Causes of personality disorders
The emergence of a personality disorder is a consequence of the impact of unfavorable biological, genetic and psychosocial factors (often neglect and rejection by caregivers). Until recently, the attention of researchers focused on family aspects (e.g. unfavorable course of various stages of development, lack of satisfaction of the need for security, increased level of tensions and conflicts in the family). Currently, genetic factors are of increasing interest. The first symptoms of personality disorders are usually observed in late childhood or adolescence, although they are most often diagnosed in adulthood. This is due to the assumption that as part of the development of the young person's psyche, the ability to constructively cope with the difficulties encountered may develop, and abnormalities perceived in adolescence may not develop into personality disorders.
How is the diagnosis made?
Usually based on a detailed psychiatric interview collected from the patient and, if possible, from relatives. Psychological tests can be supplemented. The presence of other mental disorders or lesions, including brain damage, that may be the cause of the adverse behavior should also be excluded.
When should I suspect a personality disorder in a loved one?
It is worth looking at whether the following criteria are present:
clearly disharmonious attitudes and behaviors, usually covering many areas of functioning, including emotionality or excitability - people with personality disorders have, for example, a tendency to behave too aggressively during an ordinary conversation, they may shout, be demanding;
the pattern of inappropriate behavior is long-lasting and not limited to episodes of mental illness;
the pattern of behavior is comprehensive and clearly unsuited to various individual and social situations - a person with a personality disorder does not comply with generally accepted norms, and does not pay attention to the feelings of others in situations where it is expected, e.g. a difficult life situation, instead of providing support;
these difficulties always appear in childhood or adolescence and persist into adulthood;
the disorders lead to a markedly unwell feeling, which may only appear later;
the disorder may coexist with significant difficulties in terms of professional and social efficiency (people with personality disorders may find it difficult, for example, to cooperate with other people or listen to other people's comments).
What are the types of personality disorders?
He distinguishes three groups of personality disorders, which are grouped below due to common features:
Group A - eccentricity, weirdness and lack of relationship
Paranoid Personality Disorder - a person suspects others of taking advantage of him or her, even though there is no evidence of it. He constantly wonders about the loyalty of friends or co-workers. She reads various behaviors as hidden insults, holds grudges, finds it difficult to forgive. He is easily angered and lashes out in response to what he perceives as an attack on his reputation, although others do not see it that way. Has recurring suspicions of partner infidelity without sufficient evidence. He rarely seeks help because of his mistrust. Patients suffering from this personality disorder are overly suspicious and believe that other people want to harm them. For this reason, they are secretive and reluctant to tell others about themselves. They may see insults in actions and words that were not intended to convey such a message. In addition, people with paranoid personality disorder are unlikely to be forgiving. Living with a person with a paranoid personality can be difficult, because it is often the partner who is directed (usually unfounded) suspicions about infidelity.
Schizoid personality – people with this personality type are individualists, exhibit antisocial features and behavior. They do not enter into closer emotional relationships (or any other) with other people. They prefer to work and spend time alone, sometimes they devote themselves completely to some hobby or work treated as a mission. Their erotic life and social contacts are of little interest to them. They have no friends, acquaintances. They maintain contact only with first-degree relatives. They can be unpleasant and surly if someone - in their opinion - disturbs their solitude and peace. They are characterized by strange beliefs, magical thinking that deviates from cultural norms (telepathy, sixth sense, seeing auras), unusual sensory experiences and unusual speech and thinking (metaphorical, stereotypical, strange), suspicious and features of paranoid thinking, inadequate or limited emotions. It is also often accompanied by excessive social anxiety, which does not go away after tightening the relationship and is associated with paranoid fears (not negative self-evaluation).
Group B - turbulent relationships, intense emotions, lack of resistance to stress
Antisocial Personality Disorder – A person with this personality disorder is unable to conform to social norms. Importantly, he feels no remorse, or very little. He usually cheats and lies to others to achieve his goals. She is impulsive - she is not able to control her emotions, she is easily irritated, she can be aggressive. He is completely unconcerned with risk or his own safety. She is irresponsible, unable to keep a steady job, unable to pay her debts. In addition, he often abuses various psychoactive substances (alcohol or drugs). An important feature is also the loss of a sense of moderation and lack of reflection as to one's own behavior, inconsistent with the prevailing social norms.
