1. Definition of personality disorder

Personality is a collection of emotions, thoughts, behaviours and interaction patterns of an individual, which are consistent over time and situations.

2. What is a Personality Disorder?

Individuals with a Personality Disorder have certain patterns of inner processes and behaviour which differ clearly from the majority of the population. These differences appear in the person's perception, thoughts, emotions and relations to others. The patterns are long-lasting and rigid, and they appear in different situations. They cause them to interpret situations in a different way from other people.

It is important to keep in mind that there is no clear line between socially accepted and socially deviant differences. Depending on cultural values, the same behaviour can be regarded as normal, extreme or as a disorder.

Therefore it is particularly important to distinguish between a personality style and a personality disorder.

To every personality disorder belongs a personality style, which characterizes the "extreme" parameter value within a normal human characteristic.

Personality Style	Personality Disorder
conscientious, diligent	obsessive-compulsive (Note:Obsessive-compulsive PD is not the same as OCD)
ambitious, self-confident	narcissistic
expressive, emotional	histrionic
alert, suspicious	paranoid
erratic, spontaneous	borderline
affectionate, loyal	dependent
Independent, secretive, chary, lonely	schizoid
Self-critical, careful	anxious, avoidant
full of foreboding, sensitive	schizotypal
adventuresome, likely to take risks	antisocial (diagnosis)

A Personality Disorder exists only if the characteristics or symptoms produce personal harm and suffering or if they cause social disturbance, which means that the environment is suffering because of the symptoms (for example antisocial behaviour, delinquency). A person who despite his/her distinctive or maybe even conspicuous personality style is socially stable, doesn't suffer and if his/her behaviour does not have a negative impact on the environment, does not have a Personality Disorder.

3. Which different Personality Disorders exist?

In order to standardize the description and interpretation of mental disorders, diagnosis and classification systems have been set up.

At present there exist two established classification systems for mental disorders: The International Classification of Diseases (ICD-10) published by the World Health Organization (WHO), and the classification system of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

(For more information see "Mental Disorders and classification of mental disorders (ICD-10, DSM-IV)")

ICD-10 and DSM-IV differentiate between the following Personality Disorders (PDs):

Description:	ICD-10:	DSM-IV:
Suspicious, believes that other people will treat you wrongly, insists on own rights.	Paranoid PD	Paranoid PD
Shows great social detachement and is restricted in emotional expressions and is indifferent to emotional expressions of others and not interested in social relationships.	Schizoid PD	Schizoid PD
Social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships.		Schizotypal PD
	Dissocial PD	Antisocial PD
Characterized by instability, impulsivity, recklessness, explosiveness.	Emotionally Unstable PD Explosive type Borderline type Aggressive type	Borderline PD
People who show exaggerated emotional expressions and have an extremely strong longing for attention.	Histrionic PD	Histrionic PD
Difficulty to perform work because of an obsession of making everything perfectly right. (Not the same as OCD, Obsessive Compulsive Disorder).	Anankastistic PD	Obsessive-compulsive PD (Note: Obsessive-compulsive PD is not the same as OCD)
People with a basic fear of beeing judged, shyness and constant social discomfort (embarassed, avoiding social situations), unwillingness to commit themselves to a relation.	Anxious, avoidant PD	Avoidant PD
Not able to make day-to-day decisions. They ares afraid of being rejected or abandoned, and they put aside their own wishes and needs, while doing what others want.	Dependent PD	Dependent PD
Too strong self-importance. Exaggerates own capabilities and achievements.	Other specific PDs eccentric "unstable" type narcissistic passive-aggressive psychoneurotic immature	Narcissistic PD

4. Treatment of Personality Disorders

To people who have a Personality Disorder their (inappropriate) behaviour seems completely normal and appropriate. The feeling for malfunctioning or suffering is mostly diffuse and vague.

This makes therapy more difficult, since these patients are not not motivated to change, but try to avoid making changes. They are motivated to stabilize their situation and therefore they often block the efforts of the therapist.

Most of the patients don't seek therapy because of their Personality disorder, but because of other problems (for example depression). Often it is a relative who makes the person with a Personality Disorder consult a therapist, because it is a problem to live with someone who has that kind of disorder.

Another factor making therapy more complicated is that the patient has a problem with his/her interpersonal relations. This can also lead to problems in the relationship between patient and therapist.

Therefore it is very important for the patient with a Personality Disorder to develop a motivation for therapy and to actively aim for a change. The actual therapy of a patient with a Personality Disorder can be twofold: Psychopharmacological treatment (medication) and psychotherapy.

a) Pharmacological treatment (medication)

There is no pharmacological standard therapy for Personality Disorders. Symptoms of different Personality Disorders may be treated with different kinds of medication.

Examples:

Selective Serotonin Reuptake Inhibitors (SSRIs) (for example Citalopram, Paroxetine, Sertraline, Fontex, Prozac) More info for

• Depressive syndromes More
• Obsessive-compulsive syndromes More
• Anxiety More
• Being tense, loss of impulse control, aggressiveness

Atypical Antipsychotics (for example Quetiapin) for

• Psychotic symptoms More
• Loss of impulse control, aggressiveness

Anticonvulsants/Antiepileptics (for example Lithium, Carbamazepin, Valproat) for

• Loss of impulse control, aggressiveness
• Labile mood

Benzodiazepines (for example Lorazepam, Diazepam) for More

• Acute arousal states More
• Acute anxiety states More

b) Psychotherapy More

Two important (but not the only) forms of therapy for Personality disorders are:

• Cognitive Behavioural therapy More
• Insight therapy (psychodynamic therapy More , gestalt therapy More , etc.)

The purpose of a therapy of a Personality Disorder is not a complete cure, because it would neither be possible nor desirable to change the personality of a person completely. In fact, the main intention of psychotherapy is to compensate the differences for a longer period, so that the patient becomes socially adaptive and will feel better. This is about working on thinking and behaviour patterns, which cause problems and are harmful for the patient and his/her environment.