Personalities Disorders

Personality is the characteristic way in which an individual thinks, feels, and behaves; it accounts for the ingrained behaviour patterns of the individual and allows the prediction of how he will act in particular circumstances.

Personality embraces a person's moods, attitudes, and opinions, and is most clearly expressed in his interactions with other people.

A personality disorder is a deeply ingrained, long-enduring, maladaptive, and inflexible pattern of thinking, feeling, and behaving that either significantly impairs an individual's social or occupational functioning or causes him subjective distress.

Personality disorders are not illnesses but rather are pronounced accentuations or variations of personality in one or more of its traits.

A personality disorder may occur with another psychiatric condition or on its own, and it is particularly likely to be associated with neurotic conditions. The causes of personality disorders are obscure.

There is undoubtedly a constitutional and therefore hereditary element in determining personality type.

Psychological and environmental factors are also important in causation, for instance, the association of antisocial personality disorders with other features of social deviance found in some families and in members of lower socioeconomic groups.

Some generally accepted types of personality disorder are listed below. It is important to recognize that simply exhibiting the trait or even having it to an abnormal extent is not enough to constitute disorder--for that, the degree of abnormality must cause disturbance to the individual or to society.

Paranoid personality disorder

In this disorder there is a pervasive and unjustified suspiciousness and mistrust of others, whose words and actions are misinterpreted as having special significance for, and as being directed against, the individual. Sometimes such people are guarded, secretive, aggressive, quarrelsome and litigious, and excessively sensitive to the implied criticism of others.

Affective personality disorder

Three particular types of persistent mood disturbance can be described under this heading: (1) the trait of anxiety may be persistent and highly developed, so that the person encounters all new circumstances with fearful anticipation; (2) the chronic depressive personality is a gloomy pessimist who is skeptical in outlook and who may regard suffering as meritorious; and (3) the cyclothymic personality shows excessive swings of mood as a persistent lifelong trait.

Schizoid personality disorder

In this disorder there is a disinclination to mix with others, the individual appearing aloof, withdrawn, indifferent, unresponsive, and disinterested. Such a person prefers solitary to gregarious pursuits, involvement with things rather than with people, and often appears humourless or dull.

Schizotypal personality disorder

This category has been used to describe people who show various oddities or eccentricities of thought, speech, perception, or behaviour (such as bizarre fantasies or persecutory delusions) but whose symptoms are not severe enough to be labeled as schizophrenic.

Explosive personality disorder

Such people have a tendency to sudden emotional rages or tantrums that result in their physically assaulting others or impulsively attempting to commit suicide. The emotional outburst may be precipitated by a minor frustration that is disproportionate to the degree of reaction.

Anankastic, or compulsive, personality disorder

A person with this disorder shows prominent overscrupulous, perfectionistic traits that are expressed in feelings of insecurity, self-doubt, meticulous conscientiousness, indecisiveness, and rigidity of behaviour. The person is preoccupied with rules, procedures, and efficiency, is overly devoted to work and productivity, and is usually deficient in the ability to express warm or tender emotions. This disorder is more common in men and is in many ways the antithesis of antisocial personality disorder.

Histrionic personality disorder

Overly dramatic and intensely expressed behaviour, a tendency to call attention to oneself, a craving for novelty and excitement, egocentricity, highly reactive and excitable behaviour, and tendencies toward dependency and suggestibility are characteristic of this condition, which is more common in women than men.

Asthenic, dependent, or inadequate personality disorder

In this condition the person lacks the mental energy and ability to act on his own initiative and therefore passively allows others to assume responsibility for major aspects of his life.

Antisocial, asocial, sociopathic, or psychopathic personality disorder

This disorder is marked by a personal history of chronic and continuous antisocial behaviour, in which the rights of others are violated, and by poor or nonexistent job performance. It is manifested in persistent criminality, sexual promiscuity or aggressive sexual behaviour, and drug use.

People with this disorder are impulsive, mendacious, irresponsible, and callous; they feel no guilt over their antisocial acts and fail to learn from their mistakes. The symptoms usually appear in adolescence. Antisocial personalities are less liable to criminal acts as they grow older, but there remains a high risk of suicide, accidental death, drug or alcohol abuse, and a tendency toward interpersonal problems.

