Identity personality disorder
Dissociative Identity Disorder (Multiple Personality Disorder): Signs, Symptoms, Treatment
Written by WebMD Editorial Contributors
In this Article
- What Is Dissociative Identity Disorder?
- Who Is At Risk for DID?
- How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders
- How Is Dissociative Identity Disorder Diagnosed?
- What Other Psychiatric Illnesses Might Occur With DID?
- Are There Famous People With Dissociative Identity Disorder?
- What's the Treatment Plan for Dissociative Identity Disorder?
Dissociative identity disorder (previously known as multiple personality disorder) is thought to be a complex psychological condition that is likely caused by many factors, including severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse).
What Is Dissociative Identity Disorder?
Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from a combination of factors that may include trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally shuts off or dissociates themselves from a situation or experience that's too violent, traumatic, or painful to assimilate with their conscious self.
Who Is At Risk for DID?
Research indicates that the cause of DID is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances or traumas at a sensitive developmental stage of childhood (usually before age 6).
Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative. Studies indicate DID affects about 1% of the population.
How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders
Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior. With dissociative identity disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which may fluctuate.
Although not everyone experiences DID the same way, for some the "alters" or different identities have their own age, sex, or race. Each has their own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals' behavior and thoughts, it's called "switching." Switching can take seconds to minutes to days. Some seek treatment with hypnosis where the person's different "alters" or identities may be very responsive to the therapist's requests.
Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and "out of body experiences." Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn't normally do, such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.
There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:
- Depersonalization. This is a sense of being detached from one's body and is often referred to as an "out-of-body" experience.
- Derealization. This is the feeling that the world is not real or looking foggy or far away.
- Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
- Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person has trouble defining the things that interest them in life, or their political or religious or social viewpoints, or their sexual orientation, or their professional ambitions. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.
It is now acknowledged that these dissociated states are not fully mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a "host" personality within the individual, who identifies with the person's real name. Ironically, the host personality is usually unaware of the presence of other personalities.
How Is Dissociative Identity Disorder Diagnosed?
Making the diagnosis of dissociative identity disorder takes time. It's estimated that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have coexisting diagnoses of borderline or other personality disorders, depression, and anxiety.
The DSM-5 provides the following criteria to diagnose dissociative identity disorder:
- Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices.
- The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
The distinct personalities may serve diverse roles in helping the individual cope with life's dilemmas. For instance, there's an average of two to four personalities present when the patient is initially diagnosed. Then there's an average of 13 to 15 personalities that can become known over the course of treatment. Environmental triggers or life events cause a sudden shift from one alter or personality to another.
What Other Psychiatric Illnesses Might Occur With DID?
Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems, including symptoms:
- Depression
- Mood swings
- Suicidal tendencies
- Sleep disorders (insomnia, night terrors, and sleep walking)
- Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers")
- Alcohol and drug abuse
- Compulsions and rituals
- Psychotic-like symptoms (including auditory and visual hallucinations)
- Eating disorders
Are There Famous People With Dissociative Identity Disorder?
Famous people with dissociative identity disorder include comedienne Roseanne Barr, Adam Duritz, and retired NFL star Herschel Walker.
Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn't feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These "alters" could withstand the abuse he felt; other alters came to help him rise to national fame. Treatment helped Walker realize that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.
What's the Treatment Plan for Dissociative Identity Disorder?
There are currently no formal, evidence-based guldelines to treat DID. Many treatments are based on case reports or are even controversial.
While there's also no "cure" for dissociative identity disorder, long-term treatment can be helpful, if the patient stays committed. Effective treatment includes:
- Psychotherapy: Also called talk therapy, the therapy is designed to work through whatever triggered and triggers the DID. The goal is to help “fuse” the separate personality traits into one consolidated personality that can control the triggers. This therapy often includes family members in the therapy.
- Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors which accompany DID as well as help integrate the personalities into one.
- Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.
There are no established medication treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as depression or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy.
