Personality Disorders

A lot of clients I see are diagnosed with Axis I disorders like Schizophrenia, Major Depression and Bipolar Disorder when in actuality, they are suffering from a Personality Disorder.  Personality Disorders are rarely discussed because they ultimately cannot be medicated and require long term psychotherapy.  Insurance companies do not cover them and, at least where I live, the county mental health authority does not treat them.  So in order for people with Personality Disorders to get any help, they are mislabeled as one of the "Big Three" (Schizophrenia, Bipolar Disorder or Major Depression) - disorders which are covered by most systems.  I think this is a great disservice to patients and clients.  People have a right to know what is really going on with them and what the proper treatment provided.  What are Personality Disorders?

We come to know people by their personalities, the way they think, feel and behave.  Most Personality Disorders begin in childhood as problems in personal developoment, peak in adolescence, progress through adulthood and may lessen in severity with middle age.  These traits persist throughout life and affect every aspect of day to day behavior.

Personality Disorders are pervasive, chronic, rigid and deeply ingrained behaviors which are maladaptive, dysfunctional and/or self-destructive.  Personality Disorders affect the ways in which a person relates to others, perceives the world and people around them, experiences and expresses emotions and behaves.  They can affect every area of a person's life;  work, school, family and social relationships and can be serious enough to canse distress or impair the person's ability to function.  They affect the way a person relates, perceives, thinks, feels and behaves regardless of the situation. 

Some of the symptoms of a Personality Disorder are:

• Disturbances in self-image
• Impaired ways of perceiving themselves, others, and the world
• Inability to cope with everyday stresses and problems
• Blaming others for their problems
• Frequent conflicts with other people
• Extreme, dramatic or highly unstable mood swings
• Social isolation
• Suspicion and mistrust of others
• Difficulty establishing and/or maintaining relationships
• A need for instant gratification
• Poor impulse control
• Alcohol or substance abuse

Severity

Any Personality Disorder exists on a continuum from mild to severe.  People with mild symptoms may lead fairly normal lives and merely be considered a bit "odd" or "moody" or "overly dramatic" by friends and family.  Under stress or pressure their symptoms may increase or become severe enough to impair various areas of their lives, but decrease when the stress or pressure has been resolved.

People with more severe symptoms may require frequent psychiatric hospitalizations, may be placed on psychiatric medications and may fail to be able to function in most areas of their lives.  They may be unable to work, to maintain stable relationships, to interact appropriately with others or to maintain adequate housing.  (Research has shown that in the homeless population up to 70% have a Personality Disorder.  The prevalence of Personality Disorders in the general population is about 10%.)

Some Personality Disorders are less well tolerated than others by society and individuals.  Borderline Personality Disorder and Antisocial Personality Disorder being two of the most common examples.  These two disorders are also good examples of gender differences.  Men are must more likely to be diagnosed as Antisocial while women are more likely to be diagnosed Borderline.  Some Personality Disorders are less tolerated in one gender than another, for example Dependent men or Antisocial women.  Environmental factors may enable one person to thrive with a Personality Disorder while another person with the same Personality Disorder flounders.  An Antisocial male from an affluent family may become the CEO of a company while an Antisocial male from a poor family will go to prison.  However, sometimes even money and education will not protect the former from joining the latter as we have seen in recent years.  Some individuals with a Personality Disorder may choose careers that accomodate their symptoms.  The overdramatization of Histrionic Personality Disorder may be used to develop a successful acting career.   However, personal relationships and interactions will continue to be strained by the manifestation of the symptoms as we often read in the tabloids.   

Age of Onset

The symtpoms of Personality Disorder may be seen as early as childhood.   They often peak in adolescence, continue throughout adulthood and may decrease during middle age.  

Causes

No one factor has been shown to cause Personality Disorders.  It is believed that they are caused by a combination of family environment, the type of personality with which you were born and the type of social development you experienced while growing up.  There may also be genetic and biological factors which influence who develops a Personality Disorder. 

