Emergence of an Abnormal Personality

There are ten types of personality disorders (PDs). The overall prevalence of these in the United States of America is highest for obsessive–compulsive PD (OCPD) followed by narcissistic PD (NPD) and borderline PD (BPD). PDs are strongly correlated with mental health disorders such as depression, anxiety, and substance abuse, and they have in common a failure in impulse control. NPD is principally determined by the social environment and is composed of two different forms, the grandiose and the vulnerable, both of which involve the search for admiration to satisfy feelings of importance. The personality features of vulnerable narcissistic patients, especially shame and rumination, lend themselves to exacerbating depression. The psychodynamic personality theories of Kohut and Kernberg stress the effects of emotional abuse and neglect in childhood that give rise to the child developing a compensatory grandiose self-image and so the emergence of NPD. BPD is characterised by occasions of unreality, frequent changes in self-image, changes in mood, outbursts of anger, and dangerous acts of self-injury, of suicide attempts, and of suicide. Both inherited and environmental risk factors are independently responsible for the aetiology of this disorder. Trauma in child–parent relationships involving abuse, assault, neglect, violence, exploitation, or bullying are all strong predicators for BPD emerging between adolescence and 30 years of age.