Personality disorders

Abstract

Personality disorders (PDs) are characteristic, maladaptive patterns of thoughts, feelings, perceptions, and behaviors that begin early and last long. They are displayed in a wide range of situations. They affect many spheres of the individual's life. They also involve departures from the standards of behavior in the individual's social-cultural environment. They are often described as extreme and inflexible manifestations of personality characteristics that can be found in normal populations. The ten heterogeneous PDs in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) exist in the region between psychological health and illness. Social and occupational functioning may be impaired, but without major distress or loss of contact with reality. People do not suddenly become "ill" with a PD and seek help. Instead, people with PDs feel normal and at home with their conditions. Their disordered personalities and self-concepts are all they know and remember, and they may value the traits in themselves that are problematic for those around them. PDs are "ego-syntonic", whereas most other DSM-IV-TR disorders are ego-dystonic conditions that feel unfamiliar and undesirable. PDs are more closely tied to cultural expectations than other DSM-IV-TR disorders. Diagnosing PDs requires that judgments of personality deviance be made about persons who often value their maladaptive beliefs and habits. Although persons with PDs may not be distressed by their adjustment difficulties, they are often unhappy and distress can be found in their lives. PDs are often intertwined with academic problems, work problems, family and relationship problems, substance abuse, violence and criminality, suicide, mortality, accidents, emergency room visits, child custody battles, and therapy failures, dropouts, and referrals. PDs may affect the course of Axis I disorders and responses to psychological and pharmacological treatments. Individuals with PDs are often reluctant to accept professional help and they tend to blame others for their difficulties (O'Connor & Dyce, 2001). © 2010 Springer-Verlag US.