General Personality Disorder DSM-5
DSM-5 Category: Personality Disorder
Introduction
According to the DSM-5, General Personality Disorder is the umbrella category under which a variety of specific disorders are iterated. There are multiple parameters offered which may be used to identify the presence of General Personality Disorder (American Psychiatric Association, 2013); after which the mental health professional can further clarify the specific diagnosis according to clusters of symptom presentations. Cluster A disorders are characterized by odd or eccentric behavior; Cluster B by dramatic and overly emotional behavior and Cluster C by anxious, fearful thinking and behavior. Beneath the General Personality Disorder heading there are three clusters of specific personality disorders as well as an area labeled Other Personality Disorders that provides the framework for diagnosing the illness that may manifest in unique and unusual ways (Wakefield, 2013).
Symptoms of Generalized Personality Disorder
Under the heading of General Personality Disorder, the DSM-5 lists a number of behaviors that are considered to be markedly different from the cultural expectations of the patient. This definition is especially valuable because it takes the factor of culture into account when developing a diagnosis. The aberrant behavior may be manifested in two or more of the listed areas. These include cognition, affectivity, interpersonal functioning and impulse control. The first refers to our perceptions and interpretations of ourselves and others; while affectivity encompasses emotional responses. Interpersonal functioning is the manner in which people relate to each other – an association that may range in duration – and impulse control refers to the ability to resist temptations and/or urges.
There are a number of additional determinants for General Personality Disorder. For example, the DSM-5 states the pattern of behavior is enduring, inflexible and persistent across a wide range of social and personal situations; and is especially stressful to the sufferer. Moreover, its onset can be traced to adolescence or early adulthood; and the manifestations cannot be explained more appropriately by another disorder (Berghuis, Kamphuis & Verheul, 2012). Listed under General Personality Disorder are the specific types of personality disorders including Borderline, Obsessive-Compulsive, Avoidant, Schizotipal, Antisocial and Narcissistic. Finally, there is no evidence of substance abuse or physiological explanation for the behavior – such as drugs or head trauma.
There are two main causes of personality disorders; either it is physiological or environmental – or perhaps a combination of both. In some cases the individual may have inherited a propensity for a mental disposition from parents; or it may exist somewhere further back in the gene pool. In other cases, an individual’s upbringing will influence one’s behavior leading to a manifestation of a personality disorder (Berghuis, Kamphuis & Verheul 2012).. Then, again, these two factors may work in concert to cause the personality disorder. Despite an inability to pinpoint the exact origin of General Personality Disorder(s) there are risk factors that will be taken into consideration when a diagnosis is being formulated. These include a family history of mental disorders, socioeconomic status, any and all forms of child abuse and/or neglect, evidence of a conduct disorder, and variations in brain chemistry and/or structure.
Daily Life
A review of the symptoms listed in the DSM-5 underscores the complexity of this disorder. There is no question that personality disorders in general can significantly disrupt the lives of the affected person, their loved ones and all those with whom the individual interacts. They have the potential to result in ongoing problems with relationships in the home, at school or on the job. This may lead to social isolation and substance abuse. Therefore, if there are ongoing indications of personality deviation; medical attention should be sought to confirm a diagnosis of the disorder. Afterwards, the parents of the adolescent or young adult should solicit recommendations from the diagnostician for appropriate avenues for treatment. This will vary according to the specific disorder; but will likely include suggestions for a combination of psychotherapeutic and pharmacological treatments.
The most important thing to know about living with a personality disorder is that it is possible to lead a full life with the support of family and loved ones. The support may take the form of simply having someone to talk to or it may be more involved. For example, the individual with a General Personality Disorder might need help in organizing their life; creating a schedule or similar activities. There are a variety of resources outside of the family that can be accessed including self-help groups, a family physician, or a broader mental health team that may have been put in place at the initial diagnosis. Living with General Personality Disorder requires patience and a willingness to ask for help without feeling embarrassed or defeated.
Treatment for General Personality Disorder
Treating a personality disorder will probably require a combination of medications and therapy. As there are a variety of personality disorders treatment should be tailored to the symptoms as they appear in the DSM-5.
There are a number of psychotherapy options to treat any of the clusters of disorders that fall within General Personality Disorder; and a variety of therapy formats that could be utilized. Some of the most successful have been Cognitive Therapy that works to change unhelpful or detrimental patterns of thinking; and a form of Cognitive Therapy known as Schema Focused Therapy that explores and changes collections of deep unhelpful beliefs (Skodol, Shedler Bradley, & DeFife, 2012). Another helpful therapy is Dialectical Behavior Therapy that is a combination of individual and group therapies in which cognitive and behavioral therapies are applied.
Other therapies that have demonstrated success are Transference Focused Therapy; a structured treatment in which the therapist explores and changes unconscious processes; and Mentalization; yet another example of individual and group therapy that delves into one’s own thinking and that of others (Gask, Evans, & Kessler, 2013). Persistent display of symptoms may require admittance to a therapeutic community for long-term care.
There are a number of pharmacological choices that have been found to be helpful; and in some cases are necessary to allow the individual with a General Personality Disorder to function in normal society. Different types of drugs may be helpful in treating different clusters of personality disorders. One class of drugs commonly used for Cluster A disorders are antipsychotic drugs. Because personality disorders often present with cormorbid mood disorders; antidepressants may also be described. Persons that are diagnosed in Cluster B may find these especially helpful as well.
Selective serotonin reuptake inhibitor antidepressants (SSRIs) may be prescribed to help people with impulse urges and anxiety disorders; while lithium, carbamazepine, and sodium valproate can also reduce impulsiveness and aggression.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Berghuis H; Kamphuis JH; Verheul R: (2012). Core features of personality disorder: differentiating general personality dysfunctioning from personality traits. J Pers Disord; 26:704–716
Gask; L.; Evans; M. & Kessler, D. (2013). General Personality Disorder.British Medical Journal, International edition, Vol. 347, Iss. 7924, p. 28.
Skodol AE; Shedler J; Bradley B; DeFife J: (2012). Personality disorders in DSM-5. Annu Rev Clin Psychol; 8:317–344.
Wakefield, J. (2013). DSM-5 and the General Definition of Personality Disorder.Clinical Social Work Journal, Vol. 41, Iss. 2, pp. 168 – 183.
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