Personality: Hidden Face of psychiatry ?

Personality analysis hardly aroused the interest of psychiatry until the 1980s. Before it was considered a marginal matter that lacked scientific interest. However, its modulatory role in mental disorders and, even in many medical diseases, has been progressively recognized. The personality affects the totality of the working areas of the human being, it is his spine. A patient with borderline features or personality limit shows impulsivity and instability that can lead to their job dismissal 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 by not being responsible for compliance. Narcissism in a schizophrenic patient will impoverish his prognosis as it generates denial of his own problems and the need for help. A phobic patient with incipient cancer will postpone the diagnosis and turn into a disease that, if treated early, could have been cured.

However, these traits can be severe and persistent and reach the category of personality disorder, diagnosis present in 40-60% of mental patients and the most frequent in current psychiatry. The factors that determine our way of being derive essentially from our genes, our biography, our cultural influence and the way we interpret the experiences we have. Overvaluing or underestimating any of these dimensions can lead to misconceptions as well as to dogmatic and sterile reductionisms.

Classification of disorders

Today we base the classification of personality disorders on the criteria of the DSM IV TR (American Society of Psychiatry) and the ICD10 (World Health Organization) which, although they show some differences among themselves, are very similar. We can group personality disorders into three major groups:

• Group A: Includes "rare" or eccentric personalities (schizotypal, schizoid, and paranoid).
• Group B: Includes the dramatizing, erratic and hyper-emotional personalities (antisocial, histrionic, limit and narcissistic).
• Group C: Includes anxious and fearful personalities (avoidant, dependent and obsessive-compulsive).

Of them, the personalities of group A are those that have a greater severity for showing a poor response to treatments and those of group C are those that have fewer repercussions because they imply in general a better adaptation to the environment than the rest. Group B is the one that registers more 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 growing, perhaps due to social and cultural factors and, on the other hand, research has achieved important achievements with respect to the pharmacological and psychotherapeutic tools that we have been incorporating.  

Advances in treatment

The deepening of the biological knowledge of these diseases today allows treatments that improve, among others, the emotional aspects, the impulse control, the violent behaviors and the stability of the mood of these patients, and also reduce the side effects.

The clinical stabilization and the improvement of the basal state of these patients has also increased the efficiency of psychotherapeutic techniques, which, overall, has significantly improved the quality of life in these patients, their social integration, their job and social stability as well as a stable and lasting restructuring of his personality.

Having a personality disorder today no longer assumes that the patient sees his own life or that of his loved ones broken. Recent advances allow us to see the problem now with greater optimism. We can say with confidence that the personality no longer constitutes or will constitute the hidden face of psychiatry.