used to treat severe symptoms.

contents

• Overview of personality disorders
• definition
• frequency
• symptoms
• List of personality disorders
• Paranoid personality disorder
• Schizoid personality disorder
• Dissocial personality disorder
• Borderline error
• Histrionic personality disorder
• Compulsive personality disorder
• Anxious (avoiding) personality disorder
• Dependent personality disorder / asthenic PS
• Other disorders
• causes
• diagnosis
• treatment
• Naturopathy

definition

The psychiatric condition of personality disorders (PS) includes a wide range of mental illnesses associated with severe disorders of experience and behavior. A distinction should be made between the pathological disturbances in the personality structure of salient features of the personal lifestyle, which may seem to many to be abnormal but do not affect their psychological well-being and do not unduly burden their social environment. These personality traits are not to be understood as mental illness. The demarcation can be quite difficult here, however, because the transition between a peculiar lifestyle and a disturbed personality is often fluid.

Not every salient personality trait is a personality disorder, but a peculiar lifestyle is often a sign of a disorder. (Image: Photographee.eu/fotolia.com)

When does one speak of a personality disorder?

The starting point is often extremely pronounced personality traits, for example, a very inflexible, rigid or inappropriate behavior. One speaks of a personality disorder, when these traits take on a level at which the person is constantly due to the extreme behavior over a long period of time

• subjectively suffering,
• get into frequent conflict situations,
• to lower one's own quality of life,
• stand in the way of achieving their goals,
• Feeling dissatisfaction.

A personality disorder arises independently

This type of disorder is not triggered as a result of drugs or medications, other illnesses, injuries and accidents do not cause personality disorder. In this mental illness, the basic personality traits can be traced back to adolescence or young adulthood. These traits are then marked out until there is a disruption.

classification

The World Health Organization (WHO) "International Statistical Classification of Diseases and Related Health Problems" (ICD-10) uses the term "specific personality disorder" for the symptoms presented below. In addition to the ICD-10, the classification often uses the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

In a personality disorder, those affected can sometimes understand their own behavior. (Image: pix4u / fotolia.com)

frequency

The individual forms of PS occur with varying degrees of frequency, with many forms such as the schizoid PS or the anxious (avoiding) PS affecting less than one percent of the population. Other forms such as the Borderline PS or compulsory horsepower, however, are much more common. "Recent studies have shown that about ten percent of all people meet the criteria for a personality disorder," reports the Department of Psychiatry and Psychotherapy of the Charité Universitätsmedizin Berlin. Accordingly, it can be assumed that a total of around eight million people in Germany suffer from a personality disorder.

symptoms

A disturbed personality expresses itself depending on the respective type by different mental impairments and striking behavior patterns. In general, it can be said that these are usually certain personality traits that occur in an extreme form and thus become a burden on the social stability of those affected, their personal well-being and their environment.

Certain features can cause certain disturbances

The Berlin Charité has provided a compilation in which the various characteristics of the personality style and its exaggerated variant are presented as a form of personality disorder. Accordingly, a conscientious, careful lifestyle is associated with the exaggeration in the form of compulsive behavior or compulsive behavior. An ambitious, self-confident behavior assumes narcissistic traits in a personality disorder.

Expressive, emotional people become histrionic (theatrical, selfish). Watchful, suspicious people become paranoid and jumpy, spontaneous people show a borderline personality. An affectionate, loyal behavior is assigned the exaggerated form of a dependent personality, reserved, lonely persons become schizoid in a personality disorder, adventurers and risk-takers dissocial.

List of personality disorders

According to this relatively simple scheme, different forms can be determined, each associated with specific symptoms and then described in more detail below. The classification is done according to the "International Statistical Classification of Diseases and Related Health Problems". This is called as various forms of personality disorders (PS) one

• paranoid PS,
• schizoid PS,
• dissocial PS,
• emotionally unstable horsepower (borderline),
• histrionic horsepower,
• Anankastische (compulsive) PS,
• fearful (avoiding) horsepower,
• dependent (asthenic) horsepower,
• other specific personality disorders.
• Another variant considered separately in the ICD-10 is the schizotypal or schizotypal personality disorder.

The generic term personality disorders summarizes many mental illnesses in which extremely pronounced personality traits form the cornerstone of the disease. (Image: heilpraxis.de)

Paranoid personality disorder

Paranoid disorders are expressed in a mistrust-like behavior that often culminates in conspiracy theories and is accompanied by a conspicuous quibble. Even normal actions of fellow human beings are often perceived as hostile or despising. In the relationship, a paranoid personality disorder often leads to massive, unfounded jealousy.

