| Personality
Disorders "Personality" is that central set of characteristics that defines who
we are. It includes our attitudes, beliefs, emotional responses, values, ability to relate
to others, behavioral tendencies, motivations, and so much more. It is relatively constant
and predictable.
A "personality disorder" is some dysfunction in personality
that is persistent and pervasive, and that significantly affects our ability to
successfully handle emotions, self-regulate our behavior, maintain healthy relationships,
accurately view the world, meet our responsibilities, and function effectively in work or
school.
Understand this: We are not talking about the idiosyncrasies and
vulnerabilities that we all have, but that do not greatly interfere with our lives.
Someone with a personality disorder has very serious problems with handling one or more
areas of life. Furthermore, these difficulties are fairly constant throughout most of
their life.
People with personality disorders rarely are happy or satisfied with
life. And, frankly, it is no picnic for other people to deal with them, either.
In the sections below, we discuss some general issues about personality
disorders, describe what they are like, and review the role of psychologists in diagnosis
and treatment. (By the way, someone can have a personality disorder that blends
characteristics from more than one subtype.)
Some Important Notes
One important thing to
keep in mind as you read about personality disorders is that these personality
characteristics exist in all of us. In a healthy personality, problematic traits are not
predominant. They are not so extreme, or are expressed only in limited circumstances.
It is also worth noting that traits that might be problematic in most
situations can be adaptive if they emerge in certain other situations. For example, a
salesman earns a better living if he convinces someone to pay more for his merchandise
than it is really worth. The fact that this might involve some dishonest communication (at
least by omission) and a willingness to take advantage of someone else does not, by
itself, make the salesman personality-disordered.
It is a matter of degree and pervasiveness that determines if a given
personality trait is outside normal bounds, and it is the combination of several
out-of-bounds traits that defines a personality disorder.
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The Seeds of Personality Disorders
The seeds of
personality disorders are planted early in life, and you usually can see the potential for
a personality disorder in adolescence.
However, the diagnosis of a personality disorder usually is not made
until the person enters adulthood because adolescents are still defining who they will be.
Adolescence is, after all, a time for sorting out behaviors, attitudes, feelings, values,
and motivations; some instability and exploration of different styles are inherent to the
age.
One thing is clear about personality disorders when you deal with them
in most circumstances: They just don't make sense. The emotions, behaviors, and choices
are just too costly and maladaptive to serve any useful purpose.
On another level, however, personality disorders do make sense. Since
the patterns developed early in life, you have to look at them in that context.
For example, a child whose father is alcoholic and abusive might manage
his anxiety by becoming perfectionistic (thinking, "If I am good enough, he will stop
drinking and hitting Mom"). He might also try to make everything as predictable and
controlled as possible, and manage his anger and fear by suppressing it. In reactions like
these lie the seeds of obsessive-compulsive personality traits.
Now, the fact that these problems might make sense based on the past
does not make them any easier to live with in the present. Unfortunately, changing these
patterns is an extremely difficult and lengthy process, and many people with personality
disorders never break the cycle of dysfunction.
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Odd/Eccentric/Suspicious Personality Types
People who fall in the
odd/eccentric/suspicious category tend to have significant problems relating to others.
They may lack any desire to have a relationship with others (except,
perhaps, for their immediate family), and may be detached and seem emotionally cold or
empty.
Others cannot trust people, may take a benign event and interpret it as
an intentional slight, or may be certain that others are exploiting them or cheating them.
Some have a very eccentric take on life, and may strike others as quite
odd or strange. For example, they might believe they can use telepathy or read special
meaning into insignificant events (like seeing an ad on television and thinking it has
special meaning just for them).
Not surprisingly, these people rarely seek treatment.
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Unstable/Chaotic/Dramatic/Self-Serving Personality Types
This section is by far
the largest. That is partly because these personality types are the most disruptive and
visible in day-to-day life. They also are more common. Because there is so much to convey
about this group, this section is broken down into several subsections.