Histrionic personality disorder – a person with this disorder constantly wants to be the center of attention, emotionally or sexually provocative to get attention. He talks and acts in a dramatic way. He expresses strong opinions, but cannot justify them. Is easily influenced by others. Her emotions change quickly. She is very preoccupied with her appearance. She thinks her relationship is closer than it really is. The constant need to be the center of attention is associated with inappropriate behavior, for example, very seductive or sexually suggestive. Attention is usually drawn to excessive theatricality in behavior and interpreting interpersonal contacts excessively intimately.
Borderline personality disorder (borderline) is currently an increasingly diagnosed personality disorder. There is a very thin line between love and hate. In a short time, a person's mood can oscillate from euphoria to extreme despair, and feelings for a given person or group of people change dramatically. One moment a person can profess love for someone, and the next moment he will throw himself at him with anger and reproaches. Patients with this type of personality disorder tend to engage in impulsive, risky behaviors such as gambling, substance abuse, and excessive risky sexual activity. One of the main symptoms is an intense fear of abandonment. The history of borderline patients is usually characterized by turbulent relationships with other people, and during therapy – an unstable self-image. Emotions are very intense and volatile, and the mood of these patients is usually irritable (dysphoric). The main theme of the first meetings during therapy is a persistent sense of emptiness. The patient feels intense anger over objectively minor difficulties. Shows impulsive and self-destructive behavior. May exhibit self-destructive and suicidal behaviors and transient paranoid symptoms, and loses touch with reality when stressed. It is not only patients with borderline personality disorder who have a harder time living - the problems associated with this disorder are also felt by the closest environment of the affected person. The most illustrative in the case of this category will be the term "from love to hate". The transition from one emotional state to another (confessions of love intertwined with attacks of hatred) typical of this type of personality disorder is difficult for people with a healthy personality structure to endure in relationships with the patient. Often in the offices of psychotherapists there are relatives of patients, traumatized by relationships "on the edge".
Narcissistic personality disorder - a person with this disorder sees himself in the opinion of others "like in a mirror". He attaches decisive importance to success, power, ideal love, fame as determinants of values. He exaggerates his successes and talents, expects constant praise and admiration. He believes he deserves special treatment. She can't read other people's emotions, she lacks empathy. He uses relationships for his own purposes. She is jealous, she also believes that they envy her. He sets himself unrealistic goals. She is easily hurt because she has a fragile sense of self-worth and an overwhelming feeling of emptiness. He often abuses psychoactive substances (alcohol, drugs), may suffer from depression, suicidal thoughts and behavior, difficulties in family relationships and problems in professional relationships. Also in the case of this personality disorder, people close to you are traumatized. Subordination, not paying attention to the needs and feelings of loved ones, the constant expectation of "being ready" and responding to the patient's needs are the cause of the gradual destruction of personality structures and traumatization of loved ones. In psychotherapists' offices, we consult people who are looking for a return to their "former strength" after destructive relationships with people with this type of personality disorder.
Group C - fear, shyness, avoidance of relationships and stressful situations
Avoidant personality (fearful) – people with this personality type avoid social and social contacts due to fear of criticism and rejection. The source of such behavior is their low self-esteem and fear of negative evaluation of others. People with this disorder prefer not to enter into any relationships than to expose themselves to disappointment as a result. The person prefers to work alone because he is afraid of criticism, disapproval, rejection. She doesn't get involved in relationships until she's sure she's liked. She is withdrawn in intimate relationships because she is afraid of embarrassment or ridicule. She is preoccupied with the thought of being criticized in social situations. She is withdrawn in new relationships because she feels inadequate. He sees himself as maladjusted, unattractive, worse than others. She is not ready to take risks or try new things because she is afraid of failure.
Dependent personality disorder is a personality disorder involving excessive dependence of a given person in adulthood, for no apparent reason (e.g. poor health). Patients have difficulty expressing their own opinion and making independent decisions. They demand constant support, help and care, making decisions for them. They are convinced that without the help of other people they will not manage. They are passive and learned helplessness. A person needs a lot of reassurance from others to make small decisions in everyday life. She needs others to take responsibility for most areas of her life. Is unassertive (for fear of losing support and acceptance). She cannot initiate projects on her own because she lacks self-confidence, not motivation or energy. She feels helpless when she is alone. He is afraid that he will not be able to cope without the support of another person. When her relationship ends, she immediately looks for another one. She is preoccupied with the fear of being alone and not being able to cope. Patients expect constant support and care from others, and these needs are so great that in order to satisfy them, patients are ready to endure even severe discomfort.
