Personality disorder is a type of mental health problem that affects an individual’s thinking system, emotions, relationship building, behavior and perception of events.
It refers to problems that occur in areas related to cognition (the way of interpreting and perceiving oneself, the environment and events); affect ( being able to feel emotions in accordance with the event and situation); interpersonal functioning and impulse control (being able to control behavior). This observed behavior pattern is not flexible and does not vary according to the situation. It causes dysfunction in the individual’s life area. The age of onset is usually adolescence or the beginning of adulthood.
In order to receive a diagnosis of personality disorder in adolescents under the age of 18, the symptoms must have continued for at least one year. During this period when personality development continues and identity formation is taking place, the duration of the symptoms is very important in order to clarify whether the behavior in question indicates a mental problem. The only exception to this is that the age limit for diagnosis is not 18 for antisocial personality disorder.
As with all other mental health problems, only a mental health specialist (psychiatrist) can make a diagnosis that is appropriate for an individual’s symptoms . It is very important for individuals to seek support from a mental health specialist (psychiatrist/psychologist) before naming or diagnosing the symptoms they observe in themselves or in their environment.
The observed symptoms occur independently of any psychological problem or substance use and are long-lasting. Personality disorders are divided into three clusters, considering their symptoms and effects on the individual: a) Odd, eccentric cluster; b) Dramatic, variable cluster and c) Anxious-fearful cluster.
A)
Odd/Eccentric Cluster
This cluster is named because of the strange, eccentric thoughts and behaviors observed. The types in this cluster are: Schizoid Personality Disorder, Paranoid Personality Disorder, Schizotypal Personality Disorder.
Paranoid Personality Disorder:
Despite the lack of sufficient evidence, symptoms such as suspicion of people, concerns about being harmed or deceived, distrust of others, suspicion that information about oneself will be used against oneself, reluctance to trust people due to this suspicion and fear, interpreting clues as being likely to be harmed, anger or hostile reactions, feeling resentful, suspicion that one’s spouse/partner is cheating on one, and uncertainty about one’s fidelity are observed. Although it is more common in men, its incidence in the population is around 2-3%.
Schizoid Personality Disorder:
Being detached from social relationships, limited expression of emotion in interpersonal relationships, not enjoying close relationships, being isolated, preferring activities to be done alone, not feeling sexual desire or desire towards someone, participating in very few social activities, lack of close friends, being indifferent to people’s praise and criticism, emotional coldness, detachment and blunt expression are among the observed symptoms. It is known to be seen in 4% of the society. Related symptoms are observed from early adulthood onwards.
Schizotypal Personality Disorder:
It is a disorder that occurs acutely in social and interpersonal relationships and expresses decreased skills in establishing close relationships. It is also characterized by cognitive and perceptual impairments and strange behaviors. It is accompanied by strange beliefs and magical thoughts (unlike social beliefs such as superstition and prophecy) (for example, thinking that one has telepathy or a sixth sense). There is a strange style of thinking and speaking (such as stereotyped, vague, metaphorical, overly detailed). Suspicious and paranoid thoughts are observed. Affect that is irrelevant or incompatible with the current situation, lack of close or primary close friends, extreme anxiety and fear in social environments (may be accompanied by paranoid thoughts). It is known to start in early adulthood and is seen in 1-2% of the society.
B)
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Dramatic/Variable Set
The disorders in this cluster are named after the ones that have an emotionally dramatic content and include unpredictable thought patterns or behaviors. This cluster includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
Antisocial Personality Disorder:
Violating the rights of others, not being able to adapt to social norms and laws, getting involved in crime that often ends with legal proceedings, being prone to crime, lying for one’s own interests, deception, impulsive behaviors, anger and aggression (mostly getting into physical fights), not caring about the safety of others, not being able to maintain a certain job consistently, stealing, not feeling remorse after a negative behavior are among the most frequently observed symptoms. The frequency of occurrence is around 1-3%, more common in males. Symptoms usually start to be observed from the age of 15, but the minimum age of diagnosis is 18.
Borderline Personality Disorder:
Inconsistent emotions and behaviors are observed in interpersonal relationships and self-perception. Separation and individuation problems, symptoms related to emotional control problems and intense personal attachments can be seen at the core. Symptoms such as excessive fear of abandonment, all-or-nothing behavior, identity confusion, self-harming behaviors, constant feelings of emptiness, and angry outbursts are observed. Although it is reported that the prevalence in society, more frequently in women, is between 6-10%, it is known that this rate reaches 10% in clinical samples.
