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TOPIC TITLE: IMPORTANT FACTS ABOUT PERSONALITY DISORDERS
Created On 7/18/06 12:08 PM
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eps
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7/18/06 12:08 PM
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IMPORTANT FACTS ABOUT PERSONALITY DISORDERS
By EPS

The personality of an individual consists of some characteristics that differentiate him or her from other people. It would be fair to say that behavior is the actual product of personality. Mental problems that lead to behave in a very non-standard way and impair the individual’s functioning are known as personality disorders. On certain occasions, these problems even put some kind of emphasis to a particular characteristic that produces a very peculiar type of behavior. Although people might regard personality disorders as illnesses, they are not to be given the same interpretation. If they really were, the emotional, intellectual or perceptual functioning would need to have some kind of disruption.

It could be basically said that there are six types of personality disorders: paranoid, schizoid, explosive, histrionic, dependent, and passive aggressive.
• Paranoid disorders display a very noticeable and inappropriate mistrust or suspiciousness of others. People experiencing this type of disorder are usually secretive, aggressive, and very sensitive either when someone does not listen to them or when they are criticized.
• Schizoid disorders cause people to appear indifferent, remote, shy, quiet, unresponsive, humorless, and boring, as well as to feel very desolate.
• Explosive disorders present a tremendous emotional insecurity and, as the name implies, possess some explosive, violent expressions of anger upon minor provocation.
• Histrionic disorders exhibit a very dramatic, excitable, and expressed behavior.
• Dependent disorders put on view a significant lack of energy and initiative, correspondingly causing someone to rely on someone else for the most important aspects of life.
• Passive-aggressive disorders are characterized by the expression of opposition by indirect resources like, for example, stubbornness, procrastination, inefficiency, and forgetfulness.

A sociopath – or also known as antisocial or psychopathic - personality disorder is probably the most significant one. People who suffer from it, commonly known as sociopath, usually have a history of chronic and antisocial behavior in which the rights of someone else are violated. Typical examples of them would be criminal and delinquent people, drug addicts, and alcoholics. Among the sociopath with more standard life styles, the poor or the even non-existent job performance could be present. Interesting though it is, the sociopath do not believe there is anything wrong with their personality and are very resistant to therapy and / or medications. What’s even worse, they might not feel any guilt when they hurt someone.

Some psychologists and psychiatrists claim that a hereditary element is involved in personality disorders but at the same time ascertain that the real cause is unknown. It is also believed that some personality and behavior characteristics are permanent and only some help – not a complete cure – is available.

It has been seen that people with auditory processing and focusing deficiency, commonly regarded as “learning disabled”, display some kind of personality problems - they don’t get along with siblings and with other relatives, they have fights with their co-workers, etc. It has also been noticed that they are prone to criticize and make fun of other people whenever they have an opportunity to do so. Inevitably if a child with auditory processing and focusing deficiency attends a school in which there are children with Down syndrome and with severe mental retardations, he or she will feel very out of place, as people who are learning disabled usually function in the world pretty well - as long as there is no reading or writing involved -, whereas people with Down syndrome or with mental retardations do not. Interesting though it is, some people with learning disabilities in a given academic area such as reading or math can also have social learning disabilities where they have difficulty attending to, interpreting, and reacting appropriately to social cues. Therefore, they would need social skills training, which may involve individual and in particular group counseling to provide feedback on how to process and respond to social information. A peaceful and friendly home environment is also very helpful on several instances.

Psychiatric treatment is usually sought when the individual is pressured to by his relations or by a court. Before a professional is seen, it is imperative that the person in question be honest with him/herself. For instance, a person who over-focuses on the negative, becomes irreversibly angry with someone for some reason, while forgets or disregards a great many favors the other person has once done to him or her, finds very hard to admit that he or she is wrong, and feels insulted if he or she were told about personality disorders - depression, anxiety, mood swings, paranoia, etc. –, might not get any help on contacting a mental health professional. Meanwhile, that person could eventually be a candidate to some incurable diseases, like high blood pressure, diabetes, cancerous ulcers, etc. On some occasions, it might be helpful for those kinds of resistant clients to be invited in as "collaterals" for some other identified patients who are willing and more insightful.

Personality disorders are sometimes picked up immediately, whereas many other times their detection can be very complicated by the presence of an acute disorder of anxiety, mood or psychosis, which may resolve quickly leaving the professional with a very different impression of the underlying personality. The severity of the personality disorder and the accuracy of the information can also influence the diagnosis. Collateral history and getting to know the patient well over time help clarify matters.

