The personality disorders | Analysis

Personality or personality traits are the basis of what makes a person who they are. When expressed in a healthy way that is beneficial to a person, they are described as “an enduring pattern of our thoughts, feelings, and behaviors. They are how we think, feel, make decisions, and take actions” (Barker, 1995). They are determined both by a person’s genetic makeup and environmental factors and are a determining factor as to how a person lives their life. When a personality trait becomes rigid and dysfunctional, where it significantly hinders healthy thoughts and activities and harms the person who has them, this may be the basis for a personality disorder.

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According to the DSM-IV a personality disorder must show a “lasting pattern of behavior and inner experience that markedly deviates from norms of the person’s culture” (James Morrison, 2006). This could include personality patterns that are normal in some people, but are exaggerated or accentuated in those with a personality disorder. In order for a person to be diagnosed with a personality disorder, the symptoms must show a lifelong pattern of manifestation. This means that the disorder is typically identified in late adolescence or early adulthood and persists throughout a lifespan. Another requirement for the diagnosis of personality disorders is that the negative behavior patterns must have a pervasive effect on all areas of a person’s life; this includes employment, intimate relationships, social functioning, and family. The behavior must routinely causes problems or dysfunction, and cannot be attributed to any other sort of mental or physical illness (James Morrison, 2006). An individual with a personality disorder will show maladjustment in all aspects of their life and the disorder will be reflected in the ingrained, rigid, and dysfunctional patterns that they present throughout their lifetime. According to Frances, “personality disorders usually produce ego-syntonic behavior, or consistent with the ego integrity of the individual, and, therefore, are usually considered appropriate by the individual. This may cause the negative behavioral patterns to be inflexible and tough to change.” (Frances, 1999) The treatment of personality disorders is usually difficult and often has limited results.

In the DSM-IV there are three “groups” or clusters that each of the 10 personality disorders fall into. People with cluster A disorders are characterized by odd or eccentric behavior, abnormal cognitions or ideas, strange speech or actions, and difficulty relating to others (Frances, 1999). People diagnosed with personality disorders are more frequently diagnosed with an Axis I disorders as well (James Morrison, 2006). Frequent co-morbid diagnosis for cluster A personality disorders are: agoraphobia, major depression, obsessive-compulsive disorder, and substance abuse (Frances, 1999). Type A disorders include paranoid, schizoid, and schizotypal personality disorders.

Paranoid personality disorder, the first of the cluster A disorders, is characterized by extreme or unnecessary paranoia, suspiciousness, and a general mistrust of organizations, groups, and others, is found in 0.5%-2.5% of the population, as a whole and occurs more commonly in males (Frances, 1999).

A person with paranoid personality disorder often thinks, without reason or cause, that others are exploiting, harming, or deceiving them, which inhibits them from developing close relationships. According to Dobbert, “The delusional belief that others are disloyal and untrustworthy precludes their ability to confide in others. The afflicted person believes that the information that they provide in confidence will be later utilized to bring them harm” (Dobbert, 2007).

People with paranoid personality disorder also tend to hold grudges and become angry for seemingly benign perceptions of insults or injuries. These grudges can be long lasting and based out of perceived threats or insults. Even if the intention to harm or defame the person is not present, due to the constant expectation that others are trying to hurt them, an individual with a paranoid personality disorder creates a threat and will then hold malice toward another person for an exaggerated amount of time. This malice will evoke anger and hostility that will eventually lead to the alienation and isolation (Dobbert, 2007).

The second of the cluster A disorders is the schizoid personality disorder, it is characterized by a general detachment from social settings, a restricted or muted range of emotions, and need for solidarity. It is found in 3% of the general population and affects women more commonly then men (Frances, 1999). A person with schizoid personality disorder neither desires nor enjoys close or intimate relationships.

