Personality disorder is an umbrella term that covers a wide range of psychological problems with subtle differences. These can be grouped together under three clusters for a better understanding.

Cluster A

Paranoid: Suspiciousness and mistrust of others; tendency to see oneself as blameless; on guard for perceived attacks by others

Schizoid: Impaired social relationships; inability and lack of desire to form attachments to others

Schizotypal: Peculiar thought patterns; oddities of perception and speech that interfere with communication and social interaction

Cluster B

Histrionic: Self dramatisation; over concern with attractiveness; irritability and temper outbursts if attention seeking is frustrated

Narcissistic: Grandiosity; preoccupation with receiving attention; self-promotion, lack of empathy

Anti-social: Lack of moral or ethical development; inability to follow approved models of behaviour; deceitfulness; shameless manipulation of others; history of conduct problems as a child

Borderline: Impulsiveness; inappropriate anger, drastic mood shifts; chronic feeling of boredom; attempts at self-mutilation or suicide.

Cluster C

Avoidant: Hypersensitivity to rejection; shyness, insecurity in social interaction and initiating relationships

Dependent: Difficulty in separating in relationships; discomfort at being alone; subordination for needs in order to keep others involved in a relationship; indecisiveness

Obsessive compulsive: Excessive concern with order, rules, and trivial details; perfectionistic; lack of expressiveness and warmth; difficulty in relaxing and having fun

Who is at risk?

By the time we are adults, most of us have a personality that is attuned to the demands of society. In other words, we readily comply with most societal expectations. We go to school or office; we honour our financial obligations and we develop and try to sustain relationships. We also have a sense of who we are.

In contrast, there are certain people who, although they do not necessarily display obvious symptoms of most of the disorders discussed in this section, nevertheless have certain traits that are so inflexible and maladaptive that they are unable to function effectively or meet the demands of the society. In such cases, we may describe them of having a personality disorder. The general features that characterise most personality disorders are chronic interpersonal difficulties, problems with one’s identity or sense of self, and an inability to function adequately in society.

Let us look at some of these conditions in detail.

Paranoid personality disorder

An excessive distrust and suspiciousness of others to the point of thinking that they are plotting to bring harm to oneself. The trait usually begins by early adulthood and continues unless tackled by therapy. Here are some contexts and if four or more are applicable in an individual, then he/she needs to seek professional help.

• Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
• Is preoccupied with unjustified doubts about the locality or trustworthiness of friends or associates
• Is reluctant to confide in others because of unwarranted fear that the information will be used against him or her
• Reads hidden motive or meaning into harmless remarks or events
• Persistently bears grudges and is not ready to forgive insults, injuries, or slights
• Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily
• Has recurrent suspicions without justification regarding fidelity of spouse or sexual partner
• Does not occur exclusively during the course of schizophrenia or bipolar or depressive disorder with psychotic features or another psychotic disorder and is not attributable to the physiological effects of another medical condition

Histrionic personality disorder

People who suffer from this condition show excessive emotionality and attention seeking behaviour. They display inappropriate sexually seductive or provocative behaviour while interacting with others. Their emotions are shallow and shifting rapidly. They are seen using physical appearance to draw attention to themselves and have a style of speech that is excessively impressionistic and lacking in detail. They are prone to theatrics and excessive display of emotion and consider relationships to be more intimate than they actually are.

Narcissistic personality disorder

Let us look at some of the common symptoms of this disorder:

 A pervasive pattern of grandiosity in fantasy or behaviour, need for admiration, and lack of empathy

• They have a grandiose sense of self-importance. They exaggerate achievements and talents, expect to be recognised as superiors without commensurate achievements
• They are preoccupied with fantasises of unlimited success, power, brilliance, beauty or ideal love
• They believe that they are special and unique and should associate with other special or elite people
• They seek excessive admiration
• They have a sense of entitlement. In other words, they expect to be treated in a special way and their demands or expectations met automatically
• They try to take advantage of others to achieve their own ends
• They lack empathy and are unwilling to recognise or identify with the feelings and needs of others
• They are often envious of others or believe that others are envious of them.
• They show arrogant behaviour or attitude

Antisocial personality disorder

As the name itself suggests, people with this disorder have utter disregard for the rights of others. Their failure to conform to social norms make them perform illegal acts. They are deceitful and use aliases and con others for personal pleasure.
Some of the other symptoms:

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• Impulsivity or failure to plan ahead
• Irritability
• Aggressiveness as indicated by repeated physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
• Lack of remorse

Borderline personality disorder

Those who suffer from this condition find it difficult to maintain interpersonal relationships and are very impulsive in nature. This kind of behaviour usually begins by early adulthood and symptoms are present in a variety of contexts.

Such people make frantic efforts to avoid real or imagined abandonment. There is a pattern of unstable and intense interpersonal relationships, characterised by alternating between extremes of idealisation and devaluation. They are unsure of their identity and are not stable when it comes to their self-image or self-worth. They show impulsivity in at least two areas -- spending, sexual relations, substance abuse, reckless driving, binge eating, etc – that are self-damaging.

HOW EFFECTIVE IS OUR TREATMENT?

We are psychotherapy specialists, trained to help people overcome difficulties they face by using highly effective types of psychotherapies such as cognitive behaviour therapy, hypnotherapy, solution focussed brief therapy and experiential therapy.
Medication is not usually recommended in the treatment of mild to moderate psychological problems. However, in some cases,it may be helpful to consider a combined approach and our psychiatrists would be able to advise on this.