Group therapy has become a common and a very effective practice for people with personality disorders. It could perhaps be said that the advantage group therapy has over regular psychotherapy is the opportunity to learn some social skills. Besides, on learning about someone else with similar problems, one might be likely to understand better his or her own. There is certainly therapeutic value to professionally supervised group therapy, as well as friendship and sponsorship.

Some people apparently would not have any improvement in their personality disorder unless they go for psychotherapy and take medications. Medication can indeed make a dramatic change in personality disorders by improving some of the most difficult symptoms such as paranoid ideation, depression, anxiety, mood swings, irritability and obsessiveness. With these features ameliorated, psychotherapy may progress more effectively.

Typically two kind of medication are used for depression, as well as for other personality disorders: SSRI’s and MAOI’s. While SSRI's elevate only serotonin (mostly) hence their name SELECTIVE serotonin reuptake inhibitors, MAOI's inhibit their enzyme, which breaks down other neurotransmitters as well thus elevating them. One must adhere to a rigid diet while on some MAOI’s which limits their use to more severe cases which might be managed with medications that do not require dietary restrictions, like SSRI's.

St. John's Wort – an herb used to help depression - may work in a similar fashion as MAOI’s, which also increase serotonin levels, as does, for example, Prozac – an antidepressant drug used medically in the treatment of depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. Therefore, one may suffer from an over-abundance of serotonin (serotonin syndrome- shaking, sweating, fever...) or possibly increases in blood pressure. Caution is to be used and/or a doctor is to be consulted when trying to combine medications and herbs. Side effects and their time to onset are highly variable person to person. MAOI-like herbs do not seem to require the dietary restrictions MAOI's do, but caution is still advisable when taking medicinal herbs because they are essential pharmaceuticals with a broad range of effects, side effects and interactions with medications

One of the side effects of Prozak is being excessively happy. One may wonder how it is possible to determine that the happiness he or she is presently having is beyond the normal level. Most people believe that happiness is the goal of the average person living in the world, while Prozak is usually given to people who feel excessively sad because of their depression. It might be hard to believe that someone who has been very sad for quite some time and has just managed to eliminate that sadness taking Prozak would ever feel that there is something wrong with him or her, however too high he or she might be. The answer is quite simple: the goal in life is balance, not too happy and not too sad. Too happy would be a state where one is experiencing a non-functional happiness as in mania. Mania may include impulsive spending, hyper-religiosity, excessive talking or inappropriate laughter. Taken to extreme, people have lost their job, spouse and shirt without much insight. This kind of "happiness" is sad indeed. A way of making certain that the happiness obtained is appropriate is through functionality, i.e. If neither the person itself nor anyone else finds the mood or the behavior inappropriate, maladaptive or dysfunctional, it is probably within the normal standards of living.

It has been claimed that Welbutrin causes someone with some stuttering history to stutter even more, since it increases the Dopamine level - a nitrogen-containing organic compound formed as an intermediate compound from dihydroxyphenylalanine (dopa) during the metabolism of the amino acid tyrosine and the precursor of the hormones epinephrine and norepinephrine. Given that speech therapists say that the real cause of stuttering is unknown and, therefore, only help toward it is available, not a complete cure, when looking at stuttering as a nervous habit which stress may exacerbate and as Wellbutrin in some people can worsen anxiety symptoms, raising neurotranmitter levels may refer to the amount present between neurons and how much/how strong of a message is sent between them. This might as a result cause or increase stuttering. As a matter of fact, some people believe that one could help stuttering by trying medications used for other stress/anxious/compulsive-related behavior such as benzodiazepines (Ativan, Klonopin etc.) and/or SSRI's.

In the event the psychologist or the counselor fails to pick up a personality disorder, it would not be appropriate to consider him or her negligent before all facts have been appropriately clarified. Once the negligence has been ascertained, it is up to the damaged person to file a complain or a lawsuit against the mental health professional. Whenever the latter is chosen, a lawyer usually requests an impartial expert mental health professional to offer an objective opinion as to whether malpractice occurred. The expert hears all sides, reviews the case and offers a professional assessment.

Some people have been lead to believe that a psychiatrist would never criticize or testify against either a colleague or someone else like, for example, a psychologist, a counselor, a social worker doing psychotherapy, etc., even when he or she has a complete proof that there has been a significant incompetence in the service the other professional has been rendering. This assumption is probably erroneous, but it is indeed very intricate to allocate malpractice in the field of psychiatry.

Four typical personality disorders would be depression, mood swings, anxiety and paranoia.