According to Dobbert, “Persons afflicted with schizoid personality disorder find no interest in initiating, developing, and maintaining close relationships. It is not uncommon for these persons to lack the interest or desire to be considered a part of their biological family” (Dobbert, 2007). These people do not find inclusion in groups or social settings particularly interesting or desirable and work to avoid such settings.

A person with schizoid personality disorder is described as “appearing introverted, but not shy”, and seems to prefer their own company instead of seeking relationships with others. This often leads the person showing little if any interest in sexual or intimate experiences, preferring acts of self-gratification and sexual fantasy over personal contact. (Dobbert, 2007)

Due to the indifference of intimate relationships, the person with schizoid personality disorder develops limited interest in activities they enjoy and does not seek to share these activities with others. They would prefer to focus their attention on a few activities and interests of a solitary nature and to obsess about those interests with little regard to the perceptions of others.

They also seem to be unaffected by the acceptance, praise, or criticism of others involving their actions and isolation. It becomes obvious to those around them that a person with schizoid personality disorder does not care what others perceptions are and they often seem cold, detached, and unemotional, “presenting a bland or blank expression to the world” (Dobbert, 2007).

The final disorder in cluster A is the schizotypal personality disorder which is a condition characterized by distorted thoughts, behaviors, and functioning. “Magical thinking”, relationship difficulties, severe anxiety, and poor social skills are also common. (James Morrison, 2006) This disorder affects 3% of the general population and is diagnosed slightly more in females then males. (Frances, 1999)

People with schizotypal personality disorder perceive things in an odd or unusual way. Their interpretation often differs from that of others and is “specific to themselves” (meaning nobody else shares similar perceptions and thoughts), but is not based out of delusional thought or differing cultural norms. Many of these people believe that that they have extrasensory or magical powers and attribute their odd perceptions to this ability (Dobbert, 2007).

The belief in clairvoyance, mind control, the “sixth sense” and other forms of “magical thinking” often lead others to view these people as odd which strains social and work relationships. To compound this, many people with schizotypal personality disorder have a reduced ability to understand other people’s actions and respond to them inappropriate and in a socially unacceptable manner. Having few successful experiences with others often leads to social anxiety, suspiciousness, and paranoid ideation. Dobbert states “rather than examining one’s self to determine the source of others avoidance, people with schizotypal personality disorder believe that the others are conspiring against them. Due to the inability of self-introspections, the afflicted person withdraws deeper and further isolates themselves, leading the person to further fall into their delusional thinking” (Dobbert, 2007).

People with cluster B disorders are characterized by dramatic, unpredictable, and destructive behaviors as well as difficulty with impulsiveness, the violation of social norms, and being self-abusive and hostile to others. It is common for these disorders to share co-morbidity with eating disorders, social phobias, somatization disorder, pathological gambling, substance abuse, and post traumatic stress disorder (Frances, 1999). Included in cluster B are antisocial, borderline, histrionic, and narcissistic personality disorders.

According to the DSM-V, the first of the cluster B disorders is “the antisocial personality disorder, which is a pervasive pattern of disregard for, and violations of, the rights of others” (James Morrison, 2006). It is characterized by failure to conform to social norms, deceitfulness, impulsivity, aggression, irresponsibility, and lack of remorse. It affects 3% of men and 1% of women, and is distributed evenly throughout all races (Frances, 1999).

People with antisocial personality disorder act against social norms and show little respect for lawful behaviors. They are often arrested or commit acts that could lead to confrontations with law enforcement. According to Dobbert, people with this disorder “don’t just violate social norms…but, perform behaviors that are significant violations of the criminal code” (Dobbert, 2007). This indicates that people with antisocial personality disorder are capable of committing “the most heinous of crimes” including rape, armed robbery, and murder. This diagnosis had been applied to many of the documented serial killers such as Ted Bundy, Jeffery Dahmer, and John Wayne Gacy. (Dobbert, 2007)

The level of deceptiveness that is involved in antisocial personality disorder has been directly linked to the intelligence of the individual. While all people diagnosed with this disorder pathologically lie, as intelligence increases the use of aliases and conning operations also shows an increase. Deception contributes to the notable involvement with law enforcement and is often utilized in criminal acts (Dobbert, 2007).

