Personality Disorders

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by Zeenat Farooq

A personality disorder is a mental health condition that affects the way a person thinks, behaves and relates to other people. There are many types of personality disorders. To help with diagnosis, doctors organize them into different groups called clusters.

Cluster B

Cluster B personality disorders are a group of mental health conditions that affect a person’s emotions and relations. It is the most complex group of personality disorders because it is very difficult to spot in the first place. They display emotional patterns which are very disturbing and most of the times can lead to mental disturbances to the people associated with them, because the individuals do not behave like typical maniac or depression patients. They are found to be doing very good in their work, profession, activities. Most of these disorder afflicted people have a very grandiose kind of image and lifestyle that far from remotely imagining that they might be afflicted with a psychological condition, other people actually imitate them and want to become like them. Most of us might have actually been with them, worked with them, spoken to them or might even be dealing with them presently but they look “so normal” that it is almost impossible for a non-professional to spot their condition. A person with a cluster B personality disorder may have trouble controlling their emotions and display seemingly irrational behaviours. If untreated, this may cause various problems, especially interpersonal problems.

Major Types

The Medical Bible used for the study and classification of mental health conditions is Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5). It lists three main classes of personality disorders

Cluster A: People diagnosed with Cluster A Personality Disorders may find it hard to relate to others. They may behave in a way that others consider odd, eccentric, or paranoid.

Cluster B: People diagnosed with Cluster B Personality Disorders may find it hard to regulate their emotions. This may cause relationship problems. They may behave in a way that others consider overly emotional, dramatic, or erratic.

Cluster C: People diagnosed with Cluster C Personality Disorders may be seen by others as antisocial or withdrawn. They may feel very anxious and behave in a fearful manner. Within each cluster, there is a range of related personality disorders.

Under the Cluster B fall (a) Anti-social personality disorder, (b) Borderline personality disorder (BPD), (c) histrionic personality disorder and (d) narcissistic personality disorder (NPD).

Symptoms

Experiencing the symptoms of a personality disorder may cause a person to behave in ways that are distressing for them and others. Understanding the symptoms of cluster B personality disorders may help a person seek treatment. Increased awareness of symptoms may also help friends and relatives support those experiencing a cluster B personality disorder.

Antisocial personality disorder: A person may behave in ways that suggest they do not care about other people’s needs. The person may lie or manipulate the truth, break rules or other societal conventions, deceive other people, use fake names to defraud others. It may seem that they are behaving in this way for their own benefit. A person with this condition may develop behavioural patterns that are aggressive, violent, impulsive or irresponsible. The person does not usually show remorse or feel sorry for the way they are acting. If they do not get treatment, their behaviour may cause problems with law enforcement.

Borderline personality disorder: A person with borderline personality disorder may have low self-esteem and a fragile sense of self. The way they feel about themselves may affect the way they relate to others. They may feel afraid of being abandoned or alone empty, paranoid about how others think of them or behave toward them. Feeling this way may lead to unhealthy thought patterns and extreme reactions to interpersonal stress. They may react with intense anger or sadness to minor things other people say or do that would not be considered distressing to most people. These exaggerated reactions can cause difficulty in relationships. People who spend time with a person with borderline personality disorder may consider their behaviour manipulative. Interpersonal stress may cause unstable patterns in mood, with high and low periods. Sometimes a person with borderline personality disorder may talk about or carry out self-harming behaviour. They may experience suicidal thoughts and are at risk of acting on these feelings.

Histrionic personality disorder: A person diagnosed with histrionic personality disorder may behave in an attention-seeking manner that is not always appropriate. The traits which are highly noticeable in a person with this condition are behaviour that is overly emotional or sexually provocative speech that uses lots of dramatic expressions and emphasis, a tendency to be overly keen to express strong opinions that may seem unsubstantiated, believing and behaving as if people are closer to them than they are. Like borderline personality disorder, this condition is also linked to suicidal behaviour.

Narcissistic personality disorder: A person diagnosed with narcissistic personality disorder may act in a way that suggests they believe they are superior to others. They may overreact to criticism, believe they are very important, focus on grand plans and visions of success, have a strong need for admiration, act with a sense of entitlement and have trouble empathizing with others. Others may feel that a person with narcissistic personality disorder is using or manipulating them to improve their own situation.

Causes The exact cause of personality disorders is not understood. However, researchers believe they are likely influenced by both environmental and genetic factors. Some studies have shed light on some potential causal factors:

1. Sexual trauma: A 2002 study suggests a link between experiencing sexual trauma and personality disorders.

2. Verbal abuse in childhood: A 2001 study found a link between childhood verbal abuse and risk of personality disorder.

3. Brain development: A 2017 study found that people diagnosed with a personality disorder shared similar types of brain development.

4. Family history: A 2017 study found that having a sibling with a personality disorder is related to personality disorder development.

However, more research is certainly required in order to fully understand the causes of personality disorders.

Diagnosis

Recognizing some of the symptoms listed above does not mean a person has a cluster B personality disorder. Most people show some of these behaviours at certain times in their lives. A person should not attempt to diagnose themselves or others. If a person thinks they or someone they know may have a cluster B personality disorder, they should speak to a doctor. A doctor can refer a person to a mental health professional who can help diagnose the condition. The mental health professional will use DSM-5 as a reference for diagnosis.

To determine if a person meets the criteria for a condition, they will ask a person questions about their life, thoughts, feelings and behaviour. They might also talk to a person’s family or partner to get a more clear picture of their behaviour.

In order to diagnose a person with a cluster B personality disorder in accordance with DSM-5, symptoms must start when a person is an adolescent or young adult, symptoms must have continued for over a year if a person is under eighteen years of age, symptoms are consistent over time, place, and different circumstances, lead to distress and affect the person’s well-being, the symptoms being experienced are not due to another disorder or a stressful situation.

Treatment

There is a range of treatments available. What works for one person may not work for someone else. Therefore a doctor will help different afflicted individuals find the best treatment. Available treatment options include:

Talk therapy: Talk therapy or psychotherapy allows a person to express themselves to a therapist verbally. The therapist will listen to their thoughts and feelings without judgment and may offer advice.

Cognitive behavioral therapy (CBT): This helps a person examine their thought patterns and behaviours to find practical ways to change them.

Dialectical behavioural therapy (DBT): This teaches people new skills, with the aim of making positive changes in their life.

Medication: There are no specific drugs for personality disorders. However, mood stabilizers, antidepressants, antipsychotics, and anti-anxiety medications may improve specific symptoms or may be used if there are co-occurring mental health disorders such as anxiety or depression.

Coping and support: Speaking to a doctor and accessing treatment is the first step toward coping with a personality disorder.

Caution

Sometimes, a person may feel that a loved one who is experiencing a personality disorder has overstepped a personal boundary. If this is the case, they should be honest about it and discuss the situation with the person affected without passing judgment. If anyone believes a person with a personality disorder is at risk of harming themselves or others they should take emergency steps immediately. As with any mental health condition, mindfulness, meditation, and exercise may also help improve a person’s overall well-being. If left untreated, cluster B personality disorders may make it hard for a person to maintain positive relationships. With treatment, however, many but not all people can manage their condition well.

(Author is a Research Fellow at the Department of Biotechnology, University of Kashmir).

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