PERSONALITY DISORDERS

While personality determines what you think and how you behave, personality disorders
are marked by thoughts and behavior that are disruptive and distressing in everyday life.
Someone with a personality disorder may have trouble recognizing their condition
because their symptoms are ingrained in their personality.

Personality disorders include Paranoid Personality Disorder, Schizoid Personality Disorder,

Antisocial Personality Disorder, Borderline Personality Disorder (BPD), and Narcissistic
Personality Disorder (NPD).

While the symptoms of personality disorders vary based on the condition, some common
signs include:

1. Aggressive behavior
2. Delusional thinking
3. Distrust of others
4. Flat emotions (no emotional range)
5. Lack of interest in relationships
6. Violating others' boundaries
7. Some people with BPD experience suicidal thoughts or behavior as well.

It is often challenging to live with a personality disorder, but there are treatment options
such as therapy and medication that can help.

1. PARANOID PERSONALITY DISORDER

Paranoid personality disorder is a chronic and pervasive condition characterized by

disruptive patterns of thought, behavior, and functioning. Individuals with paranoid
personality disorder are at a greater risk of experiencing depression, substance abuse,
and agoraphobia.

Symptoms

Individuals with paranoid personality disorder typically experience symptoms that

interfere with daily life.

a. In general, people with this condition feel suspicious of others.

While this mistrust is unfounded, their distrust of others makes it difficult to form
relationships and can interfere with many aspects of life including at home, at school,
and at work. People with PPD do not see their behaviors as out of the ordinary but are
perceived by others as hostile and suspicious. The primary characteristic of this condition
is a chronic and pervasive distrust and suspicion of others. Other symptoms of paranoid
personality disorder include:

b. Feelings that they are being lied to, deceived, or exploited by other people. They
may believe that friends, family, and romantic partners are untrustworthy and
unfaithful

c. Outbursts of anger in response to perceived deception

d. Often described as cold, jealous, secretive, and serious

e. Overly controlling in relationships in order to avoid being exploited or manipulated

f. Look for hidden meanings in gestures and conversations

g. Find it difficult to relax

h. Often hold negative views of other people

i. Overly sensitive to criticism

j. Overreacts in response to perceived criticism

Causes

1. While the exact causes of PDD are not known, it is believed that both genetics and
psychological factors play a role. There is also likely a strong genetic component
since a family history of schizophrenia is considered a risk factor for paranoid
personality disorder.

2. Childhood experiences and trauma may also play a part in the development of the
condition.

Treatment

▪ Paranoid personality disorder is generally treated with psychotherapy. With

ongoing treatment and appropriate support, people with this condition can
manage their symptoms and function more effectively in daily life.

▪ However, people who have PPD may not seek treatment for their condition, usually
because they do not feel that they have a problem. To those with PPD, their
suspicions of others are justified and it is other people who are the problem.

▪ The distrust and paranoia that characterizes the condition also make it difficult for
people with PPD to trust their doctors and therapists. This can make it challenging
for healthcare professionals to establish a therapeutic rapport with the individual.
Medication

While medication is not usually used to treat paranoid personality disorder, but may be
used in cases where symptoms are severe or if an associated condition such as depression
or anxiety is also present. Prescribed drugs include antidepressants, antipsychotics, and
anti-anxiety medications. Medications alone are not a recommended treatment for
personality disorders and are best used in combination with psychotherapy.

2. SCHIZOID PERSONALITY DISORDER

Schizoid Personality Disorder (SPD) is a chronic and pervasive condition characterized by

social isolation and feelings of indifference toward other people. Those who live with this
disorder are often described as distant or withdrawn and tend to avoid social situations
that involve interaction with other people.

They find it difficult to express emotions and lack the desire to form close personal
relationships. This type of personality disorder is believed to be relatively rare and tends
to affect more men than women. People with schizoid personality disorder are also at risk
of experiencing depression. The disorder is often first noticeable during childhood and is
usually apparent by early adulthood. The symptoms of the disorder can have an impact
on multiple life domains including family relationships, school, and work.

Symptoms

People with schizoid personality disorder typically experience:

1. A preoccupation with introspection and fantasy

2. A sense of indifference to praise and affirmation, as well as to criticism or
rejection
3. Detachment from other people
4. Little or no desire to form close relationships with others
5. Indifference to social norms and expectations
6. Infrequent participation in activities for fun or pleasure
7. Not enjoying social or family relationships
8. Often described as cold, uninterested, withdrawn, and aloof

Causes

The causes of schizoid personality disorder are not known although it is believed that a
combination of genetic and environmental factors play a role. Personality is shaped by a
wide variety of factors including inherited traits and tendencies, childhood experiences,
parenting, education, and social interactions. All of these factors may play some part in
contributing to the development of SPD.5
Treatment

Schizoid personality disorder can be challenging to treat. Those with the disorder rarely
seek treatment and may struggle with psychotherapy because they find it difficult to
develop working relationships with a therapist. The social isolation that characterizes
schizoid personality disorder also makes it difficult to find support and assistance.

