Personality Disorders

Personality disorders are a mental disorders characterized by rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder struggles to correctly perceive interpersonal situations. The inability to perceive and relate causes significant problems, limiting success in relationships, work and school.

Personality disorders typically function beneath the surface. Those inflicted often miss the oblivious dysfunction because their way of thinking and behaving seems natural—the way it has always been. Their blindness to the underlying misfiring of their mind often motivates a host of reactionary behavioral adaptations that further alienate the personality disorder victim from others.

Personality disorders are patterns from areas like cognitive, emotional, impulse control, and relationships with others (Trifu, et al. 2019). Personality disorders are behaviors that diverge from societal and cultural norms. Personality disorders usually begin in the teenage years or early adulthood.

The APA defines personality disorder as disorders that involve “pervasive patterns of perceiving, relating to, and thinking about the environment and the self that interfere with long-term functioning of the individual and are not limited to isolated episodes” (APA definition).

Roberta Camilleri wrote, “personality disorders may be diagnosed when behaviour differs from expected norms, and abnormal traits are persistent, pervasive, and problematic (2018).

Personality Disorders Do Not Follow Medical Model of Disease

Personality disorders diverge from the medical model of disease. Consequently, personality disorders do not fit into the classic patterns of disease, making them difficult to diagnose and treat. Furthermore, personality disorders do not have a specific onset time, a period of disease, and a treatment that promotes healing (Trifu, et al. 2019).

Personality disorders are not the result of trauma or disease. Although, a patient may experience shifts in behaviors from a traumatic brain injury, the personality change should not be diagnosed as a personality disorder.

DSM-IV-TR Recognized Personality Disorders

Beginning with DSM IV-TR and continuing to current editions, there are ten recognized personality disorders:

• ​paranoid
• schizoid
• schizotypal
• antisocial
• borderline
• histrionic
• narcissistic
• avoidant
• dependent
• obsessive–compulsive

This list if identified personality disorders does not exhaust the possibility of clinically significant maladaptive personality traits. Many more specific classifications have been considered for inclusion. Some of these additional “personality disorder” classifications (such as: Negativistic Personality Disorder) are placed in the index, requiring further research before inclusion as an APA recognized personality disorder.

Often, those suffering from one personality disorder classification may also meet the criteria of one or more other classifications. Personality disorders are difficult to diagnose, and often are misdiagnosed. Often clinicians may diagnose a personality disorder as “personality disorder not otherwise specified.”

Personality Disorder Clusters

The DSM-IV-TR divides the ten recognized personality disorders into three clusters.

Personality Disorder Cluster A

Cluster A personality disorders include traits centered around unhealthy “suspicion.” This cluster describes personalities with odd and eccentric behaviors.

Paranoid

Paranoid personality disorder exhibits a pattern of suspicion of others, expecting others to act in mean or spiteful ways. People with paranoid personality disorder often assume people will harm or deceive them so they create barriers to protect their vulnerability by limiting trust.

They possess four or more of these characteristics:

• Suspicions of others intent to harm
• unjustifiable doubts of loyalty
• reluctance to confide in others
• bears grudges
• recurrent suspicions
• gives meaning to benign remarks (Wright & Carbajal, 2021)

Schizoid

Schizoid personality disorder emotionally detaches from social relationships, expressing little emotion, sharing some qualities of someone suffering from alexithymia. A person with schizoid personality disorder typically chooses to be alone and seems impervious to the praise or criticism.

They possess four or more of these characteristics:

• neither enjoys or seeks relationships
• prefers solitary activities
• minimal interest in sexual activity
• few close friends outside of first degree relatives
• indifference to praise or criticism
• emotional detachment
• little pleasure in activities (Wright & Carbajal, 2021)

See Schizoid Personality Disorder for more on this disorder

Schizotypal

Schizotypal personality disorder exhibits a pattern of discomfort in close relationships, distorted thinking and eccentric behavior. A person with schizotypal personality disorder may hold odd beliefs and have peculiar behavior. they often have excessive social anxiety.

