Most personality disorders begin as problems in personal development and character which peak during adolescence and then are defined as personality disorders. 

Personality disorders are not illnesses in a strict sense as they do not disrupt emotional, intellectual, or perceptual functioning.  However, those with personality disorders suffer a life that is not positive, proactive, or fulfilling.  Not surprisingly, personality disorders are also  associated with failures to reach potential.

The Diagnostic and Statistical Manual of Mental Health Disorders DSM-IV-TR, published by the American Psychiatric Association, defines a personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

 Currently, there are 10 distinct personality disorders identified in the DSM-IV:

• Antisocial Personality Disorder:  Lack of regard for the moral or legal standards in the local culture, marked inability to get along with others or abide by societal rules.  Sometimes called psychopaths or sociopaths.  Known as conduct disorder for persons under age 18.
• Avoidant Personality Disorder:  Marked social inhibition, feelings of inadequacy, and extremely sensitive to criticism.
• Borderline Personality Disorder:  Lack of one’s own identity, with rapid changes in mood, intense unstable interpersonal relationships, marked impulsively, instability in affect and in self image.
• Dependent Personality Disorder:  Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on his or her own. Fear of separation and submissive behavior. Marked lack of decisiveness and self-confidence.
• Histrionic Personality Disorder:  Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.
• Narcissistic Personality Disorder:  Behavior or a fantasy of grandiosity, a lack of empathy, a need to be admired by others, an inability to see the viewpoints of others, and hypersensitive to the opinions of others.
• Obsessive-Compulsive Personality Disorder:  Characterized by perfectionism and inflexibility; preoccupation with uncontrollable patterns of thought and action.
• Paranoid Personality Disorder:  Marked distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive him or her; lack of trust; belief of others’ betrayal; belief in hidden meanings; unforgiving and grudge holding.
• Schizoid Personality Disorder:  Primarily characterized by a very limited range of emotion, both in expression of and experiencing; indifferent to social relationships.
• Schizotypal Personality Disorder:   Peculiarities of thinking, odd beliefs, and eccentricities of appearance,  behavior, interpersonal style, and thought (e.g., belief in psychic phenomena and having magical powers).

According to Dr. Sam Vaknin, self-proclaimed narcissist and author of Malignant Self Love – Narcissism Revisited, individuals with personality disorders have many things in common:

• Self-centeredness that manifests itself through a me-first, self-preoccupied attitude
• Lack of individual accountability that results in a victim mentality and blaming others, society and the universe for their problems
• Lack of perspective-taking and empathy
• Manipulative and exploitative behavior
• Unhappiness, suffering from depression and other mood and anxiety disorders
• Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks
• Distorted or superficial understanding of self and others’ perceptions, being unable to see his or her objectionable, unacceptable, disagreeable, or self-destructive behaviors or the issues that may have contributed to the personality disorder
• Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs
• No hallucinations, delusions or thought disorders (except for the brief psychotic episodes of Borderline Personality Disorder)

Vaknin does not propose a unified theory of psychopathology as there is still much to learn about the workings of the world and our place in it.  Each personality disorder shows its own unique manifestations through a story or narrative (see Metaphors of the Mind), but we do not have enough information or verifying capability to determine whether they spring from a common psychodynamic source.

It is important to note that some people diagnosed with borderline, antisocial, schizoid, and obsessive-compulsive personality disorders may be suffering from an underlying biological disturbance (anatomical, electrical, or neurochemical).  A strong genetic link has been found in antisocial and borderline personality disorders (see Genetics and Mental Disorders, The Chemistry of Personality and The Biology of Borderline Personality Disorder).

Treatment of Personality Disorders

Dr. David B. Adams of Atlanta Medical Psychology says that therapists have the most difficulties with those suffering from personality disorders. They are difficult to please, block effective communication, avoid development of a trusting relationship, [and] cannot be relied upon for accurate history regarding problems or how problems arose (The Psychological Letter, February 2000).

According to the Surgeon General, mental disorders are treatable.  An armamentarium of efficacious treatments is available to ameliorate symptoms . . . Most treatments fall under two general categories, psychosocial and pharmacological.  Moreover, the combination of the two — known as multimodal therapy — can sometimes be even more effective than each individually. (See Mental Health: A Report of the Surgeon General)

By reading the DSM-IV’s definition of personality disorders, it seems that these conditions are not treatable.  However, when individuals choose to be in control of their lives and are committed to changing their lives, healing is possible.  Therapy and medication may help, but it is the individual’s decision to take accountability for his or her own life that makes the difference.