Close social environment is included

Mistrust also does not stop at family members and longtime friends. Their actions and loyalty are regularly questioned by paranoid persons. In the long term, paranoid personality disorder is associated with significant social and personal impairments.

Personality traits associated with a paranoid PS

According to ICD-10, in paranoid personality disorder, at least four of the following characteristics or behaviors are detectable:

• mistrust,
• a hostile or contemptuous interpretation of neutral or friendly actions,
• excessive sensitivity to rejection,
• frequent, unjustified jealousy,
• Inclination to conspiracy theories,
• Quarrelsome and insisting on own rights,
• a generally excessive self-centeredness (often combined with arrogance),
• Inability to forgive subjectively experienced injuries.

Paranoid PS is not paranoid schizophrenia

Delineated is the paranoid disorder of paranoid schizophrenia and delusion in the form of paranoia, both of which form independent mental illnesses after the ICD-10. People with a paranoid personality disorder often show other mental disorders, notably schizotypal personality disorder, narcissism, borderline disorder, and passive-aggressive personality disorder.

The ICD-10 system classifies the different mental illnesses. (Image: vege / fotolia.com)

Schizoid personality disorder

Schizoid personality disorders are characterized by a neglect of social contacts, a lack of emotional compassion and problems in expressing one's own emotions. Those affected tend to retire and are often loners. A pronounced mistrust of fellow human beings can also be part of the complaints.

Personality traits associated with a schizoid PS

According to ICD-10, a schizoid disorder is assumed if at least three of the following criteria are met. Affected

• show an emotional detachment,
• are incapable of experiencing joy or enjoy only very few activities,
• can express their feelings only to a limited extent,
• are insensitive to praise or criticism,
• prefer single employment,
• are introverted,
• tend to fantasies,
• do not maintain close friendships or trusting relationships,
• show little interest in sexual experiences,
• are little familiar with social norms and conventions, which can lead to correspondingly conspicuous misconduct.

Despite the conceptual similarity, the schizotypic disorders and schizophrenia, which according to the ICD-10 each form independent mental illness, are clearly differentiated from the schizoid personality disorders.

Dissocial personality disorder

An essential feature of dissociality is an egocentric, reckless behavior towards fellow human beings, which is accompanied by a certain cold feeling and lack of remorse. Social norms and obligations are regularly disregarded and those affected can not stop their behavior even in the event of imminent sanctions. They are increasingly aggressive and sometimes violent towards other people. Often the blame for one's own misconduct is seen or at least argued in society. Responsibility and guilt do not exist among those affected.

Personality traits associated with a dissocial PS

ICD-10 criteria for determining dissocial personality disorder are:

• The disregard of social norms,
• a lack of empathy,
• attachment disorders,
• a low frustration tolerance,
• impulsive behavior,
• the inability to social learning,
• advanced justifications of one's own behavior,
• a permanently increased irritability.

Lack of empathy, permanently increased irritability, low frustration tolerance and impulsive behavior are typical features of a dissocial personality disorder. (Image: psdesign1 / fotolia.com)

Antisocial personality

The DSM classification classifies this form of personality disorder as an antisocial personality. The antisocial personality disorder can manifest itself in deliberate actions that include, for example, a targeted enrichment at the expense of other people or are determined by impulsive action over which the affected have no control.

Borderline error

Disorders of the emotionally unstable type are characterized by extremely spontaneous, impulsive behavior, mood swings, outbursts of anger as well as sometimes violent aggression and autoaggression. The behavior of those affected is often incomprehensible to their fellow human beings, especially since the consequences are completely ignored in moments of impulsive control. Conflict-rich and unstable are the interpersonal relationships in people with an emotionally unstable personality disorder.

Although they often have considerable difficulties in dealing with other people, many sufferers show a pronounced fear of being alone. Accompanying the patients often suffer from depression and they are more likely to excessive addictive behavior. In the ICD-10, emotionally unstable personality disorders are differentiated into an impulsive type and a borderline type. However, the DSM classification does not recognize such a distinction and uses the term "borderline personality disorder" as the sole name.

Personality traits associated with a Borderline PS

Borderline syndrome has at least five of the following behaviors, according to DSM:

• Fear of being abandoned,
• unstable but intense interpersonal relationships,
• disturbed self-image,
• impulsiveness,
• suicidal acts,
• a lasting feeling of emptiness,
• uncontrolled anger,
• paranoid ideas,
• dissociative behavior under stress,
• affective instability (irritability, moodiness).