Other categories of personality disorder

In the narcissistic personality disorder, there is a grandiose sense of self-importance and a preoccupation with fantasies of success, power, and achievement. Avoidant personalities are excessively sensitive to social rejection, humiliation, and shame, have low self-esteem, and are deeply upset by the slightest disapproval of others; they are consequently unwilling to enter into relationships but crave affection and acceptance. Passive-aggressive personality disorder is the term applied to people who respond aggressively and negatively to demands made upon them by using such passive means as procrastination, dawdling, intentional inefficiency, or deliberate forgetfulness.

Personality traits are, by definition, virtually permanent, and so these disorders are only partially, if at all, amenable to treatment. The most effective treatment combines various types of group, behavioral, and cognitive psychotherapy. The behavioral manifestations of personality disorders often tend to diminish in their intensity in middle and old age.

Psychosexual disorders

Homosexuality and psychosexual dysfunctions such as impotence are treated in the articles sexual behaviour, human and homosexuality. The following section is concerned with disorders of gender identity and with preferences for unusual or bizarre sexual practices or objects.

Transsexualism and disorders of gender identity

In transsexualism the person feels a discrepancy between anatomical sex and the gender the person ascribes to himself. This disorder is much more common in biological males than females. The sufferer claims that he is a member of the other sex: "a female spirit trapped in a male body." He may assume the dress and behaviour and participate in activities commonly associated with the other sex and may even use hormones and surgery to achieve "restitution to my rightful appearance"; i.e., to achieve the physical characteristics of the other sex. The cause of the condition is unknown. Once established, transsexualism persists for many years, perhaps for the rest of life. There is a risk of developing depression and an increased risk of suicide. Psychiatric treatment is generally supportive in type.


Paraphilias, or sexual deviations, may be classified into disorders of sexual object and of the sexual act. Disorders of sexual object include the following. (1) In fetishism, inanimate objects are the repeated sexual preference and means of sexual arousal. (2) In transvestism, the recurrent wearing of clothes of the opposite sex is carried out to achieve sexual excitement. (3) In zoophilia, or bestiality, an animal is used as the repeated and preferred means of achieving sexual excitement. (4) In pedophilia, an adult has sexual fantasies about or engages in sexual acts with a prepubertal child of the same or opposite sex.

Disorders of the sexual act include the following. (1) In exhibitionism, repeated exposure of the genitals to an unsuspecting stranger is used to achieve sexual excitement. (2) In voyeurism, observing the sexual activity of others repeatedly is the preferred means of sexual arousal. (3) In sexual masochism, the individual achieves sexual excitement from being made to suffer. (4) In sexual sadism, the individual achieves sexual excitement by inflicting suffering upon another person.

There are, of course, other unusual sexual objects or acts that may be used for gratification. The causes of these conditions are generally not known. Behavioral, psychodynamic, and pharmacological methods have been used with varying efficacy to treat these disorders.

Disorders usually first evident in infancy, childhood, or adolescence

Children are usually referred to a psychiatrist or therapist because of complaints or concern over the child's behaviour or development by a parent or some other adult. Family problems, particularly difficulties in the parent-child relationship, are often an important causative factor in the symptomatic behaviour of the child. For the practice of child psychiatry, the observation of behaviour is especially important as the child may not be able to express his feelings in words. Isolated psychological symptoms are extremely common in children, but in one survey, disturbance amounting to psychiatric disorder was found to be present in 7 percent of all 10 and 11 year olds; boys were affected to twice the extent of girls.

Attention disorders

Children with these disorders show a degree of inattention and impulsiveness that is markedly inappropriate for their stage of development. Gross overactivity in children has many causes, including anxiety, conduct disorder, or the effects of living in institutions. One type of overactivity, the hyperkinetic, or hyperactive, syndrome, is characterized by extreme restlessness and by sustained and prolonged motor overactivity such as running around. Learning difficulties and antisocial behaviour may occur secondarily. This syndrome is 10 times more common in boys than in girls.

Conduct disorders

These are the most common psychiatric disorders in older children and adolescents, accounting for nearly two-thirds of disorders in those aged 10 and 11 years. Abnormal conduct more serious than ordinary childlike mischief persistently occurs; lying, disobedience, and aggression may be shown at home, and truancy, delinquency, and deterioration of work may occur at school. Vandalism, drug and alcohol abuse, and early sexual promiscuity may also occur. The most important causative factors are the family background; broken homes, unstable and rejecting families, institutional care in childhood, and a poor social environment are frequently present in such cases.

