Personality disorders

A personality disorder is a type of mental illness in which you have trouble perceiving and relating to situations and to people including yourself. There are many specific types of personality disorders. In general, having a personality disorder means you have a rigid and unhealthy pattern of thinking and behaving no matter what the situation. This leads to significant problems and limitations in relationships, social encounters, work and school. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you, and you may blame others for the challenges you face. Symptoms General symptoms of a personality disorder Personality disorder symptoms include:

Frequent mood swings Stormy relationships Social isolation Angry outbursts Suspicion and mistrust of others Difficulty making friends A need for instant gratification Poor impulse control Alcohol or substance abuse

Specific types of personality disorders The specific types of personality disorders are grouped into three clusters based on similar characteristics and symptoms. Many people with one diagnosed personality disorder also have signs and symptoms of at least one additional personality disorder. Cluster A personality disorders These are personality disorders characterized by odd, eccentric thinking or behavior and include: Paranoid personality disorder

Distrust and suspicion of others Believing that others are trying to harm you Emotional detachment Hostility

Schizoid personality disorder

Lack of interest in social relationships Limited range of emotional expression Inability to pick up normal social cues Appearing dull or indifferent to others

Schizotypal personality disorder

Peculiar dress, thinking, beliefs or behavior Perceptual alterations, such as those affecting touch Discomfort in close relationships Flat emotions or inappropriate emotional responses Indifference to others "Magical thinking" believing you can influence people and events with your thoughts Believing that messages are hidden for you in public speeches or displays

Cluster B personality disorders These are personality disorders characterized by dramatic, overly emotional thinking or behavior and include: Antisocial (formerly called sociopathic) personality disorder

Disregard for others Persistent lying or stealing Recurring difficulties with the law Repeatedly violating the rights of others Aggressive, often violent behavior Disregard for the safety of self or others

Borderline personality disorder

Impulsive and risky behavior Volatile relationships Unstable mood Suicidal behavior Fear of being alone

Histrionic personality disorder

Constantly seeking attention Excessively emotional Extreme sensitivity to others' approval Unstable mood

Excessive concern with physical appearance

Narcissistic personality disorder Believing that you're better than others

Fantasizing about power, success and attractiveness Exaggerating your achievements or talents Expecting constant praise and admiration Failing to recognize other people's emotions and feelings

Cluster C personality disorders These are personality disorders characterized by anxious, fearful thinking or behavior and include: Avoidant personality disorder

Hypersensitivity to criticism or rejection Feeling inadequate Social isolation Extreme shyness in social situations Timidity

Dependent personality disorder

Excessive dependence on others Submissiveness toward others A desire to be taken care of Tolerance of poor or abusive treatment Urgent need to start a new relationship when one has ended

Obsessive-compulsive personality disorder

Preoccupation with orderliness and rules Extreme perfectionism Desire to be in control of situations Inability to discard broken or worthless objects Inflexibility

Obsessive-compulsive personality disorder isn't the same as obsessive-compulsive disorder, a type of anxiety disorder.

Bipolar disorder
Bipolar disorder sometimes called manic-depressive disorder is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time. Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy). Symptoms Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous. Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania. Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

Bipolar disorder symptoms reflect a range of moods. The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode. Manic phase of bipolar disorder Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:

Euphoria Inflated self-esteem Poor judgment Rapid speech Racing thoughts Aggressive behavior Agitation or irritation Increased physical activity Risky behavior Spending sprees or unwise financial choices Increased drive to perform or achieve goals Increased sex drive Decreased need for sleep Easily distracted Careless or dangerous use of drugs or alcohol Frequent absences from work or school Delusions or a break from reality (psychosis) Poor performance at work or school

Depressive phase of bipolar disorder Signs and symptoms of the depressive phase of bipolar disorder can include:

Sadness Hopelessness Suicidal thoughts or behavior Anxiety Guilt Sleep problems Low appetite or increased appetite Fatigue Loss of interest in activities once considered enjoyable Problems concentrating Irritability Chronic pain without a known cause

Frequent absences from work or school Poor performance at work or school

Other signs and symptoms of bipolar disorder Signs and symptoms of bipolar disorder can also include:

Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed they become depressed in the spring or summer and manic or hypomanic in the fall or winter. Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours. Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations).

Symptoms in children and adolescents Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.

