A.

Nature of the Disorder

A personality disorder is a type of mental disorder in which you have a

rigid and unhealthy pattern of thinking, functioning and behaving. A person with

a personality disorder has trouble perceiving and relating to situations and people.

This causes significant problems and limitations in relationships, social activities,

work and school.

The term ‘personality’ derives from the Greek word persona or mask. It

refers both to an individual’s attitudes and ways of thinking, feeling and behaving,

and to the social ways in which individuals interact with their environment. At an

individual level, personality is not a single unitary entity, but a way to organise a

number of different capacities that underpin one’s sense of self (Allport 1961). At

a social level, an individual personality profile allows one to be recognised over

time by others, and is a powerful regulator of social relationships, which, as we

are group animals, are crucial for our survival. In evolutionary terms, personality

is best understood as a regulation of bio psychosocial factors in the service of

goodquality survival of the individual within the particular constraints of their

habitat and environment.

In Ancient Greece, physicians attributed individual differences in

personality to imbalances of bodily fluids or humors; other popular theories have

included the influence of the stars’ positions at birth, body build and skull shape

(Knutson 2004). In the 20th century, research into personality moved to the level

of the psychological, although still influenced by dominant social assumptions

such as gender or racial difference. Freud emphasised the role of innate drives, an

early account of what we might now understand as the genetic basis of stress

responses. He is also attributed as being the first to describe the concept of

‘defences’ against stress and their effect on the expression of adult personality.

Later theorists, such as Klein and Bowlby (in somewhat different ways),

emphasised the importance of the interaction between the child’s innate individual

features and the environment in the development of normal personality

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functioning. In the 1960s, Allport highlighted the role of ‘traits’ in the makeup of

personality, which he defined as the ‘dynamic organization of those

psychophysical systems that determine characteristics of behaviour and thought’

(Allport 1961: p. 28). Factor analysis enabled the description of personality in

terms of dimensions such as dominance and affiliation (Freedman 1951). Like

Allport, some theorists see the self as an organising principle of a number of

personality traits, some of which are inherited, and some of which develop in

relation to early social experience with others. Others see the self as the subjective

experience of personal identity (the ‘I’ of experience) and the personality as the

objective aspect (the ‘me’ that others experience). More recent concepts of

personality link it with related concepts such as the self and personal identity

(McAdams 1992).

Personality Disorders can be classified as basic, mild and severe, and it

can be identified through different clusters. Cluster A personality disorders are

characterized by odd, eccentric thinking or behavior. They include paranoid

personality disorder, schizoid personality disorder and schizotypal personality

disorder. Cluster B personality disorders are characterized by dramatic, overly

emotional or unpredictable thinking or behavior. They include antisocial

personality disorder, borderline personality disorder, histrionic personality

disorder and narcissistic personality disorder. Cluster C personality disorders are

characterized by anxious, fearful thinking or behavior. They include avoidant

personality disorder, dependent personality disorder and obsessive-compulsive

personality disorder.

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B. Etiology (cause of origin) of the Disorder

Research suggests that genetics, abuse and other factors contribute to the

development of obsessive-compulsive, narcissistic or other personality disorders.

Personality disorders usually begin in the teenage years or early adulthood. There

are many types of personality disorders. Some types may become less obvious

throughout middle age.

Personality is the combination of thoughts, emotions and behaviors that

makes you unique. It's the way you view, understand and relate to the outside

world, as well as how you see yourself. Personality forms during childhood,

shaped through an interaction of:

Your genes. Certain personality traits may be passed on to you by your

parents through inherited genes. These traits are sometimes called your

temperament. Your environment. This involves the surroundings you grew up in,

events that occurred, and relationships with family members and others.

Personality disorders are thought to be caused by a combination of these

genetic and environmental influences. Your genes may make you vulnerable to

developing a personality disorder, and a life situation may trigger the actual

development.

Risk factors. Although the precise cause of personality disorders is not

known, certain factors seem to increase the risk of developing or triggering

personality disorders, including:

 Family history of personality disorders or other mental illness

 Abusive, unstable or chaotic family life during childhood

 Being diagnosed with childhood conduct disorder

 Variations in brain chemistry and structure

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 Complications/Stress. Personality disorders can significantly disrupt the

lives of both the affected person and those who care about that person. Personality

disorders may cause problems with relationships, work or school, and can lead to

social isolation or alcohol or drug abuse.

Personality disorders are disorders that begin early in development and

last a lifetime, tend to be inflexible and pervasive across different domains of

functioning, lead to clinically significant distress or impairment, are not due to

another mental disorder or the direct physiological effects of a substance or

medical condition and deviate markedly from the expectation of the person’s

culture.

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C. Prevalence of the Disorder

Prevalence data are similar worldwide and recent figures from the World

Health Organization show no important or consistent differences across countries

(Huang 2009). In primary care, the prevalence of personality disorder is around

10–12%, and it consists mainly of patients with depressive and somatising

symptoms. However, the prevalence of personality disorder in general psychiatric

outpatients is 33%, rising to about 40% in eating disorder services and 60% in

substance misuse services (Herzog 1992; Sanderson 1994; Rounsaville 1998;

Moran 2000; Torgersen 2001). In forensic services and prisons, the prevalence of

personality disorder is 70%, and the principal subtypes are antisocial, borderline

and narcissistic (Singleton 1998). Prisoners’ problems include lack of empathy,

social hostility and contempt for weakness, as well as affect dysregulation. In

specialist forensic personality disorder treatment settings, virtually all patients

have comorbid psychiatric disorders such as substance misuse or depression, and

most fulfil criteria for several personality disorders (Duggan 2007). Prevalence

data can be misleading because of selection bias. Services for behavioural

conditions such as eating disorder, substance misuse or antisocial behaviour are

likely to be ‘selecting’ for comorbid personality disorders that manifest in the

particular behaviour. It is important for clinicians not to generalise about

personality disorders as a whole on the basis only of the group they see in their

service settings.

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D. Prevention and Intervention

These are signs/symptoms of personality disorder such as: Self-harming

and suicidal behaviours, substance and alcohol misuse and dependence, eating

disorders, unstable relationships and social isolation, persistent complaining and

vexatious litigation, deceptive behaviour, such as duping, conning and factitious

illnesses, attacks on attachment figures (partners, children, care staff, etc.),

persistent rule-breaking, violent attacks on others, clinging behaviours and

compulsive behaviours.

Medication is somewhat controversial in the treatment of personality

disorders. This is because it does not cure the disorder itself. However, it can be

vital in reducing symptoms such as anxiety, depression or psychosis so that

treatment can be more effective.

Early detection and intervention for personality disorders are now justified

and practical in adolescence and emerging adulthood, and novel early intervention

programmes have been developed and researched in Australia and The

Netherlands. Such programmes should be differentiated from conventional

personality disorders treatments programmes that are applied to individuals who

have established, complex and severe disorder but happen to be less than 18 years

old. Intervention for the personality disorder should now be considered part of

routine clinical practice in adolescent mental health.

According to the interviewees of this study, personality disorders can be

prevented through proper management of stress, through the help of significant

others such as doctors, nurses, teachers, guidance counsellor, friends and family

members. And also, positive attitude, meditation, self-reflection, self-actualization

and contentment can help people who are having these personality disorders.

Overall, personality disorders can be prevented, but if it becomes complicated

seek for professional advice.