Overview of personality disorders
Personality disorders form a mental illness in which the behavior, character traits and other characteristics of the personality structure deviate drastically from the norm. Those affected are caught in certain patterns of thought and behavior that they can hardly break through on their own. The disorders can manifest themselves in a variety of ways. The behavior of people suffering from a personality disorder is often perceived by others as strange, eccentric, paranoid, dramatic, narcissistic, moody, compulsive, or insecure. The most important things in brief:
- definition: A personality disorder is understood to mean a number of different mental illnesses in which those affected suffer from disorders in their experience and behavior.
- Clinical pictures: The clinical pictures include paranoid, schizoid, histrionic, narcissistic, emotionally unstable, dissocial, self-uncertain, dependent, and compulsive personality disorder.
- Symptoms: Certain personality traits are so pronounced that those affected constantly suffer from the effects of their behavior or are severely restricted in terms of quality of life and the achievement of their goals.
- causes: So far, the exact causes have not been sufficiently understood. Experts largely agree that a combination of genetic disposition and psychological stress caused by environmental factors such as early childhood events play a role.
- diagnosis: The diagnosis is in most cases made by a psychiatrist or psychotherapist based on predetermined criteria of the ICD-10 and the DSM classification.
- therapy: Psychotherapeutic procedures such as cognitive behavioral therapy, psychology-based psychotherapy and analytical psychotherapy are increasingly being used. Psychopharmaceuticals are occasionally used against severe symptoms.
The psychiatric clinical picture of personality disorders (PS) encompasses a wide range of mental illnesses that are associated with serious disorders of experience and behavior. A distinction must be made between pathological disorders in the personality structure and conspicuous characteristics of one's personal lifestyle, which may seem unusual to many, but do not impair the psychological well-being of those affected and do not place an undue burden on their social environment. These personality traits are not to be understood as a mental illness. The demarcation can be difficult here, however, because the transition between an unusual lifestyle and a disturbed personality is often fluid.
When does one speak of a personality disorder?
The starting point is often extremely distinctive personality traits, which can result in very inflexible, rigid or inappropriate behavior, for example. One speaks of a personality disorder if these traits take on an extent in which the affected person constantly over a long period due to the extreme behavior
- subjectively suffer,
- get into frequent conflict situations,
- lower your own quality of life,
- stand in the way of reaching their goals,
- Feel dissatisfaction.
A personality disorder arises independently
This type of disorder is not caused as a result of drugs or medication, and other illnesses, injuries and accidents do not trigger personality disorders. With this mental illness, the basic personality traits can be traced back to adolescence or young adulthood. These trains then develop until there is a malfunction.
In the "International Statistical Classification of Diseases and Related Health Problems" (ICD-10) of the World Health Organization (WHO), the term "specific personality disorder" is used for the symptoms shown below. In addition to ICD-10, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is often used for classification.
The individual forms of PS occur with varying frequency, with many forms such as the schizoid PS or the fearful (avoiding) PS affecting less than one percent of the population. However, other forms such as the Borderline PS or the compulsive PS are much more common. "Recent studies have shown that around ten percent of all people meet the criteria for a personality disorder," reports the Clinic for Psychiatry and Psychotherapy at Charité Universitätsmedizin Berlin. Accordingly, it can be assumed that a total of around eight million people in Germany suffer from personality disorders.
Depending on the type, a disturbed personality manifests itself through various psychological impairments and conspicuous behavior patterns. In general, it can be said that these are usually certain personality traits that occur in an extreme form and thus become a burden on the social stability of those affected, their personal well-being and their environment.
Certain characteristics can lead to certain faults
The Berlin Charité has provided a compilation in which the various characteristics of the personality style and their exaggerated variant are presented as a form of personality disorder. Accordingly, the exaggeration in the form of compulsive actions or compulsive behavior is assigned to a conscientious, careful lifestyle. Ambitious, confident behavior takes narcissistic traits in a personality disorder.
Expressive, emotional people become histrionic (theatrical, selfish). Watchful, suspicious people become paranoid and erratic, spontaneous people show a borderline personality. A clingy, loyal behavior is assigned the exaggerated form of a dependent personality, reserved, lonely people become schizoid in the case of a personality disorder, adventurers and risk-taking people dissocial.
