What is Mixed Personality Disorder

Personality disorders

Abstract

Personality disorders are conditions and deep-rooted behavior patterns that deviate significantly from the norms to be expected and accepted in a society. In this sense, regional and cultural peculiarities (e.g. different affectivity in different cultures) must always be taken into account. These behavior patterns usually begin in adolescence and are characterized by the fact that they can hardly be influenced and are therefore difficult to treat. Personality disorders do not generally require treatment - therapies are necessary when the level of suffering for the person (and / or the environment) or the impairments in social and professional life become too great.

Well-known examples are the "querulous personality disorder", in which those affected constantly fight against alleged injustice and thereby, for example, sue their entire neighborhood for various things, or the histrionic personality disorder, in which a massively increased affect and theatrical behavior are in the foreground. Here, too, therapy is usually only necessary when the psychological stress becomes too strong. In the case of the most well-known disorder, the emotionally unstable personality disorder of the borderline type, this is different, as those affected are so impaired in their lives that inpatient therapy is almost always necessary (see also: Emotionally unstable personality).

General criteria of personality disorders

  • Deviant behavior
  • Stable, deeply rooted, inflexible behavior patterns
  • Onset in late childhood or adolescence
  • Subjective suffering and impairments in social and professional life
  • Exclusion of an organic cause
  • The deviation cannot be explained by other mental illness patterns

The ICD-10 does not provide for a fixed age limit from which the personality disorder can generally be diagnosed. A diagnosis made in late childhood or adolescence is considered inappropriate or may only be made in special cases. The reason for this is that massive changes in personality still take place in the development of children and adolescents, so that the often “stigmatizing” diagnosis cannot be made with certainty. Children and adolescents can only speak of a personality development disorder - but this is not (!) A diagnosis according to ICD-10.

However, a history of onset in late childhood or adolescence should be used to diagnose a personality disorder in adulthood.

Specific personality disorders according to the ICD classification

The diagnostic criteria for the individual personality disorders are very complex and can be read in the guidelines (see: Tips & Links on the Subject). An overview of the individual malfunctions is given below.

  • Paranoid personality disorder (F60.0): Constant suspicion: even insignificant events are perceived as directed against oneself. The frequent preoccupation with "conspiracies" as explanations for events in the immediate vicinity and the world in general is also typical.
    • Querulatory personality: those affected are constantly fighting against alleged injustice (e.g. pushing a cyclist who has disregarded the traffic rules)
  • Schizoid personality disorder (F60.1): loner who is noticeable for emotional coolness, anhedonia and little interest in social contacts; he tends to be isolated and lonely
  • Dissocial personality disorder (sociopathic personality disorder, F60.2): Person often acts antisocial, with a lack of empathy and without a sense of guilt or responsibility. It is also characterized by a low tolerance for frustration, which is shown by strong impulsiveness, among other things. This disorder is common among offenders.
  • Emotionally unstable personality disorder (F 60.3): impulsive and borderline type
  • Histrionic personality disorder (F60.4): Person with exaggerated theatrical affects and behaviors that appear superficial and exaggerated to others. Slight discomfort is shown excessively exaggerated. The person always sees something special and exciting in everything and basically wants to be the center of attention.
  • Compulsive personality disorder (anankastic personality disorder, F60.5): The person is overly conscientious. Perfectionism is maintained through constant controls and caution. While a patient with obsessive-compulsive disorder cannot organize their life due to their compulsions, compulsive personalities can be very successful through virtues such as punctuality and perfectionism.
  • Anxious personality disorder (avoidant personality disorder, F60.6): The person is characterized by constant insecurity and anxiety. She tends to be overly concerned about the potential dangers of everyday situations, which leads to avoidance behaviors.
  • Dependent personality disorder (asthenic personality disorder, F60.7): The person relies steadily on other people. Life decisions are made passively by other people's decisions, one's own wishes are subordinated. There is a tendency to subordinate themselves to supposedly more experienced people. Dependent personalities are afraid of being abandoned, but are also afraid of leaving a partner.
  • Other specific personality disorders (F60.8):
    • E.g .: Narcissistic personality disorder: The narcissistic personality disorder is characterized by overestimation of oneself, extreme sensitivity to criticism and possibly an inability to empathize
  • Schizotypic personality disorder (F21): Schizotypal personality disorder used to be classified as a delusional disorder and is now increasingly viewed as a personality disorder. It is characterized by paranoid bizarre ideas and anomalies of thinking.

Cluster classification according to DSM-5

According to the American classification system DSM-5, personality disorders can be divided into three clusters. In the clusters, personality disorders are grouped on the basis of common characteristics (e.g. an outsider would describe both a person with paranoid and schizoid personality disorder as a "strange" person). In Germany, this classification is not used to make a diagnosis, but it does give a good overview of the different forms.

therapy

Due to the deep "roots" in the psyche, therapy for personality disorders is generally difficult. While the need for therapy is controversial in the case of mild forms, therapy is usually unavoidable in the case of severe forms due to the suffering for the patient (and / or the environment) or the impairments in social and professional life. In addition to psychoeducation and various psychotherapeutic methods, drug therapy is often used depending on the type of symptoms (e.g. antipsychotics for delusional expressions of a paranoid personality disorder). The main goal is to improve the patients' living conditions.

Coding according to ICD-10-GM version 2021

F60.-: specific personality disorders

F61: Combined and other personality disorders

  • This category is intended for personality disorders which frequently lead to impairments, but which do not exhibit the specific symptom patterns of the disorders described in F60.-. Therefore, they are often more difficult to diagnose than the disorders in F60.-.
  • Examples:
    • Combined personality disorders with features from various of the disorders listed under F60.-, but without a predominant symptom pattern that would enable a more precise diagnosis.
    • Disruptive personality changes that cannot be classified under F60.- or F62.- and are secondary diagnoses for an existing affect or anxiety disorder.
  • Exclusive: Accentuated personality traits (Z73)

Source: Based on the ICD-10-GM version 2021, DIMDI.

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  2. Gleixner et al .: Neurology and Psychiatry for Study and Practice (2011/12). 8th edition Medical Publishing and Information Services 2011, ISBN: 978-3-929-85157-1.