Byline: Pratap. Sharan
Personality disorders have significant, but often unrealized, public health importance. The present review summarizes the published work on personality disorders in the Indian population or by Indian researchers residing in the country. Researchers who have worked on assessment methodology in India have demonstrated that clinical diagnosis has a low reliability when compared with semi-structured interviews; and have attempted to increase the feasibility of the standardized use of International Personality Disorder Examination, a semi-structured interview developed by the World Health Organization (WHO). Studies on epidemiology demonstrate that none of the general population studies have employed standardized interviews, and hence, they grossly underestimate the prevalence of personality disorders in the community. The clinical epidemiology studies have employed questionnaires and interviews developed in the West, mostly without local adaptations, with discrepant results. However, these studies show that personality disorders are common in the clinical population and that rates vary across sub populations. While, there are a few reports attesting the theoretical importance of the role of culture in the formation and expression of personality disorders, empirical literature from India in this area is scanty. Similarly, there are few reports on the treatment of personality disorders, while, important areas such as service delivery, etiology, and validity of personality disorders, are unaddressed. The study of personality disorder in India is maturing, with researchers showing increased familiarity with the methodological nuances of this complex area of research.
The definition of personality disorders given by the International classification of diseases (ICD-10) states that 'personality disorders' comprise of deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They represent extreme or significant deviation from the manner in which an average individual in the given culture perceives, thinks, feels, and particularly relates to others. They are frequently, though not always, associated with varying degrees of subjective distress and problems in social functioning and performance. These patterns are usually evident during late childhood or adolescence, but the requirement to establish their stability and persistence usually (but not necessarily) restricts the use of the term 'disorder' for adults. [sup] The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) definition is similar, although it is more explicit, and emphasizes the impulse control problems that many patients with personality disorders would have. [sup]
Personality disorders lead to a disturbance in functioning as great as that in most major mental disorders. [sup] They are associated with high rates of separation and divorce; unemployment and inefficiency; and poor quality of life for the individual and his/her family. Patients with personality disorders have an increased risk of mortality through suicide, homicide, and accidents. Moreover, when a personality disorder is present, the treatment of other coexisting psychiatric or medical conditions is frequently more complicated, lengthier, or less successful; a pattern that may at times be due to lack of recognition of the personality disorder. [sup],,
Since the publication of the Diagnostic and Statistical Manual (DSM-III) in 1980, and its creation of a separate diagnostic axis (i.e., Axis II) for personality disorders, interest in the description and classification of personality disorders has expanded dramatically in the West. The present review summarizes the published work on personality disorders in the Indian population or by Indian researchers residing in the country. It excludes studies on normal personality variants and studies that use personality measures in relation to other foci of interest. …