What are personality disorders
Personality Disorders: Extreme manifestations of character traits that deviate significantly from the norm and are noticeable due to their inappropriateness and rigidity. Those affected are severely impaired in their performance and social adaptability and suffer greatly from the disease.
Precursors of these personality disorders often appear for the first time in childhood or adolescence as "deviant behavior", but only become fully apparent in adulthood. Personality disorders always “arise” in early adulthood. However, the effects of a personality disorder can only become apparent later in life.
Problematic are the flowing transitions to the normal - many artists, successful managers and even politicians meet the diagnostic criteria - and the rather limited treatment options. Accordingly, the therapy focuses on coping with acute life crises.
There is always a need for therapy in such crisis situations, especially since there is a risk of secondary psychological disorders. Personality disorders have increased significantly in the last few decades or are being diagnosed with increasing frequency (borderline disorder). The number of unreported cases is high, it is estimated that around 7% of the population are affected.
According to the ICD-10 list, general criteria are determined for the diagnosis of a personality disorder, which are based on all Personality disorders apply, most notably extreme imbalance
- of emotional life (affectivity)
- of drive (motivation)
- the impulse control
- of perception and thinking.
When to the doctor
Personality disorders must always be treated by a specialist doctor or psychotherapeutic. In order to diagnose personality disorders, it must also be ruled out that these are due to organic diseases or other psychological disorders such as anxiety disorders, alcohol addiction, drug addiction and depression.
Many people stand out in everyday life because of the strong expression of individual character traits: They are tidier, more concerned, more self-confident or more suspicious than the “average person”. But only when the dominance of individual characteristics is so strong that there are disruptions in the social area and If you experience personal suffering, the doctor speaks of a personality disorder. Any character trait can "derail" in the sense of a personality disorder. Then z. B. Impulse control and perception of a person are so severely disturbed that they have a detrimental effect on social relationships and on everyday coping with life, e.g. B. divorce or job loss. In the long run, the disease leads to high levels of suffering on the part of the person concerned, but it depends less on the type than on the degree of the disorder, how strongly it dominates life.
The most common Forms of personality disorder. People who suffer from personality disorders are no longer able to respond flexibly to different social situations and other people. Rather, they impose certain, mostly unconscious expectations, prejudices or their own needs in an unadjusted and unfiltered manner on their fellow human beings. Unlike patients who primarily suffer from depression or anxiety disorders, patients with personality disorders do not see the reasons for their problems in their own weaknesses or deficits, but only in adverse circumstances or in other people. Sick people cannot learn from mistakes, as it is usually very difficult for them to see that they have done something wrong themselves.
There is no clear explanation for the development of personality disorders Root cause. If several unfavorable factors come together, it can lead to an illness:
Constitutional weakness. Emotional lability and other temperament factors can be innate and make you vulnerable to stressful living conditions.
Stressful living conditions. Permanently negative relationship experiences in childhood shape the unstable personality. Above all, the inability of the parents to establish a reliable, stable bond with the child and to adequately support it in its development favors the development of a personality disorder. Risk factors also include the early loss of a parent, mental illness in the parents, alcohol abuse, neglect, and a family climate characterized by quarrels and hostilities.
Traumatization. Many patients with a personality disorder experience traumatic experiences, in particular abuse, sexual abuse or severe neglect from the family environment.
The personality disorder usually becomes apparent in early adulthood - often when adolescents leave home. While the family has come to terms with the child's personality disorder over the years, the sick person suddenly notices that things are suddenly no longer working as usual: partnerships fail, colleagues turn out to be "malicious", their own goals in life (professional qualification, secure Position, family) are not reached. The “classic” psychological symptoms such as depression, anxiety disorders, addictions and self-harming behavior then arise as follow-up problems. Dependence and self-harm have the character of a kind of "self-medication" in that they serve to reduce unbearable internal tensions.
Many affected people manage to live relatively symptom-free and inconspicuous for many years if they manage to create a stable situation for themselves, to which their rigid behavior patterns fit. For example, a person with dependent personality disorder may find a partner who will patronize them and take care of all decisions, and a person with obsessive-compulsive personality disorder will find a job that demands their penitentiality and obsession and brings them recognition.
But if through a drastic experience, e.g. B. Termination or divorce, the affected person then slips from under the feet, he collapses psychologically, in extreme cases even threatens suicide. For the environment, however, the collapse usually comes as a complete surprise.
The doctor does that
Personality disorders are difficult to diagnose. On the one hand, this is due to the fact that intelligent people in particular often integrate them well into a friendly and inconspicuous "personality facade"; on the other hand, it is less the personality disorder itself than the subsequent problems such as depression or dependence that drive those affected to the doctor.
Treating personality disorders is difficult and tedious. It can be done on an outpatient basis, but inpatient treatment of several months is usually recommended, which is then continued as outpatient (psychoanalytic) further treatment.
Psychiatric drugs. The symptoms of personality disorder vary greatly depending on the type. That is why there is no such thing as personality disorders the healing drug. Rather, the medication depends on the accompanying symptoms. Antidepressants (e.g. SSRIs), neuroleptics or tranquilizers are used.
Psychotherapy. Various models have been developed for psychotherapy, such as B. the Transference Focused Therapy (TFT), in which the relationship and identity problems of the person concerned are the focus. From behavior therapy comes the behavioral-oriented dialectical-behavioral therapy, which is explained in the therapy of borderline disorders. Both approaches focus on dealing with disturbed relationship patterns and disturbed self-esteem, the latent risk of suicide, the addiction problems usually associated with the disease and the occurrence of depression and anxiety. It is important to establish a stable therapy - because it is part of the disorder of the disease that the patient interrupts the treatment early.
Studies show that both behavioral and depth psychological treatment approaches are effective overall, but not always the same depending on the type and severity of the symptoms. With therapy support, a third of the patients have the chance of a very favorable progression with retention of their employment, while a further third can only cope with everyday demands to a limited extent.
It is important for the success of the therapy that the treatment is not limited to the superficial symptoms: If, for example, only the depressive symptoms are treated while the underlying disease of the personality disorder is not recognized, there can be no cure.
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In the personality disorder, strategies become visible that were previously often necessary for the patient's survival: being very tidy, never showing feelings, always obeying, putting your own needs aside, always shining or always only being noticed when you scream and rage. In later life, these patterns of thought and behavior turn out to be inappropriate, obstructive and increasingly stressful. Breaking these behavioral patterns learned over a long period of time and instead trying something new not only takes strength (including that of the relatives), but above all takes time.
- P. Fiedler: Personality disorders. Beltz, 2001. Comprehensive textbook, also suitable for (pre-trained) laypeople.
- R. Sachse: Personality disorders - guidelines for psychological psychotherapy. Hogrefe, 2004. Specialist book in which the disease and treatment options are explained - also understandable for the layperson who has been informed beforehand.
AuthorsGisela Finke, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:31
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