Causes, Symptoms, Types & Treatment
Overview
What is delusional disorder?
Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.
A delusion is an unshakable belief in something that’s untrue. The belief isn’t a part of the person’s culture or subculture, and almost everyone else knows this belief to be false.
People with delusional disorder often experience non-bizarre delusions. Non-bizarre delusions involve situations that could possibly occur in real life, such as being followed, deceived or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, these situations are either untrue or are highly exaggerated.
Non-bizarre delusions are different from bizarre delusions, which include beliefs that are impossible in our reality, such as believing someone has removed an organ from your body without any physical evidence of the procedure.
People with delusional disorder often continue to socialize and function well, apart from the subject of their delusion. Generally, they don’t behave in an odd or unusual manner. This is unlike people with other psychotic disorders, who might also have delusions as a symptom. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.
What are the types of delusional disorder?
There are different types of delusional disorder, which are determined based on the main theme of the delusions the person experiences. The types of delusional disorder include:
- Erotomanic: People with this type of delusional disorder believe that another person, often someone important or famous, is in love with them. They may attempt to contact the person of the delusion and engage in stalking behavior.
- Grandiose: People with this type of delusional disorder have an overinflated sense of self-worth, power, knowledge or identity. They may believe they have a great talent or have made an important discovery.
- Jealous: People with this type of delusional disorder believe that their spouse or sexual partner is unfaithful without any concrete evidence.
- Persecutory: People with this type of delusional disorder believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them). People with this type of delusional disorder may make repeated complaints to legal authorities.
- Somatic: People with this type of delusional disorder believe that they have a physical issue or medical problem, such as a parasite or a bad odor.
- Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.
What is the difference between delusional disorder and schizophrenia?
Schizophrenia is a spectrum (or range) of conditions that involve psychotic symptoms, which include:
- Disorganized speech or behavior.
- Negative symptoms (a decrease in emotion in a person’s facial expressions and motivation).
Delusional disorder is different from schizophrenia because there aren’t any other psychotic symptoms other than delusions.
In addition, in contrast to schizophrenia, delusional disorder is relatively rare, and daily functioning isn’t as impaired as it is in schizophrenia.
Who does delusional disorder affect?
Delusional disorder most often occurs in middle to late life, with the average age of onset being 40 years.
The persecutory and jealous types of delusional disorder are more common in people assigned male at birth (AMAB), and the erotomanic type is more common in people assigned female at birth (AFAB).
People who tend to be socially isolated are more likely to develop delusional disorder. These populations include:
- Immigrants who have language barriers.
- People who are deaf.
- People who are visually impaired.
- Elderly people.
How common is delusional disorder?
Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.
What is the most common type of delusional disorder?
The most common type of delusional disorder is the persecutory type — when someone believes others are out to harm them despite evidence to the contrary.
Symptoms and Causes
What are the signs and symptoms of delusional disorder?
The presence of delusions is the most obvious sign of delusional disorder, which vary based on the type.
Another characteristic of this condition is that the person often lacks self-awareness that their delusions are problematic. They’re unable to accept that their delusions are irrational or inaccurate, even if they recognize that other people would describe their delusions this way.
Anger and violent behavior may be present if someone is experiencing persecutory, jealous or erotomanic delusions.
People with delusional disorder may also develop anxiety and/or depression as a result of the delusions.
Early symptoms of delusional disorder may include:
- Feelings of being exploited.
- Preoccupation with the loyalty or trustworthiness of friends.
- A tendency to read threatening meanings into benign remarks or events.
- Persistently holding grudges.
- A readiness to respond and react to perceived slights.
What causes delusional disorder?
As with many other psychotic disorders, researchers don’t yet know the exact cause of delusional disorder. Researchers are, however, looking at the role of various factors that may contribute to the development of the condition, including:
- Genetic factors: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests there might be a genetic factor involved. Researchers believe that, as with other mental disorders, a tendency to develop delusional disorder might be passed on from parents to their biological children.