Antidepressants
Antidepressants are a class of drugs that reduce symptoms of depressive disorders by correcting chemical imbalances of neurotransmitters in the brain. Chemical imbalances may be responsible for changes in mood and behavior. Neurotransmitters are vital, as they are the communication link between nerve cells in the brain. Neurotransmitters reside within vesicles found in nerve cells, which are released by one nerve and taken up by other nerves. Neurotransmitters not taken up by other nerves are taken up by the same nerves that released them. This process is called "reuptake." The prevalent neurotransmitters in the brain specific to depression are serotonin, dopamine and norepinephrine (also called noradrenaline). In general, antidepressants work by inhibiting the reuptake of specific neurotransmitters, hence increasing their levels around the nerves within the brain, such as selective serotonin reuptake inhibitors (SSRIs), antidepressants that will affect serotonin levels in the brain. Types of Antidepressant : Monoamime Oxidase Inhibitor (MAOIs) Monoamine oxidase inhibitors are medications included in one of a potent class of medications used to treat depression by increasing the amount of norepinephrine and serotonin in the brain. Patients who take medications in this class must avoid certain foods and medications to avoid dangerous interactions as directed by a doctor. Serious side effects may include: headache, heart racing, chest pain, neck stiffness, nausea and vomiting. If a patient should experience any of these symptoms, seek medical care immediately. 1. Isocarboxazid (Marplan) 2. Phenelzine (Nardil) 3. Tranylcypromine (Parnate) Tricyclic Antidepressants (TCAs) The following medicines fall under a class of drugs called tricyclic antidepressants, or TCAs. TCAs are one of a class of medications used to treat depression. The tricyclic antidepressants (TCAs) are also used for some forms of anxiety, fibromyalgia, and the control of chronic pain. Potential side effects of TCAs are: dry mouth, blurred vision, increased fatigue and sleepiness, weight gain, muscle twitching (tremors), constipation, bladder problems such as urine retention, dizziness, daytime drowsiness, increased heart rate, sexual problems. 1. Amitriptyline (Elavil, Endep, Levate) 2. Amoxapine (Asendin) 3. Clomipramine (Anafranil)

4. Desipramine (Norpramin, Pertofrane) 5. Doxepin (Adapin, Silenor, Sinequan) 6. Imipramine (Tofranil, Tofranil-PM) 7. Maprotiline (Ludiomil) 8. Nortryptyline (Aventyl, Pamelor) 9. Protriptyline (Vivactil) 10. Trimipramine (Surmontil, Trimip, Tripramine) Selective Serotonin Reuptake Inhibitors (SSRIs) The following drugs fall under a class of antidepressant medications called selective serotonin reuptake inhibitors, or SSRIs. Potential side effects of SSRIs are sexual problems including low sex drive or inability to have an orgasm (common but reversible), dizziness, headaches, nausea right after a dose, insomnia and jitters. SSRIs and what they do. 1. 2. 3. 4. 5. 6. Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac, Prozac Weekly, Selfemra, Sarafem) Fluvoxamine (Faverin, Luvox, Luvox CR) Paroxetine (Paxil, Paxil CR, Pexeva) Sertraline (Zoloft)

SNRI List This newer drugs in the table below increase the levels of the neurotransmitters serotonin and norepinephrine in the brain. For these medications common side effects are: drowsiness, blurred vision, lightheadedness, strange dreams, constipation, fever/chills, headache, increased or decreased appetite, tremor, dry mouth, nausea. Remeron can be sedating. Cymbalta may increase sweating and blood pressure and also cause fatigue and reduced energy. 1. 2. 3. 4. Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Milnacipran (Savella)2 Venlafaxine (Effexor, Effexor XR )

