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?

  • Abby March 15, 2010, 1:37 pm – you can read about the proposed changes in DSM -V here, they continue to seem gender-biased in my opinion.

    • Bill March 15, 2010, 3:11 pm

      Thanks, Abby. I just loaded the link into my bookmarks. Will do a read through tonight. Man, I’m lovin’ all these great comments and resources.

  • Lacey March 15, 2010, 2:02 pm

    Personality disorders are based upon long-lasting pattern of behaviors. I bet most people have had characteristics of a personality disorder on a given day. If a person has shown personality disorder characteristics for only a day or few, it is unlikely he/she has a personality disorder.

    • Bill March 15, 2010, 3:09 pm

      I’m with you, Lacey. The one that’s become so cliche these days is borderline personality disorder (BPD). It’s so easy to throw the diagnosis around, and so often someone MAY have “borderline traits.” Listen, I can look at several of the personality disorders and for sure say I have “traits.” Point well taken. Oh – I’m gonna’ post an article prob tomorrow on BPD.

  • karen March 20, 2010, 5:40 pm

    it’s so nice to have an informed, intelligent place to read about these things. (even if i am just catching up) karen

    • Bill March 20, 2010, 6:26 pm

      Well, hey – that’s why we’re here, ma’am! Glad you’re checking-in.

  • Jaime August 25, 2010, 9:54 pm

    More than two years ago, my ex-husband was unofficially diagnosed  by our marriage counselor as having Narcissistic Personality Disorder. We divorced several months later, (not because of the diagnosis). It’s taken me these two years to really absorb it and to understand it. There are days I feel as if I’ll never get over my anger (rage really) at all we (I) went through. I spent more than half my life with him, and I just don’t know how to let it go. What led me to your website was an ezine article by you about depersonalization and derealization. Yesterday, I had my first and I hope only panic attack/DP-DR episode. I feel quite sure it’s related to me stopping trazodone cold turkey, which I did 6 days prior. I hope it’s strictly related to that, because if I survived marriage with an NPD and never had one, I can’t imagine why I’d have one now. I can’t say that I have a point, but wanted to say I’m glad I ran across your article and this website.

    • Bill August 25, 2010, 10:33 pm

      Hi Jaime. I’m really glad you stopped by. And your comment is much appreciated. I know of numerous women who had the “pleasure” of being married to an NPD. I remember one telling me she felt as though the very life had been sucked out of her over the years – and she really didn’t even know she’d allowed herself to be stripped of most everything as the years ensued. And, yes, the rage factor has to be incredibly difficult to manage. It seems as if you have a handle on why the panic attack and DP/DR paid a visit. Uh, yeah – stopping most any psychotropic cold turkey isn’t such a hot idea. I’m thinking you were taking Trazodone for sleep. How have you done without it? Again, Jaime, your visit and comment mean a lot.

  • Jaime August 27, 2010, 7:46 am

    Hi Bill. Yes, I’ve been taking the trazodone for sleep for 6 or 7 years. It was pretty stupid to stop it cold turkey, but my thought was that I would just barrel through the sleeplessness and get to the “other side”. My “episode” was sooo bad and so scary though, that I took my usual dose that night and have since. I just can NOT have that thing repeat itself. It was very disturbing!! I am going to try again, but will appropriately taper myself off the med. I desperately want off the medication because I’m tired of the fog it leaves me in. Thanks for your quick comment back. I truly appreciate it!

    • Bill August 27, 2010, 7:58 am

      Jaime – I empathize with your med situation. And that’s what frustrates me the most about that with which we deal. No sure answers! I’d like to believe research is ongoing for our disorders, but it sure isn’t keeping up with situations like cancer, HIV/AIDS, etc. I did some digging yesterday and found something called L-theanine. Wrote an article on it. Check it out. Also, I’ve followed for quite some time after reading one of Dr. Phelp’s books. It’s also worth a look-see. Hang in there, and stay in touch…