- Biological factors: Researchers are studying how abnormalities of certain areas of your brain might be involved in the development of delusional disorder. An imbalance of certain chemicals in your brain, called neurotransmitters, has been linked to the formation of delusional symptoms.
- Environmental and psychological factors: Evidence suggests that delusional disorder can be triggered by stress. Alcohol use disorder and substance use disorder might contribute to the condition. Hypersensitivity and ego defense mechanisms like reaction formation, projection and denial are some psychodynamic theories for the development of delusional disorder. Social isolation, envy, distrust, suspicion and low self-esteem are also some psychological factors that may lead to a person seeking an explanation for these feelings and, thus, forming a delusion as a solution.
Diagnosis and Tests
How is delusional disorder diagnosed?
Healthcare providers — mainly mental health professionals — diagnose delusional disorder when a person has one or more delusions for one month or more that can’t be explained by any other condition. The person must also not have the characteristic symptoms of other psychotic disorders, such as schizophrenia.
If someone is experiencing signs and symptoms of delusional disorder, a healthcare provider will perform a complete medical history and physical examination. Although there aren’t any laboratory tests to diagnose delusional disorder, their healthcare provider might use various diagnostic tests — such as imaging tests, a urine drug screen and blood tests — to rule out any physical conditions, medications or substances that could be causing the symptoms.
If their healthcare provider finds no physical reason for the symptoms, a consultation with a psychiatrist or psychologist will likely be made. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. They’ll ask questions about the delusions and assess the person’s mental status.
The psychiatrist or psychologist may also interview family members and friends so they can provide further details about the person’s delusions and a timeline of the symptoms.
As other mental health conditions can cause delusions, mental health professionals carefully assess the person for other symptoms. Delusional disorder can be misdiagnosed as any of the following conditions:
- Obsessive-compulsive disorder.
- Schizophrenia.
- Delirium/major neurocognitive disorder.
- Bipolar disorder.
- Personality disorders, especially borderline personality disorder and paranoid personality disorder.
Management and Treatment
How is delusional disorder treated?
Treatment for delusional disorder most often includes psychotherapy (talk therapy) and medication, but delusional disorder is highly resistant to treatment with medication alone.
People with delusional disorder often don’t seek treatment for the condition on their own because most people with delusional disorder don’t realize their delusions are problematic or incorrect. It’s more likely they’ll seek help due to other mental health conditions such as depression or anxiety.
People with severe symptoms or who are at risk of hurting themselves or others might need to be admitted to the hospital until the condition is stabilized.
Psychotherapy for delusional disorder
Psychotherapy is a term for a variety of treatment techniques that aim to help people identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to the person and their family.
Through therapy, people with delusional disorder can learn to manage their symptoms, identify early warning signs of relapse and develop relapse prevention plans. Types of psychotherapy include:
- Individual psychotherapy: This type of therapy can help a person recognize and correct the underlying thinking that has become distorted.
- Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A mental health professional helps people take a close look at their thoughts and emotions. They’ll come to understand how their thoughts affect their actions. Through CBT, they can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
- Family-focused therapy: This therapy can help people with delusional disorder and their families. This treatment involves psychoeducation regarding delusional disorder, communication improvement training and problem-solving skills training.
Medications for delusional disorder
The primary medications used to help treat delusional disorder are called antipsychotics (neuroleptics). Medications include the following:
- First-generation (“typical”) antipsychotics: Healthcare providers have used these medications to treat mental health conditions since the mid-1950s. These medicines work by blocking dopamine receptors in your brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. First-generation antipsychotics include chlorpromazine (Thorazine®), fluphenazine (Prolixin®), haloperidol (Haldol®), thiothixene (Navane®), trifluoperazine (Stelazine®), perphenazine (Trilafon®) and thioridazine (Mellaril®).
