18. September 2019
Our personality is what makes us humans. We know about our strengths, weaknesses, quirks and idiosyncrasies and can describe our character quite well with the necessary portion of self-reflection. We also perceive the personality of our fellow human beings. It is reflected in their actions, their words and their lifestyle wider. Sometimes, however, personality disorders can occur.
Personality is our way of encountering the world and shaping our lives in it. It is quite individual and develops in childhood. But what if actions, words and lifestyle are significantly different from the norm? What is the norm, anyway? There are, of course, many facets of personality and it is always in the individual case to consider whether a disorder exists. It must be assessed whether the conduct of life and social interaction is impaired by the extreme personality expression and whether the affected person or his environment suffer from it. If this is the case, one speaks of a personality disorder, which can manifest itself in very different ways.
The timing for this article is special because a lot has happened in the description of personality disorders in 2019. Here’s why: this year, a new version of the Physicians’ Manual of Disease Description was published by the World Health Organization (WHO) and is abbreviated ICD-11. ICD stands for International Classification of Diseases. Physicians are required to adapt their diagnoses to this manual and to use the abbreviations used there. More on this later.
We all know that there are people who are a little different. People who do not perfectly adapt to norms and conventions and thus stand out a little. We know people who are very quiet, live secluded lives and do not seek company. We may also have acquaintances who are completely self-sacrificing in their partnership and are barely viable without their partner. Do all these people have a personality disorder?
The answer is clearly “no”, because personalities are very different and have different styles. One can then speak of a personality accentuation , i.e. a tendency in a certain direction. Meanwhile, this fluid transition between exceptional character traits and personality disorders is given more attention, so that disorders of personality are no longer strictly divided into categories, but are considered according to the extent of impairment in the conduct of life.
Personality disorders may be caused by a genetic predisposition. Pregnancy complications, poisoning in the womb, and general psychological constitution may also play a role. These factors lead to an increased susceptibility to a personality disorder (vulnerability). If unfavorable psychosocial factors, e.g. stressful parent-child relationships or traumatic events, then a personality disorder can develop. Many experts understand the disorder as a kind of protection against the demands of the environment on one’s own competencies, which are reduced by the genetic preload (Fiedler, 2009).
Specialists in psychiatry will in future have to take a three-stage approach to the diagnosis of personality disorders. This is to prevent individuals from simply being pigeonholed without looking closely at what dimension the (suspected) personality disorder occupies.
The three stages of personality disorder diagnosis in ICD-11 proceed as follows:
Stage 1: Review of general criteria for the presence of a personality disorder
A personality disorder is present if the pattern of personality and behavior persistently deviates from the socially expected behavior. The personality and behavior are very rigid and inflexible and the abnormalities have existed since adolescence and early adulthood. The personality abnormalities are evident in thoughts, emotions, interpersonal relationships, and impulse control, among other areas. Examples are:
– Bizarre ways of perceiving self and others
– High or low intensity of emotions or great emotional instability
– Impulsive, uncontrolled behavior
– Too many or very few social contacts
Important: Symptoms must result in suffering and interfere with social and occupational life for a diagnosis to be made. Other mental illnesses or the influence of medication must be ruled out.
Stage 2: Assessment of severity
Affected individuals are now no longer just put in the “personality disorder” box, but a closer look is taken at how severe the disorder is impacting their lives. This has the advantage that patients are dealt with in a much more individualized way and subsequent therapy can be better adapted. In the following areas, measuring instruments are used to determine the severity of the disorder:
– The person’s self-image and self-worth
– The quality of human relationships
– Behavior, emotions, thoughts
– The impact of the personality in personal and professional contexts
– The harm done to oneself and others
Stage 3: Analysis of the predominant personality traits
The third step then looks more closely at what form of personality disorder is present. In the past, personality disorders had special names, from which more and more distance is taken (exception: borderline personality disorder). However, they are still listed in this article because they are (in part) very common and are used in communication by physicians and therapists. You will learn which forms of personality disorder may be present in the next section.
In the ICD-11, there are six different personality types that can be pathological if highly expressed (Berberich & Zaudig, 2015). In the overview, you will find the personality types with a brief description and, in addition, the formerly common names for the personality disorder.
For a long time, the myth persisted in academia and in practice that personality disorders are difficult to treat because personality was assumed to be stable. A study by Skodol et al. (2005) showed that over time, the likelihood that individuals still meet all diagnostic criteria for a personality disorder decreases. Personality disorders can thus improve with the right treatment.
If the personality disorder causes suffering or problems in the social and professional spheres, then psychotherapy is indicated. Personality disorder may also be accompanied by other psychiatric illnesses, such as depression or addiction. Sometimes it is the case that those affected first seek treatment for the secondary illness and only then is a personality disorder diagnosed.
Psychotherapy is the treatment of choice for personality disorders. According to Bohus et al (1999), such psychotherapy should include the following:
– Reductions in threats to self or others (especially relevant in borderline type or dissociality).
– Stabilization of the patient (e.g., in the case of negative affectivity)
– Improved self-direction and behavioral control (e.g., in dissociality, low inhibition, and negative affectivity)
– Normalization of emotional experience (e.g., for negative affectivity, attachment weakness, and compulsivity)
– Help with life management (e.g., with inhibition weakness)
The relationship between therapist and patient is of enormous importance in therapy. Working together, the patient can gain new relational experiences and learn to better appreciate the impact of his personality on living with other people.
As mentioned earlier, studies are making it increasingly clear that personality disorders are modifiable and that appropriate therapy is worthwhile. The results are encouraging people to seek help! In addition, there are therapy programs that are tailored to particular subtypes of personality disorders, so that specific subtypes can be treated specifically.
It is also to be welcomed that the strict approach to defined personality disorders has been relaxed in the ICD-11. Overlaps of symptoms and attention to severity can now be much better represented and taken into account in therapy.
Categories: Personality Disorders