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chipur learning: The Personality Disorders

I’ve always been fascinated by the personality disorders, and have wanted to post an article about them for quite some time. Well, let’s roll-up our sleeves and get busy, okay?

As a point of reference, I’d like you to check-out an article I posted two months ago about what’s known as a multi-axial diagnosis. In a formal psychiatric diagnostic workup there are five axes in which a number of diagnoses and circumstances are listed. For our immediate purposes, we’ll talk about the first two. Axis I includes what most know as the emotional and mental disorders – i.e. panic disorder, major depressive disorder, bipolar disorder, etc. On Axis II you’ll find the personality disorders and mental retardation.

Now, there’s no connection between the personality disorders and mental retardation, but the personality disorders are recorded on Axis II for a reason – they require independent consideration and a keen diagnostic eye. So putting them on Axis II prevents them from blending in with the wallpaper as Axis I diagnoses are formulated.

At one time known as a character disorder, a personality disorder, according to the American Psychiatric Association, is…

“An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.”

The rigidity of patterns of thought, emotion, and behavior seen in the personality disorders is consistent across most of the environments in which the individual finds him/herself. And the end result is most often some pretty intense personal and social disruption.

Key to understanding the personality disorders are two self-perceptions…

Egosyntonic: One’s pattern of thought, emotion, and behavior is a fit with their ego integrity.
Egodystonic: One’s pattern of thought, emotion, and behavior conflicts with their ego integrity.

In other words, an egosyntonic disorder would cause no concern to the individual because he/she would believe nothing’s wrong. An egodystonic disorder would cause the individual distress. Axis I disorders are generally egodystonic; personality disorders are typically egosyntonic.

Though I’ve seen personality disorders diagnosed in children and early-adolescents, the diagnosis is generally held until the late-teens or adulthood. And I can’t stress enough how important it is that the diagnosing professional knows what he/she is doing, as a diagnosis of a personality disorder is serious business. And under no circumstances is the suspicion of the presence of a personality disorder to be tossed around loosely in conversation.

Now, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) organizes the personality disorders in clusters…

Cluster A     odd/eccentric

paranoid personality disorder – irrational distrust and suspicion of others
schizoid personality disorder – little interest in social relationships, seeing no point
schizotypal personality disorder – very odd patterns of behavior or thought

Cluster B     dramatic/emotional/erratic

antisocial personality disorder – disregard for the law and rights of others
borderline personality disorder – relational, self-image, and behavioral instability; “black or white” thinking (splitting)
histrionic personality disorder – attention seeking, shallow or exaggerated emotions, inappropriate sexual seductiveness
narcissistic personality disorder – intense grandiosity, need for admiration, lack of empathy

Cluster C     anxious/fearful

avoidant personality disorder – social inhibition/avoidance, feelings of inadequacy, extreme sensitivity to negative evaluation
dependent personality disorder – pervasive dependence on others
obsessive-compulsive personality disorder – rigid conformity to rules, moral codes, and excessive orderliness

Of note, the DSM-IV-TR designates depressive personality disorder and passive-aggressive personality disorder for further study. But I don’t think that got too far because rumor has it the coming DSM-V will bring a brand new approach to the diagnosis of the personality disorders, including cutting their number in half.

Oh, one final and very huge bit of business – a diagnosis of a personality disorder does not equate to hopeless circumstances!!!

So, you’re thoughts on the personality disorders? Any personal experiences? Why not share in a comment?