- Second-generation (“atypical”) antipsychotics: These newer antipsychotics are also effective in treating the symptoms of delusional disorder. They work by blocking dopamine and serotonin receptors in your brain. These drugs include risperidone (Risperdal®), clozapine (Clozaril®), quetiapine (Seroquel®), ziprasidone (Geodon®) and olanzapine (Zyprexa®). These medications are usually better tolerated than first-generation antipsychotics.
Other medications that healthcare providers might prescribe to treat delusional disorder include anxiolytics and antidepressants. Anxiolytics might help if the person has a very high level of anxiety and/or problems sleeping. Antidepressants can help treat depression, which often occurs in people with delusional disorder.
Prevention
Can delusional disorder be prevented?
There’s no known way to prevent delusional disorder. However, early diagnosis and treatment can help decrease the disruption to the person’s life, family and friendships.
Outlook / Prognosis
What is the prognosis (outlook) for delusional disorder?
The prognosis (outlook) for people with delusional disorder varies depending on a few factors, including:
- The type of delusional disorder.
- The severity of the delusions.
- The person’s life circumstances, including the availability of support and a willingness to stick with treatment.
Delusional disorder doesn’t usually significantly affect a person’s daily functioning, but the severity of the delusion may gradually get worse. Most people with delusional disorder can remain employed as long as their work doesn’t involve things related to their delusions.
The prognosis of delusional disorder is better if the person sticks to their treatment plan. Almost 50% of people have a full recovery, more than 20% of people report a decrease in symptoms and less than 20% of people report minimal to no change in symptoms.
Unfortunately, many people with this condition don’t seek help. It’s often difficult for people with mental health conditions to recognize they’re not well. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long condition.
What are the possible complications of delusional disorder?
If left untreated, delusional disorder might lead to:
- Depression, often as a consequence of difficulties associated with the delusions.
- Social isolation.
- Legal issues — for example, stalking or harassing the person involved with the delusion could lead to arrest.
- Self-harm or harm to others. This is more common in the jealous and persecutory types.
Living With
How can I help someone with delusional disorder?
If you know someone with delusional disorder, you can help by providing support and encouragement for them to seek help and treatment.
People with delusional disorder who feel pressured or repeatedly criticized by others will likely experience stress, which may worsen their symptoms. Because of this, a positive approach may be more helpful and effective.
The friends and family members of people with delusional disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.
A note from Cleveland Clinic
It’s important to remember that delusional disorder is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to life. Mental health professionals can offer treatment plans that can help manage thoughts and behaviors.
Personality disorder - causes, types, types, symptoms, signs, diagnosis (test), treatment
Features
Causes
Symptoms
Diagnosis
Treatment
Personality disorder, the causes of which are not always obvious, used to be called constitutional psychopathy. This is a mental disorder that accompanies a person throughout life. The main changes affect the character, thinking and behavior, which causes difficulties in social adaptation. The psychopath breaks the norms and rules accepted in the social environment. The severity of the changes is different - from everyday inconsistency to criminal acts with subsequent restriction of freedom.
Features of personality disorder
World statistics of diseases states that about 10% of the world's population suffers from psychopathy. Each type of personality disorder accounts for an average of about 2% of cases. A distinctive feature is that the first manifestations are noticeable already in early childhood, practically unchanged throughout life.
Psychopathy is not quite a disease in the usual sense of the word. The disease has a beginning, progression and consequences in the form of organic (irreversible) disorders of the function and structure of organs. Psychopathy is a special, painful personality structure that does not undergo any changes in the changing conditions of life. This prevents the psychopath from adapting to the environment. Relatively speaking, a person with a personality disorder will behave in the same way with a first grader and a scientist, in a tram and a living room, not realizing that different people and situations require different behavior.
The problem of psychopathic personalities, anomalies of character was thoroughly studied by the Soviet and Russian psychiatrist Pyotr Borisovich Gannushkin, whose definitions of personality disorders have not lost their relevance to this day.
