Personality disorders are quite common, and sufferers experience difficulties managing their feelings and their relationships with family, friends, and others in their surroundings.

EVERYONE encounters different personality types in daily life. Some people are outgoing and easy to relate to, while others are reticent and difficult to relate to. However, some people behave in a manner different from the majority, even to the extent of being odd.

Personality disorders are common mental health conditions, the sufferers of which have difficulties in managing their feelings and their relationships with family, friends and others in their surroundings. This may result in odd behaviour, which is distressing and upsetting to others.

People with personality disorders often have other mental health conditions, particularly substance abuse or misuse, and depression.

People with type A personality disorders consider other people as strangers. Their behaviour would be considered by most people as abnormal and weird. They may appear to be living in a world of their own. – AFP

Personality disorders are due to a combination of genetic causes and unpleasant or distressing experiences during childhood, eg abuse, neglect. They usually begin in adolescence and continue into adult life. They may be mild, moderate or severe. There may be periods when the sufferers can function as well as normal people.

The incidence of personality disorders is not well known. It is estimated that in developed countries, about one in 20 people have a personality disorder.

Different types

There are different types of personality disorders and they are grouped into one of three categories: types A, B or C.

People with type A personality disorders consider other people as strangers. Their behaviour would be considered by most people as abnormal and weird. They may appear to be living in a world of their own.

People with type B personality disorders have problems controlling their feelings. Their views of other people swing from positive to negative and vice versa, leading to behaviour that others would view as unpredictable and dramatic.

People with type C personality disorders have constant and overpowering anxiety and fear. They are withdrawn and are viewed by others as antisocial.

Many people with personality disorders have a mild condition, which they are able to cope with most of the time. Such people only require assistance when they encounter stress situations, eg loss of a job, family member or friend.

Those with moderate or severe personality disorders require medical assistance, and for a longer time too. Fortunately, severe disorders are uncommon.

The incidence of the different types of personality disorders in Malaysia is not known. Data from developed countries report that obsessive personality disorder is most common and affects 2% of the population surveyed randomly, and antisocial personality disorder is less common, affecting less than 1% of the population. Other personality disorders found were schizoid, avoidant, paranoid and borderline personality disorders.

Signs and symptoms

People with type A personality disorders include:

● Paranoid personality disorder, in which the sufferer is extremely suspicious and distrustful. The features include feelings that family, friends and associates cannot be trusted, unwarranted worries about the faithfulness of the spouse, often thinking that innocent comments made by others have other meanings, and thinking that others are telling lies and being manipulative.

● Schizoid personality disorder, in which the sufferer is detached and avoids social contact. The features include preference for activities that do not require interaction with others.

● Schizotypal personality disorder, in which the sufferer has poor social skills, delusions and abnormal behaviour. The features include undue attachment and significance to daily events like media reports, belief in supernatural powers and an unusual manner of speaking.

People with type B personality disorders have major problems controlling their feelings. Their views of other people swing from positive to negative, leading to behaviour that others would view as unpredictable and dramatic. They include:

● Antisocial personality disorder, in which the sufferer perceives others as vulnerable and may enjoy threatening or bullying them without concern about the consequences. The features include lack of trust or remorse, dishonesty, lying, agitation and depression, and manipulation and exploitation of others.

● Borderline personality disorder, in which the sufferer is emotionally unstable, with tendencies to self harm. Their relationships with others can be very strong but unstable.

● Histrionic personality disorder, in which the sufferer has an overpowering urge to be noticed by others because of an anxiety about being ignored. The features include displays of excessive emotion, appearing insincere, self-centred, provocative, inappropriate flirting or sexually seductive conduct, and constantly seeking reassurance and approval from others. There may be co-existing features with borderline and narcissistic personality disorders.

● Narcissistic personality disorder, in which the sufferer alternates between thoughts of uniqueness and fears of worthlessness. They behave as if they are very important, with others looking up to them. The features include an exaggeration of the sufferer’s abilities and achievements, looking down and envying others, lack of empathy, and exploitation of others for personal gain.

People with type C personality disorders have constant and overpowering anxiety and fear. They are withdrawn and viewed by others as antisocial. They include:

● Avoidant personality disorder, in which the sufferer is very shy, socially inhibited and very sensitive to rejection. The person has the desire to form a close relationship with others, unlike those with schizoid personality disorder, but does not have the confidence and ability to do so.

● Dependent personality disorder, in which the sufferer feels there is an inability to be independent. The features include an overwhelming need for others to look after them, needing others to be responsible for decisions, difficulty in decision-making without guidance by others, feelings of helpless and discomfort when alone, and having an unrealistic and constant fear of being left alone to fend for themselves.

● Obsessive compulsive personality disorder, in which the sufferer is anxious about issues that appear to be out of control, and preoccupation with orderliness and control of their surroundings. Others may call such a person a “control freak”. The features include unusual focus on rules and time tables, rigid views about various issues, an inability to delegate tasks, and perfectionism.

There are important differences between obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD), a related mental health condition.

● OCD sufferers are aware of their abnormal behaviour and are anxious about it. Most OCPD sufferers think their behaviour is perfectly acceptable and have no wish to change it.

● Most OCD sufferers have a compulsion to carry out rituals. This is usually not the case with OCPD sufferers.

● OCD sufferers may have a compulsion to make lists or organise items, but are anxious about it. OCPD sufferers find relief from anxiety when doing such tasks, and may get irritated when prevented from doing so.

Management

Many of those with mild or moderate personality disorders seek medical attention. However, there are some of those with moderate or severe personality disorders who do not do so, either because they think they do not have a problem, or they are afraid of doctors or other healthcare professionals.

Most personality disorders are managed with psychotherapies, which involve discussions of the sufferer’s feelings, thoughts and emotions with a doctor or other healthcare professional. Some sufferers may require group therapy to address the problems of social relationships.

The objective of treatment is to improve the understanding and control of the sufferer’s thoughts and emotions.

The management of personality disorders have to be carried out by doctors and other healthcare professionals who have the required training and experience. The reason is that personality disorders have serious consequences, which include self harm.

The duration of treatment is between six months to a year depending on the severity of the condition and other concurrent problems.

There are three major categories of psychotherapies:

● Psychodynamic psychotherapy, based on evidence that many adult behavioural patterns are the consequence of early childhood experiences, which cause distorted thinking and beliefs. The objective of therapy is to delve into these distortions, understand their genesis and find effective ways to overcome their influence on thinking and behaviour. This therapeutic modality has been found useful in managing personality disorders, especially borderline personality disorder.

● Cognitive behavioural therapy (CBT) is based on the theory that our thinking affects our actions, which in turn affects our thinking and feeling. Any change would involve both thinking and behaviour. CBT has been found useful in reducing impulsive self-harming behaviour, especially in borderline personality disorder.

● Interpersonal therapy is based on the theory that our relationships with others have a significant impact on our mental health. This involves an exploration of the issues associated with interpersonal relationships and their resolution.

There is currently no medicine for personality disorders. However, there are medicines available for some of its symptoms, eg selective serotonin reuptake inhibitors (SSRIs) for depression. Some sufferers, particularly those with borderline personality disorder, have found mood-stabilising medicines useful.

The majority of people with personality disorders recover with different treatment modalities available. It is vital that the condition is managed by a trained doctor or other healthcare professional.

Source: Dr Milton Lum