Histrionic Personality Disorder:
It is a disorder in which dramatic, emotional, and impressive behavior patterns are present. The expectation of being the center of attention, seductive behavior, excessive attention to physical appearance and using people, rapidly changing emotions, ostentation, and being easily influenced by others are prominent. It is seen at a rate of 1-2%. It is more common in women. Despite the seductive nature, fear of sexuality is the main finding.
Narcissistic Personality Disorder:
It is a disorder in which there is excessive concern with self-esteem and self-love (excessive exaggeration of achievements, etc.). The mind is constantly occupied with thinking about unlimited power, success, beauty or ideal love. The basic symptoms are a sense of superiority, the need to be admired, inability to put oneself in the other person’s shoes, arrogance, exploitation of people, the belief that others are jealous of oneself, and arrogance. The prevalence in society is around 1-6%.
C)
Anxious/Fearful Cluster
The contents of this cluster include anxious and fearful thoughts and behaviors. There are three subtypes: Avoidant/Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive Compulsive Personality Disorder.
Avoidant/Avoidant Personality Disorder:
Feelings of inadequacy, social withdrawal, and extreme sensitivity to negative evaluation are observed. Avoidance of interpersonal relationships and activities due to concern about criticism, rejection, or disapproval, reluctance to interact with people unless one feels absolutely loved, remaining distant in close relationships due to fear of being embarrassed or ridiculed, belief that one will be offended in social settings, and reluctance to take personal risks due to fear of being embarrassed are among the symptoms. It is seen at a rate of approximately 2% in the society.
Dependent Personality Disorder:
Dependent, submissive, clinging behavior, separation anxiety, constant need for advice and guidance regarding daily decisions, needing others to take responsibility for important issues, difficulty expressing disagreements with others, difficulty starting a business on one’s own, needing someone else to care for basic needs, feeling uncomfortable and helpless when alone, persistent need for someone in close relationships, and extreme fear of abandonment are among the most frequently observed symptoms. The incidence is around 1%.
Obsessive Compulsive Personality Disorder:
Perfectionism and inflexibility, excessive preoccupation with details, a perfectionism that makes it difficult to finish a job, excessive dedication to one’s job, reluctance to give work to others (thinking they won’t do it as well as one), keeping old or worthless things, stinginess, rigidity and stubbornness are dominant. The incidence is around 2-7%, more common in men.
Risk Factors for Personality Disorder
Although the exact cause is not known, genetic, physiological and environmental factors are mentioned in personality disorders. Exposure to intense neglect and/or abuse (physical, emotional, sexual) in early childhood, observation of psychopathology in the family, conflicting and complex family structure, inconsistent parental attitudes are among the main risk factors for personality disorders.
Intervention and Treatment Approaches to Personality Disorders in Adolescence
The basis of therapeutic approaches used in the intervention of personality disorders is the individual’s gaining insight into the emotions, thought patterns and behaviors that accompany the symptoms. Through psychotherapy, individuals receive support in overcoming existing problems and increasing their functionality. In this way, they strengthen their coping skills.
It is very important to inform family members and the individual about the problems experienced in order to strengthen their coping skills. This method, called psychoeducation in the psychotherapy process , aims to increase the awareness of the individual and family members on many issues.
The most commonly used psychotherapies in the intervention of Personality Disorders include psychodynamic/psychoanalytically oriented therapy, cognitive behavioral therapy, and schema therapy.
Therapeutic interventions for Personality Disorders involve a very long process. Changing the stereotyped patterns in the person’s emotions, thoughts and behaviors and providing insight is a very long journey. The individual’s discomfort with their current situation and their motivation to change are the most important building blocks of the therapy process.
There is no known drug treatment method for the treatment of personality disorders. However, medical treatment is an important tool used to alleviate the symptoms that occur in the individual. It especially helps individuals with anxiety, depressive symptoms, and anger management.
Advice for Teenagers with Personality Disorders
Getting support in psychotherapy and, if necessary, medical treatment is the most important part of this process. Trying to stay away from situations, experiences and content that will trigger symptoms (such as substance or alcohol use), eating healthy, exercising, not breaking social connections, and creating daily routines can be quite supportive. In some cases, keeping a diary or record can increase awareness of the events that trigger symptoms. In this way, it will be possible to catch clues about the symptoms and take the necessary precautions.