Causes of personality disorders
Experts consider several main reasons:
- genetic factor - practice shows that pathological character traits are found in representatives of different generations of the same family;
- an established vicious system of interpersonal relationships - the child does not have before his eyes an example of a normal, sympathetic and empathetic family;
- a psychopathic pattern (template, model) of behavior that the child unconsciously copies due to the lack of other examples;
- pathological pregnancy, difficult childbirth and diseases of early childhood;
- childhood abuse, physical or psychological;
- difficult childhood, unfavorable developmental conditions.
Researchers believe that genetic factors are of paramount, determining importance. This theory is confirmed by the twin method: identical brothers and sisters, separated in early childhood and raised in different families, behave exactly the same in adulthood. Twins who have never interacted with each other show the same types of personality disorder.
Personality disorder symptoms
Gannushkin identified 7 types of psychopathy. Since the 90s, when the 10th revision of the International Classification of Diseases, Injuries and Causes of Death came out, the condition has been called a personality disorder, but the essence has not changed. Each type of psychopathy has its own distinctive features.
Schizotypal personality disorder is distinguished by the minimization of social contacts, lack of need for communication, coldness, lack of empathy (the ability to empathize). Schizoids are attracted to fantasies, various distant theories, they are unable to perceive life directly, sensually. Teamwork is not for them, they can be more or less successful in individual activities. Their main feature is indifference, both to themselves and to others. Such people sincerely do not understand what pleasure and joy are, because they have never experienced them.
Bipolar personality disorder according to Gannushkin includes 3 types: depressive, agitated and cyclothymic. Depressives are lifelong pessimists who are able to see only sad, gloomy sides in all the diversity of life. Excited - easy-going, carried away, often unable to foresee the consequences of their actions. The vast majority of gamblers and swindlers are of this type. Cyclothymics combine both of the above features, they are characterized by undulating mood swings, lack of stable attachments, blurring and diversity of interests.
Dissociative identity disorder in Western culture is called a split identity. It is believed that several personalities coexist in one person, which are periodically activated. We have been using this diagnosis since 2000, but it does not take root well. Domestic psychiatrists consider this disorder a kind of psychological defense of a person who has experienced extreme, unbearably painful emotions. At the same time, a person perceives the events of his life as something that happened to others.
Narcissistic personality disorder refers to the Greek myth of Narcissus, a young man who preferred the love of a real girl to looking at his reflection in the water of a stream. Like the hero of a myth, a narcissist is convinced of his exclusivity and originality, and this applies to everything from appearance to achievements. The narcissist believes that real achievements are hindered by the envy of others who put up all sorts of obstacles. Own uniqueness requires constant confirmation, so the narcissist maintains relationships only with those who admire him.
Organic personality disorder - a consequence of damage to the brain tissue by various hazards: trauma, intoxication, infection. Such a disorder occurs in the clinic in patients who have had a stroke, encephalitis, in alcoholics and drug addicts. In the latter, the condition is aggravated by the consequences of closed craniocerebral injuries, which they receive when falling from a height of their own height in a state of intoxication.
In a mild form of the disorder, the patient is disturbed by frequent headaches, weakness, fatigue, tearfulness, intolerance to stuffiness, meteorological dependence. Over time, thinking is disturbed, thoroughness, viscosity, concentration on minor details joins. Such a patient cannot separate the main from the secondary, speech becomes impoverished, emotions coarsen, periods of an evil-dreary mood (dysphoria) occur. An intellectual decline occurs, the patient cannot cope with the previous work, criminal episodes with fights and bodily injuries to the “offender” are not uncommon.
Borderline personality disorder is manifested by unstable mood, fluctuating from overestimation of oneself to humiliation. Patients are impulsive, commit rash acts, anxious, suicidal. Any little thing causes a feeling of emptiness, fears of being unnecessary, "thrown out of life." This disorder is the basis for the formation of drug addiction and eating disorders.
Personality disorder diagnostics
It is desirable to carry out such a diagnosis as early as possible, because the disorder accompanies a person all his life. Problem children should be under the supervision of a child psychiatrist in order to overcome teenage difficulties with minimal losses. Even a single consultation with a specialist will allow parents to correct the behavior of the baby, as they will understand the motives of his actions.
