Personality Disorders

Personality Disorders 

Definition

Personality disorders are a group of mental disturbances defined by the fourth edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as "enduring pattern[s] of inner experience and behavior" that are sufficiently rigid and deep-seated to bring a person into repeated conflicts with his or her social and occupational environment. DSM-IV specifies that these dysfunctional patterns must be regarded as nonconforming or deviant by the person's culture, and cause significant emotional pain and/or difficulties in relationships and occupational performance. In addition, the patient usually sees the disorder as being consistent with his or her self-image (ego-syntonic) and may blame others for his or her social, educational, or work-related problems.

Description

To meet the diagnosis of personality disorder, which is sometimes called character disorder, the patient's problematic behaviors must appear in two or more of the following areas:

• perception and interpretation of the self and other people
• intensity and duration of feelings and their appropriateness to situations
• relationships with others
• ability to control impulses

Personality disorders have their onset in late adolescence or early adulthood. Doctors rarely give a diagnosis of personality disorder to children on the grounds that children's personalities are still in the process of formation and may change considerably by the time they are in their late teens. In retrospect, however, many individuals with personality disorders could be judged to have shown evidence of the problems in childhood.

It is difficult to give close estimates of the percentage of the population that has personality disorders. Patients with certain personality disorders, including antisocial and borderline disorders, are more likely to get into trouble with the law or otherwise attract attention than are patients whose disorders chiefly affect their capacity for intimacy. On the other hand, some patients, such as those with narcissistic or obsessive-compulsive personality disorders, may be outwardly successful because their symptoms are useful within their particular occupations. It has, however, been estimated that about 15% of the general population of the United States has a personality disorder, with higher rates in poor or troubled neighborhoods. The rate of personality disorders among patients in psychiatric treatment is between 30% and 50%. It is possible for patients to have a so-called dual diagnosis; for example, they may have more than one personality disorder, or a personality disorder together with a substance-abuse problem.

By contrast, DSM-IV classifies personality disorders into three clusters based on symptom similarities:

• Cluster A (paranoid, schizoid, schizotypal): Patients appear odd or eccentric to others.
• Cluster B (antisocial, borderline, histrionic, narcissistic): Patients appear overly emotional, unstable, or self-dramatizing to others.
• Cluster C (avoidant, dependent, obsessive-compulsive): Patients appear tense and anxiety-ridden to others.

The DSM-IV clustering system does not mean that all patients can be fitted neatly into one of the three clusters. It is possible for patients to have symptoms of more than one personality disorder or to have symptoms from different clusters.

Some psychiatrists maintain that the DSM-IV classification is inadequate and should be expanded to include three additional categories: passive-aggressive personality disorder, characterized by a need to control or punish others through frustrating them or sabotaging plans; cyclothymic personality disorder, characterized by intense mood swings alternating between high spirits and moroseness or gloom; and depressive personality disorder, characterized by a negative and pessimistic approach to life.

Since the criteria for personality disorders include friction or conflict between the patient and his or her social environment, these syndromes are open to redefinition as societies change. Successive editions of DSM have tried to be sensitive to cultural differences, including changes over time, when defining personality disorders. One category that had been proposed for DSM-III-R, self-defeating personality disorder, was excluded from DSM-IV on the grounds that its definition reflected prejudice against women. DSM-IV recommends that doctors take a patient's background, especially recent immigration, into account before deciding that he or she has a personality disorder. One criticism that has been made of the general category of personality disorder is that it is based on Western notions of individual uniqueness. Its applicability to people from cultures with different definitions of human personhood is thus open to question. Furthermore, even within a culture, it can be difficult to define the limits of "normalcy."

The personality disorders defined by DSM-IV are as follows:

Paranoid

Patients with paranoid personality disorder are characterized by suspiciousness and a belief that others are out to harm or cheat them. They have problems with intimacy and may join cults or groups with paranoid belief systems. Some are litigious, bringing lawsuits against those they believe have wronged them. Although not ordinarily delusional, these patients may develop psychotic symptoms under severe stress. It is estimated that 0.5-2.5% of the general population meet the criteria for paranoid personality disorder.

Schizoid

Schizoid patients are perceived by others as "loners" without close family relationships or social contacts. Indeed, they are aloof and really do prefer to be alone. They may appear cold to others because they rarely display strong emotions. They may, however, be successful in occupations that do not require personal interaction. About 2% of the general population has this disorder. It is slightly more common in men than in women.

Schizotypal

Patients diagnosed as schizotypal are often considered odd or eccentric because they pay little attention to their clothing and sometimes have peculiar speech mannerisms. They are socially isolated and uncomfortable in parties or other social gatherings. In addition, people with schizotypal personality disorder often have oddities of thought, including "magical" beliefs or peculiar ideas (for example, a belief in telepathy or UFOs) that are outside of their cultural norms. It is thought that 3% of the general population has schizotypal personality disorder. It is slightly more common in males. Schizotypal disorder should not be confused with schizophrenia, although there is some evidence that the disorders are genetically related.

