Personality disorders

Personality disorders

(this is a somewhat lengthy post and not entry level, should you have questions, feel free to ask)

Hollywood and the Media often will portray someone with a “Mental Condition”, often they bandy the term psychopath about. 

The question often arises, are they a psychopath or sociopath… neither term is used any longer, and there was always question between the two, as they were mostly the same. The term used now is Antisocial Personality Disorder. There continues to be, however, arguments and dissension on if ASPD should be all encompassing, or if it should even be considered a mental disorder as it is used so often in court, to escape crimes.

This is not what this post is about however. This is just to define what we now consider to be personality disorders, a basis of understanding about them with the Hollywood hype removed. 

One would think then, that this means the persons Personality is off… This is not quite right though. It more applies to a category of disorders that relate to a maladaptive reaction, belief, thinking or feeling. Their personality is not really any different from anyone else’s. Psychological geek talk though, personality is defined by the pattern of thinking, feeling, reacting or behaving. If we all lived alone in caves, this would not be an issue, but we are a social creature, a personality disorder is more in regard to social experiences. How we interpret the information we receive in this social experience can be maladapted. Misperceived. This can apply to how we look at ourself as well, or how we react to others in a social setting. This is refereed to as our “environment”, more psychological geekologie.

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How we interpret our environment, react to it establishes/defines our personality “traits”. Our reactions should be fluid, accurate, balanced. With a disordered personality not so much, reactions are more rigid, interpretations can be flawed, maladapted. For a personality disorder to be diagnosed established patterns must be looked at. Patterns that evolve over a long period in different situations, problems with these patterns that cause distress. Most diagnoses may not be established below the age of 18.

People with a personality disorder are more unlikely to notice. They are likely to feel unbalanced, or stressed, not happy overall, find relationships difficult. Others will see it in them, whereas they will not. But how could they, this is all they know, it is not like we receive two “personalities” and then choose one, but can refer to the other to see how they compare.

The DSM 5 classifies a personality disorder with a rigid and long term pattern of behaviour in these areas, Impulsiveness, Relationships, Thoughts and Feelings that leads to distress in oneself or others.

Here are 10 “Personality Disorders” 

Listed in the DSM 5:
Paranoid personality disorder,
Schizoid personality disorder,
Schizotypal personality disorder,
Antisocial personality disorder,
Borderline personality disorder,
Histrionic personality,
Narcissistic personality disorder,
Avoidant personality disorder,
Dependent personality disorder,
Obsessivecompulsive personality disorder. (this is not OCD which is an anxiety disorder)

 

They are grouped in clusters.

Cluster A: paranoid, schizoid and schizotypal personality disorders.
Cluster B: impulsive personality disorders, such as borderline, narcissistic, histrionic and antisocial personality disorders.
Cluster C: anxious personality disorders, such as obsessive-compulsive, dependent and avoidant personality disorders.

 

To continue a definition needs to be made between each of these.

The Mayo clinic has a nicely organized well written list, so I will borrow that.

 

Cluster A personality disorders

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder. It’s not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.

Paranoid personality disorder

·         Pervasive distrust and suspicion of others and their motives

·         Unjustified belief that others are trying to harm or deceive you

·         Unjustified suspicion of the loyalty or trustworthiness of others

·         Hesitant to confide in others due to unreasonable fear that others will use the information against you

·         Perception of innocent remarks or nonthreatening situations as personal insults or attacks

·         Angry or hostile reaction to perceived slights or insults

·         Tendency to hold grudges

·         Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

Schizoid personality disorder

·         Lack of interest in social or personal relationships, preferring to be alone

·         Limited range of emotional expression

·         Inability to take pleasure in most activities

·         Inability to pick up normal social cues

·         Appearance of being cold or indifferent to others

·         Little or no interest in having sex with another person

Schizotypal personality disorder

·         Peculiar dress, thinking, beliefs, speech or behavior

·         Odd perceptual experiences, such as hearing a voice whisper your name

·         Flat emotions or inappropriate emotional responses

·         Social anxiety and a lack of or discomfort with close relationships

·         Indifferent, inappropriate or suspicious response to others

·         “Magical thinking” — believing you can influence people and events with your thoughts

·         Belief that certain casual incidents or events have hidden messages meant specifically for you

Cluster B personality disorders

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. It’s not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.