As displayed by criminal and deceptive acts, a lack of impulse control is noted for those diagnosed with antisocial personality disorder. This impulsivity often leads to the disregard for personal safety and the safety of others. “In the ever increasing need for heightened stimulation, those with antisocial personality disorder do whatever gives them the feeling of power over others” (Dobbert, 2007), this may include hurtful, violent, and aggressive acts done with little regard for other people’s feelings or of the consequences of their actions.

The second disorder in cluster B, borderline personality disorder, is stated by the American Psychiatric Association as “pervasive pattern of instability of interpersonal relationships, self-image, and affects and marked impulsivity” (James Morrison, 2006). It is characterized by identity disturbances, self-damaging behavior, feelings of emptiness, anger regulation problems, and stress related paranoid ideation or dissociative symptoms. Affecting more females than males at a rate of 3-1, it is found in 2% of the general population (Frances, 1999).

Dysfunctional relationships are the key area that defines borderline personality disorder. Dobbert states that “persons afflicted with borderline personality disorder are obsessed with the potential for rejection and abandonment. Their perception of the environment and persons’ response to them influences their feeling of self-worth and image” (Dobbert, 2007). They often misconceive common circumstances and situations as rejection. This then manifests itself in anger, resentment, and feelings of abandonment.

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In order to tailor themselves to a relationship, the person with borderline personality disorder will illustrate a sudden change in self expression and perception. These changes may include sudden changes in the style of clothing, attitude, and social preferences of the individual and may also encompass hobbies, interests, and activities. If an individual is rejected by the object of that relationship, they will change themselves again to distance themselves from their past relationship and attract a new one (Dobbert, 2007).

In order to manipulate others and stage off real or perceived abandonment, a person with borderline personality disorder will threaten or attempt suicidal behavior, and self-mutilation. Threatening self-injury or suicide allows the individual to control the other person in the relationship and allows them to postpone the abandonment that they so fear. While attempts are made on the part of a person with this disorder, many of them are half-hearted and not meant to be successful; they are simply utilized as a device evoke a desired reaction from another person.

Histrionic personality disorder is the third of the cluster B disorders, and is described as “pervasive and excessive emotionality and attention-seeking behavior” (James Morrison, 2006). It is characterized by sexual promiscuity, rapidly shifting and shallow expression of emotion, self-dramatization, and suggestibility. It is found in 2-3% of the population and is diagnosed more often in women (Frances, 1999).

Typically, people with histrionic personality disorder exhibit a compulsatory need to be the center of attention. When they find themselves being ignored or not admired they feel anxiety and identify confusion. These people are very socially motivated and expect to be noticed and envied by others. In order to gain attention many people with histrionic personality disorder focus intensely on appearance or act overdramatically in hopes of creating a scene to gain attention.

Seductiveness and overtly sexual and provocative behavior is another way for people with histrionic personality disorder to gain attention. Flirtatious and intimate behavior is often used, even in inappropriate settings such as work, to gain attention. A conflict surrounding this inappropriate behavior, instead of inhibiting the behavior, only works to reinforce it as the center of attention again shifts to the disordered person.

Narcissistic personality disorder, the final disorder of the cluster B sub-type is characterized by exaggeration of achievements, preoccupation with success and power, excessive need for admiration, a sense of entitlement, exploitation, envy, and arrogance (Frances, 1999). The DSM-V states that narcissistic personality disorder is “a pervasive pattern of grandiosity, with a need for admiration, and a marked lack of empathy” (James Morrison, 2006). Of the general population less than 1% of the population suffers from narcissistic personality disorder and it is diagnosed 3-1 in males over females and is commonly classed the “male ego disorder” (Frances, 1999).

