Personality disorder

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Personality disorder ( PD ) is a class of mental disorders characterized by long-lasting patterns of behavior, cognition, and inner maladaptive experience, exhibited in many contexts and deviating from the accepted culture individual. These patterns develop early, inflexible, and are associated with significant distress or disability. The definition may be somewhat different, according to the source. The official criteria for diagnosing personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorder (DSM) and the fifth chapter of the International Classification of Diseases (ICD), the two most dominant diagnostic systems in the world.

Personality, defined psychologically, is a set of perennial behavioral and mental traits that distinguish individual human beings. Therefore, personality disorder is defined by experiences and behaviors that differ from social norms and expectations. Those diagnosed with personality disorder may experience difficulties in cognition, emotion, interpersonal function, or impulse control. In general, personality disorders are diagnosed in 40-60% of psychiatric patients, making them most frequently diagnosed with psychiatry.

Personality disorder is characterized by a collection of behavioral patterns that are often associated with personal, social, and work disorders. Personality disorder is also inflexible and diffuse in many situations, largely due to the fact that the behavior may be ego-syntonic (ie a pattern consistent with the integrity of the individual ego) and therefore deemed appropriate by the individual. This behavior can lead to maladaptive coping skills and can cause personal problems that cause anxiety, sadness, or extreme depression. These behavioral patterns are usually recognized in adolescence, early adulthood or sometimes even childhood and often have a widespread negative impact on quality of life.

Many problems occur by classifying personality disorders. Because the theory and diagnosis of personality disorder occurs in the prevailing cultural expectations, their validity is opposed by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders is based on social, or even social, political and economic considerations.

Video Personality disorder

Classification

The two main relevant classification systems are

• The International Classification of Diseases (revised tenth, ICD-10) published by the World Health Organization

• Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, DSM-5) by the American Psychiatric Association.

Both have deliberately combined their diagnosis to some extent, but some differences remain. For example, ICD-10 does not include narcissistic personality disorder as a different category, while DSM-5 does not include personality changes that persist after disaster experience or after psychiatric illness. ICD-10 classifies schizotypal personality disorder DSM-5 as a form of schizophrenia not as a personality disorder. There are accepted diagnostic issues and controversies related to different categories of personality disorders from each other.

General criteria

Both diagnostic systems provide definitions and six criteria for common personality disorder. These criteria must be met by all cases of personality disorder before a more specific diagnosis can be made.

ICD-10 lists these general guidance criteria:

• Attitudes and behaviors that are clearly not harmonious, generally involve multiple functional areas; such as effectiveness, passion, impulse control, how to understand and think, and style relate to others;
• Abnormal behavior patterns are long-lasting, long standing, and are not limited to episodes of mental illness;
• Abnormal behavior patterns are pervasive and clearly maladaptive to various personal and social situations;
• The above manifestations always appear during childhood or adolescence and continue into adulthood;
• This disorder causes considerable personal stress but this may just be too late in its journey;
• Abnormalities are usually, but not always, related to significant problems in work and social performance.

ICD adds: "For different cultures it may be necessary to develop a set of specific criteria with regard to social norms, rules and obligations."

In DSM-5, the diagnosis of personality disorder should meet the following criteria:

• The pattern of experience and perpetual inner behavior that deviates conspicuously from individual cultural expectations. This pattern is manifested in two (or more) of the following fields:

1. Cognition (ie, how to understand and interpret yourself, others, and events).
2. Effectiveness (ie, range, intensity, feasibility, and feasibility of emotional responses).
3. Interpersonal functions.
4. Impulse control.

• The eternal pattern is inflexible and pervasive in many personal and social situations.
• Perennial patterns cause clinically significant disturbances or damage in the areas of social, occupational, or other important areas of functioning.
• The pattern is stable and of long duration, and its beginning can be traced back to at least into adolescence or early adulthood.
• The eternal pattern is not explained better as a manifestation or consequence of other mental disorders.
• The long-lasting pattern is not caused by the physiological effects of a substance (eg, drug abuse, medication) or other medical conditions (eg, head trauma).

In ICD-10

Chapter V in ICD-10 contains mental and behavioral disorders and includes categories of personality disorders and persistent personality changes. They are defined as an ingrained pattern that is shown by an inflexible and disabling response that is significantly different from how the average person in the culture feels, thinks, and feels, especially in dealing with others.

Specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (boundary type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.

