What are Personality Disorders?

Personality disorders: Pervasive, inflexible, and stable personality traits that deviate from cultural norms and cause distress or functional impairment.

Personality traits are patterns of thinking, perceiving, reacting, and relating that are relatively stable over time and in various situations. Personality disorders occur when these traits are so rigid and maladaptive that they impair interpersonal or vocational functioning. Personality traits and their potential maladaptive significance are usually evident from early adulthood and persist throughout much of life.

Mental coping mechanisms (defenses) are used unconsciously at times by everyone. But in persons with personality disorders, coping mechanisms tend to be immature and maladaptive (see Table). Repetitious confrontation in prolonged psychotherapy or by peer encounters is usually required to make such persons aware of these mechanisms.

Without environmental frustration, persons with personality disorders may or may not be dissatisfied with themselves. They may seek help because of symptoms (eg, anxiety, depression) or maladaptive behavior (eg, substance abuse, vengefulness) that results from their personality disorder. Often they do not see a need for therapy, and they are referred by their peers, their families, or a social agency because their maladaptive behavior causes difficulties for others. Because these patients usually view their difficulties as discrete and outside of themselves, mental health professionals have difficulty getting them to see that the problem is really based on who they are.

Persons with severe personality disorders are at high risk of hypochondriasis, alcohol or drug abuse, and violent or self-destructive behaviors. They may have inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, leading to medical and psychiatric problems for their children. Persons with a personality disorder are less likely to comply with a prescribed treatment regimen. Even when they do, their symptoms--whether psychotic, depressive, or anxious--are far less responsive to drugs. Persons with personality disorders are often very frustrating to those around them, including physicians--who have to deal with their unrealistic fears, excessive demands, sense of entitlement, unpaid bills, noncompliance, and angry vilification. Such persons can also cause stress for other patients who are exposed to their dramatic or demanding behaviors.

Causes of Personality Disorders

A combination of personal history and biology appears to play a role in most personality disorders. Genetics play a significant — but not necessarily singular — role in the development of schizotypal, schizoid and paranoid personality disorders, which all are more common in families with a history of schizophrenia. Heredity also contributes to the development of obsessive-compulsive personality disorder.

A family history of antisocial personality disorder increases your risk of developing the condition, but childhood trauma also has considerable influence. Children with an alcoholic parent, or who have an abusive or chaotic home life, are at increased risk of developing antisocial personality disorder.

People with borderline personality disorder report the highest rate of childhood abuse — especially sexual abuse — at the youngest age, compared with that of other personality disorders. Many people with borderline personality disorder also have received a diagnosis of post-traumatic stress disorder. Heredity and childhood head injury also may influence the development of this disorder.

The causes of narcissistic, histrionic, avoidant and dependent personality disorders have been minimally studied and aren't yet well understood.

Risk Factors

More women than men develop avoidant, borderline, dependent and paranoid personality disorders. Men are much more likely than women to have antisocial personality disorder and obsessive-compulsive personality disorder.

Other risk factors for personality disorders include:

• A history of childhood verbal, physical or sexual abuse
• A family history of schizophrenia
• A family history of personality disorders
• A childhood head injury
• Being a young adult
• Being divorced, separated, widowed or never married
• Having low socioeconomic status

continue: Diagnosis and Types of Personality Disorders

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Reviewed: 04/2006