Personality Disorders
Personality disorders are chronic, non-psychotic, psychological disorders, which largely affect every aspect of a person’s life including relationships with family, friends, jobs and health. They are deeply ingrained, non-psychotic, rigid, maladaptive patterns of relating. They effect perception and behavior and are serious enough to cause impairment and dysfunction in an individual’s life.
Personality disorders can be measured on a scale due to the fact that individuals may exhibit or experience anywhere from mild to severe signs and symptoms of a specific type of personality disorder. While individuals that experience mild symptoms of a personality disorder can live relatively normal lives, during times of increased pressure or stress the symptoms of the disorder may become intensified. Intimacy may also trigger or strengthen the traits. For example becoming closer to a partner in a relationship may trigger primal intense fears of abandonment for an individual with a personality disorder causing them to send mixed messages that alternate between extreme rejection coupled with intense neediness. Because of this pattern, many people with personality disorders have a history of short intense unstable relationships.
Personality disorders used to be called “characterological disorders” because they are rooted in the character of an individual. The character of a person is shown through his or her personality by which is displayed in the way they think and act. When their behavior is rigid and inflexible, and when the behavior is egocentonic, meaning they defend it as normal, then that individual is diagnosed with a personality disorder. Many people have character traits and patterns that they wish to change or that they view as not being who they really are at their core. Individuals with a personality disorder cannot see their behavior and thoughts as maladaptive and they will defend them as being justifiable and correct. In other words, denial and defense are common. It is believed that personality disorders may be caused by deficiencies in early preverbal attachment in children.
Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders (referred to as the DSM IV) by the American Psychiatric Association. Per the DSM IV (which refers to the latest 4th edition) diagnosing a personality disorder must meet the following general criteria in addition to the specific criteria listed under the specific personality disorder under consideration. The following are the general diagnostic criteria from the DSM IV.
A. Experience and behavior that deviates signigicanlty from the norm of the individual's society and culture. This pattern is manifested in two (or more) of the following areas:
- cognition (perception and interpretation of self, others and events)
- affect (the range, intensity, and appropriateness of emotional response)
- interpersonal functioning
- impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance or a general medical condition such as head injury.
People under 18 years old who fit the criteria of a personality disorder are usually not diagnosed with such a disorder, although they may be diagnosed with a related disorder. There are certain personality disorders which do not meet the full criteria and are designated by the diagnosis “Personality Disorder not otherwise specified.”
The DSM-IV lists ten distinct personality disorders, grouped into three clusters. The clusters are divided by the traits commonly exhibited within the disorders in that cluster.
Cluster A (odd or eccentric disorders)
Paranoid personality disorder - Marked distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive him or her; lack of trust; belief of others' betrayal; belief in hidden meanings; unforgiving and grudge holding.
Schizoid personality disorder - Primarily characterized by a very limited range of emotion, both in expression of and experiencing; indifferent to social relationships.
Schizotypal personality disorder - Peculiarities of thinking, odd beliefs, and eccentricities of appearance, behavior, and thought (for example, belief in having magical powers but not in the context of a religious or cultural belief).
Cluster B (dramatic, emotional, or erratic disorders)
Antisocial personality disorder - Lack of regard for the moral or legal standards of society, marked inability to get along with others or abide by societal rules.
Borderline personality disorder - Lack of one's own identity, with rapid changes in mood, intense unstable interpersonal relationships, marked impulsively, instability in affect and in self image.
Histrionic personality disorder - Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality. Sudden and rapidly shifting emotional expressions.
Narcissistic personality disorder - Grandiosity, lack of empathy, need to be admired by others, inability to see the viewpoints of others, and hypersensitive to the opinions of others.
Cluster C (anxious or fearful disorders)
Avoidant personality disorder - Marked social inhibition, avoiding relating with other individuals, feelings of inadequacy, and extremely sensitive to criticism.
Dependent personality disorder - Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on his or her own. Fear of separation. Submissive behavior. Marked lack of decisiveness and self-confidence.
Obsessive-compulsive personality disorder – Extreme perfectionism and inflexibility, preoccupation with uncontrollable patterns of thought and action.
Personality disorders are interrelated since they are linked by the attributes that they share in common. The following is a partial list of those shared characteristics.
- Self-centeredness and a self-preoccupied attitude
- Propensity for blaming others and circumstance
- Lack of perspective-taking and empathy
- Manipulative behavior
- Depression and other mood and anxiety disorders
- Vulnerability to other mental disorders and addiction
- Distorted or superficial understanding of self
- Socially maladaptive
- No hallucinations, delusions or thought disorders (except for the brief psychotic episodes of Borderline Personality Disorder)
Each personality disorder has unique manifestations and these commonalities listed are not meant to suggest a uniform way in that the disorders show up in all people. And as stated earlier they occur on a continuum meaning everyone can relate somewhat to the characteristics to a certain degree. For example to some degree all people can identify with feeing, at some point in their lives needy, rejected, obsessed, self-righteous etc. A personality disorder is diagnoses when there is no ability for insight, reflection or accountability on the part of the individual and their lives are impaired by the characteristics.