Personality disorders and treatments

Everyone has a personality with character traits such as stinginess, generosity, arrogance and independence. However, when these traits are rigid and self-defeating, they may interfere with functioning and even lead to psychiatric symptoms. Personality traits are formed by early adulthood, persist throughout life and affect every aspect of day to day behaviour. Individuals with personality disorders often blame others for their problems. They at times deny that they have a disorder.

According to Sarason and Sarason, 10th edition, personality disorders deeply ingrained, inflexible, maladaptive patterns of thought and behaviour which persist throughout a person’s life. It is identified by a pervasive pattern of experience and behavior that is abnormal with respect to any two of the following: thinking, mood, personal relations, and the control of impulses.

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The DSM-IV-TR® 4th Edition defined personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable overtime, and leads to distress or impairment.

Personality disorders are long-term patterns of thoughts and behaviors that cause serious problems with relationships and work. People with personality disorders have difficulty dealing with everyday stresses and problems. They often have stormy relationships with other people.

Persons with a personality disorder possess several distinct psychological features including disturbances in self-image, ability to have successful interpersonal relationships, appropriateness of range of emotion, ways of perceiving themselves, others, and the world and difficulty possessing proper impulse control. These disturbances come together to create a pervasive pattern of behavior and inner experience that is quite different from the norms of the individual’s culture and that often tend to be expressed in behaviors that appear more dramatic than what society considers usual. Individuals with a personality disorder often experience conflicts with other people and vice-versa.

The character of a person is shown through his or her personality, by the way an individual thinks, feels, and behaves. When the behavior is inflexible, maladaptive, and antisocial, that is when an individual is diagnosed with a personality disorder. Most personality disorders begin as problems in personal development and character which peak during adolescence and then are defined as personality disorders.

Personality disorders are not illnesses in a severe sense as they do not disrupt emotional, intellectual, or perceptual functioning. However, those with personality disorders suffer a life that is not positive, proactive, or fulfilling. Personality disorders are also associated with failures to reach potential.

A combination of personal history and biology appears to play a role in most personality disorders. Personality forms during childhood and is shaped through an interaction of two factors. These are inherited tendencies or genes and environment or life situations. Inherited tendencies are aspects of ones personality passed on to them by their parents, such as shyness or having a happy outlook. This is sometimes called there temperament. Environment is the surroundings one grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting one had, whether loving or abusive. Both came out of the nature nurture debate where inherited is nature and environmental is nurture. Personality disorders are thought to be caused by a combination of these genetic and environmental influences. You may have a genetic vulnerability to developing a personality disorder and your life situation may trigger the actual development of a personality. http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=causes, September 11, 2010 at 7:54 p.m.

There are ten (10) distinct personality disorders that have been identified in the DSM-IV-TR®. These are: 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 and schizotypal personality disorder. These disorders are placed into three clusters. Cluster A consists of Paranoid, schizoid and schizotypal and are considered “odd” or “eccentric”. Cluster B consists of antisocial, borderline, histrionic and narcissistic and are considered as “dramatic, emotional, erratic”. Cluster C consists of avoidant, dependent and obsessive-compulsive and are considered “anxious or fearful”.

Antisocial personality disorder is the lack of regard for the moral or legal standards in the local culture, marked inability to get along with others or abide by societal rules this is sometimes called psychopaths or sociopaths.

Avoidant personality disorder is the marked social inhibition, feelings of inadequacy and extremely sensitive to criticism.

Borderline personality disorder is the lack of one’s own identity, with rapid changes in mood; intense unstable interpersonal relationships marked impulsively, instability in affect and in self image.

Dependent personality disorder is the extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on his or her own. Fear of separation and submissive behaviour, marked lack of decisiveness and self-confidence.

Histrionic personality disorder exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behaviour.

Narcissistic personality disorder is behaviour or a fantasy of grandiosity, a lack of empathy, a need to be admired by others an inability to see the viewpoints of others, and hypersensitive to the opinions of others.

Obsessive-compulsive personality disorder is characterized by perfectionism and inflexibility, preoccupation with uncontrollable patterns of thought and action.

Paranoid personality disorder marked distrust of others, including the belief without reason that others are exploiting, harming, or trying to deceive him or her; lack of trust, belief of others betrayal, belief in hidden meanings, unforgiving and grudge holding.

Schizoid personality disorder is primarily characterized by a very limited range of emotion, both in expression of and experiencing, indifference to social relationships.

Schizotypal personality disorder is peculiarities of thinking, odd beliefs and eccentricities of appearance, behaviour, interpersonal style, and though.