In addition to ten specific PDs, there are the following categories:

• Other special personality disorders (involving PD marked as eccentric, haltlose , immature, narcissistic, passive-aggressive, or psychoneurotic.)
• Personality disorder, not specific (including "character neurosis" and "pathological personality").
• Mixed and other personality disorders (defined as often troublesome conditions but not indicating specific patterns of symptoms in named disorders).
• Enduring personality changes, not caused by brain damage and disease (this is for conditions that appear to appear in adults without a diagnosis of personality disorder, after a disaster or prolonged stress or other psychiatric illness).

In ICD-11

In the proposed revision of ICD-11, all diagnoses of discrete personality disorder will be removed and replaced by a single diagnosis of "personality disorder". Instead, there will be specifiers called "prominent personality traits" and possibilities to classify degrees of severity ranging from "mild", "moderate", and "severe" based on dysfunction in interpersonal relationships and daily life of the patient.

In DSM-5

The latest fifth edition of the Diagnostic and Statistical Manual of Mental Disorder emphasizes personality disorder is a perpetual and inflexible pattern of long duration that leads to significant disturbance or damage and not due to substance or other use. medical condition. The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on separate 'axes', as before.

DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, boundary, histrionic, narcissistic, avoidance, dependence and obsessive-compulsive personality disorder.

The DSM-5 also contains three diagnoses for personality patterns that do not match these ten disorders, but still exhibits characteristics of personality disorders:

• Personality change due to other medical conditions - personality disorder due to immediate effect of medical condition.
• Other specific personality disorders - the general criteria for personality disorder are met but fail to meet the criteria for a particular disorder, given the reason given.
• unspecified personality disorder - general criteria for personality disorder are met but personality disorder is not included in the DSM-5 classification.

Cluster personality

Specific personality disorders are grouped into the following three groups based on descriptive equations:

Clusters Personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorders share some character traits, for example, acute discomfort in close association, cognitive or perceptual distortion, and eccentric behavior, with schizophrenia. However, people diagnosed with odd-eccentric personality disorder tend to have a greater understanding of reality than those diagnosed with schizophrenia. Patients suffering from this disorder can be paranoid and difficulty understood by others, as they often have strange or eccentric speech modes and the unwillingness and inability to form and maintain close relationships. Although their perception may be unusual, this anomaly is distinguished from delusions or hallucinations because the person suffering from this will be diagnosed with other conditions. Significant evidence suggests a small percentage of people with Type A personality disorders, especially schizotypal personality disorders, have the potential to develop schizophrenia and other psychotic disorders. This disorder also has a higher likelihood occurring among individuals whose first-degree relatives have a schizophrenic personality disorder or Cluster A.

• Paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interprets motivation as evil.
• Schizoid personality disorder: less interested and unrelated to limited social, apathy, and emotional expression.
• Schizotypal personality disorder: a pattern of extreme discomfort that interacts socially, and distorted cognition and perception.
Cluster B (dramatic, emotional or erratic disorder) Cluster B (dramatic, emotional or uncertain disturbances)
• Antisocial personality disorder: pervasive patterns and other rights violations, lack of empathy, bloated self-image, manipulative and impulsive behavior.
• Borderline personality disorder: Sudden pervasive patterns of mood swings, instability in relationships, self-image, identity, behavior, and influence, often lead to self-danger and impulsivity.
• Hysteric personality disorder: Pervasive patterns of attention seeking behavior and excessive emotion.
• Narcissistic personality disorder: diffuse grandiosity patterns, need for admiration, and lack of empathy that is felt or real.
Cluster C (anxious or scared disorder)

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Other personality types

Some types of personality disorders are in earlier versions of the diagnostic manual but have been removed. Examples include sadistic personality disorder (pervasive pattern of cruel, degrading, and aggressive behavior) and self-destructive personality disorder or masochistic personality disorder (marked by behaviors that consequently ruin a person's pleasure and purpose). They are listed in the DSM-III-R appendix as "The proposed diagnostic category requires more research" without specific criteria. Psychologist Theodore Millon and others consider some degraded diagnoses to be equally valid, and may also suggest personality disorders or other subtypes, including a mixture of aspects of the various categories of officially accepted diagnoses.

Description of Millon

Psychologist Theodore Millon, who has written many popular works on personality, proposes a description of the following personality disorders:

Additional factors

In addition to grouping by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution.

