A personality disorder is a mental disorder that can manifest itself as early as childhood and adolescence. It is characterized by the suppression of some personality traits and the vivid manifestation of others. Schizoid personality disorder is a reluctance to make friends, a lack of warm emotional contacts, but at the same time, excessive passion for non-standard hobbies. For example, such patients can build their own theories about leading a healthy lifestyle. In general, personality disorders have many forms and types.
You may often hear people who are overly emotional, or eccentric called psychopaths. Rarely does anyone think about the true meaning of this term. Psychopathy is a serious disorder, determined by the excessive expression of one of the personality traits with the underdevelopment of others. In Western classification, we use the term “personality disorder” rather than “psychopathy.” And this diagnosis includes many disorders that are unlike itself.
Personality disorders are a complex of deeply rooted rigid and maladaptive personality traits that cause specific perceptions and attitudes towards oneself and others, decreased social adjustment and, as a rule, emotional discomfort, and subjective distress.
The reasons why they arise most often lie in adolescence or even childhood, and each type of personality disorder has its own characteristic age of formation. From the beginning of their emergence, these maladaptive personality traits are no longer defined in time and permeate the entire period of adult life. Their manifestations are not limited to any aspect of functioning but affect all areas of the personality - emotional-volitional, thinking, style of interpersonal behavior.
• The totality of pathological character traits that manifest themselves in any environment (at home, at work);
• Stability of pathological features that are identified in childhood and persist until adulthood;
• Social maladjustment, which is a consequence of pathological character traits, not caused by unfavorable environmental conditions.
Personality disorders occur in 6-9% of the population. Their origin is in most cases ambiguous. The following reasons may play a role in their development:
• pathological heredity (primarily alcoholism, mental illness, personality disorders in parents),
• various kinds of exogenous-organic influences (traumatic brain injuries and other minor brain damage under the age of 3-4 years, as well as pre- and perinatal disorders),
• social factors (unfavorable conditions of upbringing in childhood because of the loss of parents or upbringing in an incomplete family, with parents who do not pay attention to children, alcoholics, antisocial individuals, who have incorrect pedagogical attitudes).
In addition, the following features of neurophysiological and neurobiochemical functioning are often noted:
• the presence of bipolar symmetric theta waves on the EEG, indicating a delay in brain maturation;
• in patients with a high level of impulsivity, an increase in the level of some sex hormones (testosterone, 17-estradiol, estrone) is detected;
• an increased level of monoamine oxidase correlates with a general decrease in the level of social activity of patients.
There are many classifications of personality disorders. One of the main ones is the cognitive classification of personality disorders (the other is psychoanalytic), which distinguishes 9 cognitive profiles and corresponding disorders. Let's look at the most typical ones.
A person suffering from this disorder is characterized by a tendency to attribute evil intentions to others and a tendency to form overvalued ideas, the most important of which is the thought of the special significance of one’s own personality. The patient himself rarely seeks help, and if he is referred by relatives, then when talking with a doctor he denies the manifestation of personality disorders.
Such people are overly sensitive to criticism and are constantly dissatisfied with someone. Suspicion and a general tendency to distort facts by misinterpreting neutral or friendly actions of others as hostile, often lead to unfounded thoughts of conspiracies that subjectively explain events in the social environment.
Schizoid personality disorder is characterized by isolation, unsociability, inability to have warm emotional relationships with others, decreased interest in sexual communication, a tendency to autistic fantasies, introverted attitudes, difficulty in understanding and assimilating generally accepted norms of behavior, which manifests itself in eccentric actions. People suffering from schizoid personality disorder usually live by their own unusual interests and hobbies, in which they can achieve great success.
They are often characterized by a passion for various philosophies, ideas for improving life, schemes for building a healthy lifestyle through unusual diets or sports activities, especially if this does not require direct dealing with other people. Schizoids may have a fairly high risk of becoming addicted to drugs or alcohol to gain pleasure or improve contacts with other people.
Dissocial personality disorder is characterized by a noticeable, gross discrepancy between behavior and prevailing social norms. Patients can have a specific superficial charm and make an impression (usually on doctors of the opposite sex).
