In the psychological context, the term personality is used to describe the way an individual relates to people. Personality is the sum total of all the traits that determine how we behave, and how we interact with others.
Any inherent traits we have are due to the genes we inherit from our parents. Our experiences and environment also teach us to modify our existing traits, or learn new ones. We may learn not to do certain things because it is not acceptable, or not helpful to us in our environment. So it is a combination of nature (genetic material) and nurture (our experiences and our environment) that shape our personality traits.
Most personality traits exist in all individuals, but in a varying extent. The unique combination of these universal traits is what defines our personality.
Each of us has personality traits that assist us with our functioning across different settings like home, work and social relationships. These traits help us varied situations, and changes in life. With certain people, specific traits go to a level that affect their functioning, and cause distress to themselves or to the people around them.
A person with a personality disorder can find it difficult to relate to others or adapt to any new situation.
Certain prominent traits inhibit the person's ability to cope appropriately in the face of change or overcome difficult situations. The person may also have difficulty managing their emotions and interacting with others in social settings. They may do or say things that are considered socially inappropriate. They may have very rigid ideas about what is right or wrong; how the world should be, and how things should be done. With all these difficulties, the person struggles to lead a functional life.
“For as long as I remember, I have never fit into a group. Not with my family, neighbors, friends, or classmates at school. I have trouble getting along with those around me. All my life, people around me have not treated me with the love and affection that I deserve. They can’t see sense in what I’m saying; they can’t – or don’t want to – see that I’m right and they are wrong.
No one loves me. My friends, family, colleagues – all of them reject me when I try to get close to them.
Sometimes I feel that every day is a new ordeal. Sometimes I feel like life isn’t worth it.
Sometimes I even tell my family and friends that I’m going to kill myself, because maybe that will make them realize my worth…but it doesn’t work.
I did everything they wanted me to do, I changed my behavior so they would love me, I am trying my best to do things in a way that’s best for all of us. But it doesn’t work. I have no one. I am alone.”
(This fictional narrative has been constructed to aid the understanding of this disorder by placing it in a real life situation.)
Personality disorders are not caused by the existence of certain traits. Personality traits are shared by all of us, with a degree of variation in how much or how little of the trait we exhibit in our behavior. In other words, a person with personality disorders has the same traits as everyone else, but the trait is so pronounced or extreme that it causes distress.
It’s also important to remember that culture and context play a role: certain traits may be seen as healthy or normal in some cultures, and unhealthy or extreme in some others.
To illustrate, most of us have learnt – whether from our own experiences, or by watching people around us – that it’s not safe to trust everyone we meet. The trait of trusting could be represented on a continuum: on the extremes are the people who are very gullible, and those who mistrust everyone around them. The majority of people would fall in between these two extremes, being able to trust their friends and family, and having a healthy amount of distrust of strangers to protect themselves. The population in the middle (comprising people who have a healthy amount of distrust) is better adjusted and can take care of themselves. Those who are very gullible may get cheated again and again, while those who mistrust everyone equally are unable to maintain close relationships. They find it difficult or even impossible to alter their behavior even when they see that it’s not working for them.
For a diagnosis of a personality disorder, it is necessary that the person demonstrate the same traits for a sustained duration of time, and across several settings.
Example: Persons with antisocial personality disorder are known to have a callous disregard for others, using and manipulating them to get things done or get ahead. Let’s take the case of a person who is very aggressive and manipulative at the office. He is so ambitious that he doesn’t think twice about using others to succeed. He takes shortcuts and is not as conscientious as those around him – for him, success is more important than honesty. At home, however, his behavior may be vastly different: he gets along well with his family, and has no problems relating with them emotionally.
The person’s behavior in the workplace may suggest that he has antisocial personality disorder, but this assessment is inaccurate. For him to be diagnosed with antisocial personality disorder, he must exhibit the same callousness, manipulation and disregard at work, at home, among friends, and in other settings too.
There are several types of personality disorders, each with their own sets of symptoms. Personality disorders can be divided into three categories:
Cluster A: Odd/ eccentric behavior
Cluster B: Dramatic, Erratic, emotional behavior
Cluster C: Anxious or fearful behavior
Schizoid personality disorder
Antisocial personality disorder
Avoidant personality disorder
Paranoid personality disorder
Borderline personality disorder
Dependent personality disorder
Schizotypal personality disorder
Narcissistic personality disorder
Obsessive-compulsive personality disorder (Anankastic personality disorder)
Histrionic personality disorder
Some symptoms that are common to most personality disorders are:
Difficulty in dealing with other people (friends, family or co-workers)
Difficulty in adapting to changes in life
Tendency to see the world in black and white, with fixed ideas of how things should be done
Inability to stay in long-term, healthy relationships
Inability to take responsibility for their own actions
Tendency to take things too seriously, or be completely detached (particularly in relation to emotional issues)
Inability to change patterns of behavior, even when the patterns cause distress to themselves or others
Personality disorders could be caused by genetic factors, in combination with experiences of abuse, violence or trauma during childhood.