DEPRESSION

Depression is popularly known as a state of feeling down. In a more professional way of speaking, this assumption could be refined by saying that it is a state of mood or emotion that is characterized by a great deal of sadness, inactivity, and reduced ability of enjoying life. Typical examples of symptoms of depression would be slowness of thought or action, loss of appetite, disturbed sleep and insomnia. Grief, bereavement, or mourning, which are appropriate emotional responses to the loss of loved people and/or objects, should not necessarily be considered depression. Only when sadness is disproportionately long and intense in the precipitating event, is depression to be considered present. Depression accompanied by mania (extreme elation of mood) is said to be manic-depressive psychosis.

It might be fair to believe that the most common psychiatric complaint is depression. Even Hippocrates did some study about it and called it melancholia. The way depression takes place and affects vary from individual to individual: it could be fleeting or permanent, mild or severe, acute or chronic. Study shows that depression is more common in women – with a peak ranging from the ages or 35 and 45 - than in men and that the rates of incidence increase with age in men.

Incidents like the loss of one’s parents, childhood traumas and privations are likely to trigger the vulnerability to depression. Although depression is usually comprised of both psychosocial and biochemical mechanisms, stressful life events could be a very important factor in its occurrence. The problem in the biochemical mechanism is thought to be the defective regulation of the release of one or more naturally occurring monoamines in the brain, especially nor epinephrine and serotonim. As a matter of fact, reduced quantities of nor epinephrine and sorotonim are believed to cause depression as well.

Although depression – as well as anxiety – is usually associated with insomnia, there are some cases in which sleepiness is the symptom. Depression that includes excessive sleepiness and overeating is regarded as atypical. Natural methods recommended in this particular instance would be bright light therapy, exercise, scheduling activities and avoiding daytime naps.

Depression basically has three treatments: psychotherapy, drug therapy, and electro-convulsive therapy.
• Psychotherapy, which involves verbal communication with a mental health professional, intends to resolve any underlying psychic conflicts that may be causing the state of depression and gives emotional support to the patient. It is commonly practiced through psychoanalysis, nondirective psychotherapy, reeducation, hypnosis, or prestige suggestion.
• Drug Therapy (anti-depressant medications) is meant to affect the chemistry of the brain and is presumed to achieve their therapeutic effects by correcting the chemical imbalance that is causing the depression.
• Electro-convulsive therapy, which is used in severe cases in which therapeutic results are needed sooner, is performed by producing a convulsion by passing an electric current through the person’s brain.



MOOD SWINGS
A person's mood is an observable affective state, which can consist of a combination of emotions. In normal functioning, moods are influenced by external events, which are adaptive, so, obviously, a mood disorder is described as maladaptive. A mood swing is an extreme or rapid change in mood.
A mood disorder is a condition whereby the prevailing emotional mood is distorted or inappropriate to the circumstances. The two major types of mood disorders are depression (or unipolar disorder) and bipolar disorder:
• Depression (or unipolar disorder), including subtypes: Major Depression Recurrent), Major Depression with psychotic symptoms (psychotic depression), Dysthymia, and postpartum depression.
• Bipolar disorder, a mood disorder described by alternating periods of mania and depression (and in some cases rapid cycling, mixed states, and psychotic symptoms). Subtypes include: Bipolar I, Bipolar II , and Cyclothymia

Schizo-affective disorder is a vaguely-defined term (probably at the psychotic end of the bipolar spectrum) that describes patients that show symptoms of both schizophrenia and one of the mood disorders. Basic and clinical psychiatric research is increasingly showing that unipolar and bipolar mood disorders are continuous entities within the complete mood spectrum. This spectrum runs continuously from unipolar disorder to schizo-bipolar disorder with anxiety disorders running across the gamut. However, many professionals contest this claim. Some maintain that bipolar disorder, for example, may actually be biochemically closer to schizophrenia than (unipolar) depression. There are also forms of mood disorder that are specific to women, related to physiological events such as pregnancy, giving birth or the menopause - these include Premenstrual Dysphoric Disorder and Postpartum Psychosis.

Some causes of mood swings are due to hormonal changes that can temporarily upset brain chemistry, such as during PMS, perimenopause, menopause or puberty. As the hormones involved normalize, these mood swings generally subside on their own.


