Personality disorders occur when individuals exhibit behaviors that deviate from normal social expectations. They lead to considerable suffering either on the part of the person affected and/or on the part of the environment.
For personality disorders to be present, the deviant experiences and behaviors must be clearly evident in at least two of the following areas:
- Cognition (world of thoughts)
- Affectivity (emotional world)
- Satisfaction of needs and impulse control
- Interpersonal relationships and the way we deal with them
Personality disorders begin in childhood and adolescence and last into adulthood. They persist for a long time. Those affected often do not perceive them as a "disorder", unlike the symptoms of depression, for example.
A personality disorder does not exist if the behavior is the result of another mental or organic illness. For example, a functional disorder of the brain can cause behavioral deviations. However, these are then not referred to as personality disorders.
The causes of personality disorders are not clearly understood. What is certain, however, is that they result from an interplay between
- environment (upbringing, surroundings) and
- factors (genes, genetic make-up)
arise.
Personality disorders are widespread. For example, 10 percent of the general population is said to fulfill the diagnostic criteria for a personality disorder.
Various concepts attempt to explain the causes of personality disorders. In particular, stressful life circumstances lead to lasting disturbances in personality development. Personality disorders are often also associated with psychosomatic disorders.
There are several specific personality disorders. We present these below.
Paranoid personality disorder
Patients with a paranoid personality disorder
- show an unjustified mistrust of other people that dominates their personality
- have a tendency to accuse other people of malicious motives
- tend to distort their experiences by misinterpreting neutral or friendly actions of others as hostile or contemptuous
- particularly often show an unjustified mistrust of the sexual fidelity of their spouse or sexual partner
- are usually hypersensitive to criticism
- tend to adopt an oppositional attitude and react aggressively due to their exaggerated need for autonomy
People with paranoid personality disorder have the feeling that others mean them harm © Вячеслав Думчев | AdobeStock
Schizoid personality disorder
Patients with schizoid personality disorder
- show a tendency towards social isolation and loneliness
- have no or hardly any close relationships except among first-degree relatives
- are cool and emotionally distant in interpersonal relationships and appear unapproachable. They have a low ability to show warm and tender feelings or even anger towards others
- are often indifferent to social rules, but also to praise and criticism from other people
- often show little interest in sexual experiences with another person
Dissocial personality disorder
Patients with a dissocial personality disorder
- show a clear and persistent irresponsibility and disregard for social norms, rules and obligations
- usually have a low frustration tolerance - are self-centered and incapable of genuine love and attachment
- show a low threshold for aggressive, even violent behavior
- are often superficially charming, but false and insincere
- know neither remorse nor shame
- do not have the ability to see themselves through the eyes of others
- are unable to put themselves in other people's shoes(lack of empathy)
Borderline personality disorder
Patients with borderline personality disorder
- show instability in relationships, self-image and emotions as well as impulsivity
- are often prone to self-harm and suicidal tendencies
Histrionic (hysterical) personality disorder
Patients with histrionic personality disorder
- are prone to exaggerated expression of feelings
- have an increased desire for attention and admiration
- tend towards theatricality and dramatization
- have a tendency towards inappropriate, sexually seductive and provocative-manipulative behavior
- are suggestible and easily influenced
- crave exciting excitement and activities where they are the center of attention
- are prone to manipulative behavior to satisfy their own needs
Narcissistic personality disorder
Patients with narcissistic personality disorder
- tend to have a sense of grandiosity
- have a need for admiration and a lack of empathy
Anankastic (obsessive-compulsive) personality disorder
Patients with anankastic (obsessive-compulsive) personality disorder
- tend to be precise and conscientious to the point of pedantry
- show an exaggerated love of order and rigidity
- tend towards perfectionism
- tend to have strong doubts and increased caution
- have a preference for details, rules, lists, order, organization or schemes
- are limited in their capacity for pleasure
- often suffer from the occurrence of unwanted thoughts and impulses
Anxious-avoidant/self-conscious personality disorder
Patients with an anxious-avoidant/self-insecure personality disorder
- tend to have persistent and intense feelings of tension and anxiety
- have the idea of being socially inferior, unattractive or inferior to others
- show an exaggerated expectation of being criticized or rejected by others
- avoid social or professional activities that require interpersonal contact for fear of criticism, disapproval or rejection
- are restricted in their lifestyle by the need for security
Asthenic personality disorder
Asthenic (dependent) personality disorder is also known as dependent personality disorder. Patients
- show a dependent relationship pattern
- tend to be compliant and subordinate to people with whom they have a dependent relationship
- tend to delegate important life decisions to others
- are full of helplessness and fear of not being able to take care of themselves
- passively rely on other people for minor or major life decisions
- have great separation anxiety
- are afraid of being abandoned by a caregiver and having to fend for themselves
- fail to cope with the demands of daily life
- appear weak intellectually (and) emotionally
- have a tendency to blame others for difficulties
Around 11 percent of all Germans suffer from a personality disorder.
