Personality Disorders: The Introduction

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There are some people we meet and know whose traits and behaviors astound us. They may appear isolated, eccentric, manipulative or even abusive. It could be a friend, colleague, teacher, parent or even yourself. This is simply an introduction into how DSM V characterizes personality disorders and the behaviors these people display. I shall develop on each cluster and disorder in more posts over time. As you read through, it is highly possible that you’ll recognize some traits in yourself and those around you, but it’s important to remember that each exists on a spectrum and if you believe that you or a close one exhibit similar behaviors, I would advise you seek clinical advice before jumping to any conclusions.

There are four defining features to the 10 personality disorders:

  1. Distorted thinking patterns
  2. Problematic emotional responses
  3. Over/Under-regulated impulse control
  4. Interpersonal difficulties

As mentioned in the Issues of Mental Diagnostics post, clinicians must attempt to determine the etiology of the condition as a personality disorder diagnosis is not applicable if the symptoms can be better explained by:

  • Substance Abuse (Alcohol Dependence, Cannabis Use etc…)
  • Anxiety Disorders (Social Anxiety etc..)
  • Depression (Clinical Depression etc..)
  • Dissociative Disorders (Dissociative Identity Disorder…)
  • Post Traumatic Stress Disorder
  • Schizophrenia

The patient must be at least 18 years of age, although the behaviors typically emerge in adolescence and continue into adulthood.The patient must meet the minimum number of criteria that characterize the disorder for diagnosis (e.g 5/9), symptoms must be repeatedly observed without regard to time, place, or circumstance and precipitate significant distress and functional impairment.

The DSM classifies them into three clusters:

  • Cluster A: ‘Odd, eccentric’
  • Cluster B: ‘Dramatic, emotional, erratic’
  • Cluster C: ‘Anxious, fearful’

Co-morbidity is not unusual and the individual may be diagnosed with more than one personality disorder. A study found that all three clusters were significantly comorbid with a wide range of DSM-IV Axis I disorders (Psychotic, Mood, Eating, Dissociative, Anxiety and Substance Abuse disorders) and significant associations of personality disorders with functional impairment were largely accounted for by Axis I comorbidity. 

Believed to be Schizotypal.

Adolf Hitler – Believed to have Schizotypal.

Cluster A: Paranoid, Schizoid and Schizotypal Personality disorders

Disorders in this cluster are specified by distorted thinking, social awkwardness and social withdrawal

Paranoid: Characterized by a pervasive distrust and suspiciousness of other people. These individuals believe others are out to get them in one way or another and will endeavour to protect themselves and keep their distance from others. They have a propensity to hold grudges and display pathological jealously. Their emotional life tends to be dominated by distrust and hostility.

Schizoid: Characterized by a pervasive pattern of social detachment and a restricted range of emotional expression. These individuals do not take pleasure in social interaction and are generally isolated. They may come across as aloof, detached and cold and tend to appear indifferent to praise and criticism.

Schizotypal: Characterized by a pervasive pattern of social and interpersonal limitations. Similar to Schizoid PD, they also have a reduced capacity for social relationships, hence inclined to social isolation. Though, these individuals will also experience perceptual and cognitive distortions and/or eccentric behavior e.g. seeing a shadow in peripheral vision that is infact not there. They may hold superstitious or odd beliefs systems and are prevalent in families where someone has been diagnosed with Schizophrenia.

Cluster B: Antisocial, Borderline, Histrionic and Narcissistic Personality disorders

Disorders in this cluster are specified by impulse control and emotional dysregulation. 

marilyn_monroe_3939_938x-1

Marilyn Monroe – Believed to have BPD.

Antisocial (Sociopathy): Characterized by a pervasive pattern of disregard for the rights of other people that often manifests as hostility and/or aggression. Deceit and manipulation are also central features and relative behaviors tend to spring up in childhood. These children may engage in theft, arson, bullying, hurt or torment animals or people. Conduct disorder is usually an appropriate diagnosis at this time. As they continue into adulthood, these individuals are prone to risky and dangerous situations, often acting on impulses and displaying high levels of irresponsibility that can result in legal difficulties, accidents, unemployment etc. Yet, often blame others for their wrong-doings.

Borderline: Characterized by emotional dysregulation, self harm and impulsive behavior. Typically female, they tend to experience intense and rapidly shifting moods, that require a considerable amount of time before they calm down. Consequently, they frequently have angry outbursts and engage in impulsive and self destructive behaviors (i.e. substance abuse, risky sexual liaisons, self-injury, overspending, binge eating etc) in order to soothe or self-medicate. Harsh judgements/criticisms are applied to themselves and others which causes them to vacillate back and forth between ‘all good’ and ‘all bad’ standpoints (Splitting), or have an ‘all or nothing’ mentality. Inside is an unstable sense of self, manifested in numerous ways including frequent career, life goals or partner changes that can be quite sudden, radical and lacking preparation. You could call them ‘Women of Extremes’.

Histrionic: Characterized by a pattern of excessive emotionality and attention seeking. Uncomfortable in situations where they aren’t the centre of attention, these ‘drama queens’ tend to be seductive, flirtatious and dress in a manner that draws attention to them. They can be flamboyant and theatrical, yet simultaneously display vague and shallow emotions, causing some to view them as insincere. They feel depressed when the spotlight isn’t on them and are uncomfortable being alone, especially within an intimate relationship.