Somatoform Disorders
Somatoform disorders are mental illnesses that cause physical pain and other symptoms without any physical explanation. These disorders can be very challenging and distressing for both patient and doctor. For a patient, it is very frustrating to experience pain and discomfort that has no known explanation. This frustration can turn into a vicious cycle, leading people to seek out diagnoses and imagine that they have diseases that they do not have. For doctors it can be difficult to search and search for an explanation and find nothing. Doctors and psychologists are reluctant to assert that a patient's pain is psychological because it can be very difficult to rule out all possible causes of physical pain. It is also challenging to deal with a patient who keeps complaining of symptoms - patients will often become increasingly agitated over time and may even question an attending physician's competence. Someone with a true somatoform disorder will often become increasingly preoccupied with his/her own health, display negative emotions towards doctors and healthcare workers, demand unncessary tests and fail to comply with doctor recommendations. Diagnosis of Somatoform Disorders Diagnosis combines the medical and the psychological. A patient who visits a healthcare provider with unexplained symptoms must be thoroughly examined to rule out any possibilities of physical illness or trauma. A medical doctor confronted with a patient who is preoccupied with inexplicable symptoms may recommend a mental health evaluation if he suspects a somatoform disorder. A mental health evaluation must be conducted carefully to rule out other diagnoses. The perceived symptoms, the preoccupation with the symptoms, and the repeated search for help may be part of a larger mental health problem. Additionally, two related disorders must be ruled out. Factitious Disorder and Malingering Factitious disorder and malingering must both be ruled out before moving on to a somataform disorder. A patient with factitious disorder takes on physical symptoms for internal gain. For example, someone who longs for sympathy may exaggerate or feign stomach pain. A patient who is malingering takes on physical symptoms for external gain. External gain can be something like money (in the form of disability payments, for example) or something a little more subtle such as avoidance of situations (such as family gatherings).

Two related disorders, factitious disorder and malingering, must be excluded before diagnosing a somatoform disorder. In factitious disorder, patients adopt physical symptoms for unconscious internal gain (i.e., the patient desires to take on the role of being sick), whereas malingering involves the purposeful feigning of physical symptoms for external gain (e.g., financial or legal benefit, avoidance of undesirable situations). In somatoform disorders, there are no obvious gains or incentives for the patient, and the physical symptoms are not willfully adopted or feigned; rather, anxiety and fear facilitate the initiation, exacerbation, and maintenance of these disorders. Criteria for Somatoform Disorders It is important to remember that someone who plays sick for a day does not have a somatoform disorder. Three criteria are required for diagnosis: 1. The physical symptoms cannot be fully explained by a medical condition, another mental illness, or by the effects of a substance 2. The diagnosis is not factitious disorder or malingering 3. The symptoms significantly impair in social, occupational, or other daily life functioning. Types of Somatoform Disorders Somatization Disorder (a.k.a. Briquet's syndrome) Somatization disorder patients usually have a pretty long history of doctor visits for a variety of symptoms. There are specific criteria in the DSM for somatization disorder: a history of somatic symptoms prior to the age of 30; pain in at least four different sites on the body; two gastrointestinal problems other than pain such as vomiting or diarrhea; one sexual symptom such as lack of interest or erectile dysfunction; one pseudoneurological symptom similar to those seen in conversion disorder such as fainting or blindness. Undifferentiated somatoform disorder This is a somewhat vague version of somatization disorder, requiring only one symptom for 6 months. Conversion disorder The DSM describes conversion disorder with the following criteria: one or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition; psychological factors are judged to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit; a diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual; the symptom

or deficit is not intentionally produced or feigned (as in factitious disorder or malingering); the symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience; the symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation; the symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder. Pain disorder As its name suggests, patients with pain disorder report pain that has no apparent physical cause; in pain disorder the patient is not "faking" the pain as in malingering. They have chronic pain for several months that causes stress and disrupts daily life. The pain may or may not be associated with a medical condition. Hypochondriasis The term "hypchondriac" is a familiar one that is often used casually. However, it relates to this specific mental illness. The DSM lists the following criteria for hypochondriais: a preoccupation with fears of having a serious disease based on the misinterpretation of bodily symptoms; the preoccupation persists despite medical evaluation and reassurance; the belief in the presence of disease and symptoms is not of delusional intensity and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder); the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; the duration of the disturbance is at least 6 months; the preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder. Body dysmorphic disorder A person with body dysmorphic disorder obsesses over a physical imperfection or deformity that may or may not exist. For example, a small scar on a hand might cause someone to constantly wear gloves and take extreme measures to prevent anyone from seeing their hands. The DSM-IV defines body dysmorphic disorder as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance that causes clinically significant distress or impairment in social, occupational or other important areas of functioning. The individual's symptoms must not be better

accounted for by another disorder; for example, weight concern is usually more accurately attributed to an eating disorder. Somatoform Disorder not Otherwise Specified ( NOS ) This diagnosis is reserved for those conditions that are characteristic of somatoform disorders but fail to meet the criteria for more specific diagnosis. Somatoform Disorders Treatment Treatment for somatoform disorders is usually therapy based. Medical treatments can be used, especially when another disorder is being treated in conjunction, but there is not much evidence that they are very effective for somatoform disorders by themselves. A 2007 research survey found that cognitive behavioral therapy was the most effective form of treatment.