Personality Disorders

by Linda Lebelle

Don't become a victim of yourself.

Forget about the thief waiting in the alley;

what about the thief in your mind?

-- Jim Rohn

A personality disorder is identified by

a pervasive pattern of experience and behavior that is abnormal

with respect to any two of the following:

thinking, mood, personal relations, and the control of impulses.

The character of a person is shown through his or her personality -- by the way an individual thinks, feels, and behaves.  When the behavior is inflexible, maladaptive, and antisocial, then that individual is diagnosed with a personality disorder. 

Most personality disorders begin as problems in personal development and character which peak during adolescence and then are defined as personality disorders. 

Personality disorders are not illnesses in a strict sense as they do not disrupt emotional, intellectual, or perceptual functioning.  However, those with personality disorders suffer a life that is not positive, proactive, or fulfilling.  Not surprisingly, personality disorders are also  associated with failures to reach potential.

The Diagnostic and Statistical Manual of Mental Health Disorders DSM-IV-TR, published by the American Psychiatric Association, defines a personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Currently, there are 10 distinct personality disorders identified in the DSM-IV:

• Antisocial Personality Disorder:  Lack of regard for the moral or legal standards in the local culture, marked inability to get along with others or abide by societal rules.  Sometimes called psychopaths or sociopaths.  Known as conduct disorder for persons under age 18.

• Avoidant Personality Disorder:  Marked social inhibition, feelings of inadequacy, and extremely sensitive to criticism.

• 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.

• 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 and submissive behavior. Marked lack of decisiveness and self-confidence.

• Histrionic Personality Disorder:  Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.

• Narcissistic Personality Disorder:  Behavior or a fantasy of grandiosity, a lack of empathy, a need to be admired by others, an inability to see the viewpoints of others, and hypersensitive to the opinions of others.

• Obsessive-Compulsive Personality Disorder:  Characterized by perfectionism and inflexibility; preoccupation with uncontrollable patterns of thought and action.

• 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, interpersonal style, and thought (e.g., belief in psychic phenomena and having magical powers).

According to Dr. Sam Vaknin, self-proclaimed narcissist and author of Malignant Self Love - Narcissism Revisited, individuals with personality disorders have many things in common:

• Self-centeredness that manifests itself through a me-first, self-preoccupied attitude

• Lack of perspective-taking and empathy

• Lack of individual accountability that results in a victim mentality and blaming others, society and the universe for their problems

• Manipulative and exploitative behavior

• Unhappiness, suffering from depression and other mood and anxiety disorders

• Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks

• Distorted or superficial understanding of self and others' perceptions, being unable to see his or her objectionable, unacceptable, disagreeable, or self-destructive behaviors or the issues that may have contributed to the personality disorder

• Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs

• No hallucinations, delusions or thought disorders (except for the brief psychotic episodes of Borderline Personality Disorder)

Vaknin does not propose a unified theory of psychopathology as there is still much to learn about the workings of the world and our place in it.  Each personality disorder shows its own unique manifestations through a story or narrative (see Metaphors of the Mind), but we do not have enough information or verifying capability to determine whether they spring from a common psychodynamic source.

It is important to note that some people diagnosed with borderline, antisocial, schizoid, and obsessive-compulsive personality disorders may be suffering from an underlying biological disturbance (anatomical, electrical, or neurochemical).  A strong genetic link has been found in antisocial and borderline personality disorders (see Genetics and Mental Disorders, The Chemistry of Personality and The Biology of Borderline Personality Disorder).

Treatment of Personality Disorders

Dr. David B. Adams of Atlanta Medical Psychology says that therapists have the most difficulties with those suffering from personality disorders. They are difficult to please, block effective communication, avoid development of a trusting relationship, [and] cannot be relied upon for accurate history regarding problems or how problems arose (The Psychological Letter, February 2000).

According to the Surgeon General, mental disorders are treatable.  An armamentarium of efficacious treatments is available to ameliorate symptoms . . . Most treatments fall under two general categories, psychosocial and pharmacological.  Moreover, the combination of the two — known as multimodal therapy — can sometimes be even more effective than each individually. (See Mental Health: A Report of the Surgeon General)

By reading the DSM-IV's definition of personality disorders, it seems that these conditions are not treatable.  However, when individuals choose to be in control of their lives and are committed to changing their lives, healing is possible.  Therapy and medication may help, but it is the individual's decision to take accountability for his or her own life that makes the difference.

To heal, individuals must first have the desire to change in order to break through that enduring pattern of a personality disorder.  Individuals need to want to gain insight into and face their inner experience and behavior.  (These issues may concern severe or repeated trauma during childhood, such as abuse.)

This involves changing their thinking - about themselves, their relationships, and the world.  This also involves changing their behavior, as action reflects the learned internal changes.

Then, with a support system (e.g., therapy, support groups, friends, family), they can free themselves from their imprisoned life.

