Personality Disorders

We all know what personality is, even if we find it difficult to define it. People show their character through their personality — the way an individual thinks, feels and behaves. Here’s the National Mental Health Association’s (NMHA) definition:

“Personality refers to a distinctive set of traits, behavior styles, and patterns that make up our character or individuality. How we perceive the world, our attitudes, thoughts, and feelings are all part of our personality.”

Thus, you might guess that a personality disorder is a condition that negatively impacts one’s attitudes, thoughts or feelings. And you would be essentially right. Below are some definitions offered by various authorities:

• The Personality Disorders Foundation: “Personality Disorders are generalized, inflexible patterns of inner experience and behavior. These patterns significantly differ from cultural expectations, and begin in adolescence or early adulthood. Personality Disorders are long-term, maladaptive patterns of perception, emotional regulation, anxiety, and impulse control.”
• Linda Lebelle:“A personality disorder is identified by a pervasive pattern of experience and behavior that is abnormal with respect to any two of the following: thinking, mood, personal relations, and the control of impulses.”
• National Mental Health Association: “A deeply ingrained, inflexible pattern of relating, perceiving, and thinking serious enough to cause distress or impaired functioning is a personality disorder.”
• The American Psychiatric Association (APA): “An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”

Notice the words “deviates markedly from the expectations of the individual’s culture.” What if an entire culture has it wrong? More about that later.

Everyone experiences occasional mood swings. Anger, jealousy and depression are perfectly normal and can be healthy when manifested on the right occasion.

But when these behaviors become more entrenched or extreme, or when they’re exhibited on the wrong occasions, they become maladaptive, in psychiatrists’ lingo. Normal emotions help us cope with the unpredictable things life throws at us, while personality disorders can throw a monkey wrench in life.

Victims R Us

An estimated 10-15% of adult U.S. citizens are afflicted with one or more personality disorders. It’s quite possible that a member of your family suffers from a personality disorder, and most people have associated with co-workers (or supervisors) with personality disorders.

Personality Disorders are among the most common of the severe mental disorders and commonly occur with other illnesses (e.g. substance use, mood and anxiety disorders). Many people in America’s crowded prisons have diagnosable personality disorders. Yet they’re among the least understood and recognized disorders in both psychiatry and general medical care.

Schizoid and narcissistic personality disorders are more common in males than in females. Obsessive-compulsive and antisocial personality disorders are diagnosed in men two and three times as often as in women, respectively. However, borderline personality disorder is three times more common in women.

Causes

There are as many potential causes of personality disorders as there are people who suffer from them. They may be caused by a combination of parental upbringing, one’s personality and social development, as well as genetic and biological factors. Traumatic events, such as child abuse, can be an important factor. Research has not narrowed down the cause to any factor at this time. We do know, however, that these disorders will most often manifest themselves during increased times of stress and interpersonal difficulties in one’s life. Therefore, treatment most often focuses on increasing one’s coping mechanisms and interpersonal skills.

My Own Worst Enemy

Personality disorders are notoriously difficult to treat. People who manifest these disorders are typically difficult to please. They also block effective communication, avoid development of a trusting relationship, and cannot be relied upon for accurate history regarding problems or how problems arose. Such patients can burn out therapists.

You’ve probably heard the saying, you can’t cure an alcoholic until he admits he has a drinking problem. Ditto for personality disorders. Healing is possible when victims admit they have a problem, choose to be in control of their lives and are committed to changing.

Therapy and medications can help, but an individual’s decision to embrace personal accountability is central to successful treatment. Such treatment may require an individual to confront severe or repeated childhood traumas, which may lead to depression.

The goal isn’t just to change how patients feel. Rather, they need to change their behavior. With the help of a support system (therapists, self-help groups, friends and family, etc.) they can do that.

The 10 Personality Disorders

Currently, there are ten distinct personality disorders identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM IV, 1994), organized into three groups. The descriptions below are offered by the National Institute of Mental Health.

Cluster A: Odd or Eccentric Behavior
• Paranoid Personality Disorder—The essential feature for this type of personality disorder is interpreting the actions of others as deliberately threatening or demeaning. People with paranoid personality disorder are untrusting, unforgiving, and prone to angry or aggressive outbursts without justification because they perceive others as unfaithful, disloyal, condescending or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious.
• Schizoid Personality Disorder—Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker.
• Schizotypal Personality Disorder—A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of “magical thinking” by saying they can see into the future or read other people’s minds.
Cluster B: Dramatic, Emotional or Erratic Behavior
• Antisocial Personality Disorder—People with antisocial personality disorder characteristically act out their conflicts and
ignore normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behavior, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behavior on others. These people ware at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom.
• Narcissistic Personality Disorder—People with narcissistic personality have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.
• Borderline Personality Disorder—People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behavior, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterize the person with borderline personality disorder. These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes, viewing others as either “all good” or “all bad.” A person with borderline personality may form an intense personal attachment with someone only to quickly dissolve it over a perceived slight. Fears of abandonment may lead to an excessive dependency on others. Self-mutilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of boredom or emptiness, and bouts of intense inappropriate anger are other traits of this disorder, which is more common among females.
Cluster C: Anxious Fearful Behavior
• Avoidant Personality Disorder—Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are fearful of saying something considered foolish by others; worry they will blush or cry in front of others; and are very hurt by any disapproval by others. People with avoidant personality disorder may have no close relationships outside of their family circle, although they would like to, and are upset at their inability to relate well to others.
• Dependent Personality Disorder—People with dependent personality disorder may exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They require excessive reassurance and advice, and are easily hurt by criticism or disapproval. They feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends. They have a strong fear of rejection. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males.
• Obsessive-Compulsive Personality Disorder—Compulsive personalities are conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances. People with compulsive personality are highly cautious, weigh all aspects of a problem, and pay attention to every detail, making it difficult for them to make decisions and complete tasks. When their feelings are not under strict control, events are unpredictable, or they must rely on others, compulsive personalities often feel a sense of isolation and helplessness.
• Histrionic Personality Disorder—Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.