PERSONALITY DISORDERS

About Authors:
¹Sahu Deepak*
¹Ass. Professor, Geetanjali Institute of Pharmacy,
Dabok, Udaipur [Rajasthan] – 313022
*deepak.sahu.bhl@gmail.com

DEFINITION:
Personality disorders are a group of mental disturbances & it is a psychiatric condition characterized by experience and behavior patterns that cause serious problems with respect to any two of the following: thinking, mood, personal relations, and the control of impulses.¹
Personality disorders are defined by the American Psychiatric Association as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it".^1,2

In fourth edition (1994) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) explained this disorder as "enduring pattern of inner experience and behavior" that are sufficiently rigid and deep-seated to bring a person into repeated conflicts with his or her social and occupational environment.²
DSM-IV specifies that these dysfunctional patterns must be regarded as non-conforming or deviant by the person's culture, and cause significant emotional pain and/or difficulties in relationships and occupational performance. In addition, the patient usually sees the disorder as being consistent with his or her self image (ego-syntonic) and may blame others.^1,2

Reference Id: PHARMATUTOR-ART-1556

WHO ICD-10 mental and behavioral disorders^3,4,5 :

Neurological/symptomatic Dementia (Alzheimer's disease · multi-infarct dementia · Pick's disease · Creutzfeldt-Jakob disease · Huntington's disease · Parkinson's disease · AIDS dementia complex) · Delirium · Post-concussion syndrome

Psychoactivesubstance Intoxication (drunkenness) · Physical dependence (alcohol dependence · opioid dependency) · Withdrawal (benzodiazepine withdrawal · delirium tremens) · Amnesic: (Korsakoff's syndrome)

Psychoticdisorder Schizophrenia (disorganized schizophrenia) · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder

Mood(affective) Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia

Neurotic, stress-related and somatoform Agoraphobia · Anxiety disorder · Panic disorder · Generalized anxiety disorder · Social Anxiety Disorder · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder (Ganser syndrome) · Somatoform disorder · Somatization disorder · Neurasthenia

Physiological/physical Eating disorder (anorexia nervosa · bulimia nervosa) · Sleep disorder (dyssomnia · insomnia · hypersomnia

Behavioural parasomnia · night terror · nightmare) · Sexual dysfunction (erectile dysfunction · premature ejaculation · vaginismus · dyspareunia · hypersexuality) · Postpartum depression

Adult personality and behaviour Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome

Mental retardation Mental retardation

Psychological development (developmental disorder) Specific: speechand language (expressive language disorder · aphasia · expressive aphasia · receptive aphasia · Landau-Kleffner syndrome · lisp) · Scholastic skills (dyslexia · dysgraphia · Gerstmann syndrome) · Motor function (developmental dyspraxia)
Pervasive: Autism · Rett syndrome · Asperger syndrome

Behavioural and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech (stuttering · cluttering)

DESCRIPTION^5,6 :
It is also known as character disorder. Most personality disorders are associated with problems in personal development and character which peak during adolescence and are then defined as personality disorders. Children and adolescents with a personality disorder have great difficulty dealing with others. They tend to be inflexible, rigid, with inadequate response to the changes and demands of life. They have a narrow view of the world and find it hard to participate in social activities. The patient's problematic behaviors must appear in two or more of the following areas:

perception and interpretation of the self and other people
intensity and duration of feelings and their appropriateness to situations
relationships with others
ability to control impulses

DSM-IV ⁶ classifies personality disorders into three different category based on symptoms:

Category A (paranoid, schizoid, schizotypal): Patients appear odd or eccentric to others.
Category B (antisocial, borderline, histrionic, narcissistic): Patients appear overly emotional, unstable, erratic behavior, or self-dramatizing to others.
Category C (avoidant, dependent, obsessive-compulsive): Patients appear tense, fearful and anxiety-ridden to others.

The DSM-IV category system does not mean that all patients can be fitted neatly into one of the three categories. It is possible for patients to have symptoms of more than one personality disorder or to have symptoms from different categories.