General
Characteristics
People who fall in
unstable/chaotic/dramatic/acting out group get the most attention. In fact, they cannot
get enough of it, and can act in dramatic, outrageous ways in order to become the center
of attention. Sometimes, these people are described as "bottomless pits" because
their needs are so great that no one could ever satisfy them regardless of how hard they
try.
Emotional distress is common in this group. You can see a pattern of
rapid mood swings and emotional volatility. Often their emotional reactions are extreme,
beyond what the situation would provoke in most people. They sometimes are diagnosed with
Bipolar Disorder because of their mood swings and impulsivity, or with depression when
they become despondent and suicidal after they suffer a loss or get into trouble. The
personality disorder usually can be distinguished from the mood disorder if you have an
adequate, accurate history. Of course, things can get really complicated -- the person can
have both.
These people often make a good first impression. Indeed, they can be
quite flirtatious and seductive. Often, they are very attractive and put a great deal of
effort into appearing so. Sexual promiscuity is often seen, since it serves to attract
attention and draw people in. It also is common to see substance abuse.
These people might seek treatment, sometimes during a crisis and
sometimes because they are coerced into it by the criminal court or their family. However,
they often do not stay actively involved in treatment for long, and the prognosis for
change is quite poor.
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Relationship
Issues
It is easy to get into
a relationship with someone in this group, but it is usually quite unpleasant to stay in
the relationship. Once the relationship is established, you often see dramatic changes,
with increased volatility, impulsivity, dishonesty, unpredictability, and excessive
demands.
This pattern of problematic relationships tends to be pretty pervasive,
whether the relationship is a personal one, or as an employee, or as a student. However,
sometimes the person shows problematic traits primarily in personal affairs and can
maintain appropriate behavior in other situations.
When a relationship ends, these people can unravel. Sometimes they will
plead desperately to continue the relationship. They might become self-injurious, or make
suicide threats, gestures, or attempts. They might make threats of violence or commit
actual aggression (like the murder-suicides you hear about). They might engage in acts of
vengeance, like lawsuits or slander. If there are children involved, they might pursue a
custody battle that is pursued simply to cause their ex-partner grief, without regard for
the actual well-being of the children.
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"Playing
by the Rules"
One thing that makes
these people especially hard to deal with is that they do not "play by the
rules" (socially, emotionally, or behaviorally). Instead of an honest response, they
lie. Instead of accepting responsibility for a mistake, they give irrational accusations
and blame others. Instead of an emotional response that is tempered by the actual
significance of the situation, they display a dramatic outburst and acting out.
These patterns lead to a great deal of distress for everyone in their
wake, especially if those other people have a tendency to be fair, accept responsibility.
and be considerate and understanding.
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Society's
Response to these Traits
Oddly enough, as a
society we sometimes glorify or normalize these types of behaviors. Some daytime talk
shows put on daily examples of people with personality traits that, at best, are flaky
(okay, that's not a professional term, but as soon as you read it, you knew what we meant,
right?).
Soap operas also treat personality-disordered behavior as the
"normal," expected way to handle life, and some sports stars and other
celebrities are glaring examples of dysfunctional personalities. You know, aggression,
public tantrums, impulsive marriages and divorces, and cross-dressing for the news
photographer really are not normal behaviors.
Fortunately, there are plenty of celebrities who act in reasonable ways
and serve as good role models. But which do you see in the media more often?
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Subsets
of Personality Traits in this Group
There are several
subsets of personality traits that fit into this general category, but people can have a
blend of characteristics from the different groups. Remember, we can all have these traits
to some extent; they have to be severe, pervasive, and problematic in our lives to qualify
as a personality disorder.
One subset acts habitually in antisocial ways. You see behaviors like
cheating, conning, exploitation of others, lying, theft, violence, inability to maintain a
job, and failure to meet responsibilities (like child support and other bills). Criminals
and gang members often fall into this category, but so do some professionals and everyday
folks. When caught, they might express remorse, but this is rarely genuine and rarely
leads to behavior changes. They might also claim to be depressed and suicidal but this
usually is in response to facing the consequences of their behavior, and resolves when
they get off.