Risk Factors

A family history of personality disorders or other mental illness

Verbal, physical or sexual abuse during childhood, especially sexual abuse as a child

An unstable or chaotic family life during childhood

Loss of parents through death or divorce during childhood

Treatment

Psychotherapy, or counseling, is the treatment of choice for personality disorders.  Therapy can help you learn more about the condition, recognize patterns of behavior that are causing problems and learn healthy ways to manage the symptoms.  Therapy is usually for the individual, but can also include group, family or couples therapy to help the people around you learn how to live with the disorder as well and to work on interpersonal interactions. 

Medications may be prescribed by a psychiatrist or other medical doctor to help relieve symptoms of personality disorders, especially problems with perceptions or anxiety, but should be used in conjunction with psychotherapy.

Diagnostic Criteria

There are 10 different types of personality disorders.  They are grouped in 3 different "clusters" as shown below.

Cluster A (odd or eccentric disorders)

• Paranoid Personality
• Schizoid Personality Disorder
• Schizotypal Personality Disorder

Cluster B (dramatic, emotional or erratic disorders, impulsive disorders)

• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder

Cluster C (anxious or fearful disorders)

• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive Compulsive Disorder

You can read the Diagnostic Criteria for Personality Disorders in General or view the diagnostic criteria for specific Personality Disorders below:  (listed alphabetically)

1.  Antisocial Personality Disorder
2.  Avoidant Personality Disorder
3.  Borderline Personality Disorder
4.  Dependent Personality Disorder
5.  Histrionic Personality Disorder
6.  Narcissistic Personality Disorder
7.  Obsessive Compulsive Personality Disorder
8.  Paranoid Personality Disorder
9.  Schizoid Personality Disorder
10. Schizotypal Personality Disorder

Comments

[Zoom]

Cluster B individuals, in my experience, are the most dangerous and they are, again in my experience, invariably abusive. Functionality in capitalism doesn't really interfere with that.

On sex: I find the diagnosis distribution strange, because in the very many people I've met (and I'm not licensed whatsoever; I'm just someone who tries to look very carefully at the world), borderline individuals are equally male or female, but antisocials definitely tend towards the male side. Narcissists (not that stupid "they're obnoxiously privileged and oblivious so therefore narcissistic" kind) are more commonly diagnosed when male - I've met a lot of undiagnosed ones, and I believe I grew up with one - but I've only ever met one male narcissist; I've met several female narcissists.

I take the very controversial point of view that cluster B individuals (as they aren't sufferers from their own disorder) should be killed. Yes, really. I don't much bother myself with how that would be decided, since I see the psychiatric/psychological institution as hopelessly inept at actually diagnosing these individuals, and it's not much of a problem for me because I also believe that, if you are being abused, you have the (non-legal) right to kill the person.

I don't know if you've considered this idea... but I am very behavioristic in how I perceive the world. It's a safer and more accurate way to gather information on how to proceed. Humans do lie, all the time; they speak, and their body language and actions say it's a lie.

The way they behave, individuals with personality disorders have a fundamental disconnect in their brain/mind with how their actions affect the world. Narcissists don't and can't see how they have affected the world or done anything wrong, their inner world/delusion doesn't allow it. It is essentially against the laws of physics for them to have seriously hurt someone without them deserving it. Antisocials (from what I have seen - I've never actually interacted with one) have that disconnect in a complete neutrality of what their actions mean in terms of ethics. They are unable to conceive/impress of doing something wrong, even if they did it and if someone else did the same thing, it would be wrong to them. Borderlines have that disconnect as being unable to be... powerful, or meaningful: when they hurt someone, it couldn't have been that bad. I've never met anyone with histrionic personality disorder, or known about them. At all. I can't say anything about it.

I say that about borderlines because, if you look at their behavior, their repentance/self-pitying inevitably turns into another form of self-aggrandizement. I've never known a borderline to have what I call an "apology session" without the subtle demand of validation/justification. Ask a socially inferior member of a borderline's circle (children, for example) when they're not there: what happens if you agree with the idea that they should feel bad, or tell them that they need to stop that behavior and stop apologizing for it? It's always, always the same: they become abusive and hateful.