Antisocial

Patients with antisocial personality disorder are sometimes referred to as sociopaths or psychopaths. They are characterized by lying, manipulativeness, and a selfish disregard for the rights of others; some may act impulsively. People with antisocial personality disorder are frequently chemically dependent and sexually promiscuous. It is estimated that 3% of males in the general population and 1% of females have antisocial personality disorder.

Borderline

Patients with borderline personality disorder (BPD) are highly unstable, with wide mood swings, a history of intense but stormy relationships, impulsive behavior, and confusion about career goals, personal values, or sexual orientation. These often highly conflictual ideas may correspond to an even deeper confusion about their sense of self (identity). People with BPD frequently cut or burn themselves, or threaten or attempt suicide. Many of these patients have histories of severe childhood abuse or neglect. About 2% of the general population have BPD; 75% of these patients are female.

Histrionic

Patients diagnosed with this disorder impress others as overly emotional, overly dramatic, and hungry for attention. They may be flirtatious or seductive as a way of drawing attention to themselves, yet they are emotionally shallow. Histrionic patients often live in a romantic fantasy world and are easily bored with routine. About 2-3% of the population is thought to have this disorder. Although historically the disorder has been more associated with womenin clinical settings, there may be bias toward diagnosing women with the histrionic personality disorder.

Narcissistic

Narcissistic patients are characterized by self-importance, a craving for admiration, and exploitative attitudes toward others. They have unrealistically inflated views of their talents and accomplishments, and may become extremely angry if they are criticized or outshone by others. Narcissists may be professionally successful but rarely have long-lasting intimate relationships. Fewer than 1% of the population has this disorder; about 75% of those diagnosed with it are male.

Avoidant

Patients with avoidant personality disorder are fearful of rejection and shy away from situations or occupations that might expose their supposed inadequacy. They may reject opportunities to develop close relationships because of their fears of criticism or humiliation. Patients with this personality disorder are often diagnosed with dependent personality disorder as well. Many also fit the criteria for social phobia. Between 0.5-1.0% of the population have avoidant personality disorder.

Dependent

Dependent patients are afraid of being on their own and typically develop submissive or compliant behaviors in order to avoid displeasing people. They are afraid to question authority and often ask others for guidance or direction. Dependent personality disorder is diagnosed more often in women, but it has been suggested that this finding reflects social pressures on women to conform to gender stereotyping or bias on the part of clinicians.

Obsessive-compulsive

Patients diagnosed with this disorder are preoccupied with keeping order, attaining perfection, and maintaining mental and interpersonal control. They may spend a great deal of time adhering to plans, schedules, or rules from which they will not deviate, even at the expense of openness, flexibility, and efficiency. These patients are often unable to relax and may become "workaholics." They may have problems in employment as well as in intimate relationships because they are very stiff and formal, and insist on doing everything their way. About 1% of the population has obsessive-compulsive personality disorder; the male/female ratio is about 2:1.

Causes and symptoms

Personality disorders are thought to result from a bad interface, so to speak, between a child's temperament and character on one hand and his or her family environment on the other. Temperament can be defined as a person's innate or biologically shaped basic disposition. Human infants vary in their sensitivity to light or noise, their level of physical activity, their adaptability to schedules, and similar traits. Even such traits as shyness or novelty-seeking may be at least in part determined by the biology of the brain and the genes one inherits.

Character is defined as the set of attitudes and behavior patterns that the individual acquires or learns over time. It includes such personal qualities as work and study habits, moral convictions, neatness or cleanliness, and consideration of others. Since children must learn to adapt to their specific families, they may develop personality disorders in the course of struggling to survive psychologically in disturbed or stressful families. For example, nervous or high-strung parents might be unhappy with a baby who is very active and try to restrain him or her at every opportunity. The child might then develop an avoidant personality disorder as the outcome of coping with constant frustration and parental disapproval. As another example, child abuse is believed to play a role in shaping borderline personality disorder. One reason that some therapists use the term developmental damage instead of personality disorder is that it takes the presumed source of the person's problems into account.

Some patients with personality disorders come from families that appear to be stable and healthy. It has been suggested that these patients are biologically hypersensitive to normal family stress levels. Levels of the brain chemical (neurotransmitter) dopamine may influence a person's level of novelty-seeking, and serotonin levels may influence aggression.

Other factors that have been cited as affecting children's personality development are the mass media and social or group hysteria, particularly after the events of September 11, 2001. Cases of so-called mass sociogenic illness have been identified, in which a group of children began to vomit or have other physical symptoms brought on in response to an imaginary threat. In two such cases, the children were reacting to the suggestion that toxic fumes were spreading through their school. Some authors believe that overly frequent or age-inappropriate discussions of terrorist attacks or bioterrorism may make children more susceptible to sociogenic illness as well as other distortions of personality.

