PERSONALITY DISORDER

PERSONALITY DISORDER

Causes

A combination of personal history and biology appears to play a role in most personality disorders. Genetics play a significant — but not necessarily singular — role in the development of schizotypal, schizoid and paranoid personality disorders, which all are more common in families with a history of schizophrenia. Heredity also contributes to the development of obsessive-compulsive personality disorder.

 

A family history of antisocial personality disorder increases your risk of developing the condition, but childhood trauma also has considerable influence. Children with an alcoholic parent, or who have an abusive or chaotic home life, are at increased risk of developing antisocial personality disorder.

 

Sexual abuse is a common risk factor for borderline personality disorder. People with borderline personality disorder who report sexual abuse at a younger age — younger than 13 years old — are also more likely to have post-traumatic stress disorder. Heredity and childhood head injuries also may influence the development of this disorder.

 

The causes of narcissistic, histrionic, avoidant and dependent personality disorders have been minimally studied and aren't yet well understood.

 

Treatment

A number of barriers make personality disorders among the most challenging mental health conditions to treat. People with these conditions are likely to have difficulty opening up to or retaining closeness with therapists. Perceived criticism may cause them to react angrily and break off therapy. Those who seek treatment on their own and who are motivated to stick with therapy over many years are the most likely to succeed.

 

Treatment for most personality disorders is with a combination of therapy and medications.

 

Therapy

Types of therapy that can help people with personality disorders include:

• Psychodynamic psychotherapy. This approach entails talking about your condition and related issues with a mental health professional. Psychotherapy can help people with personality disorders recognize how they're responsible for the turmoil in their lives and learn healthier ways of reacting to people and problems. Individual, group and family therapy can all be helpful.
• Cognitive behavior therapy. This form of psychological treatment involves actively retraining the way you think about problems, which in turn improves your emotions and behaviors.
• Dialectical behavior therapy. This type of cognitive behavior therapy focuses on coping skills — learning how to take better control of behaviors and emotions with techniques such as mindfulness, which helps you observe your feelings without reacting. It is most often used to treat borderline personality disorder. Doctors are studying the effectiveness of this type of therapy with all types of personality disorders.

Medications

People with personality disorders often experience serious mental and emotional strain, causing additional mental health problems, such as depression, phobia and panic. Medications may help alleviate these related conditions, but they can't cure the underlying disorder. Therapy aimed at building new coping mechanisms must be the cornerstone of treatment.

 

Medications that may offer support during therapy include:

 

• Antidepressants. Doctors commonly prescribe selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), nefazodone, and escitalopram (Lexapro), or the related antidepressant venlafaxine (Effexor) to help relieve depression and anxiety in people with personality disorders. Less often, monoamine oxidase inhibitors such as phenelzine (Nardil) and tranylcypromine (Parnate) may be used.
• Anticonvulsants. These medications may help suppress impulsive and aggressive behavior. Your doctor may prescribe carbamazepine (Carbatrol, Tegretol) or valproic acid (Depakote). Your doctor may also prescribe topiramate (Topamax), an anticonvulsant that's being studied as an aid in managing impulse-control problems.
• Antipsychotics. People with borderline and schizotypal personality disorders are at risk of losing touch with reality. Antipsychotic medications such as risperidone (Risperdal) and olanzapine (Zyprexa) can help improve distorted thinking. For severe behavior problems, doctors may prescribe haloperidol (Haldol).
• Other medications. Doctors sometimes prescribe anti-anxiety medications such as alprazolam (Xanax) and clonazepam (Klonopin) and mood stabilizers such as lithium (Eskalith, Lithobid) to relieve symptoms associated with personality disorders.