Personality Disorders
Definition | Aetiology | Pathophysiology | Risk factors | Signs and symptoms | Investigations | Management
Definition
Personality Disorders are a group of mental health conditions characterised by enduring patterns of maladaptive thoughts, emotions, and behaviours that deviate from cultural norms and cause significant distress or impairment in personal, social, and occupational functioning.
Aetiology
- Genetic factors: hereditary influences on temperament and emotional regulation.
- Neurobiological factors: dysfunction in the amygdala, prefrontal cortex, and serotonin pathways.
- Early life experiences: childhood trauma, neglect, or abuse.
- Environmental influences: unstable relationships, social disadvantage.
Pathophysiology
- Altered connectivity between the limbic system and prefrontal cortex affecting emotional regulation.
- Neurotransmitter imbalances, particularly serotonin, dopamine, and noradrenaline.
- Developmental influences impacting attachment, coping mechanisms, and stress responses.
Risk factors
- Family history of personality disorders or psychiatric illness.
- Early childhood trauma (e.g., neglect, physical, emotional, or sexual abuse).
- Unstable home environment or parental substance misuse.
- Neurodevelopmental conditions (e.g., ADHD, ASD).
- Substance misuse and impulsivity.
Signs and symptoms
- Cluster A (Odd or Eccentric):
- Paranoid personality disorder: distrust, suspicion.
- Schizoid personality disorder: detachment, lack of emotional expression.
- Schizotypal personality disorder: eccentric behaviours, social anxiety.
- Cluster B (Dramatic, Emotional, or Erratic):
- Borderline personality disorder (BPD): unstable relationships, emotional dysregulation, impulsivity.
- Antisocial personality disorder (ASPD): disregard for others, aggression, deceitfulness.
- Histrionic personality disorder: attention-seeking, excessive emotions.
- Narcissistic personality disorder: grandiosity, lack of empathy.
- Cluster C (Anxious or Fearful):
- Avoidant personality disorder: hypersensitivity to criticism, social inhibition.
- Dependent personality disorder: excessive need for reassurance.
- Obsessive-compulsive personality disorder: perfectionism, rigidity.
Investigations
- Comprehensive psychiatric assessment: history, mental state examination.
- Structured diagnostic tools: Minnesota Multiphasic Personality Inventory (MMPI).
- Collateral history: from family or caregivers.
- Exclusion of organic causes: blood tests (FBC, U&Es, TFTs) if necessary.
Management
1. Psychological therapies:
- Dialectical Behaviour Therapy (DBT) for borderline personality disorder.
- Cognitive Behavioural Therapy (CBT) for maladaptive thought patterns.
- Mentalisation-based therapy (MBT) to improve emotional regulation.
- Schema therapy for long-standing personality issues.
2. Pharmacological management (symptom-targeted approach):
- SSRIs for comorbid depression and anxiety.
- Antipsychotics for transient psychotic symptoms in cluster A and B disorders.
- Mood stabilisers (e.g., lithium, lamotrigine) for emotional dysregulation.
3. Social and lifestyle interventions:
- Support groups for individuals and families.
- Occupational support and structured routines.
- Substance misuse intervention if relevant.
4. Referral:
- Community mental health team (CMHT): for long-term support.
- Psychotherapist: for structured therapy.
- Crisis team: if acute risk of self-harm or suicide.