Personality disorders: a new frontier of psychiatry

[Loren Booda]

In brief -

Antisocial Personality Disorder (impulsive, aggressive, manipulative)
Avoidant Personality Disorder (shy, timid, "inferiority complex")
Borderline Personality Disorder (impulsive, self-destructive, unstable)
Dependent Personality Disorder (dependent, submissive, clinging)
Histrionic Personality Disorder (emotional, dramatic, theatrical)
Narcissistic Personality Disorder (boastful, egotistical, "superiority complex")
Obsessive-Compulsive Personality Disorder (perfectionistic, rigid, controlling)
Paranoid Personality Disorder (suspicious, distrustful)
Schizoid Personality Disorder (socially distant, detached)
Schizotypal Personality Disorder (odd, eccentric)

- but in reality personally pervasive, hard to diagnose and treat, and isolating. Most psychiatrists will not see such patients. Social conventions are often means of manipulation for sufferers. A personality disorder can go unnoticed by clinicians, but is usually experienced by the family - as one book title describes it, "I Hate You, Don't Leave Me." Many prisoners suffer from one or more of the personality disorders.

Not listed is Dissociative Identity Disorder (formerly Multiple Personality Disorder). These folks are generally meek and unstable, having been subjugated as children to extreme sexual, physical, emotional and/or abandonment abuse.

I believe the incidence of personality disorders in society is large (approaching 10%) and is either increasing or being more effectively diagnosed. The most common is the borderline personality disorder, sometimes co-occurring with bipolar disorder. See http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23040 . Someone you encounter who is not just "crazy," but whose relationships are maladaptive and seek predominantly their own benefit may have a personality disorder. What is your experience with people who behave in this manner?

 

[devil-fire]

is there a criteria for different personality types to be considered disorders? i can think of a few people i would like to have committed for Narcissistic and Obsessive-Compulsive Personality Disorders.

i'm interested in the difference between someone who is odd & eccentric and someone who has Schizotypal Personality Disorder

 

[arildno]

It might one day dawn upon the members of the psychiatric profession that many of those they love to diagnose as "sick" are actually more exposed to social rejection processes of these individuals as persons rather than that it is the individual as such who is "sick".
I.e, there are lots of persons who are victimized by slander, back-biting, and that everything they do is "sicklified" by the contemptuous on-lookers, the psychiatrist being the arch-priest among them.

Until that day comes, I choose to hold the psychiatrists themselves in contempt.
Their profession has done more than enough evil during its existence to justify my attitude.

 

[honestrosewater]

It might one day dawn upon the members of the psychiatric profession that many of those they love to diagnose as "sick" are actually more exposed to social rejection processes of these individuals as persons rather than that it is the individual as such who is "sick".
I.e, there are lots of persons who are victimized by slander, back-biting, and that everything they do is "sicklified" by the contemptuous on-lookers, the psychiatrist being the arch-priest among them.

Until that day comes, I choose to hold the psychiatrists themselves in contempt.
Their profession has done more than enough evil during its existence to justify my attitude.

Has no one in the profession done anything recently to correct mistakes they may have made in the past?

And there are people who are really sick- who feel sick themselves- and seek help from psychiatrists. Many also receive help from them.

 

[yourdadonapogostick]

from the top definitions, i have: Narcissistic Personality Disorder, Paranoid Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personality Disorder. i think i need a doctor :D

 

[arildno]

Has no one in the profession done anything recently to correct mistakes they may have made in the past?

And there are people who are really sick- who feel sick themselves- and seek help from psychiatrists. Many also receive help from them.

Very true; in particular the evolution of group therapy sessions where real personal bonding can occur is an immense improvement.
I remain, however, deeply skeptical to the preferred modes of therapeutic talks where the patient wring his heart out whereas the psychiatrist sits cold and aloof on the other side of the desk.
This type of "therapy" is, to my mind, deeply degrading (and, IMO, totally untherapeutic), and it is too entrenched and common in the psychiatric profession to this day.

 

[Kerrie]

Loren, does Bi-polar disorder fit into this category?

 

[Loren Booda]

In my experience, those "psychiatric survivors" who refuse, evade or deny psychotherapy are more likely to be labeled with a personality disorder. Dangerous medicinal side effects and uncaring public hospitals can sometimes turn a patient against psychiatry, as an abusive upbringing can turn them against authority.

For the great majority of persons with mental illness and their doctors, however, psychotherapies of many kinds are effective means to treatment. Medicines and psychology are usually benign compared to the disease itself, whose alternative often seems suicide.

 

[zoobyshoe]

I can think of two people I have known fairly well who were diagnosed with personality disorders, one with borderline personality, and the other with histrionic.