Anankastic personality disorder is characterized by excessive adherence to rigid rules, lack of flexibility and spontaneity. People with this disorder are characterized by excessive perfectionism, the need for control. This is due to the fear of change, which is sometimes so strong that the person with this personality disorder gives up social contacts. The patient is preoccupied with lists, rules. Shows perfectionism that makes it impossible to complete tasks. Usually, a person with this disorder is devoted to work, but at the same time excludes all pleasures and free time from everyday life. She is overly conscientious and pathologically meticulous. Her moral standards are rigid and non-negotiable. He can't throw away old things even when they have no sentimental value. She cannot outsource her work unless someone is following her instructions exactly. He does not spend money on himself and others because he has to save for a rainy day. Characteristic features are stubbornness and rigidity of behavior and norms.
Can personality disorders be cured?
The prognosis for personality disorders varies by type. Positive treatment results depend, among others, on on the durability of given features, but above all on the patient's motivation.
Should personality disorders be treated?
Definitely yes. The earlier treatment is started, the better the prognosis. With these disorders, problems usually begin during adolescence. Personality difficulties are often accompanied by other disorders: depression, anxiety disorders, addictions, eating disorders. It is for this reason that patients usually seek the help of a specialist. Lack of appropriate treatment usually leads to social disengagement and alienation, deterioration of professional and other life functioning, and increases the risk of suicide.
What are the treatments?
The basic method of treating personality disorders is long-term psychodynamic psychotherapy. Currently, more and more reliable research results confirming the effectiveness of such a procedure are available. There are also reports on the usefulness of other psychotherapeutic approaches, for example various modifications of cognitive-behavioral therapy. In the case of various psychotherapeutic approaches, the importance of establishing a therapeutic relationship based on commitment and trust is invariably emphasized. In patients with personality disorders, pharmacotherapy is sometimes used, which, although it is effective only for individual symptoms, often helps to control episodes of deterioration of well-being and facilitates psychotherapy.
Why do they write everywhere that the basic method of treating personality disorders is psychotherapy?
Psychotherapy is the only method of treatment that unmasks the causes of functional disorders, and not only reduces the symptoms of personality disorders. Psychotherapy of a person with personality disorders should also include couples and family therapy. The effectiveness of these treatment methods depends on the pathogenesis, clinical picture, depth of disorders, degree of persistence and severity of disturbed features, as well as the course of the disease and the dynamics of changes.
The emergence of a personality disorder is a consequence of the impact of unfavorable biological, genetic and psychosocial factors (often neglect and rejection by caregivers). Until recently, the attention of researchers focused on family aspects (e.g. unfavorable course of various stages of development, lack of satisfaction of the need for security, increased level of tensions and conflicts in the family). Currently, genetic factors are of increasing interest. The first symptoms of personality disorders are usually observed in late childhood or adolescence, although they are most often diagnosed in adulthood. This is due to the assumption that as part of the development of the young person's psyche, the ability to constructively cope with the difficulties encountered may develop, and abnormalities perceived in adolescence may not develop into personality disorders.
How is the diagnosis made?
Usually based on a detailed psychiatric interview collected from the patient and, if possible, from relatives. Psychological tests can be supplemented. The presence of other mental disorders or lesions, including brain damage, that may be the cause of the adverse behavior should also be excluded.
When should I suspect a personality disorder in a loved one?
It is worth looking at whether the following criteria are present:
clearly disharmonious attitudes and behaviors, usually covering many areas of functioning, including emotionality or excitability - people with personality disorders have, for example, a tendency to behave too aggressively during an ordinary conversation, they may shout, be demanding;
the pattern of inappropriate behavior is long-lasting and not limited to episodes of mental illness;
the pattern of behavior is comprehensive and clearly unsuited to various individual and social situations - a person with a personality disorder does not comply with generally accepted norms, and does not pay attention to the feelings of others in situations where it is expected, e.g. a difficult life situation, instead of providing support;
these difficulties always appear in childhood or adolescence and persist into adulthood;
the disorders lead to a markedly unwell feeling, which may only appear later;
the disorder may coexist with significant difficulties in terms of professional and social efficiency (people with personality disorders may find it difficult, for example, to cooperate with other people or listen to other people's comments).
What are the types of personality disorders?
