Hello XXXXXXX

Thanks for your query.

I appreciate your efforts for medical consultation.

From your query it is clear to me that you have difficulty in expressing your feeling to others which leads to frequent change of mood. I too feel it is part of your personality.

I would like to have following information to help you better: (Please answer in YES or NO)
•     Displays emotional coldness, detachment, or flattened affectivity.
•     Limited capacity to express warm, tender feelings for others as well as anger.
•     Appears indifferent to either praise or criticism of others.
•     Almost always chooses solitary activities.
•     Excessive preoccupation with fantasy and introspection.
•     Callous unconcern for the feelings of others.
•     Incapacity to maintain enduring relationships, though having no difficulty to establish them.
•     Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
•     A marked tendency to act unexpectedly and without consideration of the consequences.
•     A marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts
•     are thwarted or criticized.
•     Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions.
•     Difficulty in maintaining any course of action that offers no immediate reward.
•     Unstable and capricious mood.
•     Disturbances in and uncertainty about self-image, aims and XXXXXXX preferences (including sexual).
•     Liability to become involved in intense and unstable relationships, often leading to emotional crises.
•     Excessive efforts to avoid abandonment.
•     Recurrent threats or acts of self-harm.
•     Chronic feelings of emptiness.
•     Self-dramatization, theatricality, or exaggerated expression of emotions.
•     Suggestibility, easily influenced by others or by circumstances.
•     Continually seeks excitement and activities in which the subject is the centre of attention.
•     Overly concerned with physical attractiveness.
•     Preoccupation with details, rules, lists, order, organization or schedule.
•     Undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.
•     Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable
•     Persistent and pervasive feelings of tension and apprehension.
•     Belief that oneself is socially inept, personally unappealing, or inferior to others.
•     Excessive preoccupation about being criticized or rejected in social situations.
•     Unwillingness to get involved with people unless certain of being liked.
•     Restrictions in lifestyle because of need of security.
•     Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear
•     of criticism, disapproval or rejection.
•     Encouraging or allowing others to make most of one's important life decisions.

Awaiting your answers to provide more specific suggestions.
Regards,

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Hello again,

Thanks for your patience for answering all questions.

Above questions were related to personality issues. These question only used for screening and not for final diagnosis. As you answered most of the question by YES so there is high chances of having personality related problem which can improve with psychologist help.

I want to give information related to personality disorders so that you can understand the complexity of its assessment and concurrent need of assessment of psychiatric disorder during examination.

Definition: Personality disorders as enduring subjective experiences and behavior that deviate from cultural standards, are rigidly pervasive, have an onset in adolescence or early adulthood, are stable through time, and lead to unhappiness and impairment. When personality traits are rigid and maladaptive and produce functional impairment or subjective distress, a personality disorder may be diagnosed.

Personality disorder subtypes classified in DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) are: schizotypal, schizoid, and paranoid (Cluster A); narcissistic, borderline, antisocial, and histrionic (Cluster B); and obsessive-compulsive, dependent, and avoidant (Cluster C).

Cluster A includes three disorders with odd, aloof features, such as paranoid, schizoid, and schizotypal.

Cluster B includes four disorders with dramatic, impulsive, and erratic features, such as borderline, antisocial, narcissistic, and histrionic.

Cluster C includes three disorders sharing anxious and fearful features, such as avoidant, dependent, and obsessive-compulsive.

Personality disorder is a common and chronic disorder. Its prevalence is estimated between 10 and 20 percent in the general population, and its duration is expressed in decades. Persons with personality disorder are frequently labeled as aggravating, demanding, or parasitic and are generally considered to have poor prognosis.

Personality disorder is also a predisposing factor for other psychiatric disorders (e.g., substance use, suicide, affective disorders, impulse-control disorders, eating disorders, depression and anxiety disorders) in which it interferes with treatment outcomes of other psychiatric disorder and increases personal incapacitation, morbidity, social complication and mortality of these patients.

Persons with personality disorders are far more likely to refuse psychiatric help and to deny their problems than persons with anxiety disorders, depressive disorders, or obsessive-compulsive disorder. Personality disorder symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment) and ego-syntonic (i.e., acceptable to the ego). Persons with personality disorders do not feel anxiety about their maladaptive behavior. Because they do not routinely acknowledge pain from what others perceive as their symptoms, they often seem disinterested in treatment and impervious to recovery.

Many persons exhibit traits that are not limited to a single personality disorder. When a patient meets the criteria for more than one personality disorder, clinicians should diagnose each. In your case during screening you give YES answer to questions related to all clusters of personality(A,B,C).

In last following measures will help you:

•     Personality assessment by clinical psychologist or trained psychiatrist. It may take several days to make final diagnosis. Following tests are used to assess personality which is administered by trained psychologist: Clinical interview, Sentence completion test, Rorschach Inkblot Test, Thematic Apperception Test (TAT), Minnesota-Multiphasic Personality Inventory (MMPI) and several other tests
•     Psychotherapeutic treatment after assessment in form of counselling +/- drug therapy.
•     Treatment of co morbid illness like: anxiety, depression or other problems.
•     Improvement may take weeks or months depending on the case.

Hope this answers your query. I will be available for follow up queries if any.

Regards,

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