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In this essay we will discuss about personality disorders.
Prevalence of personality disorder is general population is about 5-10%. In ICD-10, personality disorders are listed in section on ‘Disorders of Adult Personality and Behaviour’ DSM-IV classifies Personality Disorders into group of clusters (A, B and C) as given in Table 24.1.
Essay # 1. Cluster A (Odd & Eccentric):
The odd or eccentric group includes he paranoid, schizoid and Schizotypal personality disorders.
Affected individuals use the following defense mechanisms and may have a tendency towards psychotic thinking:
a) Projection:
Projection involves attributing to another person, thoughts or feelings of one’s own that are unacceptable, such as prejudice, excessive fault-finding and paranoia.
b) Fantasy:
Fantasy is the creation of an imaginary life with Somatization disorder is associated with histrionic which the patient deals with loneliness.
c) Paranoia:
Paranoia is thinking of being prosecuted, vulnerability to cognitive disorganization when stressed.
Essay # 2. Cluster B (Dramatic, Emotional Eccentric):
The dramatic, emotional and erratic group includes histrionic, narcissistic, antisocial and borderline personality disorders. Mood disorders are common in cluster B and may be the chief complaint.
Somatization disorder is associated with histrionic personality disorders:
Affected individuals tend to use the following defense mechanisms:
a) Dissociation:
Dissociation involves the ‘forgetting’ of unpleasant feeling and associations.
b) Denial:
The patient disavows a thought, feeling or wish but is unaware of doing so.
c) Splitting:
The patient divides individuals into all good and all bad and cannot experience an ambivalent relationship, often seen in borderline personalities.
d) Acting out:
Acting out involves actual motor expression of a thought or feeling that is intolerable to the patient. It is not associated with any particular anxiety.
Essay # 3. Cluster C (Anxious & Fearful):
The anxious and fearful group includes avoidant, dependent, compulsive personality disorders.
(i) Affected individuals use the following defense mechanisms:
Isolation:
It occurs when an unacceptable feeling, act or idea is separated from the associated emotion.
Passive aggression:
Passive aggression occurs when resistance is indirect and often turned against the self.
Hypochondriasis:
Hypochondriasis is often present in patients with personality disorders, particularly in dependent, passive aggressive patients.
(ii) Twin studies have demonstrated some genetic factors in the development of cluster C personality disorders (especially compulsive personality disorder). The diagnostic criteria, epidemiology, complications, differential diagnosis and treatment is given in Tables 24.1 and Table 24.2
