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A Discussion on the Personality Disorders | Dr. William Winter is a child and adolescent psychiatrist.
Will Winter, MD, FAAP
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Some people go through life without friends. They don't have problems making them. They have problems keeping them.

Personality disorders lead to problems getting along with friends and family. They also often lead to problems at work- not because of the work itself but because even at work one must deal with people.

There are a number of personality disorders categorized into clusters in the DSM IV. Ones that are more commonly talked about, i.e. Antisocial Personality Disorder, Borderline Personality Disorder or Narcissistic Personality Disorder, are all within Cluster B. More information on these is available on this website.

If someone has a personality disorder, it does not mean that he can't have another psychiatric diagnosis, i.e. Major Depression. Nonetheless, it isn't only low self-esteem, sadness or feelings of helplessness that characterize a personality disorder. It is how that person handles those feelings- this is important.

There are many maladaptive ways in which people can interact with one another. They can be categorized into a diagnosis of a personality disorder but need not be. If one symptom is marked enough to cause dysfunction in day-to-day life, it should be treated.

Why do people develop personality disorders?
This is a good question. It may have to do with a history of abuse, i.e. physical or sexual. It may have to do with a history of poor attachment in infancy or early childhood. However, in many cases these antecedents are absent. In fact, some personality characteristics may even be traced back to infancy. When it comes to personality development, it is a combination of nature and nurture.

The notion of "personality" is a fluid one. As one grows and matures throughout childhood and adolescence, so does one's personality. Although dysfunctional personality traits may be present during these years, a personality disorder is only formally diagnosed once a young person reaches the age of majority (18). Regardless, efforts to treat dysfunction prior to age 18 should not be withheld.

What is the treatment?
Talk therapy is important in the treatment of personality disorders. DBT (Dialectical Behavioral Therapy) may be very helpful to treat Borderline personality disorder. Medications may provide some help but the behaviors that characterize personality disorders come from free will choices. Medication cannot affect someone's choices or their personality. However, if related psychological issues, i.e. depression or mood instability are present, medication can help.

When it comes to the topic of the personality disorders, inevitably many if not most of us may recognize one or two characteristics that we ourselves possess. Although those may cause dysfunction, it doesn't mean that we meet criteria for the diagnosis. The best way to clarify this is to recognize if there is significant dysfunction and, if so, to have a psychiatric evaluation.