A variety of tests for personality disorder are used in adolescents and adults. Popular tests based on the work of Eysenck, Beck, Freeman. The test is a questionnaire with several standardized answers, a lie scale is provided so that the subject cannot be misled. The tests are fairly objective and are widely used in the clinic.
Personality disorder treatment
The basis of treatment is the choice of a life path, profession and occupation suitable for the type of personality. This is where a clinical psychologist can help. An occupation corresponding to a personality type can make a person so successful that no one will notice the disorder.
In severe cases, when the time for professional orientation is missed, medications (antidepressants, tranquilizers, nootropics), psychotherapeutic methods, including psychoanalysis, are used. Treatment options for advanced personality disorders are limited, especially in patients with addiction or irreversible brain damage.
The best solution for suspected psychopathy is timely consultation with an experienced psychiatrist.
Article author:
Novikov Vladimir Sergeevich
psychotherapist, clinical psychologist, kmn, member of the Professional Psychotherapeutic League
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Types of personality disorders and features of their treatment. Paranoid, schizoid, dissocial, hysterical disorder, obsessive-compulsive, obsessive-compulsive, anxious, narcissistic
The main feature of personality disorders are pronounced maladaptive features of the psyche - such patients do not know how and cannot get along with others, adapt to new conditions. Previously, personality disorders were called psychopathy, but over time, experts adopted a Western point of view - psychopathy is still a separate mental disorder. There are several types of personality disorders, sometimes there are mixed types of the disease. Treatment should only be carried out by experienced professionals, but the main problem with this disorder is that patients for the most part do not recognize their mental problems.
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Types of personality disorders and features of their treatment
Every fifteenth inhabitant of our planet suffers from a personality disorder. Moreover, he himself hardly perceives his condition as a disease that requires an appeal to specialists. He will justify all his actions and consider his behavior normal. Treatment denies, and the consequences are unpredictable.
Personality disorder: adjustment difficulties
Personality disorder is a maladaptive pattern of behavior caused by a persistent mental disorder that is not associated with a physical or neurological disease. This pathology is difficult to correct, because the patient does not believe that he needs treatment. There is no motivation, which is a catalyst for positive changes. The individual himself does not seek to get rid of the violation and does not make good contact with psychotherapists. Late appeal to specialists leads to the fact that the patient gets an appointment with a psychiatrist already in the stage of deep neglect of the disease. It can be difficult to relieve symptoms and cure. The first signs of the disease are actively manifested in adolescence. Before this period, individual episodes are possible, but only after the period of puberty can we talk about the problem. Individuals with cognitive personality disorder do not understand why others talk about any of their problems. After all, they believe that behavior and actions are normal. People with personality disorders are poorly perceived in society. They often have difficulties in personal communication. But at the same time, patients do not feel pangs of remorse and have no sympathy for others. After a certain time, their relationship with the world is built not according to the principle of personal adaptation to society, but according to the scheme, when the society is forced to accept or not accept a problematic person. The lack of motivation and desire to be treated exacerbates the problem, since not every doctor can find an approach to such a patient, relieve the symptoms of exacerbation and help get rid of the problem.
Specific personality disorders
In Soviet times, overly emotional individuals were often called psychopaths. Such a characterization and classification was not inherent in Western psychiatry. Psychopathy is a serious violation of a behavioral nature, in which, against the background of underdevelopment of a number of personality traits, one clearly dominates. This includes a number of deviations. Types of personality disorders:
- § Paranoid - the patient is dominated by overvalued ideas. He attaches special importance to his personality. But he treats others with hostility, suspecting them of malicious intent. A person with a pathology does not recognize its presence. When relatives or friends pay attention to a cognitive deviation and try to take him to a specialist, he will assure that everything is in order with him and deny the existence of a problem. Very sensitive to criticism.
