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Personality disorder

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VOL: 100, ISSUE: 04, PAGE NO: 35


- Personality disorder (PD) is an enduring pattern of inner experience and behaviours that deviates markedly from the expectations of the individual’s culture (American Psychiatric Association, 1994).



- People with a diagnosis of PD find it difficult to develop friendships, maintain stable partnerships and work cooperatively with others - their suicide risk is estimated to be three times greater than among the general population (Mind, 2000).



- Experts often disagree on what symptoms constitute this disorder and whether or not it can be treated.



- PDs often start during adolescence or early adulthood, although they can begin in childhood.



- Prevalence of all PDs is equal between men and women, although some individual PDs are more common in one or the other.



- The prevalence of PD is estimated to be 10-13 per cent of the population (De Girolamo and Dotto, 2000).



- The American Psychiatric Association (1994) defines 10 types of PD. Each has its own diagnostic criteria, although there are similarities, making diagnosis a complex process. The 10 types of PD are as follows:



- Paranoid: continual, unwarranted distrust and suspicion of others;



- Schizoid: lack of interest in forming close relationships, solitary, introspective, lack of empathy;



- Schizotypal: social anxiety, inability to form close relationships, cognitive or perceptual distortions;



- Borderline: intense unstable relationships, impulsiveness, mood swings, inappropriate anger, self-damaging acts, uncertainty about personal identity, chronic boredom;



- Histrionic: excessive emotional display, attention-seeking behaviour, dependency on approval of others, constant search for excitement;



- Narcissistic: inflated sense of self-importance, fantasies of unlimited success or achievement, constant need for attention and admiration, tendency to exploit others;



- Antisocial (‘psychopathy’ under the Mental Health Act 1983): consistent disregard for other people’s rights, superficially charming, callous and self-serving and lacking in empathy, often incapable of consistent employment and maintaining relationships, impulsive, often violent;



- Avoidant: avoidance of social situations because of feelings of inadequacy and fear of disapproval, criticism or rejection; fear of social relationships and intimacy;



- Dependent: submissive behaviour, fear of separation, overwhelming need to be taken care of;



- Obsessive-compulsive: preoccupied with orderliness, perfectionist, unrealistically high standards for self and others.



- Psychological causes are suggested for most personality disorders.



- Negative childhood experiences are important in borderline PD.



- Significant factors in developing antisocial PD seem to be the absence of a warm, intimate and continuous relationship with parents, inconsistent discipline and supervision, parents with antisocial PD or who abuse drugs or alcohol.



- Other causes are: genetic; low levels of serotonin; brain damage; and abnormalities in brain function.



- PDs are difficult to treat because they involve long-term patterns of thoughts, feelings and ways of relating to others.



- Treatments depend on the individual, but may involve: group therapy; counselling; cognitive therapy; and time in a therapeutic community.




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