Those who suffer from this disorder are prone to overinflating or creating achievements in order to brag about or prove their superiority to others. They often daydream about unlimited success and about the admiration that it will bring from others. They may also suffer from delusions that allow them to believe that they are entitled to act in any way they want, despite the effect it has on others.

Because they view themselves as superior, the narcissist does not feel that they should be concerned themselves with the feelings of others. They will often defame and exploit others for their own self promotion. This marked lack of empathy is a dominate feature of narcissistic personality disorder and is brought about as a defense mechanism to protect their grandiose ideals about themselves.

Cluster C disorders, including avoidant, dependant, and obsessive-compulsive personality disorders are characterized by fearful and anxious behaviors, as well as avoidance of social situations and feelings of loss of control (Frances, 1999). Typical Axis I co-morbid diagnosis are: social phobias, anxiety disorder, adjustment disorder, myocardial infraction, and obsessive compulsive disorder.

Treatment- (Dingfelder, 2004)

Individuals at this end of the continuum commit rape, murder, and genocide. Will a person afflicted with antisocial personality disorder start at the lease serious end of the continuum and move to the far extreme?

Recovery

Conclusion

Works Cited

• Barker, R. L. (1995). The Social Work Dictionary. In R. L. Barker, The Social Work Dictionary (p. 104). New York, New York: NASW Press.

• This source is reviewed and published by the NASW press, a division of the National Association of Social Workers, which is a leading scholarly press in social science research field. The information used gives a broad and comprehensive definition of the role that a personality plays in the life of an individual. This definition of personality and personality traits was chosen because due to its association with social work and because of its encompassing definition. This definition is used as a contrast point for the explanation of personality disorders.

• Dingfelder, S. (2004). Treatment for the Untreatable. Monitor on Psychology , Vol 35, No. 3, p. 46-48.

• This article, found in a peer reviewed scholarly journal, discusses the effectiveness of treatment for personality disorders. It states that many practitioners have had difficulty in treating personality disorders, which continue to present a pervasive and persistent pattern of dysfunction despite many treatment methods. It also discusses some effective treatment options and the hope for recovery from personality disorders.

  Frances, A. M. (1999). Your Mental Health: A Layman’s Guide to the Psychiatrist’s Bible . In A. M. Frances, Your Mental Health: A Layman’s Guide to the Psychiatrist’s Bible . New York: Scribner.

  Written by one of the authors of the American Psychiatric Association’s Diagnostic and Statistical Manual, this book provides general information about diagnosis of personality disorders and other mental health problems. It gives more detailed information on the cluster groupings (A, B, and C) for personality disorders than the DSM-IV Made Easy, as sited below. It also gives descriptive character traits that are associated with each of the personality disorders and discusses Axis I co-morbid diagnosis that are often found with personality disorders.

• James Morrison, M. (2006). The DSM-IV Made Easy. In M. James Morriosn, The DSM-IV Made Easy (pp. 461-495). New York: Guildford Publications, Inc.

• This book, containing information released in the DSM-IV, released by the American Psychological Association, is a stripped down, simplified version of the original DSM_IV. It provided detailed information on each personality disorder as well as diagnostic criteria for personality disorders. It also provides classification information and Axis diagnosis. The information in the source is considered to be extremely accurate and is therefore used to give a thorough and comprehensive information in relation to each personality disorder.

• Mayo Clinic. (2010, April 6). Personality Disorders. Retrieved April 6, 2010, from MayoClinic.com: http://www.mayoclinic.com/health/personality-disorders/DS00562

• This source, written by the psychological staff at the Mayo Clinic, is retrievable online. The Mayo Clinic, an internationally renowned medical practice and research group, has given a general overview of personality disorders and discussed some treatment options that are available for the disorders. The information for treatment is not found in the above references, and the idea of using psychotherapy and medication to treat personality disorders is discussed.