One category that had been proposed for DSM-IIIR, self-defeating personality disorder, was excluded from DSM-IV on the grounds that its definition reflected prejudice against women.

Personality disorders have their onset in late adolescence or early adulthood. Doctors rarely give a diagnosis of personality disorder to children on the grounds that children's personalities are still in the process of formation and may change considerably by the time they are in their late teens. But, in retrospect, many individuals with personality disorders could be judged to have shown evidence of the problems in childhood.

The personality disorders defined by DSM-IV are as follows:
Paranoid^6,7
Patients with paranoid personality disorder are characterized by suspiciousness and a belief that others are out to harm or cheat them. They have problems with intimacy and may join cults or groups with paranoid belief systems. Some are litigious, bringing lawsuits against those they believe have wronged them. Although not ordinarily delusional, these patients may develop psychotic symptoms under severe stress. It is estimated that0.5–2.5% of the general population meet the criteria for paranoid personality disorder.

Schizoid⁶
Schizoid patients are perceived by others as "loners" without close family relationships or social contacts. Indeed, they are aloof and really do prefer to be alone. They may appear cold to others because they rarely display strong emotions. They may, however, be successful in occupations that do not require personal interaction. About 2% of the general population has this disorder. It is slightly more common in men than in women.

Schizotypal⁷
Patients diagnosed as schizotypal are often considered odd or eccentric because they pay little attention to their clothing and sometimes have peculiar speech mannerisms. They are socially isolated and uncomfortable in parties or other social gatherings. In addition, people with schizotypal personality disorder often have oddities of thought, including "magical" beliefs or peculiar ideas (for example, a belief in telepathy) that are outside of their cultural norms. It is thought that 3% of the general population has schizotypal personality disorder. It is slightly more common in males.

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Antisocial^2,4,5
Patients with antisocial personality disorder are sometimes referred to as sociopaths or psychopaths. They are characterized by lying, manipulativeness, and a selfish disregard for the rights of others; some may act impulsively. People with antisocial personality disorder are frequently chemically dependent and sexually promiscuous. It is estimated that 3% of males in the general population and 1% of females have antisocial personality disorder.

Borderline⁶
Patients with borderline personality disorder (BPD) are highly unstable, with wide mood swings, a history of intense but stormy relationships, impulsive behavior, and confusion about career goals, personal values, or sexual orientation. These often highly conflictual ideas may correspond to an even deeper confusion about their sense of self (identity). People with BPD frequently cut or burn themselves, or threaten or attempt suicide. Many of these patients have histories of severe childhood abuse or neglect. About 2% of the general population have BPD; 75% of these patients are female.

Histrionic⁷
Patients diagnosed with this disorder impress others as overly emotional, overly dramatic, and hungry for attention. They may be flirtatious or seductive as a way of drawing attention to themselves, yet they are emotionally shallow. Histrionic patients often live in a romantic fantasy world and are easily bored with routine. About 2–3% of the population is thought to have this disorder. The disorder has been more associated with women.

Narcissistic^8,9
Narcissistic patients are characterized by self-importance, a craving for admiration, and exploitative attitudes toward others. They have unrealistically inflated views of their talents and accomplishments, and may become extremely angry if they are criticized or outshone by others. Narcissists may be professionally successful but rarely have long-lasting intimate relationships. Fewer than 1% of the population has this disorder; about 75% of those diagnosed with it are male.

Avoidant⁹
Patients with avoidant personality disorder are fearful of rejection and shy away from situations or occupations that might expose their supposed inadequacy. They may reject opportunities to develop close relationships because of their fears of criticism or humiliation. Patients with this personality disorder are often diagnosed with dependent personality disorder as well. Many also fit the criteria for social phobia. Between 0.5–1.0% of the population have avoidant personality disorder.

Dependent^7,8,9
Dependent patients are afraid of being on their own and typically develop submissive or compliant behaviors in order to avoid displeasing people. They are afraid to question authority and often ask others for guidance or direction. Dependent personality disorder is diagnosed more often in women, but it has been suggested that this finding reflects social pressures on women to conform to gender stereotyping or bias on the part of clinicians.