Severity

This involves both the idea of ​​personality difficulties as a subthreshold score measure for personality disorders using standard interviews and evidence that those with the most severe personality disorder exhibit a "ripple effect" of personality disorders across a range of mental disorders. In addition to subthreshold (personality difficulties) and a single cluster (simple personality disorder), it also originates complex or diffuse personality disorder (two or more present personality disorder clusters) and can also acquire severe personality disorders for those at greatest risk.

There are several advantages to classifying personality disorders based on severity:

• This not only allows but also takes advantage of the tendency of personality disorder to become comorbid to each other.
• It represents the effect of personality disorder on a more satisfactory clinical outcome than a simple dichotomous system with no personality disorder versus personality disorder.
• This system accommodates a new diagnosis of severe personality disorder, especially "serious and severe personality disorder" (DSPD).

Effects on social function

Social function is influenced by many other aspects of mental functioning apart from personality. However, when there is continuous social dysfunction in conditions that are not normally expected, evidence suggests that this is more likely to be created by personality disorders than by other clinical variables. Personality Assessment Schedules give priority to social functions in creating a hierarchy in which personality disorders create greater social dysfunction given primacy over others in subsequent descriptions of personality disorders.

Attribution

Many people who have a personality disorder do not recognize any abnormalities and defend with the dashing role of their ongoing personality. This group has been called Type R, or personality disorder that rejects treatment, compared to Type S or who is seeking treatment, who are interested in changing their personality disorder and sometimes demand treatment. The classification of 68 irregular patient personalities on the caseload of an assertive community team using a simple scale shows a ratio of 3 to 1 between Type R and Type S personality disorder with Cluster C personality disorder significantly more likely to be Type S, and paranoid and schizoid personality disorder ( Cluster A) are significantly more likely to be Type R than others.

Maps Personality disorder

Disorder

It is generally assumed that all personality disorders are related to impaired function and deterioration of quality of life (QoL) because it is a basic diagnostic requirement. But research shows that this may be true only for certain types of personality disorders.

In some studies, higher disability and poor quality of life are predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorders. This relationship is particularly strong for PD avoidant, schizotypal and borderline. However, obsessive-compulsive PD is not associated with QoL or impaired dysfunction. A prospective study reported that all PD was associated with a significant decrease 15 years later, except for obsessive compulsive and narcissistic personality disorder.

One study investigated some aspects of "success in life" (successful status, wealth, and intimate relationships). It shows rather bad functionality for skizotypal, antisocial, boundary and PD dependent, skizoid PD has the lowest score regarding these variables. Paranoid, hysterical and PD avoidance are average. However, narcissistic and obsessive-compulsive PD has a high function and seems to contribute positively to these aspects of life's success.

There is also a direct relationship between the number of diagnostic criteria and quality of life. For any additional personality disorder criteria that a person encounters there is a decline in the quality of life.

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Problem

In the workplace

Depending on the diagnosis, severity and individuality, and the work itself, personality disorder can be attributed to difficulty coping with work or workplace - potentially causing problems with others by disrupting interpersonal relationships. Indirect effects also play a role; for example, impairment of educational advancement or off-the-job complications, such as substance abuse and shared mental disorders, can disrupt the sufferer. However, personality disorder can also bring above-average work skills by increasing competitive impetus or causing sufferers to exploit their coworkers.

In 2005 and again in 2009, Belinda Board and Katarina Fritzon psychologists at the University of Surrey, England, interviewed and gave personality tests to high-level British executives and compared their profiles with criminal psychiatric patients at Broadmoor Hospital in England. They found that three of the eleven personality disorders were actually more common in executives than in disturbed villains:

• Histrionic personality disorder: including superficial charm, insincerity, egocentrism and manipulation
• Narcissistic personality disorder: including grandiosity, lack of focus on empathy for others, exploitation and independence.
• Obsessive-compulsive personality disorder: including perfectionism, excessive devotion to work, stiffness, stubbornness and dictatorial tendencies.

According to academic leader Manfred F.R. Kets de Vries, it seems almost inevitable that some personality disorder will be present in the senior management team.

In children

The early stages and initial forms of personality disorder require a multi-dimensional and early treatment approach. Personality developmental disorders are considered as risk factors for childhood or early stages of personality disorder later in adulthood. Additionally, in a Robert F. Krueger review of their study showed that some children and adolescents suffer significant clinical syndromes that mimic adult personality disorder, and that this syndrome has a meaningful and consequential correlation. Much of this research has been framed by an adult personality disorder built from Axis II from the Diagnostic and Statistical Manual. Therefore, they are less likely to face the first risk they described early in their review: doctors and researchers not only avoided the use of PD constructs in youth. However, they may face the second risk they describe: lack of appreciation of the developmental context in which these syndromes occur. That is, although the PD construct shows continuity over time, they are probabilistic predictors; not all teenagers who show symptoms of PD become an adult PD case.