The modern biopsychosocial model says that a combination of biological, psychological and social factors come together in a diagnosis of personality disorders.
Biological factors: These are related to the structure of the brain, and the presence of neurotransmitters that carry critical messages to and from the brain. Research suggests that a person with personality disorder may have a malfunctioning gene that could put them at risk. A person who is genetically related to someone with a personality disorder is at a greater risk of developing the disorder.
Psychological factors: Children who have experienced trauma or child abuse may develop personality disorders.
Social factors:Absence of biological and social conditions such as a loving community and supportive relationships can increase the risk of a child being affected with personality disorder. Research says that having strong, loving relationships can offset the risks posed by the biological and social factors.
Personality disorder problems usually develop in late childhood and adolescence. The person may be seen as needy, highly-strung, difficult to be with, or manipulative. Because it is seen as an attitude problem, family and friends may not identify it as a personality disorder until early or late adulthood.
If you think someone you know has a personality disorder, there are some signs you can look out for.
This trait, which is in deficit or excess, gets the person and/or those around him into difficulty across multiple situations. There is a repetition of this behavior across different settings: at home, work, school, and other areas of social interaction
A person who has a personality disorder may have problem managing emotions; he or she may be emotionally unstable
The person may frequently have trouble with friendships and relationships. They may not be able to relate to others at all, or may strive to have relationships with several people, and have too many break ups
The person may also try to harm themselves when things don’t go their way
Remember that any person with a personality disorder has the same traits as the rest of us. Any personality trait can potentially be unhealthy, but that doesn’t mean everyone around us has a personality disorder. These signs are for identification only, and it is best to leave the diagnosis to a trained mental health expert.
Diagnosing a personality disorder can be challenging, as th eperson having a personality disorder is unwilling or unable to see that they have certain personality traits that are causing difficulties to them or others.
A mental health expert makes the diagnosis based on an interview with the patient and his or her friends and family, after identifying and reviewing the traits that are causing dysfunction, and the extent of dysfunction caused. The psychiatrist may also conduct interviews with specific questions to ensure that the person is not over-diagnosed, or under-diagnosed.
Talking therapy is the main mode of treatment for patients with personality disorders. The patient is advised to meet a trained therapist regularly to discuss how he or she is feeling, become more aware of their personality traits, and how they get along with others. This helps the person identify what behavior they need to change. In the case of some personality disorders which may be caused due to some difficult experience event (trauma, physical or mental abuse) during childhood, the therapist helps the person explore why certain patterns of behavior have been learnt, and how to change this behavior.
Patients with personality disorders do not usually need medication for their traits; the doctor may prescribe some drugs for other related issues such as depression, psychosis, or anxiety.
Caring for a person with a personality disorder can be highly challenging due to several reasons: first, the patient is unable to acknowledge or understand that their behavior is ‘abnormal’ and is causing distress to them and others. Second, the patient has strong beliefs: the environment is unjust, they are alone, no one understands them, and they are worthless. The patient displaces the anger, sadness and frustration caused by these beliefs onto their family and friends. In such a situation, here are some things that you as a caregiver can do to help the patient.
Remember that a personality disorder is not a willful or deliberate choice. It is also not the end of the patient’s functional life – the earlier the intervention and the better the adherence to the recommended treatment plan, the greater are the chances of recovery.
Patients with certain types of personality disorders – antisocial personality disorder, schizoid personality disorder, paranoid personality disorder, anankastic personality disorder and narcissistic personality disorder – do not understand or acknowledge that their behavior is causing distress. The caregiver finds it difficult to convince the patient that he or she needs treatment. Rather than pointing out that their behavior is wrong, look for a situation where the individual’s unhealthy trait gets them into some level of difficulty. Use this as an opportunity to tell them how the distress was caused (avoid referring to it as their fault). Make sure to mention that you are concerned about them, and are willing to support them if they want to get help.
Try to avoid any statements or gestures that may make the individual feel responsible for the disorder they have.
If the person resists meeting a psychiatrist, you can suggest that the person meet a counselor, who will help him or her deal with the situation better. A counselor will be able to identify the problem, and is also more likely to be able to convince the patient that he or she needs treatment than you are! If you think that the person is likely to harm himself or others, meeting a psychiatrist directly will be more effective.