Diagnosis

Diagnosis of personality disorders is complicated by the fact that affected persons rarely seek help until they are in serious trouble or until their families (or the law) pressure them to get treatment. The reason for this slowness is that the problematic traits are so deeply entrenched that they seem normal (ego-syntonic) to the patient. Diagnosis of a personality disorder depends in part on the patient's age. Although personality disorders originate during the childhood years, they are considered adult disorders. Some patients, in fact, are not diagnosed until late in life because their symptoms had been modified by the demands of their job or by marriage. After retirement or the spouse's death, however, these patients' personality disorders become fully apparent. In general, however, if the onset of the patient's problem is in mid- or late-life, the doctor will rule out substance abuse or personality change caused by medical or neurological problems before considering the diagnosis of a personality disorder. It is unusual for people to develop personality disorders "out of the blue" in mid-life.

There are no tests that can provide a definitive diagnosis of personality disorder. Most doctors will evaluate a patient on the basis of several sources of information collected over a period of time in order to determine how long the patient has been having difficulties, how many areas of life are affected, and how severe the dysfunction is. These sources of information may include:

Interviews

The doctor may schedule two or three interviews with the patient, spaced over several weeks or months, in order to rule out an adjustment disorder caused by job loss, bereavement, or a similar problem. An office interview allows the doctor to form an impression of the patient's overall personality as well as obtain information about his or her occupation and family. During the interview, the doctor will note the patient's appearance, tone of voice, body language, eye contact, and other important non-verbal signals, as well as the content of the conversation. In some cases, the doctor may contact other people (family members, employers, close friends) who know the patient well in order to assess the accuracy of the patient's perception of his or her difficulties. It is quite common for people with personality disorders to have distorted views of their situations or to be unaware of the impact of their behavior on others.

Psychologic testing

Doctors use psychologic testing to help in the diagnosis of a personality disorder. Most of these tests require interpretation by a professional with specialized training. Doctors usually refer patients to a clinical psychologist for this type of test.

PERSONALITY INVENTORIES. Personality inventories are tests with true/false or yes/no answers that can be used to compare the patient's scores with those of people with known personality distortions. The single most commonly used test of this type is the Minnesota Multiphasic Personality Inventory, or MMPI. Another test that is often used is the Millon Clinical Multiaxial Inventory, or MCMI.

PROJECTIVE TESTS. Projective tests are unstructured. Unstructured means that instead of giving one-word answers to questions, the patient is asked to talk at some length about a picture that the psychologist has shown him or her, or to supply an ending for the beginning of a story. Projective tests allow the clinician to assess the patient's patterns of thinking, fantasies, worries or anxieties, moral concerns, values, and habits. Common projective tests include the Rorschach, in which the patient responds to a set of ten inkblots; and the Thematic Apperception Test (TAT), in which the patient is shown drawings of people in different situations and then tells a story about the picture.

Treatment

At one time psychiatrists thought that personality disorders did not respond very well to treatment. This opinion was derived from the notion that human personality is fixed for life once it has been molded in childhood, and from the belief among people with personality disorders that their own views and behaviors are correct, and that others are the ones at fault. More recently, however, doctors have recognized that humans can continue to grow and change throughout life. Most patients with personality disorders are now considered to be treatable, although the degree of improvement may vary. The type of treatment recommended depends on the personality characteristics associated with the specific disorder.

Hospitalization

Inpatient treatment is rarely required for patients with personality disorders, with two major exceptions: borderline patients who are threatening suicide or suffering from drug or alcohol withdrawal; and patients with paranoid personality disorder who are having psychotic symptoms.

Psychotherapy

Psychoanalytic psychotherapy is suggested for patients who can benefit from insight-oriented treatment. These patients typically include those with dependent, obsessive-compulsive, and avoidant personality disorders. Doctors usually recommend individual psychotherapy for narcissistic and borderline patients, but often refer these patients to therapists with specialized training in these disorders. Psychotherapeutic treatment for personality disorders may take as long as three to five years.

Insight-oriented approaches are not recommended for patients with paranoid or antisocial personality disorders. These patients are likely to resent the therapist and see him or her as trying to control or dominate them.

Supportive therapy is regarded as the most helpful form of psychotherapy for patients with schizoid personality disorder.

Cognitive-behavioral therapy

Cognitive-behavioral approaches are often recommended for patients with avoidant or dependent personality disorders. Patients in these groups typically have mistaken beliefs about their competence or likableness. These assumptions can be successfully challenged by cognitive-behavioral methods. More recently, Aaron Beck and his coworkers have successfully extended their approach to cognitive therapy to all ten personality disorders as defined by DSM-IV.