They possess five or more of these characteristics:

• ideas of reference without delusions
• odd beliefs
• odd perceptions
• odd thoughts and speech
• paranoid ideation
• inappropriate affect
• few friends
• excessive social anxiety (Wright & Carbajal, 2021).

See Schizotypal Personality Disorder for more on this disorder

Personality Disorder Cluster B

Cluster B Personality disorders have traits if heightened emotions and impulsivity. These personality disorders display dramatic and acting-out behaviors.

Anti-Social

Antisocial personality disorder exhibits a behavior pattern of disregarding or violating the rights of others. A person with antisocial personality disorder often does not conform to social norms, may repeatedly lie or deceive others, or act impulsively, lacking skills or desire to delay gratification.

They possess three or more of these characteristics:

• non-conforming with lawful behavior
• deceitfulness
• impulsivity and aggressiveness
• disregard for self and others’ safety
• irresponsible
• unremorseful (Wright & Carbajal, 2021)

See Sociopathy: A Personality Disorder for more on this topic

Borderline (Emotionally Unstable)

Borderline personality disorder exhibits a pattern of unstable and drama filled personal relationships, intense emotions, poor self-image and impulsivity. A person with borderline personality disorder may possess and excessive fear of abandonment, have repeated attempts to commit suicide, display inappropriate intense anger or have continually feelings of emptiness.

They possess five or more of these characteristics:

• frantic efforts to avoid abandonment
• unstable and intense relationships
• unstable self-image
• impulsivity in two self damaging ares
  • spending
  • sex
  • substance abuse
  • reckless driving
  • binge eating
• suicidal behaviors
• mood reactivity
• chronic emptiness
• inappropriate intense anger
• transient stress related paranoia (Wright & Carbajal, 2021)

Histrionic

Histrionic personality disorder exhibits a pattern of excessive emotion and attention seeking. People with histrionic personality disorder often experience discomfort when they are not the focus of attention, may use physical appearance as a means to draw people’s attention or have rapidly shifting and exaggerated emotions.

They possess five or more of these characteristics:

• uncomfortable when not the center of attention
• inappropriate sexual/seductive behavior
• rapidly shifting and shallow emotions
• uses physical appearance for attention
• excessively expressionistic speech lacking details
• exaggerated emotional expression
• suggestibility
• misperceives intimacy in relationships (Wright & Carbajal, 2021)

See Histrionic Personality Disorder for more on this disorder

Narcissistic

Narcissistic personality disorder expresses a pattern of need for admiration and lack of empathy. A person with narcissistic personality disorder often has a grandiose sense of self-importance, a sense of entitlement, and willingness to take advantage of others, while showing lack of empathy when personal actions cause harm.

They possess five or more of these characteristics:

• grandiose self-importance
• preoccupation with fantasies of:
  • unlimited success,
  • beauty,
  • ideal love
  • power
  • brilliance
• believes they are special
• entitlement
• requires excessive admiration
• exploitative
• lacks empathy
• envious
• arrogant (Wright & Carbajal, 2021)

Personality Disorders Cluster C

Cluster C personality disorders are centered on heightened anxiety. This cluster of personality disorders center around anxious and avoidant behaviors.

Avoidant

Avoidant personality disorder displays a pattern of extreme shyness, feelings of inadequacy and extreme sensitivity to criticism. People with avoidant personality disorder avoid the risk of getting involved with other people unless they are certain of being liked. Consequently, people with avoidant personality are preoccupied with possibilities of criticism or rejection, viewing themselves as not being good enough or socially inept. Feelings of shame dominate their emotional landscape.

They possess four or more of these characteristics:

• avoids interpersonal contact
• unwillingness to get involved unless assured to be accepted
• restraint to intimate relationships
• preoccupation with criticism or rejection
• inhibited in social situations
• feels socially inept
• reluctant to take risks (Wright & Carbajal, 2021)

Dependent

Dependent personality disorder expresses an excessive pattern of needing to belong. Relationship fears often are expressed through submissive and clingy behavior. People with dependent personality disorder may have difficulty making independent decisions, willingly sacrificing autonomy for security. They experience discomfort or helplessness when alone.