A disturbed self-image, uncontrolled anger, a feeling of emptiness and paranoid ideas can occur in people with a borderline disorder. (Image: Andrey Popov / fotolia.com)

Histrionic personality disorder

Characteristic for the histrionic disturbance picture is an extremely self-centered behavior and a penchant for theatricality. The afflicted are prone to dramatization, always have the desire to be in the spotlight, and show a low frustration tolerance. The ICD-10 names as features of a histrionic personality disorder:

• Theatrical appearance,
• dramatic self-expression,
• easy influenceability,
• steady pursuit of exciting experiences,
• Need to be constantly in focus,
• put special emphasis on an attractive appearance,
• to behave increasingly inappropriately seductive or provocative,
• manipulative behavior.

Compulsive personality disorder

The most striking feature of compulsive disorder is a pronounced perfectionism, which often makes it almost impossible for those affected to complete tasks and projects, since the desired goal is not achievable. In addition, they often lose themselves in details, a pedantic compliance with rules and the doubts of their own performance, whereby the actual project takes a back seat and the task fulfillment is made even more difficult. Accompanying the compulsive disorder pictures, many patients suffer from other mental health problems such as depression or obsessive-compulsive disorder.

Personality traits associated with a histrionic PS

In ICD-10, the following personality traits are considered essential for Anankastic Personality Disorder:

• Excessive doubt,
• constant occupation with details and rules,
• perfectionism,
• pedantry,
• Delegating tasks is extremely difficult for patients,
• Tendency to intensive controls,
• The life of those affected is extremely performance-related,
• Interpersonal relationships and personal pleasure tend to be neglected,
• Criticism of their own performance, the patient can hardly cope
• react quickly to criticism.

Anxious (avoiding) personality disorder

A pronounced sense of inferiority forms the basis for sustained inner tension, anxiety, insecurity, and self-doubt in the anxiety-avoiding personality disorder. Those affected are inhibited in their actions, are shy, feel unattractive and fear rejection as much as criticism. This not infrequently leads to an avoidance behavior that can significantly burden the interpersonal contacts.

Under certain circumstances, the fear of criticism and rejection results in increasing social isolation, which starts with those affected themselves. As a rule, their fellow human beings do not have any problems in dealing with the patients, since they usually appear modest, restrained or slightly submissive. Their lack of self-confidence also often manifests itself in a special willingness to sacrifice, which is also perceived positively by the fellow human beings.

Personality traits associated with a fearful PS

If four of the following behaviors are present, ICD-10 refers to a fearful (avoidance) personality disorder. The affected

• suffer from a persistent intense feeling of tension and anxiety,
• feel inferior and unattractive,
• have exaggerated concern about criticism and rejection,
• avoid activities with intensive interpersonal contacts,
• show a marked need for physical safety, which can cause lifestyle restrictions,
• Maintain personal contacts only when they are sure that acceptance is guaranteed by their fellow human beings.

Many sufferers who suffer from a fearful personality disorder have an intense sense of inferiority. (Image: ra2 studio / fotolia.com)

Dependent personality disorder / asthenic PS

Even with the dependent personality disorder is a low self-esteem an essential personality trait of those affected. This results in an extremely low assertiveness up to submissive behavior. Due to exaggerated fear of separation and loss, people with an asthenic PS often cling to people who are important to them. Alone, they feel helpless and incompetent.

Personality traits associated with a dependent PS

According to the ICD-10, at least four of the following behavioral characteristics are present in a dependent personality disorder: the persons affected

• Preferably, let others make the most important decisions for their own lives,
• Their needs are basically subordinate to those of the persons who are important to them,
• can not express their claims adequately,
• have an excessive fear of being abandoned,
• do not feel able to survive alone,
• can barely make decisions without getting lots of advice first.

Other disorders

In addition to the aforementioned disturbance images, various other forms can occur, in which case, in particular, the passive-aggressive horsepower, the narcissistic horsepower and the combined horsepower are worth mentioning.

Passive-aggressive disorder

The passive-aggressive disorder is mainly characterized by a passive resistance to external performance requirements. The achievement is denied simply simply without reasoning or thematizing. An exact classification of these special mental illnesses according to ICD-10 is not yet available.

Narcissistic personality disorder

The same applies to narcissistic personality disorder, which is characterized by an extremely exaggerated assessment of one's own abilities and personality. It usually also comes at the expense of people who tend to be rated less important than their own person. Those affected lack empathy and often show arrogant behavior towards others. People with narcissistic PS can hardly cope with criticism because it disturbs their own unrealistic self-image.

