Personality part 2: Personality disorders, risk factors and treatment.

While our last post discussed developmental factors that play a role in healthy personality development, this article discusses the disorders of personality, which are personalities that due to how they are formed, may lead to various interpersonal and emotional difficulties. Afterward is a brief overview of risk factors for personality disorders in childhood and adolescence. At the end of the article, a brief discussion of various treatments will be discussed.

 

What Are Personality Disorders

Personality Disorders, according to the American Psychiatric  Association, are conditions where “one's way of thinking, feeling and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” In other words, the personalities that one develops leads to potentially maladaptive or harmful ways of thinking, feeling, and behaving.

There are ten unique personality disorders that are often grouped into three ‘clusters.’ The first cluster, or Cluster A disorders describe personalities that engage in eccentric or unusual behaviors and who have difficulty connecting to others, including:

• Paranoid Personality Disorder: A disorder marked by difficulty trusting others, and enduring beliefs that others may be trying to hurt, trick, or betray you.
• Schizoid Personality Disorder: A disorder marked by a perceived lack of desire for intimacy, and an inability to form close or personal relationships.
• Schizotypal Personality Disorder: A disorder marked by discomfort with close relationships, distortions of reality, and a tendency to engage in superstitious or conspiracy-minded thinking.

Cluster B disorders describe personalities that center around dramatic, emotional, and impulsive behaviors. These disorders include:

• Antisocial Personality Disorder: A disorder characterized by a lack of concern for others or their rights, an impulsive and reckless approach to the world, and a disregard for the law or social norms.
• Borderline Personality Disorder: A disorder marked by an unstable sense of self and feelings of emptiness. It is also characterized by fraught interpersonal relationships, emotional lability (moving between extremes of emotions), and behavioral difficulties, and can occasionally lead to stress-induced paranoia or dissociative symptoms.
• Histrionic Personality Disorder: A disorder that is marked by a strong desire for attention, dramatic behavioral and emotional displays, and a ‘loose’ emotional interpretation of the world that leads to frequently changing opinions and memories.
• Narcissistic Personality Disorder: A disorder marked by a need for admiration from others, a feeling of being ‘special’ or ‘better than,’ and an impaired ability to empathize with others.

The last group, Cluster C disorders, are personality styles that are marked by fear, avoidance, and anxiety. These disorders include:

• Avoidant Personality Disorder: A disorder marked by a strong fear of criticism and rejection, social isolation, and low self-esteem.
• Dependent Personality Disorder: A disorder characterized by a feeling of incompetence or low self-worth, and a strong need to be taken care of by others
• Obsessive Compulsive Personality Disorder (OCPD): A disorder marked by strong rigidity and a need for control. Individuals with OCPD may also be perfectionistic and inflexible in what they think is best or right. Please note this is not the same as Obsessive-Compulsive Disorder (OCD). OCD is a disorder marked by having intrusive and repetitive thoughts (Obsessions) and feeling compelled to engage in rigid and repetitive behaviors (Compulsions).

Risk Factors and Warning Signs:

As personalities are often not considered to be ‘set’ in childhood, it is quite rare for personality disorders to be diagnosed for children and early adolescents. Most medical and psychological providers agree that in order to be diagnosed with the disorder, the person should be an older adolescent or young adult. However, as personality formation is mostly developed in childhood, this is the time caregivers and educators often may observe early warning signs and risk factors that might indicate a potential future personality disorder. Some risk factors and early warning signs are below:

Social risk factors and warning signs include:

• Exposure to adverse childhood events, such as trauma, neglect, or abuse.
• Histories of family separation or disrupted attachment to caregivers throughout childhood
• Growing up in an unstable family or social environment
• Experiencing chronic bullying, isolation, or rejection in school settings
• Not obtaining support or getting needs met from caregivers or providers.

Biological risk factors and warning signs include:

• Infant temperaments that reflect high levels of emotional expression and proneness to negative feelings.
• Exposure to lead in infancy or childhood.
• Having a family history of mental illness

Psychological risk factors and early warning signs:

• Development of an anxious or disorganized attachment style (See last blog post for more details)
• Tendency to have unusual experiences that deviate from the person’s culture, such as having out-of-body experiences, hearing voices, or experiencing supernatural or paranormal events.
• Possessing little empathy towards other people or animals.
• Tendency to engage in impulsive or dramatic behavior, including getting in fights, breaking laws, or rules, or engaging in self-harm
• Impaired ability to keep or maintain friends.

How to Seek Help

            For children and adolescents, the best form of treatment is prevention and early intervention. As personalities are much more flexible and changeable during this time, intervening early can give children and adolescents significantly better life prospects, and in some cases, might prevent the onset of a fully blown personality disorder by helping the child’s personality development back on track. Psychotherapy is a particularly helpful tool to help your child or adolescent who may be displaying some of these early warning signs or who may have been exposed to possible risk factors. Several therapies in particular have been developed to specifically address the symptoms and difficulties related to personality disorder. Below are just some of the possible therapies that may be helpful for children, adolescents, and families that are concerned about Personality Disorders:

Dialectical Behavior Therapy (DBT): DBT is a psychotherapy that is effective in treating both adults and adolescents with personality disorders. DBT centers around the teaching and practicing of four main skills: Mindfulness, Interpersonal Efficacy, Emotion Regulation, and Distress Tolerance in order to better manage symptoms related to personality disorders.

Mentalization-Based Therapy (MBT): MBT is a psychotherapy that focuses on helping clients understand how their own thoughts and feelings affect their own behavior, as well as the thoughts, feelings, and behaviors of others. Learning how to think about thinking and feeling (also called mentalizing) can help people make more effective decisions and behaviors.

Family Therapy: Family therapy can be effective in treating personality disorders by helping families create supportive systems for each other. In family therapy, families learn how to help their child or adolescent cope with their strong emotions and develop effective interpersonal skills.

            In addition to therapy, it may be important to consult with psychiatric and medical professionals when necessary.