Antisocial personality disorder

·         Disregard for others’ needs or feelings

·         Persistent lying, stealing, using aliases, conning others

·         Recurring problems with the law

·         Repeated violation of the rights of others

·         Aggressive, often violent behavior

·         Disregard for the safety of self or others

·         Impulsive behavior

·         Consistently irresponsible

·         Lack of remorse for behavior

Borderline personality disorder

·         Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating

·         Unstable or fragile self-image

·         Unstable and intense relationships

·         Up and down moods, often as a reaction to interpersonal stress

·         Suicidal behavior or threats of self-injury

·         Intense fear of being alone or abandoned

·         Ongoing feelings of emptiness

·         Frequent, intense displays of anger

·         Stress-related paranoia that comes and goes

Histrionic personality disorder

·         Constantly seeking attention

·         Excessively emotional, dramatic or sexually provocative to gain attention

·         Speaks dramatically with strong opinions, but few facts or details to back them up

·         Easily influenced by others

·         Shallow, rapidly changing emotions

·         Excessive concern with physical appearance

·         Thinks relationships with others are closer than they really are

Narcissistic personality disorder

·         Belief that you’re special and more important than others

·         Fantasies about power, success and attractiveness

·         Failure to recognize others’ needs and feelings

·         Exaggeration of achievements or talents

·         Expectation of constant praise and admiration

·         Arrogance

·         Unreasonable expectations of favors and advantages, often taking advantage of others

·         Envy of others or belief that others envy you

Cluster C personality disorders

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. It’s not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.

Avoidant personality disorder

·         Too sensitive to criticism or rejection

·         Feeling inadequate, inferior or unattractive

·         Avoidance of work activities that require interpersonal contact

·         Social inhibition, timidity and isolation, especially avoiding new activities or meeting strangers

·         Extreme shyness in social situations and personal relationships

·         Fear of disapproval, embarrassment or ridicule

Dependent personality disorder

·         Excessive dependence on others and feels the need to be taken care of

·         Submissive or clingy behavior toward others

·         Fear of having to provide self-care or fend for yourself if left alone

·         Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions

·         Difficulty starting or doing projects on own due to lack of self-confidence

·         Difficulty disagreeing with others, fearing disapproval

·         Tolerance of poor or abusive treatment, even when other options are available

·         Urgent need to start a new relationship when a close one has ended

Obsessive-compulsive personality disorder

·         Preoccupation with details, orderliness and rules

·         Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards

·         Desire to be in control of people, tasks and situations and inability to delegate tasks

·         Neglect of friends and enjoyable activities because of excessive commitment to work or a project

·         Inability to discard broken or worthless objects

·         Rigid and stubborn

·         Inflexible about morality, ethics or values

·         Tight, miserly control over budgeting and spending money

***Obsessive-compulsive personality disorder isn’t the same as obsessive-compulsive disorder, a type of anxiety disorder.***

http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/symptoms/con-20030111

 

Someone with a Personality disorder may exhibit some crossover between each, just to confuse, a mixing or a comorbidity. 

Between NPD and ASPD there are similarities. Both are extremely arrogant. To the point that the world exists to serve them. This is a trait we all have, it gradually vanishes as move through childhood. Someone with aspd will be more impulsive. With aspd criminal activities are more likely. Remorse is almost  non existent, killing is something that is not likely to concern them. With any illness, there are varying degrees, nothing is written in stone, yes or no, so there may be varying levels of remorse. This also does no mean that someone with npd does not partake in criminal activities, they are perhaps just more shrewd about it, conniving.

When diagnosing ASPD ofen we look at the family line as it is often hereditary. We also can not provide a diagnosis of ASPD before the age of 18.

Borderline Personality Disorder is possibly the next due for a name change. Many feel the name is outdated and not representative of the disorder. Previously it was felt the person was on the border between different diagnoses. We continue to learn more about this disorder and the treatment. Treatment for BPD may be applied to other personality disorders, though for many of the other disorders, the person is not as likely to seek treatment. 

The Children.

Numerous studies show Children of parents with untreated personality disorders are at a higher risk of developing a personality disorder, maladjusted schema or anxiety disorders. This is a combination of learned traits and abuse. This can often be attributed to verbal abuse alone. With many parental personality disorders though, some abuse can be sexual or physical as well. 

Many studies have shown higher numbers/more likelyhood of a child with a parent having BPD also developing this. Untreated BPD, there is a high emotional dis-regulation that will be difficult for a child. Relationship struggles  between the parents will further this.

The child of a parent with NPD, as mentioned in a previous post (here) can also be damaged. Esteem levels can be quite low. There can often be abuse, verbal or physical. Often the childs mind is tormented as they enter adulthood, the reasons are unknown, again, they have little to compare to, this was their parent or parents (as is often the case), it isn’t until they understand why their parents disorder made them behave the way they did and how it affected them that they can come to terms with it, and heal. Narcissistic traits can be passed along as the parent often molds the child to mirror them. 