Versus mental breakdown

Interference in each of the three groups can share with each other the underlying common vulnerability factors that involve cognition, influence and impulse control, and the maintenance or inhibition of behavior, respectively. But they may also have spectral connections for mental disorders of certain syndromes:

• Paranoid, schizoid or schizotypal personality disorder may be observed as a premorbid antecedent of delusional or schizophrenic disorders.
• Borderline personality disorder appears to be related to mood and anxiety disorders, with impulse control disorders, eating disorders, ADHD, or substance use disorders. Sometimes seen as a mild form of bipolar disorder.
• Avoidance personality disorder is seen with social anxiety disorders.

Versus normal personality

The problem of the relationship between normal personality and personality disorder is one of the important issues in clinical personality and psychology. The classification of personality disorder (DSM-5 and ICD-10) follows a categorical approach that views personality disorders as discrete entities different from each other and from normal personality. In contrast, the dimensional approach is an alternative approach that personality disorder is a maladaptive extension of the same traits that describe normal personality.

Thomas Widiger and his collaborators have contributed significantly to this debate. He discussed the obstacles of the categorical approach and argued for a dimensional approach to personality disorder. In particular, he proposed the Five Personality Factor Model as an alternative to the classification of personality disorders. For example, this view establishes that Borderline Personality Disorder can be understood as a combination of emotional lability (ie, high neuroticism), impulsivity (ie, low awareness), and hostility (ie, low hospitality). Many cross-cultural studies have explored the relationship between personality disorder and the Five Factor Model. This study has shown that personality disorder is largely correlated in the expected way with the size of the Five Factor Model and has set the stage for incorporating the Five Factor Model in DSM-5.

In clinical practice, individuals are generally diagnosed with interviews with a psychiatrist based on mental status checks, which can account for observations of accounts by relatives and others. One tool for diagnosing personality disorders is a process involving interviews with a scoring system. Patients are asked to answer questions, and depending on their answers, trained interviewers try to code what their responses are. This process is quite time consuming.

Abbreviations used: PPD - Personality Disorder Paranoid, SzPD - Personality Disorder Schizoid, StPD - Personality Disorder Schizotypal, ASPD - Antisocial Personality Disorder, BPD - Personality Disorder Borderline, HPD - Histrionic Personality Disorder, NPD - Narcissistic Personality Disorder, AvPD - Personality Disorder Dodge, DPD - Dependent Personality Disorder, OCPD - Obsessive-Compulsive Personality Disorder, PAPD - Passive-Aggressive Personality Disorder, DpPD - Personality Disorder Depression, SDPD - Personality Disorder Causing Yourself, SaPD - Sadness Personality Disorder, and n/a - not available.

In 2002, there were over fifty published studies related to five factor models (FFM) for personality disorders. Since then, considerable additional research has broadened this research base and provided further empirical support to understand DSM personality disorder in terms of FFM domains. In his seminal review of the personality disorder literature published in 2007, Lee Anna Clark asserts that "the five-factor personality model is widely accepted as representing the high-order structure of both normal and abnormal personality traits".

The five-factor model has been shown to significantly predict all 10 symptoms of personality disorder and outperform the Minnesota Multiphasic Personality Inventory (MMPI) in the prediction of borderline, avoidant, and dependent personality personality symptoms.

The results examined the relationship between FFM and each of the ten diagnostic categories of DSM personality disorder are widely available. For example, in a 2003 study published entitled "The five-factor model and personality disorder empirical literature: A meta-analytic review", the authors analyzed data from 15 other studies to determine how different and similar personality disorders, respectively, with regard to the underlying personality. In terms of how personality disorders differ, the results show that each disorder displays a meaningful and predictable FFM profile given its unique diagnostic criteria. With regard to their similarities, the findings reveal that the most prominent and consistent personality dimension underlying a large number of personality disorders is a positive association with neuroticism and negative associations with friendliness.

Openness to experience

At least three aspects of openness to relevant experience to understand personality disorders: cognitive distortion, lack of insight and impulsivity. Issues related to high openness that can lead to problems with social or professional functioning are over fantasizing, strange thinking, pervasive identity, unstable goals and inconsistencies with the demands of society.