Obsessive-compulsive^9,10
Patients diagnosed with this disorder are preoccupied with keeping order, attaining perfection, and maintaining mental and interpersonal control. They may spend a great deal of time adhering to plans, schedules, or rules from which they will not deviate, even at the expense of openness, flexibility, and efficiency. These patients are often unable to relax and may become "workaholics." They may have problems in employment as well as in intimate relationships because they are very "stiff" and formal, and insist on doing everything their way. About 1% of the population has obsessive-compulsive personality disorder; the male/female ratio is about 2:1.

Category “A” Disorders^10,11,12

These disorders include the following:

Schizoid personality disorder. Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. Often absorbed with their own thoughts and feelings, they fear closeness and intimacy with others. People suffering from schizoid personality tend to be more daydreamers than practical action takers, often living "in a world of their own."
Paranoid personality disorder. Paranoid personalities interpret the actions of others as deliberately threatening or demeaning. People with paranoid personality disorder are untrusting, unforgiving, and often resort to angry or aggressive outbursts without justification because they see others as unfaithful, disloyal, or dishonest. Paranoid personalities are often jealous, guarded, secretive, and scheming, and may appear to be emotionally "cold" or excessively serious.
Schizotypal personality disorder. Schizotypal personalities tend to have odd or eccentric manners of speaking or dressing. They often have strange, outlandish, or paranoid beliefs and thoughts. People with schizotypal personality disorder have difficulties bonding with others and experience extreme anxiety in social situations. They tend to react inappropriately or not react at all during a conversation, or they may talk to themselves. They also have delusions characterized by "magical thinking," for example, by saying that they can foretell the future or read other people's minds.

Category “B” Disorders^11,13,14

Category B disorders include the following:

Antisocial personality disorder. Antisocial personalities typically ignore the normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. They often have a history of violent and irresponsible behavior, aggressive and even violent relationships. They have no respect for other people and feel no remorse about the effects of their behavior on others. Antisocial personalities are at high risk for substance abuse, since it helps them to relieve tension, irritability, and boredom.
Borderline personality disorder. Borderline personalities are unstable in interpersonal relationships, behavior, mood, and self-image. They are prone to sudden and extreme mood changes, stormy relationships, unpredictable and often self-destructive behavior. These personalities have great difficulty with their own sense of identity and often experience the world in extremes, viewing experiences and others as either "black" or "white." They often form intense personal attachments only to quickly dissolve them over a perceived offense. Fears of abandonment and rejection often lead to an excessive dependency on others. Self-mutilation or suicidal threats may be used to get attention or manipulate others. Impulsive actions, persistent feelings of boredom or emptiness, and intense anger outbursts are other traits of this disorder.
Narcissistic personality disorder. Narcissistic personalities tend to have an exaggerated sense of self-importance, and are absorbed by fantasies of unlimited success. They also seek constant attention, and are oversensitive to failure, often complaining about multiple physical disorders. They also tend to be prone to extreme mood swings between self-admiration and insecurity, and tend to exploit interpersonal relationships.

Category “C” Disorders^4,7,13,14

Category C disorders include the following:

Avoidant personality disorder. Avoidant personalities are often fearful of rejection and unwilling to become involved with others. They are characterized by excessive social discomfort, shyness, fear of criticism, and avoidance of social activities that involve interpersonal contact. They are afraid of saying something considered foolish by others and are deeply hurt by any disapproval from others. They tend to have no close relationships outside the family circle and are upset at their inability to form meaningful relationships.
Dependent personality disorder. As the name implies, dependent personalities exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They fear rejection, need constant reassurance and advice, and are oversensitive to criticism or disapproval. They feel uncomfortable and helpless if they are alone and can be devastated when a close relationship ends. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently.
Compulsive personality disorder. Compulsive personalities are conscientious, reliable, dependable, orderly, and methodical, but with an inflexibility that often makes them incapable of adapting to changing circumstances. They have such high standards of achievement that they constantly strive for perfection. Never satisfied with their performance or with that of others, they take on more and more responsibilities. They also pay excessive attention to detail, which makes it very hard for them to make decisions and complete tasks. When their feelings are not under strict control, when events are unpredictable, or when they must rely on others, compulsive personalities often feel a sense of isolation and helplessness.

