Personality Disorders part 2

Welcome back to the blog, people. Last week we started a new series on personality disorders, which are one of the most common of the severe mental disorders. A personality disorder is marked by rigid patterns of thoughts and behaviors that cause significant life impairment, and deviate from what is generally expected, or considered “normal” by society. There are four core defining features that are common to all personality disorders. They are distorted thinking patterns, problematic emotional responses, impulse control issues, and interpersonal difficulties. In order for a diagnosis to be made, a person must demonstrate significant and lasting difficulties in at least two of those four areas. We’ll talk more about diagnosis later; first let’s talk about what causes personality disorders.

As we talked about last week, personality is the combination of thoughts, emotions and behaviors that makes you unique. It’s the way you view, understand, and relate to the outside world, as well as how you perceive yourself. Your personality forms during childhood, and it’s shaped through an interaction of your genetics and your environment, often referred to as nature and nurture. Have you ever been told ‘You remind me of Uncle Jimmy, the way you do xyz.’ This may be because certain personality traits can be passed on to you by your parents through inherited genes. That is to say, these natural traits may be heritable. The nurture refers to your environment, the surroundings you grew up in, the events that occurred, and your relationships with family members and others.

The exact cause of personality disorders isn’t known. Just as personalities are shaped by genetics and environment, personality disorders are thought to be caused by a combination of these genetic and environmental influences. It’s thought that your genetics may make you prone to developing a personality disorder, and then something in your environment- some life situation- may trigger the actual development. In other words, the tendency to develop a personality disorder can be inherited, but not the disorder itself. The disorder only arises if/when something interferes with the development of the healthy personality. For most personality disorders, levels of heritability are about 50 percent, which is similar to, or even higher than, that of many other major psychiatric disorders. There’s no clear reason why some people develop the feelings and behaviors associated with personality disorders, while other people don’t. The social circumstances we grow up in and the quality of the care we receive greatly affect the way our personality develops, so they seem to be part of the equation. 

The nurture side of the coin carries a lot of weight in developing personality disorders. Most of the patients I’ve diagnosed had something happen during their childhood. They may have had a chaotic family life, too little parental support, or a history of traumatic event(s). Trauma doesn’t have to mean emotional, physical, or sexual abuse; it may be the loss of a parent, or extreme poverty or neglect. Captain Obvious says that not everyone who experiences a traumatic situation will develop a personality disorder, and not everyone who develops a personality disorder will have had a traumatic experience. People have unique reactions, and develop different coping methods to deal with the situation they’re presented with. That’s often the core of the issue in the way personality disorders can develop; the strategies needed for coping with pain, fear, and anxiety as a child aren’t ones that are helpful or appropriate in adult life, and may in fact be harmful. That should sound familiar, no… perhaps maladaptive? 

Although we can’t label a precise cause, we know that there are certain factors that seem to increase the risk of developing or triggering the condition. In addition to an abusive, unstable, or chaotic family life during childhood, other risk factors seem to include a diagnosis of childhood conduct disorder, and variations in brain chemistry and structure. A family history of personality disorders or other mental illness is another risk factor. We know of some specific links; for example, a family history of depression may increase the risk of developing borderline personality disorder and/ or obsessive-compulsive personality disorder.

Diagnosing Personality Disorders

This can be a difficult diagnosis to make, and it never happens quickly. It involves a thorough medical and social history and multiple assessments, often over an extended length of time. Each of the ten personality disorders have criteria that must be met to qualify for diagnosis. Generally speaking, it requires finding a persistent, inflexible pattern of maladaptive traits across many life circumstances. They must also cause significant distress and impairment in at least two of the four aforementioned core areas: the way you perceive and interpret yourself, other people and events; the appropriateness of your emotional responses; how well you function when dealing with other people and in relationships; and whether you can control your impulses. 

It’s important to remember that everyone can exhibit maladaptive behavior from time to time. In order to meet the diagnostic requirement of a personality disorder, these traits must cause functional impairment and/or subjective distress, and they must be persistent and inflexible; meaning they can be repeatedly observed without regard to time, place, or circumstance. Other considerations are age of onset and the exclusion of other possible causes, like other mental health disorders, substance use, or history of head trauma. 

Next week, we’ll start taking a closer look at the ten personality disorders; we’ll talk about the signs and symptoms for cluster A, the “Odd and Eccentric” disorders: paranoid, schizoid, and schizotypal personality disorder.

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Thank you and be well people!

MGA