In general, I think it is extremely dangerous and willfully blind to consider any personality disorder-afflicted individual's self-analysis, reflection or testimony as valid. I have known borderlines to lie about childhood abuse - it's a sympathy-garnering tactic, a way to escape and receive validation. I am VERY reluctant to consider any person's testimony of rape or abuse as invalid, but it's pretty standard in the borderline repertoire. Narcissists don't do it much, though I'm not sure why - but stories of attempts seem to be standard, whether or not they're true.

So I don't think that personality disorders are behaviors. They're disconnects between the individual's inner world and the reality of the world. It's one thing that makes treating personality disorders so difficult, but there are some that are more treatable than others because of their extra reliance on an external factor (dependent personality disorder, for example). The counselors I've known (no, they hadn't gotten a degree, but I have only rarely respected someone more than them in my entire life) have immense trouble with Cluster Bs - it essentially comes down to getting the individual to stop or curtail their abusive behavior towards others.

[katye]

I started seeing a counselor at my university about 3 months ago for things that I had been dealing with for many years but which had finally reached a point of disruption wherein I felt desperate. There were many things that I had been seeing as being totally separate issues, the main ones being-- not knowing how to "be"/how to act (I feel like a different person in different situations, even when I am alone in different environments, to the point that it seems like different realities), trouble with authority figures (making them into "Gods" with the answers until they fail and piss me off), increasingly rapid mood swings with times of euphoria and times of depression provoked by external events and that change many times each day, obsessions, fear, relationship problems, and eating disorders (which we never got around to talking about because of the other stuff), long periods of depresssion at times, emptiness, nearly unbearable loneliness, bordeom, fear. There is much much more. I feel as if I could talk or write for 4 hours and not say it all.

I have researched and came across the label borderline personality disorder. Often, when I would read about it, I would get this sense that someone was reading back my life to me. I told my therapist about it, and he acted a bit surprised and refused to tell me whether or not the label applied to me. We looked over the DSM criteria together, and while I met enough of them to be diagnosed, he said that he didn't think I did so in an extreme enough sense. I wonder what the hell counts as an "extreme" enough senese? I can often imagine myself going to the extreme-- if that means what I think it does-- but it's just a matter of time until it happens. Sometimes the internal pain and chaos is so bad that I feel like I need to act out in some way just to get people's attention. I don't know how else to ask for help. I am dying and screaming inside, and on the outside people see someone who is "responsible" and in control, even having a lead role as a write this moment in a 5-week camp over 30 high schoolers and other counselors. I don't know if I can do this. It just started. I have left my university for the summer and have been away from counseling for over a month. I feel like I'm about to snap.

What should I do? Why would my therapist, why will no one, tell me what is going on? Why does everyone I know tell me that labels aren't that important? Are they or are they not?

[Cluster B]

This comment is, I suppose, directed at "Zoom," the author of the first comment.

What would you tell my children, whom I do not abuse as I have put safeguards in place for them socially and psychologically, after you had me executed for my disorder?

What would you tell my husband (to whom I apologize nearly every day)?

Would you just tell them they're better off? If I believed that, I'd kill myself. Because I do NOT believe that, I make myself live even when fantasies of suicide are sometimes all that get me through the day.

When would you have killed me?

And what's YOUR diagnosis? I'm curious as to what malfunction what makes you devalue a human life to such a degree.

[Addison]

I dont even really understand cluster b's or know if I am one. I do have BPD though and the first commentor is a barbaric idiot. First of all, I have never abused anyone...ever. Why not figure out a way to help people wit BPD instead of putting yourself on a pedastal proclaiming we all should be killed. Maybe you're the one who needs to be killed for being a self righteous asshole. Just sayin'.

[Glen Godfrey84]

Paranoid personality disorder is a type of personality disorder that can become a debilitating condition and needs immediate treatment. People with this disorder are extremely suspicious of others and do not trust anyone including faithful friends and the other relatives.
http://www.disorderscentral.com/paranoid-personality-disorder.html