Specific personality disorders

Specific Personality Disorder= A severe disturbance in the personality and behavioural tendencies of a person, that is not a direct consequence from another psychiatric or organic brain disorder. It is often leading to dysfunction in multiple areas of the patient’s life, including social interactions, occupations, self-image and is associated with maladaptive patterns of behaviour and thinking. The development of such a personality disorder is completed, and thus, only diagnosed in late adolescence (after age 16-17). Personality disorders persist through life. Even though certain aspects such as maladaptive and disruptive patterns of behaviour, inappropriate emotional reactions to situations and associated comorbidities (anxiety, mood disorders, etc.) can be significantly changed by various psychotherapeutic methods, there is no definitive curative treatment for the disorders themselves.

ETIOLOGY
1.     Genetic (#1)

2.     Psychosocial factors: upbringing, parent-child relationships, social environment

==ICD-10 classification: Disorders of adult personality and behavior (F60-F69) == F60 Specific personality disorders

F60.0 Paranoid personality disorder

F60.1 Schizoid personality disorder

F60.2 Dissocial personality disorder

F60.3 Emotionally unstable personality disorder

F60.4 Histrionic personality disorder

F60.5 Anankastic personality disorder

F60.6 Anxious (avoidant) personality disorder

F60.7 Dependent personality disorder

F60.8 Other specific personality disorders

F60.9 Personality disorder, unspecified

The ICD-10 classification system lists a general diagnostic checklist for the diagnosis of any personality disorder:

1)    Dysfunctional behaviour, and reactions, including affectivity, arousal, impulse control, perception, etc

2)    The abovementioned dysfunctional pattern of behaviour is persistent, and not dependent on/ a consequence of episodes of other psychiatric illnesses

3)    The dysfunctional pattern of behaviour is pervasive and maladaptive in a multitude of areas of the patient’s life

4)    The onset of the manifestations of the personality features is in childhood/ adolescence and they persist into adulthood

5)    Significant personal distress results from the manifestations of the dysfunctional personality traits

6)    There is usually, but not invariably, association with significant problems in occupational and social performance

Similar to other psychiatric disorders, in diagnosing personality disorders, it is important to take into consideration the cultural background and associated “social norms” relevant to the patient and setting.

F60.0 Paranoid personality disorder
Personality disorder characterized by excessive sensitivity to setbacks, unforgiveness of insults; suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous; recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner; and a combative and tenacious sense of personal rights. There may be excessive self-importance, and there is often excessive self-reference. (Expansive paranoid| fanatic | querulant | paranoid | sensitive paranoid)

F60.1 Schizoid personality disorder
Personality disorder characterized by withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection. There is a limited capacity to express feelings and to experience pleasure.

F60.2 Dissocial personality disorder
Personality disorder characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society. (Amoral| antisocial | asocial | psychopathic | sociopathic)

F60.3 Emotionally unstable personality disorder
Personality disorder characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts. (Aggressive | borderline | explosive)

F60.4 Histrionic personality disorder
Personality disorder characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention. (Hysterical | psychoinfantile)

F60.5 Anankastic personality disorder
Personality disorder characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder. (compulsive | obsessional | obsessive-compulsive)

F60.6 Anxious (avoidant) personality disorder
Personality disorder characterized by feelings of tension and apprehension, insecurity and inferiority. There is a continuous yearning to be liked and accepted, a hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.

F60.7 Dependent personality disorder
Personality disorder characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others. (Asthenic | inadequate | passive | self-defeating)

F60.8 Other specific personality disorders:
Eg: eccentric, haltlose type, immature, narcissistic, passive-aggressibe, psychoneurotic