High disclosure is characteristic of schizotypal personality disorder (strange and fragmented thinking), narcissistic personality disorder (self-assessment of excess) and paranoid personality disorder (sensitivity to external hostility). Lack of insight (indicating low disclosure) is a characteristic for all personality disorders and may explain the persistence of maladaptive behavior patterns.

Issues related to low openness are difficulty adapting to change, low tolerance for different worldviews or lifestyles, emotional alignment, alexithymia and a narrow range of interest. Rigidity is the most obvious aspect of openness (low) among personality disorders and it indicates a lack of knowledge about one's emotional experiences. This is a characteristic of obsessive-compulsive personality disorder; the opposite is known as impulsivity (here: an aspect of openness that shows a tendency to behave remarkably or autis) is characteristic of schizotypal and borderline personality disorder.

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Causes and risk factors

At present, there is no definite cause for personality disorders. However, there are many possible causes and known risk factors supported by scientific research that vary depending on the disorder, the individual, and the circumstances. Overall, the findings suggest that genetic dispositions and life experiences, such as trauma and abuse, play a key role in the development of personality disorders.

Child abuse

Child abuse and neglect consistently appear as a risk factor for the development of personality disorders in adulthood. A study observed retrospective reports of abuse of participants who had demonstrated psychopathology throughout their lives and were subsequently found to have past experience with abuse. In a study of 793 mothers and children, the researchers asked mothers whether they had yelled at their children, and told them they did not love them or threatened to expel them. Children who have experienced such verbal abuse are three times more likely than other children (who have not experienced such verbal abuse) have borderline, narcissistic, obsessive-compulsive or paranoid personality disorder in adulthood. Sexually abused groups show the most consistent pattern of psychopathology. Offially verified physical infringement shows a very strong correlation with the development of antisocial and impulsive behaviors. On the other hand, cases of abuse of negligent types that create childhood pathology are found to be the subject of partial remission in adulthood.

Socioeconomic status

Socioeconomic status is also considered a potential cause of personality disorder. There is a strong relationship with the low socioeconomic status of parents/neighbors and symptoms of personality disorder. In a recent study comparing the socioeconomic status of parents and childhood personality, it appears that children from higher socioeconomic backgrounds are more altruistic, less risk-seeking, and have higher IQs overall. These traits correlate with the low risk of developing personality disorder later in life. In a study looking at girls held for disciplinary action found that psychological problems were most negatively related to socioeconomic issues. In addition, social disorganization is found to be inversely correlated with symptoms of personality disorder.

Parenting

Evidence showing personality disorder can begin with a parenting personality problem. This causes parents to experience their own difficulties in adulthood, such as the difficulty of achieving higher education, getting a job, and securing a reliable relationship. With genetic or modeling mechanisms, children can take on these characteristics. In addition, poor parenting seems to have symptoms of an increased effect on personality disorders. More specifically, the lack of maternal bonding has also been correlated with personality disorders. In a study comparing 100 healthy individuals with 100 personality impairment thresholds, the analysis showed that BPD patients were significantly more likely to not get breastmilk (42.4% in BPD vs 9.2% in healthy controls). The researchers suggest this action may be important in fostering maternal relationships. In addition, the findings indicate a personality disorder showing a negative correlation with two attachment variables: maternal availability and dependence. When left unchecked, other attachments and interpersonal problems occur later in life leading to the development of personality disorders.

Genetics

Currently, genetic research to understand the development of personality disorder is lacking. However, there are several risk factors that may be currently found. Researchers are looking for genetic mechanisms for traits such as aggression, fear and anxiety, associated with the individual being diagnosed. Further research is being conducted into the specific mechanism of the disorder.

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Epidemiology

The prevalence of personality disorders in the general population was largely unknown until the survey began in the 1990s. In 2008 the average rate of diagnosed PD was estimated at 10.6%, based on six large studies in three countries. This figure is about one in ten, mainly due to high service use, described as a major public health issue that requires attention by researchers and doctors.

The prevalence of individual personality disorders ranges from about 2% to 3% for more general varieties, such as schizotypal, antisocial, limits, and histrionic, up to 0.5-1% for the most common, such as narcissistic and avoidance.

A screening survey in 13 countries by the World Health Organization using the DSM-IV criterion, reported in 2009, estimates a prevalence of about 6% for personality disorders. Levels sometimes vary with demographic and socioeconomic factors, and functional impairments are partially explained by co-occurring mental disorders. In the US, data filtering from Replication of National Assistance Surveys between 2001 and 2003, combined with interviews from a subset of respondents, shows a population prevalence of about 9% for total personality disorder. Functional disabilities related to diagnosis appear to be largely due to a coexisting mental disorder (Axis I in DSM).