The woman with borderline personality disorder also told me she did an eating binge on junk food every evening after she put her kids to bed. She said it took about an hour every day, and she did it in a blissful trance state during which she suddenly stopped all her worrying, and hardly had a thought in her mind at all. Sometime before she fell asleep she would take her laxatives. She characterized her life as a kind of hell interrupted by 7 good hours a week: the hours during which she ate junk food.

At a few points in her life she had engaged in cutting herself. Last time I saw her she had several fine white lines down the length of her arms from shoulder to wrist. She said what impelled her to do his was the need to feel the pain which she felt she deserved for being such a bad person.

The guy with Histrionic Personality Disorder was actually a housemate. He was about 35 but seemed stuck emotionally at about 10. He taught himself to play several intruments and would produce them at the drop of a hat to perform for any unsuspecting listener: his playing was very choppy, and his singing was enthusiastic but quite ugly; nasal and has intonation was sketchy.

He wore very odd clothes, almost like a sort of costume: a floppy cap, and a clip-on necktie that was made of segmeted wood glued to a fabric base. He had never learned to drive and would walk to the store to shop. At the corner the neighbor's little yap dog would come to the fence and bark furiously at anyone walking by. This guy took this personally, and would stand there confronting the dog shrieking "SHUT UP! SHUT UP! each and every time he walked by that house.

He liked to sleep late, but since his room faced east, he also got involved in a war with the sun. After several trials of different heavy curtains failed him, he glued aluminum foil onto the glass.

He watched TV all the time he was awake, and could be heard giggling and chuckling loudly all the time he was in his room. He went into the bathroom about five times a day for periods of 20 minutes or so, and stood in front of the mirror combing his hair, and staring at himself. After a while he developed this loud cough/throat clearing habit that went on constantly the whole 20 minutes he was in there. I asked him what was the matter with his throat, and he said nothing, he was trying to make himself burb because he felt chronically full of stomach gas.

His mother called him two or three times a week and this always ended with him yelling anxiously and desperately at her about one thing or another. Every day he came out to the kitchen and cooked himself a meal of five hot dogs, or three hamburgers, or some humongous quantity of microwave food.

He told me he'd been diagnosed with a personality disorder, but didn't believe there was anything to it, although he admitted to not being able to handle "some social situations." He said his mother rigged the whole thing up with a psychiatrist so he could go on Social Security because he had just had the damndest bad luck trying to find a job a few years earlier.

 

[zoobyshoe]

i'm interested in the difference between someone who is odd & eccentric and someone who has Schizotypal Personality Disorder

Merely odd or eccentric is anyone's guess, but schizotypal is defined thus:

PTypes - Schizotypal Personality Disorder Criteria
Address:http://www.ptypes.com/schizotypalpd.html

 

[hitssquad]

I remain, however, deeply skeptical to the preferred modes of therapeutic talks where the patient wring his heart out whereas the psychiatrist sits cold and aloof on the other side of the desk.

This type of "therapy" is, to my mind, deeply degrading (and, IMO, totally untherapeutic), and it is too entrenched and common in the psychiatric profession to this day.

Psychiatry does not necessarily involve psychotherapy.

 

[hitssquad]

Personality disorders vs other mental disorders

Loren, does Bi-polar disorder fit into this category?

Bi-polar is not a personality style, so "no." Personality disorders are dysfunctional variants of personality styles. Personality styles are ego defense profiles. A personality style becomes a personality disorder in any given person who is ego defensive beyond the threshold needed for social dysfunctionality.

A general overview of personality disorders can be found here:
http://www.toad.net/~arcturus/dd/pdsa.htm

White papers and summaries of the ten currently recognized (DSM-IV) types of personality disorders that Loren listed can be found here:
http://www.toad.net/~arcturus/dd/ourdesk.htm

That link also lists one extra personality disorder that may appear in the next addition of the DSM (The Diagnostic and Statistical Manual of Mental Disorders): Passive-Aggressive (Negativistic) Personality Disorder.

Note: all of those personality-disorder white papers and summaries at the above link are going to be permanently taken down soon. Parties interested in personality disorders should copy all of those white papers and summaries to their hard drives.

 

[arildno]

Psychiatry does not necessarily involve psychotherapy.

Agreed; some are quite happy with just lobotomizing individuals, or physically castrate them.

 

[zoobyshoe]

Agreed; some are quite happy with just lobotomizing individuals, or physically castrate them.

Not so very long ago at all. You're right. Things have "evolved" however, to what is known, sardonically, by its detractors, as "the chemical straightjacket". No one really objects to it in the case of someone who has killed, or tried to kill, because of their delusions, but the question as to whether or not it is abusively overused is a matter of debate.

