Approximately 50 years ago, personality disorders were regarded as untreatable conditions. However, after the 1950s, through the dedicated work of scientists interested in psychology and in line with the theories that were developed, personality disorders were defined, classified, and various techniques were developed for their treatment.
Freud, one of the foundational figures of the science of psychology, in his work on personality disorders, focused on neurotic problems (such as hysteria, conversion, etc.) that emerge from the oedipal period (ages 3–6) and concluded that personality disorders or psychotic disorders (such as schizophrenia, etc.) occurring in the pre-oedipal period, that is, between ages 0–3, could not be treated.
After the 1950s, detailed and meticulous studies on personality disorders were carried out by various scientists such as John Watkins, Heinz Kohut, Melanie Klein, J. F. Masterson, and Otto Kernberg. In line with these studies, many theories on personality disorders were developed, and various techniques related to the treatment of these redefined conditions were introduced. Object relations theory, self psychology theory, and ego therapy theory, in particular, pioneered the treatment of personality disorders that were asserted by Freud to be untreatable—those formed in the pre-oedipal period, that is, ages 0–3.
What Are Personality Disorders?
A personality disorder is a pattern that emerges when a person’s subjective inner experience and behaviors deviate or differ markedly from the expectations of the culture in which the individual lives. This pattern, called a personality disorder, may manifest in the person’s ways of perceiving themselves, others, and the outside world, in the emotions they experience, in their interpersonal relationships, or in several of these at the same time.
In personality disorders, the deviation that occurs in the person is not tied to a specific event or distress; it is inflexible, does not change on its own, and is not due to the direct effects of conditions arising from another substance or a medical condition (such as head trauma).
In general, a person acts through many strategies such as dependence, suspicion, aggression, avoidance, compliance, and isolation, which make survival easier and facilitate adaptation to demands and threats coming from the environment. While a person chooses which to use depending on the situation, in the presence of a personality disorder, the person uses only a few of these strategies in an inflexible and maladaptive way.
How Many Types of Personality Disorders Are There?
The primary source used today for the diagnosis and classification of personality disorders is the Diagnostic and Statistical Manual of Mental Disorders. Accordingly, personality disorders are classified under three headings.
Cluster A Personality Disorders
Paranoid Personality Disorders: there is a constant search for malicious intent in others’ behaviors; accordingly, the person is continually distrustful and suspicious.
- Without a definite or sufficient basis, the person continually suspects that people around them are exploiting, deceiving, or harming them.
- The person has unfounded suspicions, baseless interpretations, a persistent sense of grudge, and anger carried in that direction.
Schizoid Personality Disorders: the person shows persistent detachment from social relationships and restriction in the expression of emotions. There is a lack of enjoyment of and avoidance of close relationships, and a lack of interest in having sexual experiences.
- The person, who has no close friends or confidants, shows emotional coldness, detachment, and flat affect. Schizotypal Personality Disorder: it manifests with an inability to enter into close relationships, discomfort with close relationships, unusual behaviors, and cognitive and perceptual distortions.
- There are situations of social and interpersonal inadequacy, oddness in speech and thinking, and lack of close friends.
- Excessive and persistent social anxiety is observed in the person.
Cluster B Personality Disorders
Antisocial Personality Disorder: it manifests with a pattern of disregard for and violation of the rights of others since the age of 15.
- There is an inability to conform to laws and social rules.
- Due to personal interests being prioritized, lying, inability to make plans for the future, irritability and aggressiveness, harming others, and mistreating others are observed.
Narcissistic Personality Disorders: there is a sense of superiority, a tendency to seek admiration, and an inability to empathize.
- There are situations such as a sense of being very important, a desire to be admired, and inability to empathize.
- The person often envies others, thinks others envy them, and accordingly displays arrogant and self-important attitudes.
Histrionic Personality Disorder: it manifests with persistent excessive emotionality and attention-seeking.
- There is discomfort when not the center of attention, rapidly shifting and shallow emotions, and using physical appearance to draw attention.
- Suggestibility and being easily influenced are observed.
Borderline Personality Disorder: it manifests with instability in self-image and affect, and marked impulsivity.
- There are various efforts to avoid abandonment, swinging between extremes, and tense and inconsistent attitudes.
- Inability to control anger and a persistent feeling of emptiness are observed in the person.
Cluster C Personality Disorders
Avoidant Personality Disorder: it manifests with social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
- There is avoidance of developing relationships due to fear of criticism, disapproval, or rejection.
- Due to fear of inadequacy and embarrassment, the person refrains from personal initiatives or participating in new activities.
Dependent Personality Disorder: it becomes excessive due to a need to be taken care of.
- There is difficulty making decisions without receiving abundant advice and support from others.
- An excessive fear of being unable to care for oneself and a constant search for a relationship as a source of care and support are observed.
Obsessive-Compulsive Personality Disorder: it manifests as mental and interpersonal control and perfectionism.
- There is reluctance to work with others and inflexibility regarding values such as morality and correctness.
- Rigid and stubborn attitudes are observed in the person.
Therapy Process for Personality Disorders
In the therapy and treatment process of personality disorders, it is rarely seen that the patient’s primary complaint is personality problems. Instead, the person experiences difficulties due to depression, anxiety, or external factors that lead the person to seek treatment.
- Patients with personality disorders generally evaluate their situation independently of their own behaviors and contributions.
- They generally and frequently declare themselves victims of others or of the system globally.
- The person has very little idea about how they arrived at their current point and what they can do regarding the problems in question.
In the personality disorder therapy process, the patient should be enabled to question why—despite being isolated due to the chronic nature of the disorder—they continue these dysfunctional behaviors. In the second stage, patients should be supported to face change and the accompanying anxiety, and accordingly to modify their adaptations.
