Introduction

Personality disorders are a class of mental disorders characterized by long-term patterns of distorted thinking, feeling, and behavior that deviate from cultural and societal expectations. These patterns of behavior and thinking are typically inflexible and persistent, meaning that they are difficult to change and are present across a wide range of situations. These patterns can cause significant distress or impairment in social, occupational, or other areas of functioning.

Individuals with personality disorders tend to have difficulty maintaining healthy relationships, may struggle to maintain stable employment, and may have difficulties with impulse control. They also may have a hard time regulating their emotions which can lead to intense and unstable relationships, distorted self-image, impulsivity, and reckless behavior.

It’s important to note that personality disorders are not the same as normal personality traits, which everyone possesses. Personality disorders are considered abnormal because they are inflexible, persistent, and maladaptive, and cause significant impairment or distress. A personality disorder diagnosis is made by a mental health professional after a comprehensive evaluation, including a clinical interview and the use of standardized self-report or interview measures.

The Personality Disorder Type Clusters

There are several different types of personality disorders, which are grouped into three clusters.

1. Cluster A personality disorders include paranoid, schizoid, and schizotypal disorders. These disorders are characterized by odd or eccentric thinking and behavior.
2. Cluster B personality disorders include borderline, narcissistic, histrionic, and antisocial disorders. These disorders are characterized by dramatic or emotional thinking and behavior.
3. Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive disorders. These disorders are characterized by anxious or fearful thinking and behavior.

Symptoms of specific Personality Disorders

Some of the specific disorders and their associated symptoms include:

• Paranoid personality disorder: characterized by a persistent distrust and suspicion of others, even when there is no evidence to support these beliefs
• Schizoid personality disorder: characterized by a lack of interest in social relationships, and a tendency to be emotionally detached or withdrawn
• Schizotypal personality disorder: characterized by odd or eccentric thinking, behavior, and appearance, as well as a lack of close relationships
• Borderline personality disorder: characterized by intense and unstable relationships, a distorted self-image, and impulsive or reckless behavior
• Narcissistic personality disorder: characterized by an inflated sense of self-importance, a lack of empathy for others, and a need for admiration and validation
• Histrionic personality disorder: characterized by excessive emotionality and attention-seeking behavior
• Antisocial personality disorder: characterized by a disregard for the rights of others, a lack of empathy or remorse, and a tendency to engage in criminal or reckless behavior
• Avoidant personality disorder: characterized by feelings of inadequacy and social inhibition, as well as a fear of rejection or disapproval
• Dependent personality disorder: characterized by a need to be taken care of, and a fear of abandonment
• Obsessive-compulsive personality disorder: characterized by a preoccupation with orderliness, perfectionism, and control.

It’s important to note that a personality disorder diagnosis is made by a mental health professional after a comprehensive evaluation, including a clinical interview and the use of standardized self-report or interview measures. Additionally, it is possible for an individual to have traits of multiple personality disorders, and there is ongoing debate and research in the field about the specific diagnostic criteria and categorization of these disorders.

Treatment options for personality disorders

Treatment options for personality disorders typically include a combination of psychotherapy and medication.

Psychotherapy, also known as talk therapy, is the primary form of treatment for personality disorders. Different types of psychotherapy can be used, but the most commonly used are:

• Cognitive-behavioral therapy (CBT) which helps individuals change their thought patterns and behaviors that contribute to the disorder.
• Dialectical behavior therapy (DBT) which helps individuals regulate their emotions and improve their relationships with others.
• Schema Therapy which focuses on changing negative patterns of thoughts and behaviors.
• Transference-focused therapy (TFP) which is a form of psychoanalytic therapy that focuses on the individual’s relationship with the therapist as a way to understand and change the personality disorder.

Medication can also be used to help alleviate symptoms associated with personality disorders, such as anxiety and depression. Antidepressant and/or anti-anxiety medications, as well as mood stabilizers, may be prescribed. However, it is important to note that medication alone is not considered sufficient treatment for personality disorders.

It’s important to note that treatment for personality disorders can be challenging and may take time, but with the help of a mental health professional, individuals can make significant improvements in their symptoms and quality of life. Additionally, in severe cases, inpatient or day treatment programs may be recommended to provide more intensive treatment and support.

It’s important to consult with a mental health professional to determine the best course of treatment for the specific diagnosis and individual.

Schema therapy for personality disorders

Schema therapy is a form of psychotherapy that can be used to treat personality disorders. It is based on the idea that individuals with personality disorders have underlying “schemas” or patterns of thinking, feeling, and behaving that are negative and maladaptive. These schemas can be triggered by certain situations and can lead to a wide range of negative emotions and behaviors.

In schema therapy, the therapist works with the individual to identify and understand these schemas and the situations that trigger them. The therapist then helps the individual develop new, more adaptive ways of thinking, feeling, and behaving. This can be done through a variety of techniques, such as cognitive restructuring, imagery, and role-playing.

One of the key elements of schema therapy is the use of “mode work”, which involves identifying and working with different “modes” or parts of the self. These modes can include the inner critic, the abandoned child, the angry child, and the healthy adult, among others. The therapist helps the individual understand how these different modes interact with each other and how they contribute to the individual’s schemas and symptoms.

Schema therapy also place emphasis on the therapeutic relationship and encourages the therapist to be empathic, validating and supportive as well as setting boundaries and challenging the client when necessary.

Schema therapy has been found to be effective in treating personality disorders, particularly Borderline Personality Disorder and Narcissistic Personality Disorder. Studies have shown that individuals who receive schema therapy have significant improvements in their symptoms and overall functioning, compared to those who receive other forms of treatment.

It’s important to note that schema therapy is a complex and long-term treatment that requires a skilled therapist who is trained in this approach, and the best treatment plan will be tailored to the specific needs and diagnosis of the individual.

Attachment Theory and personality disorders

According to attachment theory, individuals develop an internal “working model” of relationships based on their early experiences with attachment figures. This internal working model shapes the individual’s expectations and behaviors in future relationships.

Research has suggested that individuals with personality disorders may have experienced disruptions or difficulties in their early attachment relationships, leading to the development of maladaptive attachment patterns. For example, individuals with Borderline Personality Disorder may have experienced inconsistent or emotionally unavailable caregiving, leading to a fear of abandonment and difficulty regulating emotions in relationships. Individuals with Narcissistic Personality Disorder may have experienced excessive praise or admiration in childhood, leading to an inflated sense of self-importance and a lack of empathy for others.

It’s important to note that not all individuals with personality disorders have a history of insecure attachment, and also not all individuals with a history of insecure attachment develop a personality disorder. Additionally, other factors such as genetics, environment, and life experiences also play a role in the development of personality disorders.

Attachment theory can inform the treatment of personality disorders by helping therapists understand the individual’s early experiences and attachment patterns, and how they may be impacting the individual’s current behavior and relationships. It can also be used to help individuals understand their own patterns of behavior and how they may have developed. Therapy approaches such as schema therapy and mentalization-based therapy that incorporate attachment theory can help individuals to repair their early attachment patterns and improve their relationships with others.