Classification

Attempts have been made to group personality disorders into categories. These have not been highly successful. Most psychiatrists (and in fact lay-people) would agree when a person's behaviour constitutes personality disorder, but there is much less agreement over which category of disorder a given person would have. In an attempt to tackle this problem ICD-10 has grouped together "a variety of clinically significant conditions and behaviour patterns which tend to be persistent and are the expression of an individual's characteristic lifestyle and mode of relating to self and others." These 8 groupings are:

Paranoid personality disorder.
Schizoid personality disorder.
Dissocial personality disorder.
Emotionally unstable personality disorder (inc. impulsive and borderline types).
Histrionic personality disorder.
Anankastic personality disorder.
Anxious (avoidant) personality disorder.
Dependent personality disorder.

Paranoid personality disorder.

These individuals have strong beliefs that others are intent upon causing harm to them and that they would not be able to cope with this. This results in excessive vigilance for signs of danger, questioning of other peoples motives and tendency to counter-attack in response to a perceived threat or insult.

Schizoid personality disorder.

This grouping includes those who have an indifference to relationships and others' feelings. This results in solitariness, few friendships and a restricted range of emotional expression.

Dissocial personality disorder (previously called 'psychopathy' or 'antisocial').

These individuals' believe their desires justify their actions. They regard themselves as infallible and other peoples' needs and the risks of their conduct are not important. Such people appear impulsive, irresponsible, and callous, they exploit others, have unstable relationships and are drawn to criminality. This is an important category because of the forensic implications of the psychopathic personality disorders in the Mental Health Act.

Emotionally unstable personality disorder.

A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. Two subtypes are described:

Impulsive type: the predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.
Borderline type: there is marked instability of mood, relationships and self-image. They exhibit marked rapid mood shifts, intense unstable relationships and recurring impulsive self-damaging behaviour. They experience a persistent lack of identity, a sense of emptiness or boredom and they may engage in frantic efforts to avoid real or imagined abandonment.

Histrionic personality disorder.

These individuals believe that they are incapable of looking after themselves, that other people hold the key to fulfillment and that being loved by virtually everyone is essential. They therefore conducts a relentless search for reassurance, approval and praise, seek to be the centre of attention and exhibit exaggerated and inconsistent emotional responses.

Anankastic personality disorder.

This categorisation is characterised by feelings of excessive doubt and caution, preoccupation with details, rules, lists, order etc., perfectionism that interferes with task completion, pedantry, rigidity and stubbornness.

Anxious (avoidant) personality disorder.

These individuals have underlying beliefs that they are defective and unlikeable, they wish to be accepted but expect others to reject them. Such people exhibit excessive hurt following criticism, they avoid involvement with others and fear being embarrassed.

Dependent personality disorder.

These individuals believe that they are helpless and that they should be protected by someone else. They are excessively submissive, leaving important decisions to others, they are helpless when alone, they are easily hurt by criticism and fear rejection.

Great care should be made before diagnosing some categories such as histrionic. Some studies have shown the only consistent findings regarding these patients are that they are young women, treated by male doctors, with depressive symptoms but not being treated for depression. Personality disorders also confer non-specific vulnerability to developing mental illnesses, particularly of the depressive, anxious or adjustment disorder categories.

The similarities between some features of personality disorder and mental illness can bring about diagnostic confusion. It is vital that the diagnosis of personality disorder only be made after a careful longitudinal history, ideally from a reliable other. Personality influences responses to physical as well as mental illnesses and should therefore be taken into account in the assessment of patients in a wide variety of settings.

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