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Personality disorders

Epidemiology

Vaguely 6% of the population has a personality disorder, but amongst psychiatric patients prevalence is around 20%. In prison, as much as 70% of inmates has dissocial personality.

Pathophysiology

Some genetic cause, some biological cause, a hell of a lot of social – if you’re parents beat you up, then got a divorce and you ended up living on the streets you are approximately 1,000,000% more likely to have a personality disorder. Some link to alcohol/drug abuse as well, especially dissocial and borderline.

Types of personality disorder

ICD10 classification of personality disorders is based on three clusters; A, B and C. The easiest way to remember it is:

  • Mad (Cluster A)
  • Bad (Cluster B)
  • and Sad (Cluster C

Cluster A

The mad category has two main disorders:

  • Paranoid disorder – patient has excessive sence of own importance, and blames others for mistakes and problems. Big on conspiracy theories, and mistrusts others.
  • Schizoid personality disorder – Emotionally cold, finding little pleasure in any activities. Solitary and introspective, and indifferent to expectations of others within society.

Cluster B

The bad category has four main disorders:

  • Dissocial personality disorder – Disregard for people’s feeling and social norms, with a failure to feel guilt. Easily frustrated, with low threshold for anger/violence.
  • Histrionic personality disorder – Exaggerated emotions, and craves attention. Shallow personality, easily influences by others/circumstances.
  • Emotionally unstable personality disorder: borderline type – uncertain about personal and sexual identity. Feeling of emptiness. Forms intense unstable relationships, with big rejection issues. Recurrent suicidal/self harm threats. Violent and threatening behaviour.
  • Emotionally unstable personality disorder: impulsive type – impulsive and lack self control, with sudden outbursts of anger.

Cluster C

The sad category has 3 main types:

  • Anankastic personality disorder – rigid, stubborn, excessively organised. Perfectionist. Insist people do things their way or not at all.
  • Anxious (avoidant) personality disorder – persistent tension and apprehension. Low self esteem. Avoid situations where they may feel criticised, rejected or disapproved.
  • 'Dependant personality disorder – Feel unable to cope and make decisions on own, fear being left alone, and put the needs of those they are dependent on ahead of their own.