Personality disorder overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]
Overview
Personality disorders (PD) are described as unique, long-term pervasive patterns of expressing and manifesting emotions, thoughts, and behaviors in an inflexible and maladaptive manner leading to significant functional impairment in one's life. Personality traits, in contrast, are specific patterns of thinking, perceiving, and responding to different situations in an adaptive and tenaciously stable way throughout life. The personality traits formulate an essential aspect in one's life in facing and dealing with contrasting situations as maladaptive personality can result in clinical distress and psychosocial impairment. In order to differentiate normal responses from abnormal or pathological, the criterion employed requires behaviors displayed by a majority in the population as normal and pathological if they are rare or there is the absence of a sense of contentment and adaptability to the social environment or marked deviation from cultural expectations. Hence, these are relative terms, and therefore, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has established a set criterion for diagnosing personality disorders. This is based on the presence of impaired personality functioning and pathological traits. The pathophysiology of PD remains unclear to date. There are countless complex psychodynamic theories explaining the development of the disorder. Both genetic and environmental factors interplay in the causation of PD. A decrease in monoamine oxidase (MAO), and serotonin levels are seen with multiple PD. Although mostly recognized and diagnosed in adults, PD is present and develops in youth and adolescence. About 1 in 10 adolescents meets the criteria for PD. There are ten personality traits classified into 3 clusters; A, B, and C, based on similar characteristics. A clinical criterion as set by DSM-V is used for the diagnosis after the exclusion of other similar conditions (mental health disorder, substance use disorder, structural central nervous system (CNS) disorder). For most personality disorders, an age greater than 18 years is required for the diagnosis. This disorder is retained throughout an individual's life; however, certain types become less intense with age. The presence of PD is associated with increased mortality. The increased mortality is associated with unnatural causes like suicide, accidents, homicide, substance abuse, and depression. Natural death chances may also be enhanced in PD due to negative perspectives and emotions regarding health problems in life and the correlation of impaired mental health with physical health. Alcoholism and substance abuse contribute as precipitating factors and complications in PD. Psychotherapy remains the mainstay of treatment in both management and preventing complications. Medications are used as adjuncts. Cognitive-Behavioral therapy, impulse control, interpersonal psychotherapy, self-help groups, and family therapy are required. Medical therapy is required to balance and restore the neurotransmitter abnormalities associated with PD. Among them, Selective serotonin reuptake inhibitors(SSRIs) and newer antidepressants remain the hallmark. Antipsychotics and mood stabilizers also help. Despite individual and supportive psychotherapy, treatment of PD remains challenging and difficult.