Medications may be used to treat some of the symptoms of schizoid personality disorder
such as anxiety and depression. Such medications are usually used in conjunction with
other treatment options such as cognitive behavioral therapy (CBT) or group therapy.

CBT can help people with SPD identify problematic thoughts and behaviors and develop
new coping skills. Group therapy may help people practice interpersonal skills.

3. ANTISOCIAL PERSONALITY DISORDER (ASPD)

Antisocial personality disorder (ASPD) is a condition characterized by a lack of empathy

and regard for other people.

People with antisocial personality disorder have little or no regard for right or wrong. They
antagonize and often act insensitively or in an unfeeling manner. Individuals with this
disorder may lie, engage in aggressive or violent behavior, and participate in criminal
activity.

Symptoms of Antisocial Personality Disorder

There are a number of defining symptoms of antisocial personality disorder. People with
ASPD:

❖ May begin displaying symptoms during childhood; such behaviors which may
include fire setting, cruelty to animals, and difficulty with authority

❖ Often have legal problems resulting from failures to conform to social norms and
a lack of concern for the rights of others

❖ Often act out impulsively and fail to consider the consequences of their actions

❖ Display aggressiveness and irritability that often lead to physical assaults

❖ Have difficulty feeling empathy for others

❖ Display a lack of remorse for damaging behavior

❖ Often have poor or abusive relationships with others and are more likely to abuse
or neglect their children

❖ Frequently lie and deceive others for personal gain

These characteristics often lead to major difficulties in many life areas. At its core, the
inability to consider the thoughts, feelings, and motivations of other people can lead to
harmful disregard for others.

As adults, the disorder can be destructive to both the person living with it and those who
come into contact with them. People with antisocial personality disorder are more likely
to engage in risk-taking behaviors, dangerous activities, and criminal acts. Those with the
disorder are often described as having no conscience and feel no regret or remorse for
their harmful actions.

Adults have antisocial personality disorder and the condition tends to affect men more
than women.

Causes of Antisocial Personality Disorder

The exact causes of antisocial personality disorder are not known. Personality is shaped
by a variety of forces including nature and nurture.

1. Genetics

2. Upbringing

Upbringing can also have an important influence. Childhood abuse, neglect, and trauma
have also been linked to the onset of ASPD. If a child's parents are abusive and
dysfunctional, children may learn such behavioral patterns and later display them with
their own kids.

Children who grow up in disorganized and neglectful homes also lack the opportunities
to develop a strong sense of discipline, self-control, and empathy for others.

3. Maternal smoking during pregnancy

Treatment for Antisocial Personality Disorder

Antisocial personality disorder is difficult to treat for a number of reasons. People with
the disorder rarely seek out treatment on their own. Those who do generally receive
treatment only after some type of altercation with the legal system.

1. Psychotherapy

Cognitive behavioral therapy (CBT) can be useful in helping individuals gain insight into
their behaviors and to change maladaptive thought patterns. Effective results usually
occur only after long-term treatment.
 2. Group and family therapy as well as mentalization-based therapy, which targets
the ability to recognize and understand the mental state of oneself and others,
have also been studied for ASPD and show promise.

Medication

Medications may be used to treat some of the symptoms that a person with ASPDl may
experience. Some of the medications that may be prescribed include:

❖ Anti-anxiety medications
❖ Antidepressants
❖ Antipsychotics
❖ Mood stabilizers

4. BORDERLINE PERSONALITY DISORDER (BPD)

Borderline personality disorder (BPD) is a serious psychological condition characterized

by unstable moods and emotions, relationships, and behavior. During a BPD episode, a
person may act impulsively engage in risky behaviors, switch moods quickly, have higher
levels of anger, appear numb, or experience paranoia.

Symptoms of Borderline Personality Disorder

Borderline personality disorder can interfere with a person's ability to enjoy life or achieve
fulfillment in relationships, work, or school. Because it is a personality disorder, someone
may not show signs of BPD until their personality develops, with most diagnoses occurring
in patients over 18 years of age.

Symptoms of borderline personality often appear and can create significant problems in
the following areas:

Behaviors:

▪ BPD is associated with a tendency to engage in risky and impulsive behaviors, such
as going on shopping sprees, excessive drug or alcohol use, engaging in
promiscuous or risky sex, or binge eating.

▪ They are also more prone to engage in self-harming behaviors, such as cutting or
burning and attempting suicide.

Emotions:

Emotional instability is a key feature of BPD. Individuals feel like they are on an emotional
roller coaster with quick mood shifts (i.e., going from feeling okay to feeling extremely
down or blue within a few minutes). Mood changes can last from minutes to days and
are often intense. Anger, anxiety, and overwhelming emptiness are common as well.

Relationships:

▪ People with borderline personality disorder tend to have intense relationships with
loved ones characterized by frequent conflict, arguments, and break-ups.