The main feature is the desire to continuously have fun, avoiding work as much as possible. Starting from childhood, their life is a rich history of antisocial behavior: deceit, truancy, running away from home, involvement in criminal groups, fights, alcoholism, drug addiction, theft, manipulating others in their own interests. Antisocial behavior peaks in late adolescence (16–18 years).
Histrionic personality disorder is characterized by excessive emotionality and a desire to attract attention, which manifest themselves in various life situations. The prevalence of histrionic personality disorder in the population is 2-3% with a predominance in women. It is often combined with somatization disorder and alcoholism.
Let us list the main features characteristic of this disorder: seeking the attention of others towards oneself, inconstancy in affection, capriciousness, an irresistible desire to always be the center of attention, to arouse sympathy or surprise (no matter for what reason). The latter can be achieved not only by extravagant appearance, boasting, deceit, fantasy, but also by the presence of “mysterious diseases”, which can be accompanied by pronounced vegetative paroxysms (spasms, a feeling of suffocation during excitement, nausea, aphonia, numbness of the limbs and other sensitivity disorders) . The most intolerable thing for patients is indifference on the part of others; in this case, even the role of a “negative hero” is preferred.
People with obsessive-compulsive personality disorder are characterized by a preoccupation with order, a desire for perfection, control over mental activity and interpersonal relationships, to the detriment of their own flexibility and productivity. All this significantly narrows their adaptive capabilities to the surrounding world. Patients are deprived of one of the most important mechanisms for adapting to the world around them - a sense of humor. Always serious, they are intolerant of anything that threatens order and perfection.
Constant doubts in making decisions, caused by the fear of making a mistake, poison their joy from work, but the same fear prevents them from changing their place of activity. In adulthood, when it becomes obvious that the professional success they have achieved does not correspond to their initial expectations and efforts, the risk of developing depressive episodes and somatoform disorders is increased.
An anxious (avoidant, avoidant) personality disorder is characterized by limited social contacts, a feeling of inferiority, and increased sensitivity to negative evaluations. Already in early childhood, these patients are characterized as excessively timid and shy; they perceive attitudes towards themselves distortedly, exaggerating its negativity, as well as the risk and danger of everyday life. They find it difficult to speak in public or simply address someone. Loss of social support can lead to anxiety-depressive and dysphoric symptoms.
The most clearly manifested ideas in people from adolescence are ideas about their own greatness, the need for admiration from others and the impossibility of experiencing. A person does not admit that he can become the object of criticism - he either indifferently denies it or becomes furious. It is worth emphasizing the features that occupy a special place in the mental life of a person with narcissistic personality disorder: an unfounded idea of one’s right to a privileged position, automatic satisfaction of desires; the tendency to exploit, to use others to achieve one’s own goals; envy of others or the belief in an envious attitude towards oneself.
Therapy for disorders associated with characterological deviations is purely individual. When choosing a therapeutic intervention, as a rule, not only diagnostic and typological characteristics are taken into account, but also the structure of the personality disorder, the possibility of introspection and subjective mediation of psychopathology, characteristics of behavior and reactions (aggressive and auto-aggressive tendencies), the presence of comorbid personal and mental pathology, readiness to cooperation and a fairly long therapeutic alliance with the doctor (which is especially important for avoidant, recognition-seeking and dissocial individuals).
Numerous studies indicate the effectiveness of psychotherapy for personality disorders, as well as social, environmental and pedagogical influences that harmonize behavior and contribute to the achievement of stable adaptation. Psychopharmacological agents as a method of correcting personality disorders are a relatively new concept. Psychopharmacotherapy in this case does not pursue the goal of complete relief of symptoms that develop within the framework of the dynamics of personality disorders; its tasks are limited to the correction of pathocharacterological manifestations that hypertrophy to the level of psychopathological formations. Accordingly, treatment of personality disorder is carried out on an outpatient basis and is supportive in nature.
For example, SSRIs are used for depressive disorders and agitation, while the use of anticonvulsants can reduce agitation and anger. A drug such as Risperidone can be prescribed to patients with depression, as well as to those who have the initial stage of a personality disorder.
