Introduction

‘Personality’ can be defined as the lifelong persistent and enduring characteristics and attitudes of an individual, including that person’s ways of thinking (cognition), feeling (affectivity) and behaving (impulse control and ways of relating to others and handling interpersonal situations). For instance, we may recognize individuals as being characteristically lifelong worriers or oversensitive, or having a temper under stress.

Personality is a theoretical concept and a basis for prediction, in that it is considered to remain relatively uniform over time. Personality development occurs in one’s early years and remains modifiable up to adolescence and early adulthood. Thereafter, although defined as enduring, it is not true to say that personality characteristics (traits) never change after about the age of 30. Change after such an age may be much more limited, but an analogy has been made to the way an adult body changes in shape and weight with age. Everyday life demonstrates that personality traits can become more prominent in the elderly. For instance, previously ‘prickly’ personalities may become more so in old age, whereas those previously described as ‘nice’ may become even nicer.

Normal personality may be used to refer to:

Normal personality has been considered to have five major dimensions: extroversion, emotional stability (in contrast to ‘neuroticism’), agreeableness, conscientiousness and intellectual open-mindedness.

Personality disorder can be defined as an extreme persistent variation from the normal (statistical) range of one or more personality attributes (traits), causing the individual and/or family and/or society to suffer.

It is unlikely that a diagnosis of personality disorder would be appropriate before the age of 16 or 17, as personality remains very malleable until then. Critics of the concept of personality disorder see it as representing a social rather than a medical diagnosis, i.e. a way of designating, for instance, those who behave antisocially as ‘sick’ and in need of medical treatment and control. There may also be no clear cut-off point between personality disorder and normal personality. For example, there may be a continuum among individuals from those whose personality can be described as empathic and sensitive to those who are oversensitive, to those who have a paranoid (suspicious) personality. Mild personality difficulties or personality accentuation may become apparent only under stress or, for instance, after the removal of support through the death of parents or a spouse.

Epidemiology

Statistics demonstrating the prevalence of personality disorders are generally unreliable owing to problems over the exact meaning of the term, sample selection and limited research undertaken in this area. For instance, we all have our inadequate ‘neurotic’ personality traits. Estimates suggest that up to 10–20% of the population may be diagnosed as suffering from personality disorder, as may over a quarter of those presenting to a GP with psychiatric problems. About 10% of the outpatient psychiatric population and about 5% of psychiatric hospital admissions may also be placed in this category. Overall, personality disorder is more commonly diagnosed in patients between the ages of 18 and 35, in males and in those who are of lower social class.

Clinical features

Personality disorders have been classified by:

Research demonstrates considerable reliability between psychiatrists on an individual’s trait descriptions. However, there is much less reliability on an overall actual diagnostic category of personality disorder for an individual. In the UK, ICD-10 is used for official data collection. The types of personality disorders described, with their prominent traits, are shown in Table 15.1. Not all the features described for each personality disorder will necessarily be present; three are required as a minimum for diagnosis. In clinical practice there is often an overlap between diagnostic categories, but personality disorders do tend to cluster into three or four groups, as shown in Figure 15.1. These are:

Table 15.1 ICD-10 classification of personality disorders

Figure 15.1 • Clustering of personality disorders.

The differences in the onset and course of these three clusters are illustrated in Figure 15.2.

Figure 15.2 • Differences in onset and course of clusters of personality disorders.

(Reproduced with permission from Tyrer P 2010; see Further reading)

Individuals with personality disorders may or may not regard their personalities as desirable (i.e. respectively egosyntonic or egodystonic). However, most are dissatisfied with the resulting difficulties they experience in everyday life and in sustaining interpersonal relationships. This frequently results in depression or anxiety, which may be the main complaint that leads an individual to seek psychiatric contact.

Related posts:

Cultural psychiatry Psychiatry of the elderly Psychiatry of sexuality Sleep disorders Mood disorders, suicide and parasuicide History taking and clinical examination

Stay updated, free articles. Join our Telegram channel

Join