Group therapy

Group therapy is frequently useful for patients with schizoid or avoidant personality disorders because it helps them to break out of their social isolation. It has also been recommended for patients with histrionic and antisocial personality disorders. These patients tend to act out, and pressure from peers in group treatment can motivate them to change. Because patients with antisocial personality disorder can destabilize groups that include people with other disorders, it is usually best if these people meet exclusively with others who have APD (in homogeneous groups).

Family therapy

Family therapy may be suggested for patients whose personality disorders cause serious problems for members of their families. It is also sometimes recommended for borderline patients from overinvolved or possessive families.

Medications

Medications may be prescribed for patients with specific personality disorders. The type of medication depends on the disorder. In general, however, patients with personality disorders are helped only moderately by medications.

ANTIPSYCHOTIC DRUGS. Antipsychotic drugs, such as haloperidol (Haldol), may be given to patients with paranoid personality disorder if they are having brief psychotic episodes. Patients with borderline or schizotypal personality disorder are sometimes given antipsychotic drugs in low doses; however, the efficacy of these drugs in treating personality disorder is less clear than in schizophrenia.

MOOD STABILIZERS. Carbamazepine (Tegretol) is a drug that is commonly used to treat seizures, but is also helpful for borderline patients with rage outbursts and similar behavioral problems. Lithium and valproate may also be used as mood stabilizers, especially among people with borderline personality disorder.

ANTIDEPRESSANTS AND ANTI-ANXIETY MEDICATIONS. Medications in these categories are sometimes prescribed for patients with schizoid personality disorder to help them manage anxiety symptoms while they are in psychotherapy. Antidepressants are also commonly used to treat people with borderline personality disorder.

Treatment with medications is not recommended for patients with avoidant, histrionic, dependent, or narcissistic personality disorders. The use of potentially addictive medications should be avoided in people with borderline or antisocial personality disorders. However, some avoidant patients who also have social phobia may benefit from monoamine oxidase inhibitors (MAO inhibitors), a particular class of antidepressant.

Prognosis

The prognosis for recovery depends in part on the specific disorder. Although some patients improve as they grow older and have positive experiences in life, personality disorders are generally life-long disturbances with periods of worsening (exacerbations) and periods of improvement (remissions). Others, particularly schizoid patients, have better prognoses if they are given appropriate treatment. Beck and his coworkers estimate that effective cognitive therapy with patients with personality disorders takes two to three years on average. Patients with paranoid personality disorder are at some risk for developing delusional disorders or schizophrenia.

The personality disorders with the poorest prognoses are the antisocial and the borderline. Borderline patients are at high risk for developing substance abuse disorders or bulimia. About 80% of hospitalized borderline patients attempt suicide at some point during treatment, and about 5% succeed in committing suicide. Borderline patients are also the most likely to sue their mental health professional for malpractice.

Prevention

The most effective preventive strategy for personality disorders is early identification and treatment of children at risk. High-risk groups include abused children, children from troubled families, children with close relatives diagnosed with personality disorders, children of substance abusers, and children who grow up in cults or extremist political groups.

Key terms

Character — An individual's set of emotional, cognitive, and behavioral patterns learned and accumulated over time.

Character disorder — Another name for personality disorder.

Cognitive therapy — A form of psychotherapy that focuses on changing people's patterns of emotional reaction by correcting distorted patterns of thinking and perception.

Developmental damage — A term that some therapists prefer to personality disorder, on the grounds that it is more respectful of the patient's capacity for growth and change.

Ego-syntonic — Consistent with one's sense of self, as opposed to ego-alien or dystonic (foreign to one's sense of self). Ego-syntonic traits typify patients with personality disorders.

Neuroleptic — Another name for older antipsychotic medications, such as haloperidol. The term does not apply to such newer atypical agents as clozapine (Clozaril).

Personality — The organized pattern of behaviors and attitudes that makes a human being distinctive. Personality is formed by the ongoing interaction of temperament, character, and environment.

Projective tests — Psychological tests that probe into personality by obtaining open-ended responses to such materials as pictures or stories. Projective tests are often used to evaluate patients with personality disorders.

Rorschach test — A well-known projective test that requires the patient to describe what he or she sees in each of 10 inkblots. It is named for the Swiss psychiatrist who invented it.

Temperament — A person's natural or genetically determined disposition.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.

Beck, Aaron T., Arthur Freeman, Denise D. Davis, et al. Cognitive Therapy of Personality Disorders. 2nd ed. New York: The Guilford Press, 2004.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Personality Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Battle, C. L., M. T. Shea, D. M. Johnson, et al. "Childhood Maltreatment Associated with Adult Personality Disorders: Findings from the Collaborative Longitudinal Personality Disorders Study." Journal of Personality Disorders 18 (April 2004): 193-211.

