概述
人格障碍是一种精神障碍，会让您出现僵化和不健康的思维、机能和行为模式。人格障碍患者在理解和处理各种情况和人际关系方面存在困难。这会给人际关系、社会活动、工作和学习带来重大问题和限制。
有些患者可能不会意识到自己存在人格障碍，因为您的思维方式和行为方式对您自己来说似乎极为自然。而且您可能会在自己面临问题时责怪别人。
人格障碍通常始于青少年时期或成年早期。人格障碍有多种类型。有些类型可能会在中年时期变得不那么明显。
症状
基于相似的特征和症状，人格障碍类型被分为三类。许多患有一种人格障碍的人也至少有一种其他人格障碍的体征和症状。患者不一定要表现出所列的所有体征和症状才能确诊。
A 类人格障碍
A 类人格障碍的特征表现为古怪的思想或行为。包括偏执型人格障碍、类精神分裂型人格障碍和精神分裂型人格障碍。
偏执型人格障碍
- 对他人的动机普遍表现出不信任和怀疑
- 毫无根据地认为他人试图伤害或欺骗自己
- 毫无根据地对他人的忠诚或诚信产生怀疑
- 由于无端地担心他人会利用获知的信息对付您，而不愿向他人倾诉
- 将无恶意言论或无威胁性情况视为人身侮辱或攻击
- 对察觉到的侮辱或轻蔑表现出愤怒或敌对反应
- 有怨恨倾向
- 毫无根据地反复怀疑配偶或性伴侣不忠
类精神分裂型人格障碍
- 对社会或人际关系缺乏兴趣，喜欢独处
- 情感表达范围有限
- 在大多数活动中都无法获得乐趣
- 无法察觉社交暗示
- 看起来对别人很冷淡或漠不关心
- 几乎没有兴趣与他人发生性关系
精神分裂型人格障碍
- 穿着奇特、思想奇怪、有奇异的信念、言语怪异或行为怪癖
- 具有奇怪的感知经验，例如听到有声音在轻声呼唤自己的名字
- 表现出情绪平淡或不适当的情绪反应
- 社交焦虑、缺乏密切关系或对密切关系感到不适
- 表现出对他人冷淡、不当或怀疑的反应
- “奇幻思维”— 相信能用自己的思想影响身边的人和事
- 相信某些偶然事件具有仅对自己有意义的隐藏信息
B 类人格障碍
B 类人格障碍的特征表现为戏剧性、过度情绪化或不可预测的思想或行为。包括反社会型人格障碍、边缘型人格障碍、表演型人格障碍和自恋型人格障碍。
反社会型人格障碍
- 忽视他人的需求或感受
- 习惯撒谎、偷窃、使用别名和哄骗他人
- 反复违法
- 屡次侵犯他人的权利
- 经常有攻击和暴力行为
- 忽视自己或他人的安全
- 冲动行为
- 一贯不负责任
- 对自己的行为毫无悔意
边缘型人格障碍
- 表现出冲动和危险行为，例如不安全性行为、赌博或暴饮暴食
- 自我形象不稳定或脆弱
- 关系不稳定且紧张
- 心情起伏不定，往往是对人际压力的反应
- 自杀行为或自残威胁
- 强烈恐惧孤独或被抛弃
- 持续的空虚感
- 频繁且强烈地表现出愤怒
- 压力引起的妄想症，时有时无
表演型人格障碍
- 不断寻求关注
- 用过度情绪化、戏剧化或性挑逗行为引起注意
- 固执己见，但几乎没有事实或细节支持
- 容易受他人影响
- 头脑简单，情绪变化太快
- 过度关注外表
- 过度乐观估计与他人的关系
自恋型人格障碍
- 认为自己很特别，且比他人更重要
- 对权力、成功和吸引力抱有幻想
- 不能认识到他人的需求和感受
- 对自己的成就或才能夸大其辞
- 期望得到不断的赞美和欣赏
- 傲慢自大
- 不合理地期望得到利益和好处，经常利用他人
- 嫉妒他人，或认为被他人嫉妒
C 类人格障碍
C 类人格障碍表现为焦虑和恐惧的思想或行为。包括回避型人格障碍、依赖型人格障碍和强迫型人格障碍。
回避型人格障碍
- 对批评或拒绝太过敏感
- 感觉能力不足、自卑或缺乏吸引力
- 回避需要人际交往的工作活动
- 在社交上压抑、胆怯和孤立，不愿参加新的活动或与陌生人见面
- 在社交场合和人际关系中极为害羞
- 害怕不被认可、尴尬或受到嘲笑
依赖型人格障碍
- 过度依赖他人，感觉自己需要被照顾
- 对他人表现出顺从或粘人的行为
- 害怕独自一人时不得不照顾自己
- 缺乏自信，即使做出很小的决定也需要别人的过度建议和肯定
- 因缺乏自信而难以独立开始或完成项目
- 难以与他人持不同意见，担心不被认可
- 即使有其他选择，也会容忍粗暴或虐待行为
- 当一段亲密关系结束时，迫切需要开始一段新的关系
强迫型人格障碍
- 对于细节、秩序和规则的先占观念
- 极端的完美主义，当未能达到完美时，例如因为没有达到自己的严格标准而感到无法完成一个项目，会导致身体机能障碍和痛苦
- 渴望控制他人、任务和局势，却无法委派任务
- 对工作或项目过度投入，从而忽视朋友和娱乐活动
- 无法丢弃破损或毫无价值的东西
- 刻板而固执
- 在道德、伦理或价值观方面过于死板
- 在控制预算和花钱方面很严格且吝啬
强迫型人格障碍不同于强迫障碍，强迫障碍是焦虑障碍的一种类型。
何时就诊
如果您有任何一种人格障碍的体征和症状，请咨询您的医生、其他初级保健专家或心理健康专家。如果不加以治疗，人格障碍会给您的生活带来严重问题，并且情况可能变得越来越糟。
Group A personality disorders
Group A personality disorders have a consistently dysfunctional pattern of thinking and behavior that reflects suspicion or lack of interest in others. They include:
Paranoid personality disorder