Demographics Results¹⁵ :
According to the National Institutes of Health, nearly 31 million Americans meet criteria for at least one personality disorder. A survey showed that nearly 14.8 percent of adult
·         7.9% Population had obsessive-compulsive personality disorder,
·         4.4% Population had paranoid personality disorder,
·         3.6% Population had antisocial personality disorder,
·         3.1% Population had schizoid personality disorder,
·         2.4% Population had avoidant personality disorder, and
·         0.5% Population had dependent personality disorder.

The risk of having avoidant, dependent, and paranoid personality disorders is greater for females than males, whereas risk of having antisocial personality disorder is greater for males than females. There are no gender differences in the risk of having compulsive or schizoid personality disorders.

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CAUSES^16,17:
The exact cause of personality disorders is unknown. However, evidence points to genetic and environmental factors such as a history of personality disorders in the family. Some experts believe that traumatic events occurring in early childhood exert a crucial influence upon behavior later in life. Others propose that people are genetically predisposed to personality disorders or that they have an underlying biological disturbance (anatomical, electrical, or neurochemical).

Personality Disorder is only rarely found in men. Some patients with personality disorders come from families that appear to be stable and healthy. It has been suggested that these patients are biologically hypersensitive to normal family stress levels. Levels of the brain chemical (neurotransmitter) dopamine may influence a person's level of novelty-seeking, and serotonin levels may influence aggression.

SYMPTOMS^12,14,15:
Symptoms vary widely depending on the specific type of Personality Disorder, but according to the Psychiatric Association, individuals with personality disorders have most of the following symptoms in common:

The symptoms include:

Constant seeking of reassurance or approval.
Excessive dramatics with exaggerated displays of emotions.
Excessive sensitivity to criticism or disapproval.
Inappropriately seductive appearance or behavior.
manipulative and exploitative behavior
Excessive concern with physical appearance.
A need to be the center of attention (self-centeredness).
Low tolerance for frustration or delayed gratification.
Rapidly shifting emotional states that may appear shallow to others.
Opinions are easily influenced by other people, but difficult to back up with details.
Tendency to believe that relationships are more intimate than they actually are.
Make rash decisions
Threaten or attempt suicide to get attention
self-destructive behavior
self-centeredness that manifests itself through a "me-first," self-preoccupied attitude
lack of individual accountability that results in a "victim mentality" and blaming others for their problems
lack of empathy and caring
unhappiness, suffering from depression, and other mood and anxiety disorders
vulnerability to other mental disorders
distorted or superficial understanding of self and others' perceptions that results in being unable to see how objectionable, unacceptable, and disagreeable their behavior is
socially maladaptive, changing the "rules of the game," or otherwise influencing the external world to conform to their own needs

DIAGNOSIS^16,17,18:
Diagnosis of personality disorders is complicated by the fact that affected persons rarely seek help until they are in serious trouble or until their families (or the law) pressure them to get treatment. The reason for this slowness is that the problematic traits are so deeply entrenched that they seem normal (ego-syntonic) to the patient. Diagnosis of a personality disorder depends in part on the patient's age. Although personality disorders originate during the childhood years, they are considered adult disorders. Some patients, in fact, are not diagnosed until late in life because their symptoms had been modified by the demands of their job or by marriage. After retirement or the spouse's death, however, these patients' personality disorders become fully apparent. In general, however, if the onset of the patient's problem is in mid-or late-life, the doctor will rule out substance abuse or personality change caused by medical or neurological problems before considering the diagnosis of a personality disorder. It is unusual for people to develop personality disorders "out of the blue" in mid-life.

The person's appearance, behavior, and history, and a psychological evaluation are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy may also be of benefit.