Bienenfeld, David, MD. "Personality Disorders." eMedicine August 18, 2004. http://www.emedicine.com/med/topic3472.htm.

Doyle, C. R., J. Akhtar, R. Mrvos, and E. P. Krenzelok. "Mass Sociogenic Illness—Real and Imaginary." Veterinary and Human Toxicology 46 (April 2004): 93-95.

Gutheil, T. G. "Suicide, Suicide Litigation, and Borderline Personality Disorder." Journal of Personality Disorders 18 (June 2004): 248-256.

Jordan, A. "The Role of Media in Children's Development: An Ecological Perspective." Journal of Developmental and Behavioral Pediatrics 25 (June 2004): 196-206.

Organizations

American Academy of Child and Adolescent Psychiatry (AACAP). 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. http://www.aacap.org.

American Psychiatric Association (APA). 1400 K Street, NW, Washington, DC 20005. http://www.psych.org.

National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. http://www.nimh.nih.gov.

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disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a morbid physical or mental state.

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acute stress disorder  an anxiety disorder characterized by development of anxiety, dissociative, and other symptoms within one month following exposure to an extremely traumatic event. If persistent, it may become posttraumatic stress disorder.

adjustment disorder  maladaptive reaction to identifiable stress (e.g., divorce, illness), which is assumed to remit when the stress ceases or when the patient adapts.

affective disorders  mood d's.

amnestic disorders  mental disorders characterized by acquired impairment in the ability to learn and recall new information, sometimes accompanied by inability to recall previously learned information.

anxiety disorders  mental disorders in which anxiety and avoidance behavior predominate, i.e., panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and substance-induced anxiety disorder.

attention-deficit/hyperactivity disorder  a controversial childhood mental disorder with onset before age seven, and characterized by inattention (e.g., distractibility, forgetfulness, not appearing to listen), by hyperactivity and impulsivity (e.g., restlessness, excessive running or climbing, excessive talking, and other disruptive behavior), or by a combination of both types of behavior.

autistic disorder  autism; a severe pervasive developmental disorder with onset usually before three years of age and a biological basis; it is characterized by qualitative impairment in reciprocal social interaction, verbal and nonverbal communication, and capacity for symbolic play, by restricted and unusual repertoire of activities and interests, and often by cognitive impairment.

behavior disorder  conduct d.

binge-eating disorder  an eating disorder characterized by repeated episodes of binge eating, as in bulimia nervosa, but not followed by inappropriate compensatory behavior such as purging, fasting, or excessive exercise.

bipolar disorders  mood disorders with a history of manic, mixed, or hypomanic episodes, usually with present or previous history of one or more major depressive episodes; included are bipolar I d., characterized by one or more manic or mixed episodes, bipolar II d., characterized by one or more hypomanic episodes but no manic episodes, and cyclothymic disorder. The term is sometimes used in the singular to denote either bipolar I disorder, bipolar II disorder, or both.

body dysmorphic disorder  a somatoform disorder characterized by a normal-looking person's preoccupation with an imagined defect in appearance.

breathing-related sleep disorder  any of several disorders characterized by sleep disruption due to some sleep-related breathing problem, resulting in excessive sleepiness or insomnia.

brief psychotic disorder  an episode of psychotic symptoms with sudden onset, lasting less than one month.

catatonic disorder  catatonia due to the physiological effects of a general medical condition and neither better accounted for by another mental disorder nor occurring exclusively during delirium.

character disorders  personality d's.

childhood disintegrative disorder  pervasive developmental disorder characterized by marked regression in various developmental skills, including language, play, and social and motor skills, after two to ten years of initial normal development.

circadian rhythm sleep disorder  a lack of synchrony between the schedule of sleeping and waking required by the external environment and that of a person's own circadian rhythm.

collagen disorder  an inborn error of metabolism involving abnormal structure or metabolism of collagen, e.g., Marfan syndrome, cutis laxa. Cf. collagen disease.

communication disorders  mental disorders characterized by difficulties with speech or language, severe enough to interfere academically, occupationally, or socially.

conduct disorder  a type of disruptive behavior disorder of childhood and adolescence marked by persistent violation of the rights of others or of age-appropriate societal norms or rules.

conversion disorder  a somatoform disorder characterized by conversion symptoms (loss or alteration of voluntary motor or sensory functioning suggesting physical illness) with no physiological basis and not produced intentionally or feigned; a psychological basis is suggested by exacerbation of symptoms during psychological stress, relief from tension (primary gain), or gain of outside support or attention (secondary gains).

cyclothymic disorder  a mood disorder characterized by alternating cycles of hypomanic and depressive periods with symptoms like those of manic and major depressive episodes but of lesser severity.

delusional disorder  a mental disorder marked by well-organized, logically consistent delusions of grandeur, persecution, or jealousy, with no other psychotic feature. There are six types: persecutory, jealous, erotomanic, somatic, grandiose, and mixed.