The worst thing I know of that is still going on is the use of "convulsive" treatments for the severely depressed. Chemically inducing tonic-clonic seizures provides a kind of relief from depression for the sufferer simply because it gossly degrades memory functions for a time after the induced seizure.

This is a completely voluntary procedure, but is a severely depressed, suicidal person really in a position to make an informed judgement, if a doctor says "Well, the only thing left to try is convulsive therapy," ?

----

The kind of analysis you mentioned before was a descendent of Freudian analysis, which had branched off into many schools after him. That whole line of therapy is pretty much dead and burried now. I would be very surprised if you had run into someone still practising this. Today psychiatrists pretty much just diagnose and presribe medications. "Therapy", that is: any kind of back and forth discussion intended to allieviate the problems, is done by liscenced therapists, and "counsellers", not psychiatrists.

 

[Loren Booda]

Kerrie,

Please forgive my not responding to your question immediately.

[Wikipedia]

Personality disorders form a class of mental disorders that are characterized by long-lasting rigid patterns of thought and behaviour. Because of the inflexibility and pervasiveness of these patterns, they can cause serious problems and impairment of functioning for the persons who are afflicted with these disorders.

What I was noting is the high comorbidity between bipolar disorder and borderline personality disorder. Symptoms like irritability and grandiosity are shared by both.

 

[Math Is Hard]

Something that I found confusing in my abnormal psych class was that personalilty disorders fell on the same axis (axis II) of the DSM IV as mental retardation because they are persistent conditions. In other words, the personality disorder isn't what you you would go into treatment for (not an axis I problem, or the main area of focus) but you might be treated for anxiety or depression that you experience as a result of dealing with the personality disorder.

 

[zoobyshoe]

Something that I found confusing in my abnormal psych class was that personalilty disorders fell on the same axis (axis II) of the DSM IV as mental retardation because they are persistent conditions.

I'm not sure why your teacher would say that. The DSM says they are on a separate axis so that they won't be overlooked in the shadow of the more easily recognised mental illnesses:

"The listing of Personality Disorders and Mental Retardation on a separate axis ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation that might otherwise be overlooked when attention is directed to the usually more florid axis I disorders."

-DSM-IV
p.26

In other words, the personality disorder isn't what you you would go into treatment for (not an axis I problem, or the main area of focus) but you might be treated for anxiety or depression that you experience as a result of dealing with the personality disorder.

You wouldn't be treated for a Personality Disorder in any circumstances because no known meds work on any given one per se. The same is true of Autism and Asperger's: there aren't any meds for those conditions as a whole. So, yes, the best they could do is treat for accompaning depression or anxiety, and they might reccomend a group therapy of some kind, probably just to prevent the person from becoming too alienated.

A diagnosis is important however for access to social services.

 

[devil-fire]

Merely odd or eccentric is anyone's guess, but schizotypal is defined thus:

PTypes - Schizotypal Personality Disorder Criteria
Address:http://www.ptypes.com/schizotypalpd.html

i don't think i worded my question quite right.

"Schizotypal Personality Disorder" is discribed as someone who is "odd, eccentric" but what is the distinguishing line between the disorder and the discription? what's the difference between someone is who is odd and eccentric vs. someone who has Schizotypal Personality Disorder?

what I am getting at is that it seems no one doesn't have one of the listed disorders to some degree. is no one is without a personality disorder?

 

[zoobyshoe]

"Schizotypal Personality Disorder" is discribed as someone who is "odd, eccentric"...

No, you're getting caught up in a couple of tag words Loren Booda used to typify the disorder,when he was trying to briefly characterize all the Personality Disorders. Don't take it so seriously. I linked you to an actual, expanded description. Read that.

 

[devil-fire]

i understand its a discription. I am asking about the criteria of a 'disorder' instead of just a personality type

 

[zoobyshoe]

i understand its a discription. I am asking about the criteria of a 'disorder' instead of just a personality type

Google Search: define:Personality disorder
Address:http://www.google.com/search?hl=en&lr=&ie=UTF-8&oi=defmore&q=define:Personality+disorder

 

[hitssquad]

Criterion marking the threshold between personality style and personality disorder

is there a criteria for different personality types to be considered disorders?

Yes.
http://allpsych.com/disorders/personality/index.html

To be diagnosed with a disorder in this category, a psychologist will look for the following criteria:

1. Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood.
   
   
2. The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life.
   
   
3. Symptoms are seen in at least two of the following areas:
   
   
   • Thoughts (ways of looking at the world, thinking about self or others, and interacting)
     
     
   • Emotions (appropriateness, intensity, and range of emotional functioning)
     
     
   • Interpersonal Functioning (relationships and interpersonal skills)
     
     
   • Impulse Control