He distinguishes three groups of personality disorders, which are grouped below due to common features:
Group A - eccentricity, weirdness and lack of relationship
Paranoid Personality Disorder - a person suspects others of taking advantage of him or her, even though there is no evidence of it. He constantly wonders about the loyalty of friends or co-workers. She reads various behaviors as hidden insults, holds grudges, finds it difficult to forgive. He is easily angered and lashes out in response to what he perceives as an attack on his reputation, although others do not see it that way. Has recurring suspicions of partner infidelity without sufficient evidence. He rarely seeks help because of his mistrust. Patients suffering from this personality disorder are overly suspicious and believe that other people want to harm them. For this reason, they are secretive and reluctant to tell others about themselves. They may see insults in actions and words that were not intended to convey such a message. In addition, people with paranoid personality disorder are unlikely to be forgiving. Living with a person with a paranoid personality can be difficult, because it is often the partner who is directed (usually unfounded) suspicions about infidelity.
Schizoid personality – people with this personality type are individualists, exhibit antisocial features and behavior. They do not enter into closer emotional relationships (or any other) with other people. They prefer to work and spend time alone, sometimes they devote themselves completely to some hobby or work treated as a mission. Their erotic life and social contacts are of little interest to them. They have no friends, acquaintances. They maintain contact only with first-degree relatives. They can be unpleasant and surly if someone - in their opinion - disturbs their solitude and peace. They are characterized by strange beliefs, magical thinking that deviates from cultural norms (telepathy, sixth sense, seeing auras), unusual sensory experiences and unusual speech and thinking (metaphorical, stereotypical, strange), suspicious and features of paranoid thinking, inadequate or limited emotions. It is also often accompanied by excessive social anxiety, which does not go away after tightening the relationship and is associated with paranoid fears (not negative self-evaluation).
Group B - turbulent relationships, intense emotions, lack of resistance to stress
Antisocial Personality Disorder – A person with this personality disorder is unable to conform to social norms. Importantly, he feels no remorse, or very little. He usually cheats and lies to others to achieve his goals. She is impulsive - she is not able to control her emotions, she is easily irritated, she can be aggressive. He is completely unconcerned with risk or his own safety. She is irresponsible, unable to keep a steady job, unable to pay her debts. In addition, he often abuses various psychoactive substances (alcohol or drugs). An important feature is also the loss of a sense of moderation and lack of reflection as to one's own behavior, inconsistent with the prevailing social norms.
Histrionic personality disorder – a person with this disorder constantly wants to be the center of attention, emotionally or sexually provocative to get attention. He talks and acts in a dramatic way. He expresses strong opinions, but cannot justify them. Is easily influenced by others. Her emotions change quickly. She is very preoccupied with her appearance. She thinks her relationship is closer than it really is. The constant need to be the center of attention is associated with inappropriate behavior, for example, very seductive or sexually suggestive. Attention is usually drawn to excessive theatricality in behavior and interpreting interpersonal contacts excessively intimately.
Borderline personality disorder (borderline) is currently an increasingly diagnosed personality disorder. There is a very thin line between love and hate. In a short time, a person's mood can oscillate from euphoria to extreme despair, and feelings for a given person or group of people change dramatically. One moment a person can profess love for someone, and the next moment he will throw himself at him with anger and reproaches. Patients with this type of personality disorder tend to engage in impulsive, risky behaviors such as gambling, substance abuse, and excessive risky sexual activity. One of the main symptoms is an intense fear of abandonment. The history of borderline patients is usually characterized by turbulent relationships with other people, and during therapy – an unstable self-image. Emotions are very intense and volatile, and the mood of these patients is usually irritable (dysphoric). The main theme of the first meetings during therapy is a persistent sense of emptiness. The patient feels intense anger over objectively minor difficulties. Shows impulsive and self-destructive behavior. May exhibit self-destructive and suicidal behaviors and transient paranoid symptoms, and loses touch with reality when stressed. It is not only patients with borderline personality disorder who have a harder time living - the problems associated with this disorder are also felt by the closest environment of the affected person. The most illustrative in the case of this category will be the term "from love to hate". The transition from one emotional state to another (confessions of love intertwined with attacks of hatred) typical of this type of personality disorder is difficult for people with a healthy personality structure to endure in relationships with the patient. Often in the offices of psychotherapists there are relatives of patients, traumatized by relationships "on the edge".
Narcissistic personality disorder - a person with this disorder sees himself in the opinion of others "like in a mirror". He attaches decisive importance to success, power, ideal love, fame as determinants of values. He exaggerates his successes and talents, expects constant praise and admiration. He believes he deserves special treatment. She can't read other people's emotions, she lacks empathy. He uses relationships for his own purposes. She is jealous, she also believes that they envy her. He sets himself unrealistic goals. She is easily hurt because she has a fragile sense of self-worth and an overwhelming feeling of emptiness. He often abuses psychoactive substances (alcohol, drugs), may suffer from depression, suicidal thoughts and behavior, difficulties in family relationships and problems in professional relationships. Also in the case of this personality disorder, people close to you are traumatized. Subordination, not paying attention to the needs and feelings of loved ones, the constant expectation of "being ready" and responding to the patient's needs are the cause of the gradual destruction of personality structures and traumatization of loved ones. In psychotherapists' offices, we consult people who are looking for a return to their "former strength" after destructive relationships with people with this type of personality disorder.
