Personality disorders represent a clinical condition encompassing various patterns of behaving, feeling, perceiving, managing impulses, and relating to others that are ingrained and habitual. Personality is a term used by psychologists to organize a set of characteristics that distinguish one individual from another (Magnavita, 2002). Although each person is unique, there are certain personality adaptations or styles that psychological scientists use to classify people, and research has shown through factor analysis that most people can be categorized on the basis of just three to five different dimensions.
When an individual’s personality is chronically dysfunctional, a personality disorder is likely to result. Personality can be considered an emotional immune system that, when functioning adaptively, wards off stress and optimizes health (Millon & Davis, 1996). There are various systems for classifying and diagnosing personality disorders, including categorical, structural, protypal, and relational approaches to classification. The most widely used of these is a categorical diagnostic system developed by a team of clinical scientists in the 1980s and codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (2000), of which there have been various editions and changes as research in this area has accumulated.
The DSM has been influential in stimulating renewed interest in personality disorders and in spawning research on the epidemiology and clinical treatment of personality disorders. This categorical system refers to discrete personality disorders, of which there are 10 specific ones divided into three clusters: Cluster A, which is considered the eccentric cluster and includes paranoid, schizoid, and schizotypal personality disorders; Cluster B, which is considered the erratic cluster and includes antisocial, borderline, histrionic, and narcissistic personality disorders; and Cluster C, which is considered the anxious cluster and includes avoidant, dependent, and obsessive-compulsive personality disorders. There is controversy about this part of the DSM system, in that many theoreticians and researchers believe that these personality disorders are not discrete categories but rather that there exists a continuum of traits from normal to abnormal. Much research has demonstrated that there is, in fact, significant overlap among these categories, and it is also a fact that in clinical practice multiple personality disorder diagnoses are often given to the same individual.
Historically, personality disorders were originally termed character disorders, and various types of character disorders were identified by early psychoanalytic writers on the basis of presumed points of fixation in an individual’s psychosexual development. Although this psychoanalytic formulation has not been scientifically verified, many of the major character types inferred by psychoanalysts from their clinical observations are represented in contemporary systems of classification.
Recently, a new diagnostic system embracing psychodynamic principles has been developed. This system, published in the Psychodynamic Diagnostic Manual and referred to as the PDM, contributes to conceptualizing and classifying personality disorders more precisely than the DSM and has a substantial evidence base (PDM, 2006). The PDM, which was designed to serve as a companion to the DSM, is based on the assumption that personality exists in three basic structures or organizations: neurotic, borderline, psychotic. Each organization has certain functional deficits or weaknesses and can shape the development and manifestation of such traits as being passive, dependent, obsessive, or avoidant.
The study of personality disorders is critical for mental health professionals, because many people who come into treatment for anxiety, depression, substance abuse, and other symptomatic disorders are also diagnosed with a comorbid or co-occurring personality disorder. Hence the treatment of persons with clinical syndromes is often complicated by their having a personality disorder, which often includes a tendency toward self-sabotage and self-defeating patterns of behavior. The treatment of personality disorders has advanced rapidly over the past two decades, which have seen the development of specialized treatments that are well suited for benefiting individuals with personality disorders. Approaches for which there has been an accumulating database to demonstrate their effectiveness include a variety of cognitive-behavioral, schema-focused, psychodynamic, and integrative treatments of these disorders.
The etiology or cause of personality disorders is considered multifactorial and includes genetic predispositions, temperamental variation, parental influence, and sociocultural factors like racism and poverty (Magnavita, 2004). Substantial research and clinical evidence also suggest that, for such severe personality disorders as borderline personality disorder, there is a high (about 60%) probability of the individual having been traumatized by childhood experiences of sexual, physical, or emotional abuse. One ongoing controversy concerns whether borderline or other personality disorders should be diagnosed in children. Those who believe that these conditions should be diagnosed in children cite the need for early identification and prevention, whereas those who oppose doing so consider the diagnosis of a personality disorder is overly stigmatizing and inappropriate for anyone under age 18.
As an even broader issue, some mental health professionals regard the whole concept of personality disorders as unnecessarily stigmatizing, even for adults, and regard diagnosing these disorders as society’s way of ignoring ways in which people, especially children and women, have been victimized by their life experiences. However, in order to develop as a science, psychology must have ways of organizing and characterizing maladaptive forms of behavior, for them to be researched and for clinical scientists to have a language for communicating with one another. Personality theory and theories of personality disorders are constantly evolving, and emerging evidence from related disciplines like neuroscience is illuminating the personality system. Newer approaches are also emphasizing personality systematics, which involves attempting to understand the processes that interrelate at all levels of the total ecological system. In this approach, personality is seen as broadly contextualized and influenced by a number of interacting domains, including neurobiological, intrapsychic, interpersonal, family, cultural, and political. As we increasingly become a global village, the concept of personality disorder must take into consideration the array of domains and forces that are exerted on human adaptation and evolution.
Antisocial Personality Disorder; Avoidant Personality Disorder; Borderline Personality Disorder; Dependent Personality Disorder; Histrionic Personality Disorder; Narcissistic Personality Disorder; Obsessive-Compulsive Personality Disorder; Paranoid Personality Disorder; Schizoid Personality Disorder; Schizotypal Personality Disorder.
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