- Lacks trust and is suspicious of others and the reasons for their actions.
- Believes that others are trying to do harm with no reason to feel this way.
- Doubts the loyalty of others.
- Is not willing to trust others.
- Hesitates to confide in others for fear that others will use that information against them.
- Takes innocent remarks or situations that are not threatening as personal insults or attacks.
- Becomes angry or hostile to what are believed to be slights or insults.
- Has a habit of holding grudges.
- Often suspects that a spouse or sexual partner is unfaithful with no reason to feel this way.
Schizoid personality disorder
- Appears to be cold to or not interested in others.
- Almost always chooses to be alone.
- Is limited in how emotions are expressed.
- Cannot take pleasure in most activities.
- Cannot pick up typical social cues.
- Has little to no interest in having sex with another person.
Schizotypal personality disorder
- Has unusual thinking, beliefs, speech or behavior.
- Feels or thinks strange things, such as hearing a voice whisper their name.
- Has flat emotions or emotional responses that are socially unusual.
- Has social anxiety, including not being comfortable making close connections with others or not having close relationships.
- Responds to others in ways that are not proper or shows suspicion or lack of interest.
- Has "magical thinking"— the belief that their thoughts can affect other people and events.
- Believes that some casual incidents or events have hidden messages.
Group B personality disorders
Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. They include:
Borderline personality disorder
- Has a strong fear of being alone or abandoned.
- Has ongoing feelings of emptiness.
- Sees self as being unstable or weak.
- Has deep relationships that are not stable.
- Has up and down moods, often due to stress when interacting with others.
- Threatens self-harm or behaves in ways that could lead to suicide.
- Is often very angry.
- Shows impulsive and risky behavior, such as having unsafe sex, gambling or binge eating.
- Has stress-related paranoia that comes and goes.
Histrionic personality disorder
- Always seeks attention.
- Is overly emotional or dramatic or stirs up sexual feelings to get attention.