Group C - fear, shyness, avoidance of relationships and stressful situations
Avoidant personality (fearful) – people with this personality type avoid social and social contacts due to fear of criticism and rejection. The source of such behavior is their low self-esteem and fear of negative evaluation of others. People with this disorder prefer not to enter into any relationships than to expose themselves to disappointment as a result. The person prefers to work alone because he is afraid of criticism, disapproval, rejection. She doesn't get involved in relationships until she's sure she's liked. She is withdrawn in intimate relationships because she is afraid of embarrassment or ridicule. She is preoccupied with the thought of being criticized in social situations. She is withdrawn in new relationships because she feels inadequate. He sees himself as maladjusted, unattractive, worse than others. She is not ready to take risks or try new things because she is afraid of failure.
Dependent personality disorder is a personality disorder involving excessive dependence of a given person in adulthood, for no apparent reason (e.g. poor health). Patients have difficulty expressing their own opinion and making independent decisions. They demand constant support, help and care, making decisions for them. They are convinced that without the help of other people they will not manage. They are passive and learned helplessness. A person needs a lot of reassurance from others to make small decisions in everyday life. She needs others to take responsibility for most areas of her life. Is unassertive (for fear of losing support and acceptance). She cannot initiate projects on her own because she lacks self-confidence, not motivation or energy. She feels helpless when she is alone. He is afraid that he will not be able to cope without the support of another person. When her relationship ends, she immediately looks for another one. She is preoccupied with the fear of being alone and not being able to cope. Patients expect constant support and care from others, and these needs are so great that in order to satisfy them, patients are ready to endure even severe discomfort.
Anankastic personality disorder is characterized by excessive adherence to rigid rules, lack of flexibility and spontaneity. People with this disorder are characterized by excessive perfectionism, the need for control. This is due to the fear of change, which is sometimes so strong that the person with this personality disorder gives up social contacts. The patient is preoccupied with lists, rules. Shows perfectionism that makes it impossible to complete tasks. Usually, a person with this disorder is devoted to work, but at the same time excludes all pleasures and free time from everyday life. She is overly conscientious and pathologically meticulous. Her moral standards are rigid and non-negotiable. He can't throw away old things even when they have no sentimental value. She cannot outsource her work unless someone is following her instructions exactly. He does not spend money on himself and others because he has to save for a rainy day. Characteristic features are stubbornness and rigidity of behavior and norms.
Can personality disorders be cured?
The prognosis for personality disorders varies by type. Positive treatment results depend, among others, on on the durability of given features, but above all on the patient's motivation.
Should personality disorders be treated?
Definitely yes. The earlier treatment is started, the better the prognosis. With these disorders, problems usually begin during adolescence. Personality difficulties are often accompanied by other disorders: depression, anxiety disorders, addictions, eating disorders. It is for this reason that patients usually seek the help of a specialist. Lack of appropriate treatment usually leads to social disengagement and alienation, deterioration of professional and other life functioning, and increases the risk of suicide.
What are the treatments?
The basic method of treating personality disorders is long-term psychodynamic psychotherapy. Currently, more and more reliable research results confirming the effectiveness of such a procedure are available. There are also reports on the usefulness of other psychotherapeutic approaches, for example various modifications of cognitive-behavioral therapy. In the case of various psychotherapeutic approaches, the importance of establishing a therapeutic relationship based on commitment and trust is invariably emphasized. In patients with personality disorders, pharmacotherapy is sometimes used, which, although it is effective only for individual symptoms, often helps to control episodes of deterioration of well-being and facilitates psychotherapy.
Why do they write everywhere that the basic method of treating personality disorders is psychotherapy?
Psychotherapy is the only method of treatment that unmasks the causes of functional disorders, and not only reduces the symptoms of personality disorders. Psychotherapy of a person with personality disorders should also include couples and family therapy. The effectiveness of these treatment methods depends on the pathogenesis, clinical picture, depth of disorders, degree of persistence and severity of disturbed features, as well as the course of the disease and the dynamics of changes.
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