When personality traits become rigid
Personality disorders impair lives
by Michael E. Judd, M.D., Adult Psychiatrist, Piedmont Psychiatric Center

Each of us has personality traits — our unique patterns of perceiving or interacting within our environment. These traits develop as a result of the combination of inherited traits, experiences and learned behaviors.

Personality traits become disorders when behavior patterns become rigid and inflexible or extremely unstable. People with personality disorders may have difficulty interacting with others, which leads to an impairment in social, academic or occupational functioning. They may be loners and withdraw from others or they may create a sense of chaos in all of their relationships. They ultimately have a difficult time dealing with life's challenges. Unfortunately, these individuals rarely seek treatment because of the ego-syntonic nature of the disorders, (believing their behavior is normal and everyone else's is not).

One out of every 10 to 18 people suffers from some type of personality disorder. These percentages are significantly higher in outpatient clinic settings, running 30 to 50 percent, and on inpatient units at upwards of 50 percent.

Many theories exist as to the origin of personality disorders, the most common of which is the psycho-analytic theory of Sigmund Freud which argues that personality disorders are the product of a fixation at a particular stage in a person's development. Although many existing theories provide insight, none totally explains the cause of personality disorders. The over-riding belief is that personality, healthy or unhealthy, is multifactorial, formed by inherited traits, experiences and learned behavior.

Types of personality disorders

According to DSM IV criteria, there are three clusters of personality disorders. (Percentages of the population suffering from these disorders are in parentheses.)

Cluster A comprises odd or eccentric behavior. The disorders are:

Paranoid: Individuals exhibit a sense of distrust and suspiciousness (.5 to 2.5 percent)

Schizoid: Individuals appear detached, eccentric and indifferent to the world (up to 7.5 percent)

Schizotypal: Characterized by peculiar thought, behavior and speech, social anxiety and lack of friends (3 percent)

Cluster B is characterized by dramatic, emotional and erratic behavior.

Antisocial: Disregard for authority, social norms and rights of others. Symptoms are present prior to the age of 15 (3 percent of males, one percent of females, 75 percent of prison population).

Borderline: Instability in interpersonal relationships, self-image, behavior and mood, often characterized by self-mutilation (3 percent in general population, 12 to 15 percent in clinical settings, twice as common in females than males)

Histrionic: Excessively emotional and attention seeking (2 to 3 percent)

Narcissistic: Overwhelming and pathologic self-absorption (1 percent)

Cluster C is characterized by anxious and fearful behavior.

Avoidant: Intense discomfort in intimate or social relationships (1 percent)

Dependent: Submissive with a strong desire to be cared for by others (2.5 percent)

Obsessive-compulsive: Preoccupation with perfectionism (1 percent)

Subgroup: Personality disorder not otherwise specified, characterized by personality dysfunction that doesn't meet the above criteria but clearly causes interpersonal conflict.

Treatment

Approximately 34 percent of people treated for personality disorders have co-morbid disorders such as depression or anxiety, and it is these other disorders that drive them to treatment.

The mainstay of treatment for personality disorders is psychotherapy. Some disorders such as borderline personality disorder respond to a specific type of cognitive behavioral therapy called dialectical behavioral therapy (DBT). The goal of treatment is to help the patient recognize that his or her coping strategies and behavior patterns are maladaptive and to help them develop healthy strategies. In doing this, individuals can attain a more rewarding life.

Medications can be prescribed to treat symptoms such as depression, anxiety or impulsive behavior, but none is specifically approved to treat personality disorders.

Michael E. Judd, M.D., is a board-certified adult psychiatrist and medical director of Centra Health's Piedmont Psychiatric Center. Dr. Judd received bachelor's degrees in biology and psychology from St. John Fisher College, and his medical degree from Ross University School of Medicine. He trained in psychiatry at the University of Virginia's Roanoke/Salem Psychiatric Medicine Residency Program. Dr. Judd's areas of interest include mood and anxiety disorders, personality disorders and women's mental health issues.