The Cult of Personality…Disorders

The Cult of Personality… Disorders

Hello, people! Last week, we talked about thyroid disease and mental health, how they may exist together, and how some of the symptoms overlap. It’s definitely something to keep in mind when you’re looking for a diagnosis, and even once you’ve been diagnosed with one, as it doesn’t eliminate the other. And that brought the thyroid series to a close. If you remember nothing else, it should be that since the thyroid regulates metabolism- how every cell in the body uses energy from food to do its thing- its function controls literally everything in the body. So when it’s not working properly, the symptoms can vary widely. It may seem subtle at first, but eventually, you’re going to know about it, so the sooner you pick up on it, the better. 

Now moving on to our next topic, personality disorders. What are they? Disorder is fairly straightforward, so let’s talk about personality. Our personality is the collection of thoughts, feelings, and behaviors that makes each one of us the individuals we are. The traits of our personalities represent our patterns of thinking, perceiving, reacting, and relating to people, places, and things in our world. We don’t always think, feel, and behave in exactly the same way- that depends on the situation we’re in, the people we’re with, and all sorts of other interconnecting factors. We’re meant to be flexible to a point, but our personality traits remain relatively stable over time. Are you very talkative or very quiet? Are you constantly moving or are you a couch potato? A social butterfly or a bookworm? Are you a worry wart, always anxious, or laid back and unconcerned? These fundamental patterns make up our personality traits, and they imply consistency and stability. 

Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair interpersonal function. Maladaptive is such a great shrinky word. It just means more harmful than helpful, as opposed to adaptive, more helpful than harmful. Fun fact: every living organism, from bacteria to humans, displays maladaptive and adaptive traits, though they don’t pertain to behavior or personality in every case. In this case, maladaptations are patterns of behavior that are detrimental or counterproductive, that interfere with life. As applied to personality disorders, these maladaptive patterns of behavior deviate from what is considered “normal” or expected by society. Put it all together, and what is a personality disorder? It’s a type of mental disorder marked by rigid and enduring patterns of thoughts and behaviors that deviate from the expectations of society, and cause significant impairment in many areas of a person’s life. 

According to the shrink bible, the DSM-5, personality disorders are primarily problems with self identity and interpersonal functioning. That’s a shrinky way of saying people with personality disorders have problems with how they perceive themselves and how they interact with others. This affects how they form and maintain relationships with employers, family, friends, and intimate partners. They generally have poor coping skills, and tend to repeat patterns of behavior which are often volatile, confusing, and difficult. Maladaptive behavior may have consequences, and can cause significant problems in relationships, social activities, work, school, and potentially every facet of life. Some disorders may be so problematic that people actually avoid relationships whenever possible. These problems lead to distress, not only to the person with the disorder, but to those around them. Unlike people with anxiety or mood disorders- who know they have a problem but are unable to control it- people with personality disorders are often not aware that they have a problem, and as a result, will not seek treatment on their own. If they do, it’s the distress caused by the consequences of the maladaptive behaviors that lead them to seek treatment, rather than any discomfort with their own intrinsic thoughts and feelings. In my experience, when they do seek treatment, the chief complaint is often of depression or anxiety rather than the actual manifestations of the personality disorder.

Personality disorders are among the most common of the severe mental disorders, and often occur along with other mental illnesses, such as substance abuse disorders, anxiety disorders, and mood disorders, like depression and bipolar disorder. It’s estimated that 10 percent to 13 percent of the world’s population suffer from some form of personality disorder, and it’s thought to be underdiagnosed. While signs are sometimes apparent during childhood, most personality disorders start to become evident during the teenage years, as the personality further develops and matures. As a result, almost all diagnoses occur after the age of 18. As far as prevalence, there are no clear distinctions in terms of ethnicity. Regarding gender, most differences exist in the manifestation of symptoms within each disorder, as opposed to prevalence of diagnosis among the ten disorders, with three exceptions: antisocial personality disorder is far more common in men, while borderline and histrionic personality disorders are more common in women. Though they’re considered chronic or enduring, more recent studies indicate that some types of personality disorders may become less severe over time. 

Personality Disorders: Ten Types

The DSM-5 allocates each of the ten personality disorders to one of three groups or clusters: A, B, or C. Each disorder rarely appears in its “textbook” form, they often blur into one another. Their division into clusters is intended to reflect this tendency, with any given personality disorder most likely to blur with others within its cluster. Many people diagnosed with one personality disorder also have signs and symptoms of at least one other, typically within the same cluster.

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Cluster B personality disorders are characterized by dramatic, overly emotional, erratic or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Please note this is not the same as obsessive-compulsive disorder, OCD.

Our understanding of personality disorders and what it means to experience them is constantly evolving. It can be a controversial diagnosis, especially in regard to terminology.  

Incidence and prevalence statistics ultimately depend on where clinicians draw the line between a “normal” personality and one that leads to significant impairment. Diagnosing personality disorders reliably is difficult. Why? How far from “normal” must personality traits deviate before they can be counted as disordered? How significant is “significant impairment”? And how is “impairment” to be defined? Next week, we’ll continue with personality disorders, though I won’t be answering those questions… those are just food for thought. 

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Thank you and be well people!

MGA