A national epidemiological study of the UK (based on the DSM-IV screening criteria), reclassified to severity rather than just diagnosis, was reported in 2010 that most people exhibit some personality difficulties in one way or another (less than the threshold for diagnosis), while prevalence the most complex and heavy cases (including meeting criteria for multiple diagnoses in various groups) are estimated at 1.3%. Even low levels of personality symptoms are associated with functional problems, but those most in need of service are a much smaller group.

Personality disorders (especially Cluster A) are also very common among homeless people.

There are several sex differences in the frequency of personality disorders shown in the table below.

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Comorbidity

There is a considerable co-occurrence of diagnostic personality disorder. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder tend to meet diagnostic criteria for others. The diagnostic category provides a clear and clear description of the discrete personality type but the actual patient personality structure may be more accurately described by the constellation of maladaptive personality traits.

The site uses a set of DSM-III-R criteria. Data obtained for the purpose of informing the development of the DSM-IV-TR personality diagnostic criteria.

Abbreviations used: PPD - Personality Disorder Paranoid, SzPD - Personality Disorder Schizoid, StPD - Personality Disorder Schizotypal, ASPD - Antisocial Personality Disorder, BPD - Personality Disorder Borderline, HPD - Histrionic Personality Disorder, NPD - Narcissistic Personality Disorder, AvPD - Personality Disorder Dies, DPD - Dependent Personality Disorder, OCPD - Obsessive-Compulsive Personality Disorder, PAPD - Passive-Aggressive Personality Disorder.

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Management

Special approach

There are various forms (modalities) of care used for personality disorders:

• Individual psychotherapy has become a mainstay of care. There is a long-term and short-term form (short).
• Family therapy, including couples therapy.
• Group therapy for personality dysfunction is probably the second most widely used.
• Psychological education can be used in addition.
• Self help groups can provide resources for personality disorders.
• Psychiatric drugs to treat symptoms of personality dysfunction or concomitant conditions.
• Milieu's therapy, a kind of group-based housing approach, has a history of use in treating personality disorders, including therapeutic communities.
• Attention practices that include developing the ability to non-judge unpleasant emotions seem to be a promising clinical tool for managing different types of personality disorders.

There are different theories or schools that are different in many of these modalities. They may, for example, emphasize psychodynamic techniques, or cognitive or behavioral techniques. In clinical practice, many therapists use the 'eclectic' approach, taking elements from different schools and when they seem to be suitable for individual clients. There are also frequent focuses on common themes that seem to be useful without techniques, including therapist attributes (eg trust, competence, concern), processes given to clients (eg the ability to express and vent difficulties and emotions), and matches between them (eg aiming for mutual respect, trust, and limitation).

Challenges

The management and treatment of personality disorder can be a challenging and controversial field, as with the definition of adversity has taken place and affecting various fields of functioning. This often involves interpersonal problems, and there can be difficulties in finding and getting help from the organization in the first place, as well as by establishing and maintaining certain therapeutic relationships. On the one hand, an individual may not consider himself to have mental health problems, while on the other hand, a community mental health service can see individuals with personality disorder as too complex or difficult, and can directly or indirectly exclude individuals with diagnosis or related behaviors. Distractions that can make people with personality disorders in the organization make this, arguably, the most challenging conditions to manage.

Apart from all these problems, an individual may not consider their personality irregular or the cause of the problem. This perspective may be due to patient ignorance or lack of insight into their own conditions, the ego-syntonic perception of a problem with their personality that prevents them from experiencing it as contrary to their goals and self-image, or by the simple fact that there are no clear or objective limits between 'normal' and 'abnormal' personality. Unfortunately, there is significant social stigma and discrimination associated with the diagnosis.

The term 'personality disorder' encompasses various problems, each with a different degree of severity or disability; thus, personality disorder may require fundamentally different approaches and understandings. To illustrate the scope of this issue, consider that while some disturbances or individuals are characterized by persistent social withdrawal and ostracization, others may cause fluctuations in forwardness. The extreme is still worse: at one extreme lying self-defeating and self-neglecting, while at the other extreme some individuals may commit violence and crime. There may be other factors such as the use of substances that are problematic or addictive or behavioral addictions. A person can meet the criteria for the diagnosis of multiple personality disorders and/or other mental disorders, either at a certain time or continuously, thus making coordinated input from various services a potential need.