They possess five or more of these characteristics:

• Difficulty making everyday decisions without excessive advice
• needs others to assume responsibility for most areas of life
• difficulty expressing disagreement
• lacking self confidence
• uncomfortable or helpless when alone
• urgently seeks relationships for support
• preoccupied with fear of being alone (Wright & Carbajal, 2021)

Obsessive Compulsive (Ankastic)

Obsessive-compulsive (ankastic) personality disorder exhibits a pattern of preoccupation with orderliness, perfection and control. A person with obsessive-compulsive personality disorder overly focuses on details or schedules, may work excessively neglecting time for leisure with friends and family. Obsessive-compulsive personalities often are inflexible in their morality and values.

They possess four or more of these characteristics:

• excessively detail oriented, often obscuring purpose of task
• desire for perfection often interferes with completion of projects
• excessively devoted to work
• overly conscientious with inflexible morality
• unable to discard worthless objects
• reluctance to delegate
• frugality with money
• rigidity in beliefs and thoughts
• stubbornness (Wright & Carbajal, 2021)

See Obsessive-Compulsive Personality Disorder for more on this disorder

Personality Disorders Not Listed

Many doctors and researchers have submitted many different personality disorders for inclusion in mental illness diagnostic manuals. Many of these disorders are rejected.

A partial list of some these personality disorders:

• Empathy Deficit Disorder
• Abrasive Personality Disorder
• Machiavellianism Personality Disorder
• Negativistic Personality Disorder
• Depressive Personality Disorder

Causes of Personality Disorders

Research for causes of personality disorders continues. Many elements remain unknown. However, scientists are certain heredity and environmental factors play an important role. In the words of Scott Stossel, “it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts)” (2015).

Stossel explains causes of anxiety which aptly apply to personality disorders that, “the truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon” (2015, Kindle location 242).

Personality Disorders Develop in Early Stages of Life

Personality disorders originate in early developmental stages. Both environmental factors and genetic backgrounds are involved in the etiopathologies. Epigenetics suggest that gene expression is dependent on environments. Harsh environments may activate proteins from our genes that impacts our lives in many notable ways.

T. Franklin Murphy wrote, ” various stimuli from our internal and external environment can initiate biochemical processes that either activate or silence our genes” (2021).

A landmark study by Meaney and colleagues theorized that “early experience permanently alters behavior and physiology. These effects are, in part, mediated by sustained alterations in gene expression in selected brain regions” (2005). Disturbances in early attachment formation and childhood trauma are key etiological factors because they alter gene expression. However, we must recognize that alterations only apply to genetic coding already present within the cell.

Ma, Shen and associates reiterate this combination of environment and gene expression in their 2016 paper, “personality disorders are not simple or direct consequences of bad parenting or child abuse, but are rooted in the interactions between an abnormal temperament (usually considered to be genetically fixed) and an adverse environment” (2016).

Ma, Shen, et al. point out that the genetic variants responsible for personality disorders remain largely unknown. However, research points to genes that “regulate neurotransmitters such as serotonin, dopamine, norepinephrine, and amines, which play important roles in mood regulation, suicidality, aggression, impulsivity, lack of empathy, and other important sub-domains of the symptomatology of personality disorders” (2016).

We never know which children possess genetic predispositions for future personality disorders. Hidden in their biological make-up may be vulnerabilities that may play out in frightening ways. Our best course of action as parents, teachers, and society is to provide the conditions known to facilitate healthy development. Healthy attachment, safety and security, emotional attunement and validation.

Treating Personality Disorders

Personality disorders are stubbornly resistant to change. The strong biological correlates prevent cures. However, the disorders can be mediated through medication and behavioral therapy.

We must tread lightly when discussing genetically influenced diseases. Many programs and weekend psychologist suggest that the disordered thought and behaviors are expressions of a weak mind and can be changed through efforts of the will. Accordingly, we directly or indirectly suggest that “anyone with an undesirable personality trait retains it because she has failed to exert sufficient mental effort” (Schwartz & Begley, 2003).