- Speaks dramatically with strong opinions but has few facts or details to back them up.
- Is easily led by others.
- Has shallow emotions that change quickly.
- Is very concerned with physical appearance.
- Thinks relationships with others are closer than they are.
Narcissistic personality disorder
- Has beliefs about being special and more important than others.
- Has fantasies about power, success and being attractive to others.
- Does not understand the needs and feelings of others.
- Stretches the truth about achievements or talents.
- Expects constant praise and wants to be admired.
- Feels superior to others and brags about it.
- Expects favors and advantages without a good reason.
- Often takes advantage of others.
- Is jealous of others or believes that others are jealous of them.
Antisocial personality disorder
- Has little, if any, concern for the needs or feelings of others.
- Often lies, steals, uses false names and cons others.
- Has repeated run-ins with the law.
- Often violates the rights of others.
- Is aggressive and often violent.
- Has little, if any, concern for personal safety or the safety of others.
- Behaves impulsively.
- Is often reckless.
- Has little, if any, regret for how their behavior negatively affects others.
Group C personality disorders
Group C personality disorders have a consistently dysfunctional pattern of anxious thinking or behavior. They include:
Avoidant personality disorder
- Is very sensitive to criticism or rejection.
- Does not feel good enough, important or attractive.
- Does not take part in work activities that include contact with others.
- Is isolated.
- Does not try new activities and does not like meeting new people.
- Is extremely shy in social settings and in dealing with others.
- Fears disapproval, embarrassment or being made fun of.
Dependent personality disorder
- Relies on others too much and feels the need to be taken care of.
- Is submissive or clingy toward others.
- Fears having to take care of self if left alone.
- Lacks confidence in abilities.
- Needs a lot of advice and comforting from others to make even small decisions.
- Finds it hard to start or do projects due to lack of self-confidence.
- Finds it hard to disagree with others, fearing they will not approve.
- Endures poor treatment or abuse, even when other options are available.
- Has an urgent need to start a new relationship when a close one ends.
Obsessive-compulsive personality disorder
- Focuses too much on details, orderliness and rules.
- Thinks everything needs to be perfect and gets upset when perfection is not achieved.
- Cannot finish a project because reaching perfection is not possible.
- Needs to be in control of people, tasks and situations.
- Cannot assign tasks to others.
- Ignores friends and enjoyable activities because of too much focus on work or a project.
- Cannot throw away broken or worthless objects.
- Is rigid and stubborn.
- Is not flexible about morality, ethics or values.
- Holds very tight control over budgeting and spending money.
Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is an anxiety disorder.
Many people with one type of personality disorder also have symptoms of at least one other type. The number of symptoms a person has may vary.
When to see a doctor
If you have any symptoms of a personality disorder, see your doctor or a mental health professional. When personality disorders are not treated, they can cause serious issues in relationships and mood. Also, the ability to function and pursue personal goals may get worse without treatment.
病因
性格是想法、情感和行为综合作用的产物，使您独一无二。性格是您观察、理解和联系外部世界以及看待自己的方式。性格形成于童年时期，并在以下因素的相互作用下塑造成形：
- 基因。某些性格特征可能会通过遗传基因由父母遗传给您。这些特质有时被称为性情。
- 环境。这涉及到您的成长环境、成长经历以及与家庭成员和其他人的关系。
目前认为人格障碍是由基因和环境影响共同引起的。您的基因可能会使您更容易患上某种人格障碍，而生活状况也可能会引起实际发病。
风险因素
尽管尚不清楚人格障碍的确切原因，但某些因素似乎会增加患上或触发人格障碍的风险，包括：
- 人格障碍或其他心理疾病的家族病史
- 童年时遭受虐待、家庭生活不稳定或混乱
- 被诊断为患有儿童行为失常
- 脑部的化学和结构的变化
并发症
人格障碍会严重影响患者及其关心者的生活。人格障碍可能导致人际关系、工作或学业出现问题，并可能导致社交孤立、酗酒或吸毒。