Personality analysis hardly aroused the interest of psychiatry until the 1980s. Before that time, it was considered a marginal subject lacking scientific interest. However, its modulating role in mental disorders and even in many medical diseases has been progressively recognized. Personality affects all areas of human functioning, it is the backbone of the human being. A patient with borderline or borderline personality traits shows impulsivity and instability that can lead to dismissal from work and isolation. A diabetic, hypertensive or epileptic patient will strictly comply with his medical treatment when he has obsessive personality traits. A dependent patient, on the contrary, will evolve worse as he/she will not take responsibility for compliance. Narcissism in a schizophrenic patient will impoverish his prognosis because it will generate denial of his own problems and of the need for help. A phobic patient with an incipient cancer will postpone the diagnosis and turn a disease that, if treated in time, could have been cured, into a fatal one.
However, these traits can be severe and persistent and reach the category of personality disorder, a diagnosis present in 40-60% of the mentally ill and the most frequent in psychiatry today. The factors that determine the way we are derive essentially from our genes, our biography, our cultural influence and the way we interpret the experiences we have. Overvaluing or undervaluing any of these dimensions can lead to misconceptions as well as to dogmatic and sterile reductionism.
Classification of disorders
Today we base the classification of personality disorders on the criteria of the DSM IV TR (American Psychiatric Society) and ICD10 (World Health Organization) which, although they show some differences between them, are very similar. Personality disorders can be grouped into three major clusters:
- Group A: Includes the “rare” or eccentric personalities (schizotypal, schizoid and paranoid).
- Cluster B: Includes dramatizing, erratic and hyperemotional personalities (antisocial, histrionic, borderline and narcissistic).
- Cluster C: Includes anxious and fearful personalities (avoidant, dependent and obsessive-compulsive).
Of these, the personalities in group A are the most severe because they show a poor response to treatment and those in group C have the least repercussions because they generally have a better adaptation to the environment than the rest. Cluster B is the one that has seen the most changes in recent years (especially in antisocial, borderline and narcissistic personality disorders). On the one hand, the prevalence of these disorders in developed societies is increasing, perhaps due to social and cultural factors and, on the other hand, research has made important achievements with respect to the psycho-pharmacological and psychotherapeutic tools that we have been incorporating.
Advances in treatment
The deepening of the biological knowledge of these diseases allows today treatments that improve, among others, the emotional aspects, impulse control, violent behaviors and mood stability of these patients, and also reduce side effects.
The clinical stabilization and the improvement of the basal state of these patients has also increased the efficiency of psychotherapeutic techniques which, as a whole, has notably improved the quality of life of these patients, their social integration, their labor and social stability as well as a stable and lasting restructuring of their personality.
Having a personality disorder today no longer means that the patient no longer sees his own life or that of his loved ones as broken. Recent advances now allow us to view the problem with greater optimism. We can say with confidence that personality no longer constitutes and will no longer constitute the hidden face of psychiatry.