Overall, women and men are equally affected by personality disorders. However, there are sometimes clear gender differences for the individual personality disorders. For example, women are more affected by borderline personality disorder or anxious-avoidant personality disorder. Dissocial and obsessive-compulsive personality disorders, on the other hand, are more common in men.
People with personality disorders have a greatly increased risk of developing another mental disorder. They often develop, for example
In addition, other mental illnesses are often more severe and complicated for them than for people without personality disorders. This is why around 50 percent of all mentally ill patients have an (additional) personality disorder. Borderline personality disorder and anxious-avoidant personality disorder are particularly common.
However, it is hardly possible to diagnose a personality disorder with certainty during the acute phase of a mental illness. Almost all acutely depressed patients describe themselves as having an insecure personality. Only after the depression has subsided does the self-confident side emerge again.
Today, standardized questionnaires are available for diagnosing personality disorders. The doctor fills them out together with the patient.
Typically, the disturbed personality patterns become apparent from childhood or adolescence. They remain relatively stable in their particularity.
However, whether the person affected (and their environment) suffers greatly from these patterns or to what extent they acquire real "disruptive value" depends heavily on
- external life circumstances,
- life demands and
- the caregivers of the person concerned
depends.
Serious changes such as
- relocation,
- change of job or
- change in caregivers,
require flexibility and problem-solving skills. In such situations, people with personality disorders can get into great difficulties.
For example, a young woman with anxious-avoidant personality disorder can fulfill her social roles relatively well as long as she lives in her parents' neighborhood, completes her training in the company of an old family friend and mainly has contact with former schoolmates. However, moving to a partner living 50 km away, combined with a change of job and the need to find her way in a new social environment, can lead to
- pronounced problems,
- Anxiety,
- brooding,
- despondency and
- despair
- up to the full-blown depression
depression.
Most personality disorders are chronic. Around 30 percent of those affected can expect a very unfavorable course with pronounced impairments.
Around 50 percent of patients can benefit greatly from therapy.
The treatment of personality disorders includes
- crisis intervention and
- long-term treatment of the relationship disorders.
Psychotherapy is the treatment of choice. Psychotropic drugs only have a supportive function. The following psychotherapeutic methods can be used
- Modified analytical approaches with structure-building psychotherapeutic measures to build up deficient ego structures such as
- Affect control,
- impulse control,
- affect differentiation,
- improvement of interpersonal competence.
- Behavioral therapy approaches with
- comprehensive social training,
- systematic desensitization and
- exposure treatment.
- Cognitive therapy approaches are aimed at modifying dysfunctional beliefs about oneself and the world.
- Trauma-oriented psychotherapies are used for traumatized patients.
Personality disorders are very often treated with inpatient psychotherapy.
Case study 1: Borderline personality disorder
A 35-year-old nurse presents herself for admission to a psychotherapy program. She talks openly about her problems and quickly makes good contact. Her biggest problems are extreme states of tension and strong self-hatred. They usually occur simultaneously and unpredictably.
These problems have existed since she was regularly sexually abused by a relative over a long period of time in her childhood. In order to regulate her tension, she cuts herself in both arms and abuses alcohol and medication. She had a small circle of acquaintances and most of her relationships were changeable and complicated. There was nothing she wanted more than a stable partnership.
The patient feels rejected and unloved very quickly. As a result, various conflicts with fellow patients or practitioners arise during inpatient treatment. Such situations are analyzed in detail. In addition, the patient receives intensive symptom-oriented individual and group therapy.
At the end of treatment, she is able to reduce tension without self-harm or substance abuse. Problems in relationships and self-hatred still occur, but the patient is able to distance herself from them somewhat better.
Case example 2: Schizoid personality disorder
31-year-old Mr. P. is a patient in inpatient alcohol detoxification. He appears very quiet and withdrawn. He doesn't look at the person opposite him very much and hardly reacts to jokes or friendly comments.
Regarding his social situation, he states that the mother of his child recently separated from him. He did not quite understand the reason for this. He thinks it's a shame, of course. But overall, other people are not very important to him and he is relatively indifferent to their opinion of him. He gets on best on his own and doesn't care much about a sexual relationship either.
Since he lost his job as a bricklayer two years ago, he has hardly socialized. However, his alcohol consumption has become very heavy during this time.
Case study 3: Self-insecure personality disorder
As a trained gardener, 26-year-old Ms. P. also has to advise customers in sales. She finds this extremely difficult and is afraid of making a fool of herself. As a result, she often called in sick and was always in trouble with her boss. She is also extremely shy in private, feels inferior to her peers and does not dare to approach people she does not know. She usually feels clumsy and awkward.
Ms P. completed two years of behavioral therapy with a focus on practicing the problems she avoids. Afterwards, she is able to manage her professional tasks with confidence and has a more fulfilling social life. However, she still describes herself as shy and plagued by inferiority complexes.
