Personality Disorders
August 16th, 2009
In today’s posting, I’ll talk about personality disorders in a very broad manner. Chances are you either know someone with a personality disorder or someone with personality disorder traits. Individuals who possess only personality disorder traits do not meet enough of the criteria to fit a personality disorder category.
--Examining the Personality Disorders--
There are ten personality disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition (DSM-IV). The ten personality disorders are categorized into three clusters (A, B, and C). In the Cluster A category, the odd and bizarre category, there are three personality disorders–Paranoid, Schizoid, and Schizotypal. In the Cluster B category, the self-focused category, there are four personality disorders–Borderline, Antisocial, Narcissistic, and Histrionic. In the Cluster C category, the fearful and anxious category, there are three personality disorders–Dependent, Obsessive-Compulsive, and Avoidant. In general, Paranoids are often distrustful and suspicious of others. Maintaining long-term relationships may be quite difficult for this group as a result. Schizoids are asocial, that is they really have little, if any, need for social relationships in their lives. They could be quite content living alone in the woods by themselves without interacting with anyone for years. Schizotypals are probably the most bizarre personality disorder in the Cluster A category. Schizotypals possess odd beliefs, speech, or mannerisms. For example, they may believe in telepathic powers or clairvoyant abilities. Borderlines are what I call “flip-floppers.” Their moods, feelings about others, and feelings about themselves can change erratically. Antisocials can be socially charming, but you wouldn’t want to “turn your back” on these individuals. In the end, if they had to step on you to get what they want in life, they would do so without feeling any regret or remorse. In fact, they would probably blame you for allowing yourself to become a victim of theirs. Narcissists are clueless when it comes to other people’s feelings. They are grandiose and very fixated on receiving special treatment believing that they have earned such treatment, when in fact, they often have not. Histrionics have a high need for attention. In fact, they love being the “center” of attention and may have tremendous difficulties if such needs are not met. Dependents want others to take control of their lives and make major life decisions for them. They often fear making the “wrong” decisions in life and want others to take responsibility for their actions. Obsessive-compulsives, on the other hand, are perfectionistic and are often intensely into controlling their environment as much as possible. Finally, Avoidants are similar to Schizoids in that they avoid social relationships, but they want relationships in their lives. They just have high needs to ensure that the relationships they do let in are “safe” ones.
---Remember that Change is a Process---
Treatment can take some time. It is a journey that has many steps. What we do know is that personality disorders do not suddenly emerge late in life. They are often evident in late adolescence or early adulthood. These diagnoses are, more often than not, avoided before the age of 18 because clinicians generally feel that a number of individuals will grow up and out of the maladaptive tendencies described above. For Antisocial Personality Disorder, you cannot ascribe the diagnosis before the age of 18 period. Personality disorders are long-term and often resistant to treatment. However, some some disorders are easier to treat than others. In general, the Cluster C category is probably the easiest to treat because these are the individuals who are the most likely to come in for treatment. They are also the most likely to recognize and acknowledge their presenting problems. Cluster A individuals are probably the least likely to come in for treatment whereas Cluster B individuals may come in for treatment but at the request of others or because they want to change someone else in their lives, and they think that therapy can produce this end result.
However, Growth is Entirely Possible
As I said earlier, you may know someone with a personality disorder or someone with personality disorder traits. If you have a family member with a personality disorder, this has no doubt been a drain on your emotional resources. Please know that therapy can be helpful especially if a person with a personality disorder is ready for change. Still, it is a long and difficult journey to make visible changes even if we want such changes to occur. However, it is not impossible. The important variable is the clinician’s ability to establish rapport with a client and earn the right to provide therapy to that client. Once that type of relationship is established, the clinician must custom tailor the treatment to the client and his or her personality disorder. In general, a clinician’s focus is to listen and magnify so that the clients can see and hear how they sabotage the very relationships they generally want in their lives. If respect and credibility can be established early in the therapeutic relationship, the therapeutic process is more likely to be effective as well. There is hope. If there was not, we would not be in the business we are in today.