- § Schizoid - this diagnosis is characterized by introversion, isolation, decreased interest in life's things. The patient does not perceive the accepted norms of social behavior, often behaves eccentrically. Schizoid personality disorders are associated with a great passion for some kind of activity in which the individual succeeds. For example, he may be pathologically addicted to various health systems, to the point of attracting other people to his interests. Experts believe that in this way a certain asociality is replaced. Also, such patients may have problems with alcohol, drugs or other types of addiction.
- § Dissocial - a characteristic feature of this personality disorder is the patient's cognitive defiant behavior in order to get what he wants. With all this, such patients are able to win over people, including doctors. This type is especially pronounced in late adolescence.
- § Hysterical - the main goal of such patients is to draw attention to their person in any way, including defiant behavior. The diagnosis is more typical for women. Atypical capriciousness, inconstancy of desires, extravagance, deceit are observed. In order to attract attention, the patient invents non-existent diseases for himself, the symptoms of which can be given out by the autonomic system and which is difficult to remove.
- § Obsessive-compulsive - patients with this type of personality disorder pathologically strive for order and perfection. They have no sense of humor, they try to be perfect in everything. When the set ideal goals are not achieved, they can fall into depressive states.
- § Anxiety - such a personality disorder is characterized by the cultivation of a personal inferiority complex. Patients are in a state of perpetual anxiety and uncertainty. From childhood, such patients are shy and timid. Often suspect others of hostility. They are prone to depression.
- § Narcissistic - a deviation in which a person manifests narcissism from childhood, a desire to be constantly admired. Such a patient does not accept criticism: he reacts to it either with resentment or with aggression. Indifferent to the feelings of other people, prone to exploiting them to achieve their own goals.
Different forms of psychopathy require an individual approach to treatment. Personality disorders should not be confused with character accentuation. In the latter case, a person also has behavioral features, but they lie within the upper limit of the norm. In addition, it is adapted to social conditions. The classification of classical psychopathy is inappropriate here. Diagnosis and types are different.
Causes that cause personality and behavioral disorders
All specific personality disorders are usually divided into three clusters. Their classification:
- § Types of cluster A psychopathy: paranoid and schizoid;
- § Cluster B psychopathy: hysterical, asocial, narcissistic;
- § Types of cluster B psychopathy: obsessive-compulsive, depressive.
The causes of cluster A psychopathy are considered to be genetic and hereditary. The fact is that among the relatives of patients who have a personality disorder, as a rule, there is at least one with schizophrenia. A hereditary predisposition to pathologies can also be traced in cluster B and C psychopathy. The first option can also be aggravated by problems with alcohol: in families of people who drink, children often develop with disorders. There is a version that cognitive specific personality disorders may be associated with hormonal disorders in the body. If a person has elevated levels of testosterone, estrone and estradiol, the consequences of this are manifested in the form of aggression. In addition, he does not produce enough endorphins, which, in turn, leads to depressive disorders. The social factor also plays an important role in the formation of the psychotype. For active children, space is important. If they are forced to be brought up in a closed space, small areas, this leads to the appearance of hyperactivity. Anxious babies from birth can become balanced if they are raised by emotionally stable parents. A calm mother can help a child become confident, and an anxious one can not remove, but increase his personal anxiety state. Character traits become noticeable already in early childhood. In adolescence, they can already develop as a personality disorder. Cognitive impairment is manifested in a decrease in memory, increased fatigue. Pathologies of the nervous system are observed more often in people with an asocial temperament.