Schwartz MD and Begley warn, “even those of us who distrust the ‘My genes (or my neurochemicals) made me do it’ school of human behavior back away from the implication that will alone can bring into being the neural circuitry capable of supporting any temperament or behavioral tendency—indeed, any state of mental health” (2003).

Personality Disorders Can Be Treated

We are not helpless in the face of personality disorders. There is plenty to be done to improve the impact of the personality impediments on our happiness and success. Properly prescribed medications can soothe some of the genetic influences that aggravate emotions and lead to behavioral reactions. Accordingly, once the heightened arousal is mediated, behavioral skills can be developed.

Schwartz and Begley explain that therapy draws “on mental force, should be able to change other circuitry that underlies an aspect of personality, behavior, even thought. And that, of course, encompasses approximately everything, from the mundane to the profound: addiction or temperance, a bad temper or a forgiving nature, impatience or patience, love of learning or antipathy to it, generosity or…prejudice or tolerance” (2003, p 320).

Leslie S. Greenberg Ph.D. wrote that “building of implicit or automatic emotion-regulation capacities that is important for highly fragile, personality-disordered clients” (2015, Kindle location 415). Accordingly, building emotional regulation skills, mediating emotions through medication, and adding healthy components to surrounding environments all have a reciprocal effect, by improving behaviors, and in turn softening harsh judgements and reactions from others. With the right combination, personality disorders can improve but usually not be cured.

Markedly, a major obstacle to treating personality disorders is that those suffering from the illness, typically, don’t recognize the existence of the disorder. Consequently, the disease operates in the darkness, hiding itself from conscious exploration and, therefore, treatment.

A Few Final Words on Personality Disorders

Most if us will never be formally diagnosed with a personality disorder. However, as we read through the characteristics we notice several traits that personally apply. The traits themselves are not disorders. Accordingly, The traits are characteristics of a normal functioning personality. Only in extremes and in conjunction with other characteristics can the illness be diagnosed and properly addressed.

References:

American Psychiatric Association (2018) Personality Disorders. Accessed 3-15-2022.

Camilleri, R. (2018). Personality disorders. InnovAiT: Education and inspiration for general practice, 11(7), 357-361. DOI: 10.1002/pmh.80

Greenberg, Leslie S. (2015). Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings. ‎American Psychological Association; Second edition.

Ma, G., Fan, H., Shen, C., & Wang, W. (2016). Genetic and Neuroimaging Features of Personality Disorders: State of the Art. Neuroscience Bulletin, 32(3), 286-306. DOI: 10.1007/s12264-016-0027-8

Mayo Clinic (2016) Personality Disorders. Published 9-23-2016. Accessed 3-15-2022.

Meaney, M., & Szyf, M. (2005). Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience, 7(2), 103-123. DOI:

Mind (2020). Personality Disorders. Published 1-2020. Accessed 3-15-2022.

Murphy, T. Franklin (2021) Epigenetics. Psychology Fanatic. Published 11-9-2021. Accessed 3-16-2022.

Stossel, Scott (2015) My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind. Vintage; Reprint edition.

Schwartz, Jeffrey M.; Begley, Sharon (2003). The Mind and the Brain: Neuroplasticity and the Power of Mental Force. Harper Perennial.

Trifu, Simona; Iliescu, Ioana, Dorina; , Mateescu, Roxanna Daniela; and Trifu, Antonia Ioana (2019) Antisocial Personality Disorder. In Journal of Health and Medical Sciences, Vol. 2, No. 4, 509-515. DOI: 10.1017/9781108867542.010

Wright, M., & Carbajal, A. (2021). Personality disorders. Journal of the American Academy of Physician Assistants, 34(10), 49-50. DOI: 10.1097/01.jaa.0000791516.70522.f8

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PSYCHOLOGY – EMOTIONS – RELATIONSHIPS – WELLNESS – PSYCHOLOGY TOPICS