Use a diagnosis as a suggestion, a springboard for possibilities, not a straightjacket. -- Helen Hipp

Read All The Books

More Information on Personality Disorders

Antecedents of Personality Disorders in Young Adults ~ Because personality is shaped by experiences during childhood and adolescence, it is likely that mental disorders, unhealthy environment, abuse and trauma occurring during these years may have an influence on personality development.

Avoidant Personality Disorder in Children and Youth ~ Children who meet criteria for APD are often described as being extremely shy, inhibited in new situations, and fearful of disapproval and social rejection.

Borderline Personality Disorder in Children and Youth ~ BPD has historically been considered to be on the border between psychosis and neurosis.

Borderline Personality Disorder Sanctuary ~ Comprehensive site with articles, information, Ask the Doctor and Ask the Therapist columns, chats, boards, and links.

Brainwashed ~ Next time you are told that a psychiatric condition is due to a biochemical imbalance in the brain, ask if you can see the test results.

Chemical Imbalance ~ How mental illnesses came to be thought of as 'chemical imbalances'.

Children of Parents with a Mental Illness (COPMI) ~ Australian resource center that provides relevant information and resources to professionals and the public.

Coming Home from the Parade: Can We Live Without Images? ~ Each person has an overall self-image which consists of all his collected images from the outside combined with his inner psychological or egoic images.

Diagnosis of Mental Illness Hinges on Doctor As Much As Symptoms ~ Lacking genetic markers or brain scans to confirm psychiatric illnesses, doctors identify schizophrenia, phobias and other mental disorders based on a much more primitive diagnostic aid -- the symptoms.

The Hidden Suffering of the Psychopath ~ Hidden suffering, loneliness and lack of self-esteem are risk factors for violent, criminal behavior in psychopaths.

History of Mental Health ~ A history of mental health from 1188 A.D. until 2005 A.D.  Well-referenced with information arranged in therapeutic periods.

Mental Disorders Are Not Diseases ~  Psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that the conditions they call mental disorders are diseases -- that is, phenomena independent of human motivation or will.  Because there is no empirical evidence to back this claim (indeed, there can be none), the psychiatric profession relies on supporting it with periodically revised versions of its pseudo-scientific bible, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Health Disorders DSM-IV-TR.

Mis-Diagnosis and Dual Diagnosis of Gifted Children: Gifted and LD, ADHD, OCD, Oppositional Defiant Disorder ~ Many of our brightest and most creative minds are not only going unrecognized, but they also are often given diagnoses that indicate pathology.

Narcissistic Rage and the Sense of Entitlement ~ Rage, as destructive as its external effects may be, sometimes serves a positive psychic function when the alternative is the terror of a kind of psychic death.   Likewise, rage may function as a defense against shame that feels unbearable. 

New Way to Classify Personality Disorders Proposed ~ A new three-stage strategy for diagnosing personality disorders is being considered for inclusion in the DSM-5.

Obsessive-Compulsive Disorder in Children and Youth ~ Once believed to be relatively rare in children and adolescents, OCD now is believed to affect as many as 2% of children.  Among adolescents with OCD, the literature indicates that very few receive an appropriate and correct diagnosis, and even fewer receive proper treatment.

Overview of Mental Disorders in Children ~ From A Report of the Surgeon General.

Personality and Personality Disorders for DSM-V

Personality Theories ~ Examines a number of theories of personality, from Sigmund Freud's famous psychoanalysis to Viktor Frankl's logotherapy.

Personality Types ~ This website represents a study of Christian theological psychology.

Rage and Anger: The Common Sources of Personality Disorders ~ The striking similarity between anger and personality disorders is the deterioration of the faculty of empathy.

The Role of Infections in Mental Illness ~ Infections already recognized to induce psychiatric symptoms include pneumonia, urinary tract infection, sepsis, malaria, Legionnaire's disease, syphilis, typhoid, diphtheria, HIV, rheumatic fever and herpes.  Parasites, such as giardiasis, ascaris (roundworm), trichinae (cause of trichinosis), and Lyme borrelia, cause mental health problems as do viruses, like borna virus.

Schizophrenia and Other Psychoses in Children and Youth ~ One-half of children diagnosed with schizophrenia have received prior diagnoses, including pervasive developmental disorders (PDDs), ADD/ADHD, and internalizing disorders (e.g., bipolar disorder, depression, anxiety disorders).

Study Says Youth Disorders May Lead to Violence ~ Personality disorders among youths may increase risk for criminal and violent behavior during adolescence and young adulthood.

Teen Screen ~ A front group for the psycho-pharmaceutical industrial complex.

The Economic Disparity of Children's Mental Health Care ~ An excellent article that accurately describes the problem in mental health today. Most - if not all mental/emotional/behavioral problems - have an underlying situational issue, whether it be abuse, abandonment, loss or other trauma.