List of personality disorders
According to this relatively simple scheme, different forms can be determined, each with special symptoms and then described in more detail. The classification is based on the "International statistical classification of diseases and related health problems". These name one as different forms of personality disorders (PS)
- paranoid PS,
- schizoid PS,
- dissocial PS,
- emotionally unstable PS (borderline),
- histrionic PS,
- anankastic (compulsive) PS,
- fearful (avoiding) PS,
- dependent (asthenic) horsepower,
- other specific personality disorders.
- Another variant, considered separately in the ICD-10, is the schizotypical or schizotypical personality disorders.
Paranoid personality disorder
Paranoid disorders manifest themselves in mistrustful behavior, which often culminates in conspiracy theories and is accompanied by a striking dispute. Even normal human actions are often perceived as hostile or contemptuous. In the relationship, a paranoid personality disorder often leads to massive, unfounded jealousy.
Close social environment is included
The distrust does not stop at family members and long-time friends. Their actions and loyalty are regularly questioned by paranoid people. In the long run, the paranoid personality disorder is therefore associated with considerable social and personal impairments.
Personality traits associated with paranoid PS
According to ICD-10, paranoid personality disorder has at least four of the following characteristics or behaviors:
- a hostile or contemptuous interpretation of neutral or friendly actions,
- excessive sensitivity to rejection,
- frequent, unjustified jealousy,
- Tendency to conspiracy theories,
- Quarrel and insisting on your own rights,
- a generally excessive self-centeredness (often in connection with arrogance),
- Inability to forgive injuries experienced subjectively.
Paranoid PS is not paranoid schizophrenia
The paranoid disorder must be differentiated from paranoid schizophrenia and delusion in the form of paranoia, both of which form independent mental illnesses according to ICD-10. People with a paranoid personality disorder often show other psychological disorders, in particular the schizotypical personality disorder, narcissism, the borderline disorder and the passive-aggressive personality disorder.
Schizoid personality disorder
Schizoid personality disorders are characterized by neglect of social contacts, a lack of emotional compassion and problems expressing one's own emotions. Those affected tend to withdraw and are often loners. A pronounced distrust of fellow human beings can also be part of the symptoms here.
Personality traits associated with schizoid PS
According to ICD-10, a schizoid disorder can be assumed if at least three of the following criteria are met. Affected
- show an emotional detachment,
- are unable to feel joy or only enjoy very few activities,
- can only express their feelings to a limited extent,
- are unresponsive to praise or criticism,
- prefer individual jobs,
- are introverted
- tend to fantasies,
- do not maintain close friendships or trustful relationships,
- show little interest in sexual experiences,
- are not very familiar with social norms and conventions, which can lead to conspicuous misconduct.
Despite the similarity in terms, schizotypic disorders and schizophrenia, which according to ICD-10 each form independent mental illnesses, must be clearly distinguished from schizoid personality disorders.
Dissocial personality disorder
An essential characteristic of dissociality is an egocentric, ruthless behavior towards fellow human beings, which is accompanied by a certain coldness and a lack of remorse. Social norms and obligations are regularly disregarded and those affected cannot stop their behavior even if they face sanctions. They are increasingly aggressive and sometimes violent towards others. The guilt for one's own misconduct in society is often seen, or at least argued that way. Responsibility and feelings of guilt do not exist among those affected.
Personality traits associated with a dissocial PS
ICD-10 criteria for determining the dissocial personality disorder are:
- Disregard for social norms,
- a lack of empathy,
- Attachment disorders,
- a low tolerance for frustration,
- impulsive behavior,
- the inability to learn socially,
- advanced justifications for one's own behavior,
- a permanently increased irritability.
In the DSM classification, this form of personality disorder is referred to as an anti-social personality. The antisocial personality disorder can manifest itself in deliberate actions, which include, for example, targeted enrichment at the expense of others or are determined by impulsive actions over which those affected have no control.
Disorders of the emotionally unstable type are characterized by extremely spontaneous, impulsive behavior, mood swings, outbursts of anger as well as sometimes violent aggression and auto-aggression. The behavior of those affected is often incomprehensible to their fellow human beings, especially since the consequences are completely ignored in moments of impulsive control. Correspondingly conflicting and unstable are the interpersonal relationships in people with an emotionally unstable personality disorder.
Although they often have considerable difficulties in dealing with other people, many of those affected show a pronounced fear of being alone. At the same time, patients often suffer from depression and are increasingly prone to excessive addictive behavior. In the ICD-10, emotionally unstable personality disorders are divided into an impulsive type and a borderline type. However, the DSM classification does not recognize such a distinction and uses the term “borderline personality disorder” as the sole term.