depersonalization disorder  a dissociative disorder characterized by intense, prolonged, or otherwise troubling feelings of detachment from one's body or thoughts, not secondary to another mental disorder.

depressive disorders  mood disorders in which depression is unaccompanied by manic or hypomanic episodes.

developmental coordination disorder  problematic or delayed development of gross and fine motor coordination skills, not due to a neurological disorder or to general mental retardation, resulting in the appearance of clumsiness.

disruptive behavior disorders  a group of mental disorders of children and adolescents consisting of behavior that violates social norms and is disruptive.

dissociative disorders  mental disorders characterized by sudden, temporary alterations in identity, memory, or consciousness, segregating normally integrated parts of one's personality from one's dominant identity.

dissociative identity disorder  a dissociative disorder characterized by the existence in an individual of two or more distinct personalities, with at least two of the personalities controlling the patient's behavior in turns. The host personality usually is totally unaware of the alternate personalities; alternate personalities may or may not have awareness of the others.

dream anxiety disorder  nightmare d.

dysthymic disorder  a mood disorder characterized by depressed feeling, loss of interest or pleasure in one's usual activities, and other symptoms typical of depression but tending to be longer in duration and less severe than in major depressive disorder.

eating disorder  abnormal feeding habits associated with psychological factors, including anorexia nervosa, bulimia nervosa, pica, and rumination disorder.

expressive language disorder  a communication disorder occurring in children and characterized by problems with the expression of language, either oral or signed.

factitious disorder  a mental disorder characterized by repeated, intentional simulation of physical or psychological signs and symptoms of illness for no apparent purpose other than obtaining treatment.

factitious disorder by proxy  a form of factitious disorder in which one person (usually a mother) intentionally fabricates or induces physical (Munchausen syndrome by proxy) or psychological disorders in another person under their care (usually their child) and subjects that person to needless diagnostic procedures or treatment, without any external incentives for the behavior.

female orgasmic disorder  consistently delayed or absent orgasm in a female, even after a normal phase of sexual excitement and adequate stimulation.

female sexual arousal disorder  a sexual dysfunction involving failure by a female either to attain or maintain lubrication and swelling during sexual activity, after adequate stimulation.

functional disorder  a disorder of physiological function having no known organic basis.

gender identity disorder  a disturbance of gender identification in which the affected person has an overwhelming desire to change their anatomic sex or insists that they are of the opposite sex, with persistent discomfort about their assigned sex or about filling its usual gender role.

generalized anxiety disorder  (GAD) an anxiety disorder characterized by excessive, uncontrollable worry about two or more life circumstances for six months or more.

hypoactive sexual desire disorder  a sexual dysfunction consisting of persistently or recurrently low level or absence of sexual fantasies and desire for sexual activity.

impulse control disorders  a group of mental disorders characterized by repeated failure to resist an impulse to perform some act harmful to oneself or to others.

induced psychotic disorder  shared psychotic d.

intermittent explosive disorder  an impulse control disorder characterized by multiple discrete episodes of loss of control of aggressive impulses resulting in serious assault or destruction of property that are out of proportion to any precipitating stressors.

learning disorders  a group of disorders characterized by academic functioning that is substantially below the level expected on the basis of the patient's age, intelligence, and education.

lymphoproliferative disorders  a group of malignant neoplasms arising from cells related to the common multipotential lymphoreticular cell, including lymphocytic, histiocytic, and monocytic leukemias, multiple myeloma, plasmacytoma, and Hodgkin's disease.

lymphoreticular disorders  a group of disorders of the lymphoreticular system, characterized by the proliferation of lymphocytes or lymphoid tissues.

major depressive disorder  a mood disorder characterized by the occurrence of one or more major depressive episodes and the absence of any history of manic, mixed, or hypomanic episodes.

male erectile disorder  a sexual dysfunction involving failure by a male to attain or maintain an adequate erection until completion of sexual relations.

male orgasmic disorder  consistently delayed or absent orgasm in a male, even after a normal phase of sexual excitement and stimulation adequate for his age.

manic-depressive disorder  former name for a mood disorder now known as bipolar I d. or bipolar II d. and often called bipolar d. (q.v.).

mendelian disorder  a genetic disease showing a mendelian pattern of inheritance, caused by a single mutation in the structure of DNA, which causes a single basic defect with pathologic consequences.

mental disorder  any clinically significant behavioral or psychological syndrome characterized by the presence of distressing symptoms, impairment of functioning, or significantly increased risk of suffering death, pain, or other disability.

minor depressive disorder  a mood disorder closely resembling major depressive disorder and dysthymic disorder but intermediate in severity between the two.

mixed receptive-expressive language disorder  a communication disorder involving both the expression and the comprehension of language, either spoken or signed.