Mixed personality disorder
This type of psychopathy is less studied than others. The classification has no special criteria. The patient manifests forms of one or the other type of disorders that are not persistent. Therefore, this type of disorder is also called mosaic psychopathy. But it is also difficult for a person with a mixed type of disorder to get along in society because of the peculiarities of their behavior. Instability of character is often the basis that contributes to the development of various types of addiction. Mixed personality disorder may be accompanied by alcoholism, drug addiction, gambling addiction. Mosaic psychopathy can combine symptoms of the schizoid and paranoid types. Such people do not know how to build social contacts in society, they are obsessed with overvalued ideas. With the predominance of paranoid symptoms, patients suffer from increased suspicion. They are prone to scandals, threats, like to write angry complaints about everyone and everything. Specialists are alarmed if signs (classification) of several disorders coexist in one patient: schizoid, hysterical, asthenic, excitable. In this case, there is a high risk of developing schizophrenia. Brain injuries or complications after a number of diseases can lead to mosaic types of pathology. This mixed personality disorder is considered acquired. If we consider the situation in detail, it will look like this: a person already has an innate tendency to mosaic psychopathy, which, due to certain circumstances, is superimposed by organic pathology. Mosaic disorder requires specific treatment only when symptoms worsen, or if there is organic build-up. Then neuroleptics, tranquilizers, vitamins can be prescribed by a specialist.
Infantile personality disorder
With this type of psychopathy, signs of social immaturity are pronounced. A person is not able to withstand stressful situations and relieve tension. In difficult circumstances, he does not control his emotions in the same way as children do. Infantile personality disorders for the first time clearly declare themselves in adolescence. Hormonal storms that occur at this time with a person cause changes in the psycho-emotional sphere. As you get older, the diagnosis can only progress. It is possible to finally talk about the presence of the disease only after reaching 16-17 years. In stressful circumstances, the patient manifests himself immature, poorly controls aggression, anxiety, fear. Such a person is not hired for military service, they are denied employment in law enforcement agencies. Permits to carry weapons or obtain a driver's license are decided on a limited and strictly case-by-case basis, according to an assessment of signs and condition.
Transient personality disorder
This diagnosis refers to borderline conditions, when the symptoms of deviation are difficult to attribute to any type of personality disorder. The main causes of psychopathy are long-term stressful situations. In the modern world, a person is surrounded by many unfavorable factors: troubles at work, military operations, difficult family circumstances, financial failures, moving... All this disrupts the usual way of life and unbalances. If such circumstances last too long, the human psyche does not always have a reserve to survive and overcome them. Transient personality disorder has its own characteristics:
- § disorientation;
- § hallucinations;
- § nonsense;
- § inhibition of verbal and motor functions.
Even one of the symptoms can already signal a disorder. This diagnosis is special in that the disease does not last too long: sometimes only a day, and sometimes a month. It suddenly arises and just as it passes. Sometimes a person can go to sleep with a disturbance, and get up in a normal emotional state with residual effects in the form of increased anxiety or sleep disturbances. With each new stress, a spontaneous return of pathology is possible. Such a diagnosis does not pass without a trace. In the event that there are signs of delirium or hallucinations, such a person requires special treatment, because his condition can also threaten those around him. In the period between exacerbations, the patient experiences emotional burnout, in which nerve cells are also destroyed. Therefore, even for preventive purposes, it is recommended to take vitamins and herbal remedies. As historical examples show, partial transient personality disorder is not a benign condition. Many of the famous serial killers and maniacs had this diagnosis. They led a normal life, had families, work, but during the period of exacerbations they committed crimes. When Western experts studied the brains of executed criminals, they did not find significant changes in it. All its parts corresponded to the norm of a healthy person. And only stressful conditions could lead to the appearance of signs of a personality disorder, which entailed antisocial acts. Perhaps, if during the period when the first signs of the disease appeared, there would have been a person nearby who noticed this and helped to contact a specialist, such consequences could have been avoided. Being face-to-face with continuous stressful situations, the psyche simply could not stand it. The mechanism of the development of the disease was launched.
Treatment for personality disorders
When a person is diagnosed with psychopathy, they rarely agree with it. The peculiarity of this disease is that the patient does not see problems in himself, but looks for them in others. Treatment in this case is always difficult. According to statistics, only one in five of them agree to accept help. Treatment of psychopathy is carried out individually. It includes sessions of psychotherapy and, if necessary, the use of drugs. In difficult cases, when the antisocial behavior of the patient poses a threat to others, treatment can be carried out in a hospital.