DIAGNOSTIC CRITERIA^3,9,17,18 :
The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, defines personality disorder as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

is uncomfortable in situations in which he or she is not the center of attention
interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
displays rapidly shifting and shallow expression of emotions
consistently uses physical appearance to draw attention to self
has a style of speech that is excessively impressionistic and lacking in detail
shows self-dramatization, theatricality, and exaggerated expression of emotion
is suggestible, i.e., easily influenced by others or circumstances
considers relationships to be more intimate than they actually are.

The International Statistical Classification of Diseases defines personality disorder as characterized by:

self-dramatization, theatricality, exaggerated expression of emotions;
suggestibility, easily influenced by others or by circumstances;
shallow and labile affectivity;
continual seeking for excitement and activities in which the patient is the centre of attention;
inappropriate seductiveness in appearance or behaviour;
over-concern with physical attractiveness.

MNEMONIC¹⁶ :
A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME

P - provocative (or seductive) behavior
R - relationships, considered more intimate than they are
A - attention, must be at center of
I - influenced easily
S - speech (style) - wants to impress, lacks detail
E - emotional lability, shallowness
M - make-up - physical appearance used to draw attention to self
E - exaggerated emotions - theatrical

Interviews
The doctor may schedule two or three interviews with the patient, spaced over several weeks or months, in order to rule out an adjustment disorder caused by job loss, bereavement, or a similar problem. An office interview allows the doctor to form an impression of the patient's overall personality as well as obtain information about his or her occupation and family. During the interview, the doctor will note the patient's appearance, tone of voice, body language, eye contact, and other important non-verbal signals, as well as the content of the conversation. In some cases, the doctor may contact other people (family members, employers, close friends) who know the patient well in order to assess the accuracy of the patient's perception of his or her difficulties. It is quite common for people with personality disorders to have distorted views of their situations, or to be unaware of the impact of their behavior on others.

Psychologic testing¹⁶
Doctors use psychologic testing to help in the diagnosis of a personality disorder. Most of these tests require interpretation by a professional with specialized training. Doctors usually refer patients to a clinical psychologist for this type of test.
1. Personality Inventories. Personality inventories are tests with true/false or yes/no answers that can be used to compare the patient's scores with those of people with known personality distortions. The single most commonly used test of this type is the Minnesota Multiphasic Personality Inventory, or MMPI. Another test that is often used is the Millon Clinical Multiaxial Inventory, or MCMI.
2. Projective Tests. Projective tests are unstructured. Unstructured means that instead of giving one-word answers to questions, the patient is asked to talk at some length about a picture that the psychologist has shown him or her, or to supply an ending for the beginning of a story. Projective tests allow the clinician to assess the patient's patterns of thinking, fantasies, worries or anxieties, moral concerns, values, and habits. Common projective tests include the Rorschach, in which the patient responds to a set of ten inkblots; and the Thematic Apperception Test (TAT), in which the patient is shown drawings of people in different situations and then tells a story about the picture.

Treatment^14,15,17,18 :
There are many types of help available for the different personality disorders. Treatment may include individual, group, or family psychotherapy. Medications, prescribed by a patient's physician, may also be helpful in relieving some of the symptoms of personality disorders, such as problems with anxiety and delusions.

Psychotherapy is a form of treatment designed to help children and families understand and resolve the problems due to personality disorder and modify the inappropriate behavior. In some cases a combination of medication with psychotherapy may be more effective. Personality disorder psychotherapy focuses on helping patients see the unconscious conflicts that are causing their disorder. It also helps them become more flexible and is aimed at reducing the behavior patterns that interfere with everyday living. In psychotherapy, patients have the opportunity to learn to recognize the effects of their behavior on others. The different types of psychotherapies available to children and adolescents include the following:.