ANXIETY

People attribute the desire of obtaining something of one’s urgent wish or the one of getting rid of something one disgusts or hates to anxiety. This assumption is by no means incorrect, but in mental health science the concept of anxiety rather focuses on the feelings experienced by the individual. In a more scientific sense, a person is really anxious when he or she feels dread, fear, or apprehension without any reason whatsoever. Unlike true fear, which arises in response to a clear or actual danger, anxiety can arise in response to apparently innocuous situation or is simply the product of subjective, internal emotional conflicts, for what the causes might not be apparent to the person in question. Anxiety that arises during daily life is normal, whereas persistent, intense, chronic or recurring anxiety that is not justified in response to normal-life stress is regarded as a sign of an emotional disorder. When a specific situation or object unreasonably triggers the anxiety, a phobia is actually present. Anxiety with no particular cause or mental concern is known as general or free-floating anxiety.

Anxiety is considered to be the symptomatic expression of the inner emotional conflict that is caused when a person suppresses from conscious awareness experiences, feeling, or impulses that are too threatening or disturbing to live with. Anxiety can also arise from threats to an individual’s ego or self-esteem. Some behavioral psychologists ascertained that anxiety is an unfortunate learned response to frightening events in life. Symptoms of anxiety would be insomnia, outbursts of irritability, agitation, palpitations of the heart, and fears of death or insanity. When a very distressing fear is to be managed, fatigue could be experienced. On some occasion, the anxiety can bring along nausea, diarrhea, urinary frequency, suffocating sensations, dilated pupils, perspiration, and rapid breathing in the absence of any organic defect or pathology and in situations that most people handle with ease.

Hypochondriasis, hysteria, obsessive-compulsive disorders, phobias, and schizophrenia are also types of anxiety-related disorders.



PARANOIA

Popular concepts of paranoia would be:
• A rare chronic non-deteriorative psychosis characterized chiefly by systematized delusions of persecution or of grandeur that are commonly isolated from the mainstream of consciousness and that are usually not associated with hallucinations.
• A tendency on the part of individuals or of groups toward suspiciousness and distrustfulness of others that is based not on objective reality but on a need to defend the ego against unconscious impulses, that uses projection as a mechanism of defense, and that often takes the form of a compensatory megalomania.

A person is paranoid when he or she thinks or believes, without justification, that some other people are plotting or conspiring against him or her. Erroneous feelings of harassment and persecution might also be attributed to paranoia. A person with paranoid thoughts interprets or exaggerates minor incidents in a self-referent way. The paranoid may be normal people who simply have abnormal suspicions or an unshakable and highly elaborate delusional system involving worldwide conspiracies against them. A special type of paranoia is delusional jealousy, in which a person does not trust his or her spouse. A paranoid disorder usually impairs an individual's social or marital functioning, but the thinking remains clear and orderly, the intellectual functioning is impaired only minimally or not at all, and the core of his or her personality remains intact.

Moreover, It is often believed that it is very hard - or impossible - for someone who is paranoid to admit that he or she is wrong. One may question the fact that someone has difficulty admitting that he or she is wrong has nothing to do with paranoia; there is no clear connection with it at all. Meanwhile, it is often seen that people who are paranoid find very hard to admit that they are wrong.

The above puzzle could probably be answered by an anecdote, in which a woman believes she's actually dead. The doctor asks her, "Do dead people bleed?" She responds, "No, they are dead." Later on the doctor notices she has a cut and is bleeding. "See you are bleeding, therefore you see, you are not dead." She replies, "I guess I was wrong.... dead people do bleed."

Paranoia can range from a generalized suspiciousness as in Paranoid Personality to delusions, which false fixed beliefs. It is often easier to work around or with a delusion than to confront it directly, which may produce defensiveness or denial.

Some people associate paranoia with schizophrenia, but Paranoia does not necessarily mean Schizophrenia although many with Schizophrenia suffer from paranoia. There is a continuum with paranoia ranging from one discrete paranoid delusion while otherwise normal, paranoid personality with general suspiciousness, transient paranoia in association with a mood episode up to full Schizophrenia accompanied perhaps by hallucinations. A diagnostic evaluation with a mental health professional is needed to sort this out and determine the corresponding level of risk to offspring. Help is certainly available in terms of cognitive therapy and/or anti-psychotic medication for these individuals. When paranoid people are reluctant to seek treatment, a supportive position accompanied by family members or friends is helpful.

When a paranoid is psychoanalyzed, the mental health professional needs to corroborate the accuracy of the client's perspective and concerns with reliable collateral sources of information. Otherwise, the paranoia could easily be missed, especially if the patient does not provide a release of information for the professional to do so.

(Heartfelt thanks to Rabbi Richard Louis Price, M.D., from whom a great deal of information stated on this article was gathered.)

For critics, comments, or questions about this article, please reply, e-mail them to epsimon@frontiernet.net, or call (845) 781-9639 and leave a message. I am a writer and I appreciate all comments and suggestions.


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