In people with narcissistic personality disorder, one's own person is a permanent focus. (Image: Michael Eichhammer / fotolia.com)

Combined disturbance images

The combined disorders are to be understood as symptoms in which individual behavioral characteristics are so pronounced that it can be assumed that a mental disorder, but no assignment to an exact PS according to ICD-10 or DSM is possible. It is not uncommon for combined mental disorders to appear in the context of other mental illnesses such as phobias or mood disorders. The diagnosis of combined personality disorders is particularly difficult due to the lack of clear behavioral characteristics.

Schizotypal personality disorder

Another form is the schizotypic PS, which, however, is not assigned to the specific disorders according to the ICD-10. In particular, in interpersonal contact, the victims have significant problems. They are extremely distrustful of others, have difficulties in establishing and maintaining close ties, show extremely eccentric traits (in appearance and language), unusual ways of thinking (for example, belief in magic) and are limited in their affect, which often makes them seem cold and aloof.

causes

A generally valid explanatory model for the development of personality disorders is not yet available. However, there is widespread consensus among experts that the cause of most patients is a combination of genetic predisposition and mental stress caused by environmental factors that causes PS to develop. In particular, events in early childhood, such as severe emotional neglect, parental authority or sexual abuse, are given special significance here.

Strong negative events in early childhood such as emotional neglect, parental authority or sexual abuse are considered as possible basis for a later personality disorder. (Image: Rawf8 / fotolia.com)

Difficult social conditions are considered a risk factor

Chaotic-unstable social relationships are considered as general risk factors for the development of a personality disorder. If the parents suffer from a mental disorder, the children's chance of developing a PS is also increased. The biological and social factors can occur in the individual development histories of PS in extremely different forms, whereby a direct assignment of certain personality disorders to individual combinations of environmental factors and genetic predispositions is not possible.

diagnosis

The diagnosis is based on the specified criteria of the ICD-10 and the DSM classification. However, to determine the criteria often requires several sessions with a psychiatrist or psychotherapist, because, for example, combined personality disorders are often difficult to diagnose.

Beware of self-tests

Numerous different tests are circulating on the Internet, with which a personality disorder or the propensity for a PS is to be determined. In the tests, the participants are asked, among other things, about their reaction to certain everyday problems such as morning sleep or anger with the boss. Based on the answers, a certain personality structure is determined. However, the validity of these tests is often rather doubtful, and no treatment options can be derived from this without specialist support.

treatment

Basically, psychotherapeutic procedures are the first choice for treatment, although targeted healing is often hardly possible, but only a reduction in behavioral problems can be achieved. Cognitive behavioral therapy is increasingly used, but psychotherapy based on depth psychology and analytical psychotherapy can also be used to combat personality disorders.

Psychotherapeutic procedures are often used to treat a personality disorder. (Image: Svyatoslav Lypynskyy / fotolia.com)

Some personality traits complicate the therapy

The therapy is often complicated by the special behavioral characteristics of the various personality disorders. Patients with histrionic personality disorder, for example, often try to manipulate therapists or the course of therapy, and borderline patients are prone to treatment discontinuation.

Use of medicines

In order to avoid particularly serious symptoms of the various PS may also be an application of psychotropic drugs possible, with a restrained use is advised here because of the threat of side effects. In concomitant mental illnesses such as depression or anxiety disorders are often appropriate remedies for their treatment are used. Scientific evidence for a possible cure of the PS with the help of psychotropic drugs is not yet available. They serve here only to alleviate particularly serious symptoms.

Involvement of the family and close confidants

Since the interaction with the close social environment is often significantly burdened by the PS, it may be appropriate to involve the family or individual family members in the psychotherapeutic treatment. If necessary, also offers an additional family therapy. Furthermore, specialized psychotherapeutic treatment approaches are available for some forms of PS (eg dialectic-behavioral therapy (DBT) for emotionally unstable PS), which are geared to the individual symptoms of the affected person.

Naturopathy

Although classical naturopathy can only make a limited contribution to the treatment of the described mental disorders, homeopathy in particular is often credited with a very convincing effect against the particularly pronounced symptoms of PS. The following means have proved successful:

• Ignatia: In extreme mood swings
• Lycopodium: With pronounced insecurity towards fellow human beings
• Aurum metallicum: In anger and outbreaks of violence
• Argentum nitricum: In impulsive behavior

The choice of the appropriate remedy depends on the individual complaint of the affected person and should be left to experienced therapists. The homeopathic remedies are primarily for the relief of symptoms and can not achieve a cure for the personality disorder.

hypnosis

As a further method in the field of naturopathy hypnosis is occasionally used, in particular in patients with histrionic PS. Their use in the treatment, however, is still controversial until today, although from practice more reports of successes. If conventional psychotherapeutic methods do not show the desired success, hypnotherapy may well be considered in consultation with the therapist.
(fp, vb; updated April 9, 2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)