Cognitive Behavior Therapy (CBT)¹²: CBT is focused on improving a child's moods and behavior by examining confused or distorted patterns of thinking. With CBT, the child learns that thoughts cause feelings and moods that can influence behavior. For example, if a child has problematic behavior patterns, the therapist seeks to identify the underlying thinking that is causing them. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviors.
Dialectical Behavior Therapy (DBT)¹³: DBT is used to treat older adolescents with suicidal thoughts or who intentionally engage in self-destructive behavior or who have borderline personality disorder. DBT teaches how to take responsibility for one's problems and how to deal with conflict and negative feelings. DBT often involves a combination of group and individual sessions.
Family Therapy⁸: This therapy approach is designed to help the family unit function in more positive and constructive ways by exploring patterns of communication and providing support and education. Family therapy sessions can include the child or adolescent along with parents and siblings.
Group Therapy (GT)¹¹: Group Therapy uses group dynamics and peer interactions to increase understanding, communication, and improve social skills.
Play Therapy¹⁶: This type of therapy is directed at helping younger children. It involves the use of toys, blocks, dolls, puppets, drawings, and games to help the child recognize, identify, and verbalize feelings. The psychotherapist observes how the child uses play materials and identifies themes or patterns to understand the child's problems. Through a combination of talk and play the child has an opportunity to better understand conflicts, feelings, and behavior.
Coloring Therapy¹⁵: CT uses the activity of coloring as a self-help medium. While a person colors (with felt tipped markers, colored pens, pencils, etc.) a state of consciousness similar to meditation occurs. The approach is based on how people speak to themselves on the "inside." During a coloring session, people are asked to listen to the thoughts going on in their minds so as to become aware of where their thoughts, feelings, and opinions come from.
Creative Arts Therapies¹⁶: These therapies include art therapy, dance/movement therapy, drama therapy, music therapy, poetry therapy, and psychodrama. They use arts and creative processes to promote health, communication, and expression; they encourage the integration of physical, emotional, cognitive, and social functioning while enhancing self-awareness and facilitating change.
Neurolinguistic Programming¹⁷: NLP is a method of examining the way a person thinks and acts through language and using this knowledge to effect change.
Family Therapy¹⁵: Family therapy may be suggested for patients whose personality disorders cause serious problems for members of their families. It is also sometimes recommended for borderline patients from overinvolved or possessive families.

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Alternative Treatment :

Hospitalization¹⁵
Inpatient treatment is rarely required for patients with personality disorders, with two major exceptions: borderline patients who are threatening suicide or suffering from drug or alcohol withdrawal; and patients with paranoid personality disorder who are having psychotic symptoms.

Psychotherapy¹⁶^,18
Psychoanalytic psychotherapy is suggested for patients who can benefit from insight-oriented treatment. These patients typically include those with dependent, obsessive-compulsive, and avoidant personality disorders. Doctors usually recommend individual psychotherapy for narcissistic and borderline patients, but often refer these patients to therapists with specialized training in these disorders. Psychotherapeutic treatment for personality disorders may take as long as three to five years.

Insight-oriented approaches are not recommended for patients with paranoid or antisocial personality disorders. These patients are likely to resent the therapist and see him or her as trying to control or dominate them.

Supportive therapy is regarded as the most helpful form of psychotherapy for patients with schizoid personality disorder.

Medications¹⁷
Medications may be prescribed for patients with specific personality disorders. The type of medication depends on the disorder.

Antipsychotic Drugs¹⁷: Antipsychotic drugs, such as haloperidol (Haldol), may be given to patients with paranoid personality disorder if they are having brief psychotic episodes. Patients with borderline or schizotypal personality disorder are sometimes given antipsychotic drugs in low doses; however, the efficacy of these drugs in treating personality disorder is less clear than in schizophrenia.

Mood Stabilizers¹⁷: Carbamazepine (Tegretol) is a drug that is commonly used to treat seizures, but is also helpful for borderline patients with rage outbursts and similar behavioral problems. Lithium and valproate may also be used as mood stabilizers, especially among people with borderline personality disorder.

Antidepressants And Anti-Anxiety Medications^16,17: Medications in these categories are sometimes prescribed for patients with schizoid personality disorder to help them manage anxiety symptoms while they are in psychotherapy. Antidepressants are also commonly used to treat people with borderline personality disorder.