To heal, individuals must first have the desire to change in order to break through that enduring pattern of a personality disorder.  Individuals need to want to gain insight into and face their inner experience and behavior.  (These issues may concern severe or repeated trauma during childhood, such as abuse.)

This involves changing their thinking – about themselves, their relationships, and the world.  This also involves changing their behavior, as action reflects the learned internal changes.

Then, with a support system (e.g., therapy, self-help groups, friends, family), they can free themselves from their imprisoned life.

by Linda Lebelle

Research suggests that problems are more likely to occur during a transitional year, such as moving from elementary to middle school, or middle school to high school.

Some adolescents are able to get through this time with minimal assistance from their parents or teachers.  It may be enough for a parent to be available simply to listen and suggest coping strategies, provide a supportive home environment, and encourage the child’s participation in school activities. 

However, when the difficulties last longer than a single grading period, or are linked to a long-term pattern of poor school performance or behavior problems, parents and teachers need to intervene.

Identifying Adolescents Who Are At Risk for Failure

Some “at-risk” indicators, such as those listed here, may represent persistent problems from the early elementary school years for some children.  Other students may overcome early difficulties but begin to experience related problems during middle school or high school.  For others, some of these indicators may become noticeable only in early adolescence.

To intervene effectively, parents and teachers can be aware of some common indicators of an adolescent at risk for school failure, including:

• Attention problems as a young child – the student has a school history of attention issues or disruptive behavior.

• Multiple retentions in grade – the student has been retained one or more years.

• Poor grades – the student consistently performs at barely average or below average levels.

• Absenteeism – the student is absent five or more days per term.

• Lack of connection with the school – the student is not involved in sports, music, or other school-related extracurricular activities.

• Behavior problems – the student may be frequently disciplined or show a sudden change in school behavior, such as withdrawing from class discussions.

• Lack of confidence – the student believes that success is linked to native intelligence rather than hard work, and believes that his or her own ability is insufficient, and nothing can be done to change the situation.

• Limited goals for the future – the student seems unaware of available career options or how to attain those goals.

When more than one of these attributes characterizes an adolescent, the student will likely need assistance from both parents and teachers to complete his or her educational experience successfully.  Girls, and students from culturally or linguistically diverse groups, may be especially at risk for academic failure if they exhibit these behaviors.  Stepping back and letting these students “figure it out” or “take responsibility for their own learning” may lead to a deeper cycle of failure within the school environment.

Teens Want To Feel Connected to Their Family and Their School

In a recent survey, when students were asked to evaluate their transitional years, they indicated interest in connecting to their new school and requested more information about extracurricular activities, careers, class schedules, and study skills.  Schools that develop programs that ease transitions for students and increase communication between schools may be able to reduce student failure rates.

The Role of Parenting Style

Parenting style may have an impact on the child’s school behavior.  Many experts distinguish among permissive, authoritarian, and authoritative parenting styles.  These parenting styles are associated with different combinations of warmth, support, and limit-setting and supervision for children.

The permissive style tends to emphasize warmth and neglect limit-setting and supervision; the authoritarian style tends to emphasize the latter and not the former; while the authoritative style is one in which parents offer warmth and support, and limit-setting and supervision.  When the authoritative parenting style is used, the adolescent may be more likely to experience academic success.

It is important to remember that adolescents need their parents not only to set appropriate expectations and boundaries, but also to advocate for them.

Parents — and teachers — can assist teens by:

• Making the time to listen to and try to understand the teen’s fears or concerns

• Setting appropriate boundaries for behavior that are consistently enforced

• Encouraging the teen to participate in one or more school activities

• Attending school functions, such as sports, and plays

• Meeting as a team, including parents, teachers, and school counselor, asking how they can support the teen’s learning environment, and sharing their expectations for the child’s future

• Arranging tutoring or study group support for the teen from the school or the community through organizations such as the local YMCA or a local college or university

• Providing a supportive home and school environment that clearly values education

• Helping the teen think about career options by arranging for visits to local companies and colleges, picking up information on careers and courses, and encouraging an internship or career-oriented part-time job

• Encouraging the teen to volunteer in the community or to participate in community groups such as the YMCA, Scouting, 4-H, religious organizations, or other service-oriented groups to provide an out-of-school support system

• Emphasizing the importance of study skills, hard work, and follow-through

Don’t Give Up on Your Child

Understanding the factors that may put an adolescent at-risk for academic failure will help parents determine if their teen is in need of extra support.  Above all, parents need to persevere.  The teen years do pass, and most adolescents survive them, in spite of bumps along the way.

