Personality disorders

What is Personality disorders?

Personality disorder is a psychological disease. A personality can be described as a pervasive "characteristic configuration of behavioural response patterns apparent in everyday life," that is both stable and predictable in many diverse situations. A personality disorder is said to exist when the response patterns exceed those limits set by social opinion. The personality disorder will consequently lead to social rejection and occupational dysfunction throughout life.

Statistics on Personality disorders?

The prevalence of all personality disorders is estimated at 6-9%, but some authorities believe the true prevalence is up to 15% of the general population. These disorders affect men and women equally. The personality disorder will always begin in childhood, with the beginning of personality development.

Risk Factors for Personality disorders

The most important predisposing factor is a family history of psychiatric illness. Other predisposing factors may include: 1. Previous head injury. 2. Previous brain infection including meningitis or encephalitis. 3. Birth injury. 4. Emotionally and/or physically abusive childhood.

Progression of Personality disorders

Personality disorders comprise deeply ingrained and enduring patterns of behaviour which manifest themselves as inflexible responses to a broad range or personal and social situations. Personality disorders are developmental conditions that appear in childhood or adolescence and continue in adult life. Personality disorders are not secondary to another psychiatric disorder or brain disease, although they may precede or coexist with other disorders. In contrast, personality change is acquired, usually in adult life, following severe or prolonged stress, extreme environmental deprivation, serious psychiatric disorder or brain injury or disease. The personality disorder is normally present at an early age and persists throughout life, as the character traits are part of the patient's personality. The course is variable, but most patients tend to remain stable, with few improving over time. These patients are also more likely to develop major psychiatric conditions such as depression with increasing duration of the disease.

How is Personality disorders Diagnosed?

A number of investigations may be performed to ensure that the condition does not have an organic origin. This may include a series of blood tests and brain imaging by MRI and CT scan.

Prognosis of Personality disorders

The prognosis of personality disorders is relatively poor. As a personality is essentially a fixed system of behavioural responses, patients will sustain an abnormal personality throughout their lives. Some patients may improve but the majority remain stable or even deteriorate throughout the course of disease. The risk of major psychiatric disorders such as depression is increased, and may occur at later stages of the illness.

How is Personality disorders Treated?

The treatment of personality disorders requires long-term psychotherapy and possibly medications. The patient is usually not motivated, making psychotherapy difficult for the involved therapist. Psychotherapy remains the main form of therapy for these patients, taking the form of psychoanalysis, supportive counselling, group therapy, family therapy and occasional hospitalisation for more frequent intensive treatment during episodes of increased symptoms. Certain medications may also be useful in the management of this condition including antipsychotics, (usually olanzapine) antidepressants (usually SSRI's such as Zoloft or Prozac) and anti-anxiety therapy (usually benzodiazepines such as valium.) The patient will normally require long-term treatment for personality disorder is a lifelong disorder in the majority of cases.

Personality disorders References

Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
Sadock BJ, Sadock VA. Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry 3rd Edition. Lippincott Williams and Wilkins, Philadelphia USA.