Types of personality disorder

The types of personality disorder described in ICD-10 will now be delineated. As will be appreciated, they do overlap.

• Paranoid personality disorder F60.0: in this condition, subjects appear touchy and oversensitive; they are suspicious of the motives of others and prone to the development of overvalued ideas, including ideas of reference (see Chapter 8). They may be excessively self-reliant and self-isolatory, and often quarrel with neighbours or officialdom. The symptoms fall short of satisfying criteria for psychosis. However, some do go on to develop a psychiatric illness with paranoid symptoms, typically paranoid psychosis or schizophrenia.

• Schizoid personality disorder F60.1: these subjects tend to be shy, reserved, introspective, emotionally cold, and shunning close relationships. They are often eccentric 'with preference for fantasy, solitary activities, and introspection'. A small proportion develop schizophrenia.

• Dissocial (antisocial, sociopathic, psychopathic) personality disorder F60.2: subjects show repeated antisocial behaviour, not modified by experience or punishment. This type will be discussed in more detail below. There is an excess of males over females with this diagnosis.

• Emotionally unstable personality disorder F60.3: subjects are emotionally unstable, and prone to outbursts of excessive anger or distress. The US equivalent is borderline personality disorder, and this term has come to be more frequently used. The essential concepts are the same, however. The patient may engage in repeated acts of deliberate self-harm, such as cutting or overdoses, or otherwise sabotage his or her own interests, as when they are on the point of getting a new job or starting a new relationship. There is an excess of females over males with this diagnosis.

• Histrionic personality disorder F60.4: These patients are prone to overdramati-zation and transient emotional displays, particularly regarding relationships. They are described as self-centred and emotionally shallow, and with little concern for the feelings of others. This disorder was formerly known as hysterical personality disorder.

• Anankastic (obsessive-compulsive) personality disorder F60.5: these subjects tend to be cautious, painstaking, and perfectionist and may show stubbornness and lack flexibility. They may do well in occupations requiring extreme attention to detail; conversely, they may be handicapped in forming intimate relationships, with all the give-and-take that this entails. Under stress, they may develop a neurotic reaction, characterized by depression or full-blown obsessive-compulsive disorder.

• Anxious (avoidant) personality disorder F60.6: as evident from the name, subjects are affected by chronic feelings of worry, apprehension, and low-grade anxiety symptoms generally. They may avoid social interaction, being generally shy, and often compare themselves adversely with others, leading to low self-esteem. Under stress, these patients can develop a range of anxiety or depressive conditions.

• Dependent personality disorder F60.7: subjects are characterized by 'pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others.' A typical instance would be an individual who has normal intelligence, but who fails to separate from the family, and lives a retired life at the parental home, perhaps not working, and often not presenting until the death of the parents.

Under 'Other specific personality disorders F60.8', ICD gives the following headings: eccentric, 'haltlose' (mixture of frontal lobe, antisocial, and histrionic personality traits), immature, narcissistic, passive-aggressive, and psychoneurotic, but supplies no further information about their characteristics.

In clinical practice, it is more important to make a clear diagnosis of personality disorder, based on the temporal and other characteristics, and then to describe the difficulties presented by the patient. The types of personality disorder in the classifications are really only a guide, and the majority of patients have features from more than one type of personality disorder, as described.

Multiple personality is a rare condition of dubious validity: it seems to develop in vulnerable individuals, called forth by the interest and attention that the concept may excite in the treating professionals.

Sexual deviations (see Chapter 19) may be considered as variants of personality.

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