To be diagnosed with a personality disorder, a psychologist will look for: symptoms that have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood. The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person’s life. Symptoms are seen in at least two of the following areas: thoughts, emotions, interpersonal functioning and, impulse control

It is difficult to prevent personality disorder, however, as counsellors; we would try to identify those persons who are most likely to be at risk, such as children living with neglect or abuse. Offering early intervention may help to lower the risk. One should take steps in controlling their stress level, increase resilience and boost low self-esteem. If someone realized that they have a personality disorder and get it treated quickly and sticking with it for the long term will help them to prevent symptoms from worsening.

According to research done by PubMed the overall psychiatric hospital admission rates in Jamaica were 136 per 100,000 in 1971 and 69 per 100,000 in 1988. The admission rate for schizophrenia was 69 per 100,000 in 1971 and 35 per 100,000 in 1988. The 49% reduction in admission rates over these 17 years is attributed to the introduction of an island-wide community mental health service with psychiatric admission to general parish hospitals in 1972. This admission rate for schizophrenia is five to six times lower than the rate reported for Afro-Caribbean’s in the UK by a number of studies, and is more in keeping with the admission rate for schizophrenia reported for the general population in England.

Personality disorders are common and affect 10% to 15% of the population in the United States. Gender influences presence; for example, antisocial and obsessive-compulsive personality disorders are more common in men, whereas borderline, dependent, and histrionic personality disorders are more prevalent in women. http://www.wrongdiagnosis.com/p/personality_disorders/prevalence.htm?kcplink=1

Fredrick W. Hickling, Professor of Psychiatry at the University of the West Indies stated in his letter to the Editor of August 27, 2010 that personality disorder manifests with three main problems. These are: issues in the management of power, especially in relation to authority figures and organizations, manifest by repeated conflicts, duplicity and transgression (wrong-doing); issues with physiological dependency (addiction to licit and illicit drugs, food and gambling) and psychological dependency (emotional and economic ‘lean pon’, and men-dicancy); and issues with sexual per-formance and functioning. Personality disorder can be mild, moderate or severe.

He further stated that work done with his colleagues at the University Hospital of the West Indies funded by the CHASE Fund has identified that this condition occurs in nearly 20-30 per cent of the Jamaican population. This is nearly three to five times higher than prevalence rates in other parts of the world. Jamaicans seem to have a proclivity for transgression, perhaps rooted in the historical psychopathology of a slave society. http://www.jamaica-gleaner.com/gleaner/20100827/letters/letters2.htmlOctober 13, 2010, 10:02 p.m.

According to Dr. Sam Vaknin, author of Malignant Self-Love: Narcissism Revisited (2007), individuals with personality disorders has many things in common. These are: Self-centeredness that manifests itself through a me-first, self-preoccupied attitude. Lack of individual accountability that results in a victim mentality and blaming others, society and the universe for their problems. Lack of perspective-taking and empathy. Manipulative and exploitative behavior. Unhappiness, suffering from depression and other mood and anxiety disorders. Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks. Distorted or superficial understanding of self and others’ perceptions, being unable to see his or her objectionable, unacceptable, disagreeable, or self-destructive behaviors or the issues that may have contributed to the personality disorder. Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs. No hallucinations, delusions or thought disorders.

Example of personality disorder is a person who just came out of a relation and went into another one quickly. The first time she met her new boyfriend, she quickly became intimate with him, telling him she loved him and will not do anything to hurt him. However, things took a toll for the worse as she was attending school and started telling him she do not have anytime, she has her assignments to complete. The gentleman would contact her but she did not want to talk to him. She made promises to see him on several occasions but did not fulfill the promise. She even told him that he can also see other people. She dropped by at his house and picked up her stuff that was there. She told him that it does not make any sense she live and she preferred to die.

Therapy and medications can help persons who have personality disorder; however, it is the individual’s decision to take accountability for his or her own life that makes the difference. To heal, individuals must first have the desire to change in order to break through that enduring pattern of a personality disorder. Individuals need to want to gain insight into and face their inner experience and behavior. This involves changing their thinking about themselves, their relationships, and the world. This also involves changing their behavior, for that which is not acted upon is not learned. With a support system example, therapy, self-help groups, friends, family, medication, they can free themselves from personality disorder. They also need to accept their illness, talk about it, seek treatment and live, enjoy life and realize their dreams.

I would recommend that more treatment centres come into operation in Jamaica as patients exhibiting personality disorder same are treated at Bellevue Hospital and Ward 21 or even privately. However, these hospitals do not specialize in treating patients who have a personality disorder. Currently the facilities that we have here in Jamaica do not adequately care for person with this disorder. People need to be more educated on personality disorder as a lot of persons seem to have it although sometimes they do not realize and come to the acceptance.

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