Treatment with medications is not recommended for patients with avoidant, histrionic, dependent, or narcissistic personality disorders. The use of potentially addictive medications should be avoided in people with borderline or antisocial personality disorders. However, some avoidant patients who also have social phobia may benefit from monoamine oxidase inhibitors (MAO inhibitors), a particular class of antidepressant.

Nutritional Concerns¹⁸ :
The notion that foods and nutrients influence brain function and behavior generated in the early 2000s widespread interest in the general public and in the scientific community. However, the evaluation data are still ambiguous when it comes to establishing a direct link between personality disorders and diet, aside from recommending the avoidance of alcoholic and stimulant beverages.

PREVENTION ^15,16,17:
The most effective preventive strategy for personality disorders is early identification and treatment of children at risk. High-risk groups include abused children, children from troubled families, children with close relatives diagnosed with personality disorders, children of substance abusers, and children who grow up in cults or political extremist groups.

The prevention of personality disorders is an area surrounded with pessimism and controversy. Many mental health specialists believe that these disorders are untreatable, that individuals with personality disorder have little capacity for change; therefore not surprisingly, they remain skeptical about prevention prospects. However, even though the innate temperament of a person cannot be modified, understanding the factors that influence the development of personality disorders (such as genetic risks and environmental factors) may help prevention. Accordingly, some mental health professionals advocate primary prevention steps, which should include education of parents and primary healthcare workers, as well as early psychotherapy and protection of traumatized children, which can be carried out by child developing services. Some evidence suggests that traditional doctor-patient relationships are of much less value than programs which enable parents to see their own role as crucial and their own actions as able to bring changes for the better in their child's behavior. High quality parenting plays a critical role in child development and, thus, in the prevention of personality disorders

PARENTAL CONCERNS¹⁶ :
Understanding personality disorders can be challenging for parents as well as for children. During the last third of the twentieth century, great advances were made in the areas of diagnosis and treatment of personality disorders. Parents can help children understand that these are real illnesses that can be treated. In order for parents to talk with a child about a personality disorder, they must be knowledgeable of the subject. Parents may have to do some homework to become better informed. They should have a basic understanding and answers to questions such as what are personality disorders, who gets them, what causes them, how are diagnoses made, and what treatments are available. When explaining to a child about how personality disorders affect a person, it may be helpful to explain that feelings of anxiety, worry, and irritability are common for most people. However, when these feelings get very intense, last for a long period of time, and begin to interfere with school and relationships, it may be a sign of a personality disorder that can, however, be treated.

A child's personality disorder often causes disruption to both the parents' and the child's world. Parents may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them. Recognizing these feelings and seeking the help of professional care providers and support groups is the best way to cope with this issue.

Medication can also be an effective part of the treatment for several personality disorders in childhood and adolescence. A doctor's recommendation to use medication often raises many concerns and questions in both the parents and the child. The physician who recommends medication should be experienced in treating psychiatric illnesses in children and adolescents. He or she should fully explain the reasons for medication use, what benefits the medication should provide, as well as the possible negative side-effects or dangers and other treatment alternatives.

REFERENCE :
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11.   Krueger, R. F., and S. R. Carlson. "Personality disorders in children and adolescents." Current Psychiatry Reports 3, no. 1 (February, 2001): 46–51.
12.   Organizations
13.   American Academy of Child & Adolescent Psychiatry(AACAP). 3615 Wisconsin Ave., NW, Washington, DC 20016–3007. Web site: www.aacap.org.
14.   American Psychiatric Association. 1000 Wilson Boulevard, Suite 1825, Arlington, Va. 22209–3901. Web site: psych.org.
15.   Federation of Families for Children's Mental Health. 1101 King Street, Suite 420, Alexandria, VA 22314. Web site: ffcmh.org.
16.   National Mental Health Association (NMHA). 2001 N. Beauregard Street, 12th Floor, Alexandria, VA 22311. Web site: nmha.org.
17.   Web Sites
18.   Lebelle, Linda. "Personality Disorders." Focus Adolescent Services. Available online at focusas.com/PersonalityDisorders.html (accessed October 13, 2004).