monogenic disorder  mendelian d.

mood disorders  mental disorders characterized by disturbances of mood manifested as one or more episodes of mania, hypomania, depression, or some combination, the two main subcategories being bipolar disorders and depressive disorders.

motor skills disorder  any disorder characterized by inadequate development of motor coordination severe enough to restrict locomotion or the ability to perform tasks, schoolwork, or other activities.

multifactorial disorder  one caused by the interaction of genetic and sometimes also nongenetic, environmental factors, e.g., diabetes mellitus.

multiple personality disorder  dissociative identity d.

myeloproliferative disorders  a group of usually neoplastic diseases possibly related histogenetically, including granulocytic leukemias, myelomonocytic leukemias, polycythemia vera, and myelofibroerythroleukemia.

neurotic disorder  neurosis.

nightmare disorder  repeated episodes of nightmares that awaken the sleeper, with full orientation and alertness and vivid recall of the dreams.

obsessive-compulsive disorder  (OCD) an anxiety disorder characterized by recurrent obsessions or compulsions, which are severe enough to interfere significantly with personal or social functioning. Cf. obsessive-compulsive personality disorder, under personality .

obsessive-compulsive personality disorder  see under personality.

oppositional defiant disorder  a type of disruptive behavior disorder characterized by a recurrent pattern of defiant, hostile, disobedient, and negativistic behavior directed toward those in authority.

organic mental disorder  a term formerly used to denote any mental disorder with a specifically known or presumed organic etiology. It was sometimes used synonymously with organic mental syndrome.

orgasmic disorders  sexual dysfunctions characterized by inhibited or premature orgasm; see female orgasmic d., male orgasmic d., and premature ejaculation.

pain disorder  a somatoform disorder characterized by a chief complaint of severe chronic pain which is neither feigned nor intentionally produced, but in which psychological factors appear to play a major role in onset, severity, exacerbation, or maintenance.

panic disorder  an anxiety disorder characterized by attacks of panic (anxiety), fear, or terror, by feelings of unreality, or by fears of dying, or losing control, together with somatic signs such as dyspnea, choking, palpitations, dizziness, vertigo, flushing or pallor, and sweating. It may occur with or, rarely, without agoraphobia.

paranoid disorder  older term for delusional d.

personality disorders  a category of mental disorders characterized by enduring, inflexible, and maladaptive personality traits that deviate markedly from cultural expectations and either generate subjective distress or significantly impair functioning. For specific disorders, see under personality.

pervasive developmental disorders  disorders in which there is impaired development in multiple areas, including reciprocal social interactions, verbal and nonverbal communications, and imaginative activity, as in autistic disorder.

phagocytic dysfunction disorders  a group of immunodeficiency conditions characterized by disordered phagocytic activity, occurring as both extrinsic and intrinsic types. Bacterial or fungal infections may range from mild skin infection to fatal systemic infection.

phobic disorders  see phobia.

phonological disorder  a communication disorder characterized by failure to use age- and dialect-appropriate sounds in speaking, with errors occurring in the selection, production, or articulation of sounds.

plasma cell disorders  see under dyscrasia.

postconcussional disorder  see under syndrome.

posttraumatic stress disorder  (PTSD) an anxiety disorder caused by an intensely traumatic event, characterized by mentally reexperiencing the trauma, avoidance of trauma-associated stimuli, numbing of emotional responsiveness, and hyperalertness and difficulty in sleeping, remembering, or concentrating.

premenstrual dysphoric disorder  premenstrual syndrome viewed as a psychiatric disorder.

psychoactive substance use disorders  substance use d's.

psychosomatic disorder  one in which the physical symptoms are caused or exacerbated by psychological factors, as in migraine headaches, lower back pain, or irritable bowel syndrome.

psychotic disorder  psychosis.

reactive attachment disorder  a mental disorder of infancy or early childhood characterized by notably unusual and developmentally inappropriate social relatedness, usually associated with grossly pathological care.

rumination disorder  excessive rumination of food by infants, after a period of normal eating habits, potentially leading to death by malnutrition.

schizoaffective disorder  a mental disorder in which symptoms of a mood disorder occur along with prominent psychotic symptoms characteristic of schizophrenia.

schizophreniform disorder  a mental disorder with the signs and symptoms of schizophrenia but of less than six months' duration.

seasonal affective disorder  (SAD) depression with fatigue, lethargy, oversleeping, overeating, and carbohydrate craving recurring cyclically during specific seasons, most commonly the winter months.

separation anxiety disorder  prolonged, developmentally inappropriate, excessive anxiety and distress in a child concerning removal from parents, home, or familiar surroundings.

sexual disorders 

1. any disorders involving sexual functioning, desire, or performance.