Personality traits associated with a Borderline PS
According to the DSM, borderline syndrome shows at least five of the following behavioral characteristics:
- Fear of being abandoned,
- unstable but intense interpersonal relationships,
- disturbed self-image,
- suicidal acts,
- a lasting feeling of emptiness,
- uncontrolled anger,
- paranoid ideas,
- dissociative behavior under stress,
- affective instability (irritability, upset).
Histrionic personality disorder
An extremely self-centered behavior and a penchant for theatricality are characteristic of the Histrionic disorder. Those affected tend to be dramatic, always want to be the center of attention and show a low tolerance for frustration. The ICD-10 names as characteristics for a Histrionic personality disorder:
- Theatrical appearance,
- dramatic self-expression,
- easy to influence,
- constant striving for exciting experiences,
- Need to be the center of attention
- attach particular importance to an attractive appearance,
- behaving inappropriately seductive or provocative,
- manipulative behavior.
Compulsive personality disorder
The most striking feature of the obsessive compulsive disorder is a pronounced perfectionism, which often makes it almost impossible for those affected to complete tasks and projects because the desired goal cannot be achieved. In addition, they often get lost in details, a pedantic compliance with rules and doubts about their own performance, which means that the actual project takes a back seat and complicates the task even more. In addition to the obsessive-compulsive disorder, many patients suffer from other psychological problems such as depression or an obsessive-compulsive disorder.
Personality traits associated with a Histrionic PS
The following personality traits are mentioned in ICD-10 as essential for the Anankastic Personality Disorder:
- Excessive doubts
- constant concern with details and rules,
- delegating tasks is extremely difficult for patients,
- Tendency to intensive controls,
- Life of those affected is extremely performance-related,
- interpersonal relationships and personal pleasure tend to be neglected,
- Patients can hardly cope with criticism of their own performance
- react quickly to criticism.
Anxious (avoiding) personality disorder
A pronounced feeling of inferiority forms the basis for persistent inner tension, anxiety, insecurity and self-doubt in the anxiously avoiding personality disorder. Those affected are inhibited in their actions, are shy, feel unattractive and fear rejection as well as criticism. This often leads to avoidance behavior that can put considerable strain on interpersonal contacts.
Under certain circumstances, the fear of criticism and rejection can result in increasing social isolation, which comes from those affected themselves. As a rule, their fellow human beings have no problems in dealing with the patients, since they usually appear modest, reserved or even slightly submissive. Their lack of self-confidence often shows up in a special willingness to sacrifice, which is also perceived positively by the people around them.
Personality traits associated with an anxious PS
If four of the following behavioral characteristics are present, then ICD-10 refers to an anxious (preventive) personality disorder. The affected
- suffer from a persistent intense feeling of tension and anxiety,
- feel inferior and unattractive,
- are overly concerned about criticism and rejection,
- avoid activities with intensive interpersonal contacts,
- show a pronounced need for physical security that can lead to lifestyle restrictions,
- maintain personal contacts only if they are sure that their fellow human beings will accept them.
Dependent personality disorder / asthenic PS
Even with the dependent personality disorder, a low level of self-confidence is an essential personality trait of those affected. This results in extremely low assertiveness and even submissive behavior. Due to exaggerated fear of separation and loss, people with an asthenic PS often cling to people who are important to them. Alone they feel helpless and incompetent.
Personality traits associated with a dependent PS
According to ICD-10, dependent personality disorder has at least four of the following behavioral characteristics: Affected
- preferably leave the most important decisions for your own life to others,
- generally subordinate their needs to those of those important to them,
- cannot express their claims adequately,
- have an excessive fear of being abandoned
- don't feel viable on their own,
- can hardly make decisions without first getting a lot of advice.
In addition to the disorders already mentioned, various other forms can occur, in which case the passive-aggressive PS, the narcissistic PS and combined PS are particularly worth mentioning.
The passive-aggressive disturbance is mainly characterized by a passive resistance to external performance requirements. In many cases, the service is simply refused without justifying or addressing it. An exact classification of these special mental illnesses according to ICD-10 is not (yet) available.
Narcissistic personality disorder
The same applies to the narcissistic personality disorder, which is characterized by an extremely exaggerated assessment of one's own abilities and person. As a rule, it is at the expense of others, who tend to be less important than your own person. Those affected lack empathy and often show arrogant behavior towards others. People with narcissistic horsepower can hardly cope with criticism because it disturbs their own unrealistic self-image.
