Personality disorders

Personality disorders constitute a separate diagnostic category (Axis II) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders ( DSM). Unlike the major mental disorders (Axis I), which are characterized by periods of illness and remission, personality disorders are generally ongoing. Often, they first appear in childhood or adolescence and persist throughout a person's lifetime. Aside from their persistence, the other major characteristic of personality disorders is inflexibility. Persons affected by these disorders have rigid personality traits and coping styles, are unable to adapt to changing situations, and experience impaired social and/or occupational functioning. A further difference between personality disorders and the major clinical syndromes listed in Axis I of DSM-IV-TR ( DSM , fourth edition, text revised) is that people with personality disorders may not perceive that there is anything wrong with their behavior and are not motivated to change it. Although the DSM-IV-TR lists specific descriptions of 10 personality disorders, these conditions are often difficult to diagnose. Some characteristics of the various disorders overlap. In other cases, the complexity of human behavior makes it difficult to pinpoint a clear dividing line between pathology and normality in the assessment of personality. In still other cases, persons may have more than one personality disorder, complicating the diagnosis . There also has been relatively little research done on some of the personality disorders listed in DSM-IV-TR.

The 10 personality disorders listed in DSM-IV-TR include:

•    Paranoid personality disorder . The individual affected with this disorder believes in general that people will exploit, harm, or deceive him or her, even if there is no evidence to support this belief.
•    Schizoid personality disorder . The individual with this disorder seems to lack desire for intimacy or belonging in a social group, and often chooses being alone to being with others. This individual also tends not to show a full range of emotions.
•    Schizotypal personality disorder . With this disorder, the affected person is uncomfortable with (and may be unable to sustain) close relationships, and also has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre.
•    Antisocial personality disorder . Individuals with this disorder have no regard for the rights of others. Other, recent names associated with this personality type are psychopath and sociopath. Unable to base their actions on anything except their own immediate desires, persons with this disorder demonstrate a pattern of impulsive, irresponsible, thoughtless, and sometimes criminal behavior. They are often intelligent, articulate individuals with an ability to charm and manipulate others; at their most dangerous, they can become violent criminals who are particularly dangerous to society because of their ability to gain the trust of others combined with their lack of conscience or remorse.
•    Borderline personality disorder . People with this disorder are unstable in their relationships, decisions, moods, and self-perceptions. These individuals are often impulsive and insecure.
•    Histrionic personality disorder . The behavior of individuals of this personality type is characterized by persistent attention-seeking, exaggerated emotional displays (such as tantrums), and overreaction to trivial problems and events.
•    Narcissistic personality disorder . This disorder consists primarily of an inflated sense of self-importance coupled with a lack of empathy for others. Individuals with this disorder display an exaggerated sense of their own importance and abilities and tend to fantasize about them. Such persons also have a sense of entitlement, expecting (and taking for granted) special treatment and concessions from others. Paradoxically, individuals with narcissistic personality disorder are generally very insecure and suffer from low self-esteem.
•    Avoidant personality disorder . This disorder has characteristics that resemble those of social phobia , including hypersensitivity to possible rejection and the resulting social withdrawal in spite of a strong need for love and acceptance. Individuals with this disorder are inhibited and feel inadequate in social situations.
•    Dependent personality disorder . Persons with dependent personality disorder are extremely passive and tend to subordinate their own needs to those of others. Due to their lack of self-confidence, they avoid asserting themselves and allow others to take responsibility for their lives.
•    Obsessive-compulsive personality disorder . This disorder is characterized by a preoccupation with orderliness, perfectionism, and control.
An additional category for personality disorders exists—personality disorder not otherwise specified. This category is reserved for clinicians' use when they encounter a patient with symptoms similar to one of the above disorders, but the exact criteria for a specific disorder are not met.