Anxiety disorders

Neurotic or emotional disorders in children are similar to the adult conditions except that they are often less clearly differentiated. In anxiety disorders of childhood, the child is fearful, timid with other children, and overdependent and clinging toward the parents. Aches and other physical symptoms, sleep disturbance, and nightmares occur. Separation from the parent or from the home environment is a major cause of this neurotic anxiety.

Eating disorders

Anorexia nervosa usually starts in late adolescence and is about 20 times more common in girls than boys. This disorder is characterized by a body weight more than 25 percent below standard, amenorrhea, a fear of loss of control of eating, and an intense desire to be thin. Though grossly thin, patients nevertheless believe themselves to be fat. They go to enormous lengths to resist eating food and to lose weight, including food avoidance, purging, self-induced vomiting, and vigorous exercise.

The condition appears to start with the patient's voluntary control of food intake in response to social pressures such as peer conformity. The disorder is exacerbated by troubled relations within the family. It is much more common in developed, wealthy societies and in girls of higher socioeconomic class. There is evidence that it has become more common in such countries since the 1960s.

Patient management includes three stages: persuading the patient to accept and cooperate with treatment, achieving weight gain by medical methods of care, and helping the patient maintain weight by psychological and social therapy. Bulimia nervosa refers to episodic grossly excessive overeating binges. These may alternate with episodes of self-induced vomiting. The disorder is a variant of anorexia nervosa.

Disorders with physical manifestation

Stereotyped movement disorders involve the exhibition of tics in differing patterns. A tic is an involuntary, purposeless jerking movement of a group of muscles or the involuntary production of noises or words. Tics may affect the face, head, and neck or, less commonly, the limbs or trunk. Gilles de la Tourette's syndrome is typified by multiple tics and involuntary vocalization, especially the uttering of obscenities.

Other physical symptoms that are often listed among psychiatric disorders of childhood include stuttering, enuresis (the repeated involuntary voiding of urine by day or night), encopresis (the repeated voiding of feces into inappropriate places), sleepwalking, and night terror. These symptoms are not necessarily evidence of emotional disturbance or of some other mental illness. Behavioral methods of treatment may sometimes be effective.

Infantile autism

Psychotic disorders are very rare in childhood, and of these about one-half are cases of infantile autism; boys are affected three times as often as girls. Infantile autism begins in the first two years of life and is more common in the upper socioeconomic classes. The child shows an inability to make warm emotional relationships, has a severe speech and language disorder, and exhibits a desire for sameness in which he shows distress if thwarted from his stereotyped behaviour. There is some evidence to support genetic and organic factors in causation. Treatment involves management of the abnormal behaviour, training in life skills and occupational activities, and counseling for the family.

Other mental disorders

Factitious disorders. These are characterized by physical or psychological symptoms that are voluntarily self-induced; they are distinguished from hysteria, in which the physical symptoms are produced unconsciously. In factitious disorders, although the person's attempts to create or exacerbate the symptoms of an illness are voluntary, such behaviour is neurotic in that the individual is unable to refrain from it; i.e., his goals, whatever they may be, are involuntarily adopted.

In malingering, by contrast, the person simulates or exaggerates an illness or disability to obtain some kind of discernible personal gain or to avoid an unpleasant situation; e.g., a prison inmate may simulate madness to obtain more comfortable living conditions. It is important to recognize factitious disorders as evidence of psychological disturbance. Treatment is of the underlying conflicts.

Disorders of impulse control

These conditions are usually associated with a disorder of personality. There is a failure to resist desires, impulses, or temptations to perform an act that is harmful to the individual or to others. The individual experiences a feeling of tension before committing the act and a feeling of release or gratification upon completing it. The behaviours involved include pathological gambling, setting fires (pyromania), and impulsive stealing (kleptomania).

Adjustment disorders

These are neurotic conditions in which there is an inappropriate reaction to an external stress occurring within three months of the stress. The symptoms may be out of proportion to the degree of stress, or they may be maladaptive in the sense that they prevent the individual from coping adequately in his social or occupational setting. These disorders are often associated with other neurotic conditions such as anxiety neurosis or minor depression.