In psychotherapy in the treatment of various personality disorders, the main goal is to relieve stress and isolate the patient from the source of stressful situations. This subsequently reduces other manifestations of symptoms - anxiety, suspicion, outbursts of anger and depression decrease. However, the most difficult task for a specialist in such disorders is establishing a trusting relationship between the patient and the doctor. It is successful interaction that can bring results, since the treatment of personality disorders is a long process.
Timely and correctly selected psychotherapeutic and pharmacological treatment improves the quality of life of a person with such a difficult fate and “leaves no room for therapeutic pessimism.”
It is impossible to say unequivocally that men are characterized by one or another type of disorder: in practice, men have a variety of types of personality disorders. In particular, these are often paranoid and schizoid personality disorders, classified as category A, and borderline and antisocial disorders are also common.
With the paranoid type, the following symptoms appear:
• lack of normal relationships with other people;
• constant suspicions regarding loved ones and relatives;
• envy;
• emotional coldness;
• isolation and excessive seriousness.
Schizoid personality disorder is manifested by the following symptoms:
• indifference to others;
• unsociability;
• avoiding noisy parties and events;
• lack of social contacts;
• emotional coldness;
• callousness.
Borderline personality disorder manifests itself:
• impulsiveness;
• frequent depression;
• a tendency to self-destructive behavior - for example, such patients are able to threaten hunger strike, suicide or other injuries in order to achieve what they want;
• lack of healthy criticism, the ability to idealize a significant person;
• eccentric behavior.
Antisocial personality disorder manifests itself:
• indifference;
• irresponsibility;
• deceitfulness;
• neglect of the safety of loved ones;
• aggression;
• hot temper;
• inability to behave within the framework of established cultural and social norms.
It should be noted that this type of disorder is typical for criminals; people with this disorder often end up behind bars. They absolutely cannot understand why follow the rules and moral principles and often commit crimes, neglecting their future and the safety of loved ones.
We emphasize that any type of personality disorder requires long-term therapy. Typically, this is a combination of medication and psychotherapy. In some cases, occupational therapy or other supportive psychotherapeutic techniques may be recommended. This is a very serious disease, and it can take months to see progress in treatment.
For women, the most common types are hysterical and narcissistic personality disorder. In the first case, the following symptoms will appear:
• inappropriate behavior;
• sexual disorders;
• the need to be the center of attention;
• theatrical speech;
• excessive dramatization of situations;
• idealization of relationships;
• a tendency to attribute serious intentions to casual acquaintances;
• impulsiveness;
• eccentric behavior, strong emotions.
Symptoms of narcissistic personality disorder include:
• envy;
• tendency to consider oneself the center of the universe;
• dreams of power;
• using other people for your own benefit;
• the need for special treatment;
• the desire to win praise and recognition from others.
Personality disorder in women is treated in the same way as in men - usually a combination of pharmacotherapy and psychotherapy. All drugs and methods are selected individually by a psychiatrist. Note that, as in the case of male patients, long-term treatment is required, over several months.
Anxious and dependent personality disorders are common in children. This is due to the negative environment at home, at school or other surroundings of the child, violence, and moral humiliation.
With anxiety disorder in children, the following are observed:
• low self-esteem;
• clumsiness;
• frequent anxiety;
• exaggeration of problems;
• isolation;
• inability to build social contacts.
• the role of the victim in any situation;
• passivity;
• avoidance of responsibility;
• low performance at school;
• sensitivity to any criticism;
• tearfulness;
• isolation;
• loneliness;
• strong lack of self-confidence.
Treatment in the case of personality disorder in children is selected with great care - this includes gentle pharmacotherapy, long-term work with a psychologist, constant supervision by a psychiatrist, as well as additional psychotherapeutic techniques (hippotherapy, sports therapy, snoezelen therapy and others).
There is no established standard for the prevention of personality disorders since each person is individual. However, there are general recommendations from psychiatrists. First, avoid the negative influence of stressful situations. If a person does not control his emotions and reactions, you can consult a psychologist and receive psychological tools for adequately responding to stress and resolving conflicts.
At the same time, there are prerequisites for the development of a personality disorder; as a rule, they are associated with a person’s psychotype formed in childhood and adolescence, as well as with traumatic situations suffered. In this case, it is necessary to be observed by a psychiatrist and psychotherapist for a supportive course of psychotherapy.