Another subset has an enormous sense of entitlement and narcissism.
They think they should get what they want, no matter how it affects others (whose needs do
not even enter into the equation). From their point of view, it is okay to use others
without any concern for reciprocity. They see themselves as more important and capable
than others and can seem extremely arrogant. They might even think they are doing others a
favor by allowing them to bask in their glory and be part of their life. Ironically, under
the surface usually lies rather poor self-esteem, about which they have little insight.
A third subset is primarily desperate for attention and pursues it with
great drama. They are often seductive and use physical appearance (both attractiveness and
their style of dress) to draw attention. Their relationships generally are quite shallow
and unrewarding. They can be quite hostile toward someone who is seen as competition.
Another subset is marked by broad problems in identity, emotional
self-regulation, and impulsivity. They suffer frequent mood swings, feelings of emptiness,
and episodes of rage. Their relationships are marked by extremes -- they are frantic if
alone or feeling abandoned, but act in ways to push people away if they get too close.
They see people as either all good or all bad. They may shift from idolizing someone to
hating them based on some minor event. They may drive wedges between people, a process
called "splitting." They may engage in chaotic behavior, such as self-mutilation
and suicide gestures.
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Anxious/Dependent/Perfectionistic Personality Types
In this group, the
person feels considerable anxiety and discomfort.
One subset of people
has extreme anguish regarding the possibility of rejection or humiliation. They see
themselves as inferior and inadequate. As a result, they avoid situations where they have
to interact with others, and may go into jobs that allow them to work in isolation.
Despite a desire to have personal relationships, they often do not because they cannot
risk being rejected.
Another subset is beset by perfectionism and the need to reach
impossible standards. Whatever they accomplish is rarely good enough. They are extremely
conscientious and organized, but can lose productivity because they get lost in the
details. They find it difficult to trust anyone else to do a good job, so they often take
on more than their share of work. They may be moralistic and excessively rigid about
standards of behavior. They may neglect their personal life in pursuit of academic or
career goals.
A third subset feels so inadequate to handle life on their own that
they hand over responsibility for most decisions to someone else. In doing so, they tend
to be submissive and often end up in abusive relationships. Because they fear being left
alone and helpless, they tolerate very harmful situations. If they do end up alone, they
frantically search for another partner to meet their needs.
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The Role of the Psychologist
Diagnosis:
Psychologists can work
to establish the diagnosis and to differentiate it from other treatable disorders that can
have similar symptoms (like Bipolar Disorder).
However, diagnosis of personality disorders can be very difficult. A
person with a personality disorder often cannot describe their personality in clear and
accurate terms. Unless the disorder is quite severe and "in-your-face," the
psychologist rarely has a lot of the data that would clarify the diagnosis. Sometimes,
psychological testing can help provide some of the necessary data.
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Treatment
of the Individual:
There are different
schools of thought regarding the treatment of personality disorders, and we cannot claim
to be experts in this area.
One approach involves working with the person to identify patterns of
thinking and behavior that create problems in the person's life. The process of treatment
involves learning to catch these patterns and abort them. The person also has to learn to
tolerate and manage anxiety and internal distress. It is a long and extremely difficult
process.
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Treatment
for Significant Others:
Another area where
psychologists can be helpful has to do with people who are close to individuals with
personality disorders. These people often face considerable distress and confusion. They
may be looking for ways to fix the relationship, or to straighten out their partner, but
they really need to come to terms with the personality disorder and what it means for them
and the relationship.
The psychologist can
help them identify the personality patterns, clarify what is and is not their
responsibility, elucidate their values and goals, and guide them in making choices and
decisions that they can live with. The psychologist also can help them learn ways to
minimize the negative impact of the personality disorder on their own life.
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