▪ BPD is associated with an intense fear of being abandoned by loved ones. This
leads to difficulty trusting others and attempts to avoid real or imagined
abandonment, putting a strain on relationships.

▪ It is also common for someone with BPD to have a 'favorite person,' or someone
they feel they cannot live without.

Self-image:

Individuals with BPD have difficulties related to the stability of their sense of self. They
report many ups and downs in how they feel about themselves. One moment they may
feel good about themselves, but the next they may feel that they are bad or even evil.

Stress-related changes in thinking:

Under conditions of stress, people with borderline personality disorder may experience
changes in thinking, including paranoid thoughts (for example, thoughts that others may
be trying to cause them harm) or dissociation (feeling spaced out, numb, or like they are
not really in their body).

Not everyone with BPD experiences every symptom. Some people have a few of these
symptoms while others may experience most, if not all of them.

Causes

Brain structure:

There is evidence of differences in brain structure and function in individuals with BPD,
especially in the parts of the brain that affect impulse control and emotional regulation.
However, it is unclear if these differences are a result of having BPD or if they are part
of the cause.

Genetics:

There appears to be a genetic component to borderline personality disorder as it is not

uncommon for close family members to have this condition.
Negative experiences:

Many people diagnosed with BPD have experienced childhood abuse, trauma, neglect, or
were separated from their caregivers at an early age. At the same time, not all people
with BPD had one of these childhood experiences, and, conversely, many people who
have had them do not develop BPD.

Risk Factors for Borderline Personality Disorder

1. Certain factors may increase your risk of developing BPD. They include:

2. Being abandoned during childhood or adolescence

3. Experiencing abuse (sexual, physical, or emotional)

4. Having a disruption in your family life

5. Poor communication skills within the family unit

Treatment for Borderline Personality Disorder

The usual order of treatment for borderline personality disorder includes psychotherapy,
medication, then other treatments.

Psychotherapy

Psychotherapy is the standard treatment for BPD. Depending on the situation, this
treatment option may also include the involvement of your family, friends, or caregivers.

▪ Dialectical behavior therapy (DBT), a type of cognitive behavioral therapy (CBT)

that teaches you how to be present, also providing skills related to coping with
stress, emotional regulation, and relationship improvement

▪ Mentalization-based treatment (MBT), which helps someone with borderline

personality disorder better recognize how their thoughts and feelings are
associated with their behaviors

▪ Group therapy, or engaging in treatment with others who also have BPD, also
learning from them and their experiences

Medication

1. Antidepressants

2. Antipsychotics

3. Anxiolytics (anxiety medications)

 4. Mood stabilizers

Other Treatments

In times of crisis, hospitalization or more intensive treatments may be necessary for

someone with borderline personality disorder.

5. NARCISSISTIC PERSONALITY DISORDER

Narcissistic personality disorder (NPD) is an enduring pattern of inner experience and

behavior characterized by self-centeredness, lack of empathy, and an exaggerated sense
of self-importance.

Symptoms

Five common signs of narcissism include

1. an inflated sense of self

2. a constant need for attention

3. self-centeredness

4. lack of empathy and

5. preoccupation with power and success.

Some of the symptoms associated with NPD include:

1. Belief that one is unique or special and should only associate with other people of
the same status

2. Constant need for attention, affirmation, and praise

3. Exaggerated sense of one's own abilities and achievements

4. Exploiting other people for personal gain

5. Feeling envious of others, or believing that others are envious of them

6. Lack of empathy for others

7. Persistent fantasies about attaining success and power

8. Preoccupation with power or success

9. Sense of entitlement and expectation of special treatment

People with narcissistic personality disorder are typically described as arrogant, conceited,
self-centered, and haughty. Because they imagine themselves as superior to others, they
often insist on possessing items that reflect a successful lifestyle.

Despite this exaggerated self-image, they are reliant on constant praise and attention to
reinforce their self-esteem. As a result, those with narcissistic personality disorder are
usually very sensitive to criticism, which is often viewed as a personal attack.

Causes of Narcissistic Personality Disorder

While the exact cause is unknown, researchers have identified some factors that may
contribute to the disorder. Some early life experiences are thought to contribute to
narcissistic personality disorder, including:

1. Abuse or trauma

2. Excessive praise

3. Lack of an authentically validating environment

4. Parental overindulgence

5. Unreliable parenting

6. Genetics and biology are also thought to play a considerable role, although the
exact causes are likely complex and varied.

Treatment for Narcissistic Personality Disorder

There are treatments that can help people gain greater insights into their behaviors,
establish a more coherent sense of self, and better manage their behaviors. These
include:

1. Individual psychodynamic psychotherapy

It can be effectively used to treat narcissistic personality disorder, although the process
can be potentially difficult and lengthy.

2. Cognitive behavioral therapy (CBT)

It is often effective to help individuals change destructive thought and behavior patterns.1
The goal of treatment is to alter distorted thoughts and create a more realistic self-image.

3. Psychotropic medications are generally ineffective for long-term change but are
sometimes used to treat symptoms of anxiety or depression.