Children with a parent with ASPD are at a higher risk of developing the same disorder. Adopted children who’s birth parent had ASPD are at risk, so it is hereditary. It is also a learned behaviour, so the risk increases for a child raised by a parent with ASPD. Trauma and relationship problems are a strong possibility with the child.

As a personality disorders relate directly to relationship difficulties, raising a child whilst untreated, can be very difficult on the child, in many cases of the child developing the same disorder or being traumatized and quite likely engaging PTSD later in life. 

Childhood is when the schema is shaped, during the shaping years if in an environment that is tumultuous, maladaptive behaviours are often predisposed. The risks of depression or anxiety issues is much increased. Self esteem will be low, relationship issues/difficulties are much increased.

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About sensuousamberville

I am a Practitioner, teacher and student. I think we should always be students, we should keep our minds open, to continue to learn. :-)

5 responses »

  1. Well, I love this post Amber…..i have learned so much being a friend these past four or gosh is it even longer than that years?…..i have starred it so i can refer to it…. I love that you are so thoughtful in teaching those of us that are not as familiar with mental health conditions and issues about the intricacies associated with what to a layperson seems like a spider web of possible diagnoses…. Thank you for being you!!!! Sends big *hugs* ‘chelle

    Reply
  2. Hmm… the problem with these categories is they don’t truly exist as distinct entities. People’s emotional distress and maladaptive coping styles are too complex, individual, and variable over time to be accurately reduced to these labels. That’s why I think the DSM categories should be abolished and replaced by, at minimum, descriptions that are dimensional/based on a spectrum of severity and allow for individual variations. Also, descriptions of people’s personalities should include strengths, not only weaknesses. What a glaring omission that is in these “disorders”. No one is only a disorder, nor is anyone truly a disorder, period.

    Reply
    • The DSM is a guide to help unify diagnoses. It is constantly evolving and constantly debated. As we learn more, this will continue to be the case, it should never stop evolving. The DSM is also quck to point out the varying impact that a “disorder” will have on an individual. The varying degrees/levels of that disorder, not all symptoms apply, often separating in susubclassifications. The effort has been to make a diagnosis more simplified and recognized, moving from one health care provider to another, it “should” make this transfer more successful, making treatment more unified. This of course doesn’t always happen, there are so many ways to interpret symptoms, those “symptoms” may continue to evolve, change, they are more complex with interactions due to possible comorbidly. Is it comorbidly though? With a diagnosis of borderline quite often bipolar may exist, is it really two “disorders” at play together or is it a completely different “disorder”, or a misdiagnosis?

      We have to start somewhere, so we have the DSM, we also need to acknowledge that for each individual this will vary, treatment needs to be flexible, fluid, adapting. Treat the symptoms not the diagnosis, it is not quite this simple, but many therapies will help a patient this way. Because we are all different, all respond to treatments differently, have different levels of our diagnosis, different influencing environments, different reasons for developing our diagnosis. Having the diagnosis will often help decide the method of treatment, help. Not this is the only way. Adapt. Therapy may bring “things” out, the diagnosis may be completely incorrect. We don’t have a diagnostic port to run a software check.

      “Borderline” is a prime example, the name doesn’t really apply. Stigma is powerful and detrimental on so many levels. I suspect there will be changes in the next DSM. I think the stigma that is so powerful with borderline is a large cause for not having these changes, it slows the process. To learn more when so many refuse to treat patients with it. This annoys me to the point I want to scream. We can only change the world one person at a time though. It seems a very slow process.

      No one is a disorder, no one is their diagnosis. We are individuals.

      In the case of the above “personality disorders” There is much overlap. I am sure there will be changes to these in the future. The DSM is not a bible, not written in stone. It may be a lot of the cause for stigma. It adapts, it guides but we shouldn’t be rigid in our thinking, it is only a guide. We are too complex for that. Labels of a diagnosis a disorder can often be so wrong. Treatment or meds may be ineffective with the label. Both the patient and their health providers can give up, it happens so often. Flexibility, adjustment. We have to have this.

      Reply
      • A lot of what you said. Unfortunately, diagnoses are rarely used or understood in hospital/institutional settings in the flexible, nuanced, continuum-based way that you described. Rather, they are largely a justification for the continuing medicalization of human emotional distress, and for the increased profiteering off that distress by increasing prescription of psychiatric drugs. That is largely why the DSM has swollen to over 300 pseudo-diagnoses, none of which have any reliabe basis in genes or biology… because it’s profitable.

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