Therapists in this field may become disillusioned due to a lack of early progress, or by the apparent advances that then cause deterioration. Clients can be considered negative, resistant, demanding, aggressive or manipulative. This has been seen in terms of therapists and clients; in terms of social skills, countermeasures, defense mechanisms, or deliberate strategies; and in terms of moral judgment or the need to consider the underlying motivations for certain behaviors or conflicts. The client's vulnerability, and indeed the therapist, may be lost behind real or real strength and endurance. It is generally stated that there is always a need to maintain proper professional personal boundaries, while allowing for emotional expression and therapeutic relationships. However, there can be difficulties recognizing the world and the different views that clients and therapists can live. A therapist can assume that the kind of relationships and ways of interacting that make them feel safe and comfortable have the same effect on the client. For example from one extreme, people who may have been exposed to hostility, trickery, rejection, aggression or abuse in their lives may, in some cases be confused, intimidated or suspected by a presentation of warmth, intimacy or a positive attitude. On the other hand, assurance, openness and clear communication are usually helpful and necessary. It takes several months of sessions, and maybe a few stops and starts, to start developing a trusting relationship that can solve client problems.

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History

Before the 20th century

Personality disorder is a term with a distinctly modern meaning, in part because of the clinical use and modern institutional psychiatric character. Current accepted meanings must be understood in the context of the historical change of classification systems such as the DSM-IV and its predecessors. Although very anachronistic, and ignoring the radical differences in the character of subjectivity and social relations, some have suggested similarities with other concepts back to at least the ancient Greeks. For example, the Greek philosopher Theophrastus describes the 29 types of 'characters' he sees as deviations from the norm, and similar views have been found in Asian, Arabic, and Celtic cultures. The old influence in the Western world was the concept of Galen's personality type, which he attributed to the four humors proposed by Hippocrates.

Such a view lasted until the 18th century, when experiments began to question humor and "temperament" that should have been biological. The concept of character psychology and 'self' becomes widespread. In the nineteenth century, 'personality' refers to the awareness of one's consciousness about their behavior, a disorder that can be attributed to changing circumstances such as dissociation. The meaning of this term has been compared with the use of the term 'dual personality disorder' in the first version of DSM.

Doctors in the early nineteenth century began to diagnose forms of madness involving emotional and behavioral disorders, but apparently without significant intellectual or delusions or hallucinations. Philippe Pinel calls this 'manie sans dÃÆ' â € <â €

German psychiatrist Koch attempted to make the concept of moral madness more scientific, and in 1891 suggested the phrase 'psychopathic inferiority', theorized as a congenital disorder. This refers to patterns of continuous and rigid error or dysfunction in the absence of clear mental retardation or illness, which should be without moral consideration. Described as deeply rooted in his Christian faith, his work has been described as the basic text on personality disorders that are still in use today.

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At the beginning of the 20th century, another German psychiatrist, Emil Kraepelin, included a chapter on the inferiority of psychopaths in his work that influenced clinical psychiatry for students and doctors. He suggests six types - excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories are essentially defined by the most irregular criminal actors observed, distinguished between criminals by impulses, professional criminals, and morbid vagrants who wander throughout life. Kraepelin also describes three paranoid disorders (meaning delusional), resembling the concept of schizophrenia, delusional disorder, and paranoid personality disorder. The diagnostic term for the latter concept will be included in the DSM from 1952, and from 1980 DSM will also include schizoid, schizotypal; previous interpretations (1921) Ernst Kretschmer's theory led to differences between these and other types then included in the DSM, avoidant personality disorder.

In 1933 Russian psychiatrist Pyotr Borisovich Gannushkin published his book Psychopathic manifestations: statics, dynamics, systematic aspects, which was one of the first attempts to develop a detailed psychology typology. Regarding maladaptation, ubiquity, and stability as the three main symptoms of behavioral pathology, it distinguishes nine groups of psychopaths: cycloids (including constitutional depressive, constitutional excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers) paranoiac (including fanatics), epileptoids, hysterical personality (including pathological lies), unstable psychopaths, antisocial psychopaths, and foolish constitutionally. Some of Gannushkin's typology elements are then incorporated into the theory developed by Russian youth psychiatrist Andrey Yevgenyevich Lichko, who is also interested in psychopaths along with its lighter form, which is referred to as character accentuation.