Combined fault patterns
The combined disorders are to be understood as symptoms, in which individual behavioral characteristics occur in such a way that a psychological disorder can be assumed, but no assignment to an exact PS according to ICD-10 or DSM is possible. Combined mental disorders often appear in the context of other mental illnesses such as phobias or affect disorders. The diagnosis of combined personality disorders is particularly difficult due to the unclear behavioral characteristics.
Schizotypical personality disorder
Another form is the schizotypic PS, which, however, is not assigned to the specific disorders according to ICD-10. Those affected have considerable problems, especially when it comes to interpersonal relationships. They are extremely suspicious of others, have difficulties in forming and maintaining close ties, show extremely eccentric traits (in appearance and language), unusual ways of thinking (e.g. belief in magic) and are limited in their affect, which often makes them appear cold and unapproachable .
So far, there is no generally applicable explanatory model for the development of personality disorders. However, there is broad agreement among experts that the cause of most patients is a combination of genetic predisposition and psychological stress caused by environmental factors, the development of PS. Events in early childhood, such as severe emotional neglect, parental violence or sexual abuse, are particularly important here.
Difficult social conditions are considered a risk factor
Chaotic and unstable social conditions are considered general risk factors for the development of a personality disorder. If the parents suffer from a mental disorder, the chances of the children developing PS are also increased. The biological and social factors can occur in the individual genesis of PS in extremely different forms, whereby a direct assignment of certain personality disorders to individual combinations of environmental factors and genetic predispositions is not possible.
The diagnosis is based on the specified criteria of the ICD-10 and the DSM classification. However, it often takes several sessions to see a psychiatrist or psychotherapist to determine the criteria, since, for example, combined personality disorders are often difficult to diagnose.
Beware of self-tests
Numerous different tests are circulating on the Internet to determine a personality disorder or the tendency to PS. In the tests, participants are asked, among other things, about their reaction to certain everyday problems such as oversleeping in the morning or trouble with the boss. Based on the answers, a certain personality structure is concluded. However, the validity of these tests is often rather dubious and no treatment options can be derived from them anyway without specialist support.
Basically, psychotherapeutic procedures are primarily available for treatment, although targeted healing is often hardly possible, and only a reduction in behavioral problems can be achieved. Cognitive behavioral therapy is being used more and more, but psychotherapy based on depth psychology and analytical psychotherapy can also be used to combat personality disorders.
Some personality traits complicate therapy
The therapy is often made more difficult by the special behavioral characteristics of the various personality disorders. For example, patients with schizoid PS have difficulty building the necessary bond or trust in the therapist, patients with Histrionic personality disorder often try to manipulate the therapist or the course of therapy, and borderline patients tend to discontinue therapy.
Use of medication
In order to avoid particularly serious symptoms of the various PS, the use of psychotropic drugs may also be possible, although due to the impending side effects, cautious use is recommended. Appropriate medicinal products are often used to treat associated mental illnesses such as depression or anxiety disorders. So far, however, there is no scientific evidence that PS can be cured with the help of psychotropic drugs. Therefore, they only serve to alleviate particularly serious symptoms.
Involvement of the family and close confidants
Since the interaction with the close social environment is often significantly stressed by the PS, it may be appropriate to involve the family or individual family members in the psychotherapeutic treatment. Additional family therapy may also be appropriate. Furthermore, specialized psychotherapeutic treatment approaches are available for some forms of PS (for example, Dialectical Behavioral Therapy (DBT) for emotionally unstable PS), which are geared to the individual symptoms of those affected.
Classic naturopathy can only make a limited contribution to the treatment of the psychological disorders described, but homeopathy in particular is often credited with a thoroughly convincing effect against the particularly pronounced symptoms of PS. The following agents have proven their worth:
- Ignatia: For extreme fluctuations in feeling
- Lycopodium: With pronounced uncertainty towards fellow human beings
- Aurum metallicum: With anger and outbursts of violence
- Argentum nitricum: With impulsive behavior
The selection of the appropriate remedy should be made depending on the individual symptoms of the affected person and should be reserved for experienced therapists. The homeopathic remedies primarily serve to relieve symptoms and cannot cure the personality disorder.
As a further method from the field of naturopathy, hypnosis is occasionally used, especially in patients with histrionic PS. However, their use in treatment is still somewhat controversial to this day, although success has increasingly been reported in practice. If the conventional psychotherapeutic methods do not show the desired success, hypnotherapy can therefore be considered in consultation with the therapist.
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek, Barbara Schindewolf-Lensch
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ICD codes for this disease: F21, F60, F61ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.