2. specifically, any such disorder that is caused at least in part by psychological factors; divided into sexual dysfunctions and paraphilias.

sexual arousal disorders  sexual dysfunctions characterized by alterations in sexual arousal; see female sexual arousal d. and male erectile d.

sexual aversion disorder  feelings of repugnance for and active avoidance of genital sexual contact with a partner, causing substantial distress or interpersonal difficulty.

sexual desire disorders  sexual dysfunctions characterized by alteration in sexual desire; see hypoactive sexual desire d. and sexual aversion d.

sexual pain disorders  sexual dysfunctions characterized by pain associated with intercourse; it includes dyspareunia and vaginismus not due to a general medical condition.

shared psychotic disorder  a delusional system that develops in one or more persons as a result of a close relationship with someone who already has a psychotic disorder with prominent delusions.

sleep disorders  chronic disorders involving sleep, either primary (dyssomnias, parasomnias) or secondary to factors including a general medical condition, mental disorder, or substance use.

sleep terror disorder  a sleep disorder of repeated episodes of pavor nocturnus.

sleepwalking disorder  a sleep disorder of the parasomnia group, consisting of repeated episodes of somnambulism.

social anxiety disorder  social phobia.

somatization disorder  a somatoform disorder characterized by multiple somatic complaints, including a combination of pain, gastrointestinal, sexual, and neurological symptoms, and not fully explainable by any known general medical condition or the direct effect of a substance, but not intentionally feigned or produced.

somatoform disorders  mental disorders characterized by symptoms suggesting physical disorders of psychogenic origin but not under voluntary control, e.g., body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, and undifferentiated somatoform disorder.

somatoform pain disorder  pain d.

speech disorder  defective ability to speak; it may be either psychogenic (see communication d. ) or neurogenic. See also aphasia, aphonia, dysphasia, and dysphonia.

stereotypic movement disorder  a mental disorder characterized by repetitive nonfunctional motor behavior that often appears to be driven and can result in serious self-inflicted injuries.

substance-induced disorders  a subgroup of the substance-related disorders comprising a variety of behavioral or psychological anomalies resulting from ingestion of or exposure to a drug of abuse, medication, or toxin. Cf. substance use d's.

substance-related disorders  any of the mental disorders associated with excessive use of or exposure to psychoactive substances, including drugs of abuse, medications, and toxins. The group is divided into substance use d's and substance-induced d's .

substance use disorders  a subgroup of the substance-related disorders, in which psychoactive substance use or abuse repeatedly results in significantly adverse consequences. The group comprises substance abuse and substance dependence.

undifferentiated somatoform disorder  one or more physical complaints, not intentionally produced or feigned and persisting for at least six months, that cannot be fully explained by a general medical condition or the direct effects of a substance.

unipolar disorders  depressive d's.

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Patient discussion about Personality Disorders.

Q. How to get a bipolar person to get treatment, if refuses to carry this condition? My girlfriend’s mom told me once by phone that my girlfriend was bipolar. I started doing a little research and learned it is difficult to live with this sickness. I don't want to brake up but my safety is fading out now

A. Is your girlfriend showing symptoms of bipolar disorder? Was she ever properly diagnosed? I have noticed that a lot of people loosely make statements about others being "bipolar" when they are simply moody. If she is truly showing signs of actually havingbipolar disorder try talking to her in a calm concerned non confrontaional way. Let her know you are concerned for her safety and well being, dont give her your at home diagnosis! Tell her that it might be helpful for her to speak to someone about how she is feeling, trust me if she is symptomatic of bipolar she is suffering and may be willing to seek help if she is approached in the right manner. Assure her there is no shame in talking to someone and that you love her and care for her and you want her to be well. It is also important for you to find the right time to have this conversation, if she is manic and easily aggrivated it might not be the right time. In a mania she will feel GREAT and trying to convince some

Q. how can i know if I am a person of good fitness or not? is there any calculation with height and weight or what ever… thx!

A. people usually think that BMI (body mass index) is the best way to do so but it’s not tru. Think of it- we can be the same height and weight but I’ll be a couch potato and you a body builder. I’m an athlete, (bicycle racer) and I go to regular checkups at a sport clinic. They check what they call VO2max. that means – the oxygen volume that you consume. Unfortunately you can’t do this at home, but doctors recommend a yearly checkup here is a short video that explains it and say how to check it up and how to improve it:

http://youtube.com/watch?v=F6PnLA1bRuI

Q. What kind of job would suit a person with a disability like arthritis? My Dad is settled in USA, and he suffers from Rheumatoid Arthritis. Can anyone suggest me a job which he can take up, which he can do, without too much of physical work? He is well educated and was a teacher in India, but he is waiting for his certificates to get to USA, to apply for teaching positions.

A. Assuming you don't consider teaching in a classroom too much physical work, he should probably wait for his teaching certificates to clear and then work as a teacher. I meas, why do you feel he should change his career?