Narcissistic: Characterized by excessive preoccupation with personal adequacy, power, prestige and vanity. These individuals possess a powerful sense of entitlement and believe they deserve special treatment which leads them to act in ways that fundamentally disregard and disrespect the worth of those around them. They may come across as arrogant and exploitative and are highly frustrated or even enraged when others don’t admire them as much as they believe they deserve. Narcissists typically lack empathy and their relationships with colleagues, friends partners and even their own children tend to be superficial and devoid of intimacy and true love. They are able to use and/or discard anyone who does not conform to their way. Status and image are of utmost importance, yet the roots of these behaviors link back to their own fragile self-esteem. They can be quite manipulative and use many different strategies to gain control over others. There is a lot to say, but I shall refrain for now.

Cluster C: Avoidant, Dependent and Obsessive-Compulsive Personality disorders

These three personality disorders share a high level of anxiety.

steve-jobs-111007

Steve Jobs – Believed to have OCPD

Avoidant: Characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and a hypersensitivity to negative evaluation.They predominantly believe they are not good enough which can bring forth intense anxiety of rejection, criticism and ridicule, so they avoid social situations and interactions such as parties, speaking up in class or meetings etc. Some may perceive them as distant and shy or stiff and restricted. This perpetuates their belief and further limits their ability to develop social skills, make friends and progress professionally. 

Dependent: Characterized by a strong need for others to take care of them. They are prone to ‘clingy’ behavior and submit to the desires of other people in order to avoid conflict. This is usually due to an emotional void they are trying to fill (typically unmet emotional needs from childhood) and the fear of being alone. Hence, a dependent individual is more vulnerable to manipulation, abuse and repetition compulsion (cycle of relationships that result in disappointment again and again). 

Obsessive-Compulsive: Characterized by preoccupation with rules, regulations and orderliness. As a result, flexibility, openness, and efficiency are sacrificed in the chase for perfectionism as they become rigid, controlling, stubborn and inflexible. They love lists and schedules, and are often devoted to work to the extent that they often neglect social relationships. They have perfectionist tendencies, and are so driven in their work to be the best and get it right that they become unable to complete projects or specific tasks because they get lost in the details. A ‘sub-standard’ job is never acceptable, which leaves them hesitant to delegate tasks for fear that another person will not deliver.

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About

Economics and Finance student. University of Southampton. Autodidact. INTJ. Psychiatry devotee. To myself I am only a child playing on the beach, while vast oceans of truth lie undiscovered before me - Isaac Newton. Any Questions? Email: theoceanofknowledge@hotmail.com

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Posted in Diagnostics, Personality Disorders, Psychiatry
5 comments on “Personality Disorders: The Introduction
  1. Good summary of the personality disorders! I love this.

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  2. The unfortunate fact is that these diagnoses are completely unscientific and do not exist in a medical sense. No biological substrate has ever been identified for them, nor can psychiatrists reliably diagnose them. I do not think they are useless, since maintaining the illusion that they are valid “disorders” allows clinicians to create effective psychotherapies for the symptoms (the symptoms are real, but not the disorders) and allows patients to find help. Also, these “disorders” have the murkier purpose of creating the illusion of legitimacy for psychiatrists as medical doctors, and allowing drug companies to expand the number of “mental illnesses” from which they can profit via medication.
    However, the symptoms of each of these disorders are multifarious, subjective, constantly changing in degree and nature in each individual. It defies common sense to try to classify them as medical disorders. “Comorbidity” really has no meaning when it is used with these “disorders.” The continued belief in these conditions’ medical validity is an indication of how much harder it is for people to think of emotional problems as subjective, dimensional, ambiguous, shifting, existing on a continuum without stark divisions or categories. How much easier it seems to label and categorize “mental illnesses”, even if that approach is fundamentally mistaken.
    It is richly ironic that I was diagnosed with Borderline Personality Disorder, and recovered from it, but now can look back to realize I never had it.

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    • Joy Isaac says:

      Yeah certainly, I wrote about the issues of psychiatry in this post: http://wp.me/p4jGGM-5h
      I think the labels are useful for classification of behavioral patterns and devising appropriate techniques for treatment.
      Why do you think you never had it? I think anyone can read the DSM and find at least 5 and probably up to 20-30 ‘disorders’ they could possibly be diagnosed with. A group of APA board members review them every year and don’t seem to take it seriously. But again, for me that’s not the point, the label is simply a way to classify behavior patterns which is never black and white. I think it does make psychiatry look like a pseudoscience, and in many cases it is as there is a lack of empirical data for a large part of it,but then I believe this undermines the significant progress that has been made even since the first DSM.

      At first a label is probably good news, you finally know what’s wrong, you finally know you’re not alone, you can connect with people like you, some of whom had very similar experiences, but if you allow the label to define who you are or hold you back then you’ll probably fall victim to it.

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      • I did read that other post of yours also. I understand those positive aspects of diagnosing conditions. When I say I never had BPD, I mean I didn’t have it because no one “has” it – in the sense that BPD is an unscientific “non-diagnosis” that does not exist in the real world. But yes, I had all of the symptoms that are commonly associated with BPD… It’s a subtle but crucial difference. The symptoms can all exist without there being a condition which actually exists based on them. I think diagnosis would be better served by shifting to a dimensional, continuum/spectrum-focused approach. But if it did that, it would be deemed unscientific and non-medical, and psychiatrists and drug companies would lose their legitimacy and funding. So, that will almost certainly not happen in the near future. There are many parties invested in the continuation of the current system for reasons other than its (lack of) scientific validity or reliability.

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