Personality Disorders and Psychotic Disorders

School Nutrition’s March issue explores mental health and mental illness with the aim of starting a conversation about these conditions that often go undiscussed. In “Through the Looking Glass,” Susan Davis Gryder provides an overview of some of the major mental illnesses that affect millions of Americans, including anxiety disorders, addiction disorders and attention disorders.

Two other classes of mental illness, personality disorders and psychotic disorders, affect a smaller number of people and are even more misunderstood than relatively common conditions like depression and anxiety. Here, School Nutrition offers a closer look at these disorders.

Personality Disorders
A personality disorder is a specific kind of mental illness that includes long-lasting patterns of behavior that differ significantly from the accepted norms of the person’s culture. These patterns include distorted thinking, problematic emotional responses, poor impulse control and interpersonal difficulties. These combine in different ways to result in a set of symptoms that defines a specific personality disorder. For example, people who suffer from Histrionic Personality Disorder may appear overly dramatic, erratic and emotional, while people who have Avoidant Personality Disorder suffer from extreme social inhibition and fear of being negatively judged and may appear more odd or eccentric. Someone with Antisocial Personality Disorder typically has a disregard for society’s rules and norms and displays a lack of concern about the rights and feelings of others.

Characteristics of a person with a personality disorder include:

  • Pervasive behavior that deviates from the norm and is stable over time;
  • Rigid black-and-white thinking;
  • Vacillation between strong positive and negative feelings: If it’s not excellent, it’s horrible. If you are not my best friend, you’re my sworn enemy.
  • Odd or unusual beliefs that don’t correspond to the person’s culture.
  • Perceptual distortions—fleeting visual impressions that are distorted. (These are not the same as hallucinations; the person experiencing the distortion knows that it’s not real.)

One of the most mysterious personality disorders is Borderline Personality Disorder (BPD). People with BPD have rapidly shifting, intense and unstable moods, demonstrate a pattern of unstable interpersonal relationships and view the world in a polarized, all-or-nothing way. They can interpret others’ actions in a black-and-white way, with intense emotions, leading them to react very strongly and impulsively. Many people with BPD injure themselves through cutting or other means as a way to cope with overwhelming feelings (or sometimes overwhelming numbness).

There are many theories about the cause of personality disorders, from early biological influences to early life experiences and to the type of attachment that sufferers have to their parents. For many years, it was thought that personality disorders couldn’t be effectively treated. Today, research shows that some personality disorders can be treated with a combination of psychiatric medications like mood stabilizers and antipsychotics, along with therapy and, in some cases, hospitalization and residential treatment programs.

Psychotic Disorders
Psychosis means a shift from or loss of contact with reality, which typically takes one of two forms: hallucinations (hearing voices, seeing visions) and delusions (fixed, false beliefs that don’t change when the person is presented with new facts). A person who experiences psychosis is said to have a psychotic disorder, a serious mental illness that affects a person’s ability to understand reality and think clearly.

People with psychotic disorders often have trouble with performing daily life tasks and behaving appropriately with other people. They may be isolated or withdrawn, display paranoid thinking or experience declining hygiene or the ability to care for themselves.

Overall, psychotic disorders are rare—only about one in 100 people in the United States will develop such a disorder. The usual onset of identifiable symptoms is between ages 18 and 24 (or a little later in women), but symptoms may show up unremarked during teenage years. There are many risk factors for developing the disorder, including repeated trauma or other severe stress, substance abuse and certain environmental factors that may even occur in the womb. Scientists suspect that there is a genetic component that increases a person’s chance of having a psychotic disorder, particularly when paired with other risk factors.

The most commonly known type of psychotic disorder is schizophrenia. Schizophrenia is a chronic illness, defined as lasting longer than six months. People with schizophrenia experience abnormal thinking, hallucinations and loss of contact with reality and sometimes have irrational fears or paranoia that cause them to refuse medication.

Frequently inaccurately portrayed in the media, schizophrenia is often misunderstood. It’s important to know that schizophrenics don’t have multiple personality disorder, although they may hear voices. And the vast majority of people with the illness are not violent toward others. In fact, they are much more likely to be a victim rather than a perpetrator of violence. Many are suicidal; as much as 13% of people with schizophrenia die from suicide.

In addition to a chronic condition like schizophrenia, people also can have a condition called brief psychotic disorder, in which periods of psychosis are brief, usually less than a month. One to two women for every thousand births can experience postpartum psychosis after giving birth, and substance abuse also can induce psychosis.

Psychotic disorders are treated with medication, psychotherapy and social/community support services, including day treatment programs that help provide an accepting social environment, stability and medication monitoring. These programs are particularly important because sufferers experience many social problems, including poverty, homelessness, unemployment and loss of family support. And while the stress on family members can be severe, the family’s role can be critical to successful treatment: A person with a psychotic disorder needs an advocate, someone to keep health care providers informed and identify early warning signs of relapses or issues with medication.

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