In 1939, psychiatrist David Henderson published the theory of 'psychopathic states' that contributed to connecting the term with anti-social behavior. The 1941 text Hervey M. Cleckley, Mask of Sanity, based on his personal categorization of the similarities he recorded in some prisoners, marked the beginning of modern clinical conceptions of psychopathy and their popular use.

By the middle of the 20th century, psychoanalytic theory came to the surface based on the work of the turn of the century popularized by Sigmund Freud and others. This includes the concept of character disorder, which is considered a long-standing problem related not to specific symptoms but to pervasive internal conflicts or derailing normal childhood development. This is often understood as a deliberate weakness of character or deviation, and is distinguished from neurosis or psychosis. The term 'boundary' comes from the beliefs of some individuals who function on the edge of two categories, and a number of other categories of personality disorders are also strongly influenced by this approach, including dependent, obsessive-compulsive and histrionic, the latter beginning. off as a symptom of hysteria conversion primarily associated with women, hysterical personality, later renamed histrionic personality disorder in the DSM version. Passive aggressive style was defined clinically by Colonel William Menninger during World War II in the context of male reactions to military compliance, which would then be referred to as a personality disorder in DSM. Otto Kernberg influenced the concept of borderline and narcissistic personality then was incorporated in 1980 as a nuisance into the DSM.

Meanwhile, a more general psychology of personality has grown in academia and to a certain extent clinically. Gordon Allport published personality theories from the 1920s - and Henry Murray advanced the theory called personology , which influenced the proponents of later personality disorder, Theodore Millon. Tests developed or are being applied for personality evaluation, including projective tests such as Rorshach, as well as questionnaires such as the Minnesota Multiphasic Personality Inventory. Around the middle of the century, Hans Eysenck analyzed personality traits and types, and psychiatrist Kurt Schneider popularized clinical use as a substitute for the more common 'character', 'temperament' or 'constitution'.

American psychiatrists officially recognized the concept of long-lasting personality disorder in the Mental Disorders Diagnostic and Statistics of the 1950s, which relies heavily on psychoanalytic concepts. A more neutral language was used in DSM-II in 1968, although the terms and descriptions have little resemblance to the current definition. The DSM-III published in 1980 made some major changes, especially putting all the personality disorders into a separate second 'axis' along with mental retardation, intended to signify a more enduring pattern, different from what is considered the axis of a mental disorder. The 'inadequate' and 'asthenic' categories of 'personality' are removed, and others expand into more types, or change from personality disorders to ordinary annoyances. The sociopathic personality disorder, which has become a term for psychopathy, was changed to Antisocial Personality Disorder. Most categories are given a more specific 'operationalized' definition, with standard psychiatric criteria being able to agree to research and diagnose patients. In the revised DSM-III, self-defeating personality disorder and sadistic personality disorder are included as a temporary diagnosis requiring further investigation. They were dropped in DSM-IV, even though the proposed 'depressive personality disorder' was added; In addition, the official diagnosis of passive-aggressive personality disorder was dropped, while replaced 'negativistic personality disorder'.

International differences have been noted in how attitudes have evolved toward the diagnosis of personality disorders. Kurt Schneider argues that they are 'types of abnormal psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists are also reluctant to cope with such disorders or consider them to be equivalent to other mental disorders, partly due to resource pressures in the National Health Service, as well as negative medical attitudes toward behaviors associated with personality disorders. In the US, prevailing health systems and psychoanalytic traditions have been said to provide a reason for personal therapists to diagnose some personality disorders more broadly and provide ongoing care for them.

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References

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Further reading

• Marshall, W. & amp; Serin, R. (1997) Personality Disorder. In SM.M. Turner & amp; R. Hersen (Eds.) Adult Psychopathology and Diagnosis. New York: Wiley. 508-41
• Murphy, N. & amp; McVey, D. (2010) Treating Severe Personality Disorders: Creating Strong Services for Clients with Complex Mental Health Needs. London: Routledge
• Millon, Theodore (and Roger D. Davis, contributor) - Personality Disorder: DSM IV and Beyond - 2nd ed. - New York, John Wiley and Sons, 1995 ISBNÃ, 0-471-01186-X
• Yudofsky, Stuart C. (2005). Fatal Flaws: Navigate Damaging Relationships With People With Personality Disorders and Characters (1st ed.). Washington DC. ISBNÃ, 1-58562-214-1. Ã,

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External links

• Personality Disorder Foundation
• Fact sheet personality disorder National Mental Health Association
• Personality information leaflet information from The Royal College of Psychiatrists

Source of the article : Wikipedia