Being aware of common problems can help parents know when it is important to reach out and ask for help before a difficult time develops into a more serious situation.

What Should I Know About My Teenager’s Emotional Health?

The teenage years are a time of transition from childhood into adulthood.  Teens often struggle with being dependent on their parents while having a strong desire to be independent.  Ideally, they are maturing from the one-sided self-centeredness of childhood to a self-identity that balances responsible self-interest with care and love for others.

What Are The Characteristics of Emotionally Healthy People?

People who are emotionally healthy view all that they do and say in light of how their words and actions affect others.  They do not manipulate, exploit, or abuse others.  They understand that the world does not revolve around them. They are not self-absorbed and they don’t feel entitled.  They recognize their self-centered nature but choose to value their relationship with God and others over their own self-interest.  Because of this, they are less likely to suffer from depression or anxiety.

Emotionally healthy people accept personal responsibility for their behavior and their choices.  There is no victim mentality, no blaming others, society and the universe for their problems or disappointments.  They realize that they are in charge of their lives — responsible for every action, word and thought, and accountable for the resulting consequences.

People who are emotionally healthy experience, acknowledge, identify, and accept their own emotions.  This means that they are open to their feelings and are aware of what they are actually feeling. They don’t distract themselves from their emotions through hiding or numbing themselves with obsessive behaviors (e.g., drug and alcohol use, sex, self-injury, gambling, work, hobbies, Internet use).  Those who are not in touch with their own feelings are not likely to have a sense of conscience.

Because emotionally healthy people are in touch with their feelings, they can identify with others’ feelings — they show empathy.  It’s necessary to not only “get into the shoes,” but get “into the heart and soul” of another.  To do that, the person must put the need for acknowledgement of his or her own emotions on hold.  Being able to correctly and comprehensively read another person’s emotional messages empowers them to intuitively identify with the person.  Emotionally healthy people are able to imaginatively insert themselves in other people’s situations and experience them intimately.  In turn, they are able to feel and make a compassionate response.

What Can I Do to Help My Teen?

Working on your own emotional health and communicating your love for your teen are the most important things you can do.  Children decide how they feel about themselves in large part by how their parents behave and react to them.  It’s also important to discuss your values and spiritual beliefs, and to set expectations and boundaries (e.g., honesty, self-control, respect for others), while still allowing teenagers to have their own space.

Parents of teens often find themselves noticing only the problems, and they may get in the habit of giving mostly negative feedback and criticism.  Although teens need feedback, they respond better when it is given positively and spoken with love.

Acknowledging and praising appropriate, responsible, and caring  behavior can help your teen feel a sense of accomplishment, enhance self-esteem, and reinforce your family’s values.

A child who reaches age 21 without

smoking, abusing alcohol or using drugs

is virtually certain never to do so.

- Joseph A. Califano, Jr., Chairman and President,

The National Center on Addiction and Substance Abuse at Columbia University

Alcohol abuse and alcohol dependence are not only adult problems — they also affect a significant number of adolescents and young adults between the ages of 12 and 20, even though drinking under the age of 21 is illegal.

The average age when youth first try alcohol is 11 years for boys and 13 years for girls.

By age 14, 41 percent of children have had least one drink.

The average age at which Americans begin drinking regularly is 15.9 years old.

Teens who begin drinking before age 15 are five times more likely to develop alcohol dependence than those who begin drinking at age 21.

An early age of drinking onset is also  associated with alcohol-related violence not only among persons under age 21 but among adults as well.

U.S. Department of Health and Human Services (HHS), The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking.  HHS, Office of the Surgeon General, 2007.

While drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general adolescent turmoil that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation-seeking.

Binge drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease.  Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g., marriage, educational attainment, employment, and financial independence).

Dependence on alcohol and other drugs is also associated with several mental health problems,  such as:

• depression

• anxiety

• oppositional defiant disorder (ODD)

• antisocial personality disorder

Whether anxiety and depression lead to, or are consequences of, alcohol abuse is not known.

Alcohol use among adolescents has also been associated with considering, planning, attempting, and completing suicide.  Research does not indicate whether drinking causes suicidal behavior, only that the two behaviors are correlated.

Parents’ drinking behavior and favorable attitudes about drinking have been positively associated with adolescents’ initiating and continuing drinking.  Children who were warned about alcohol by their parents and children who reported being closer to their parents were less likely to start drinking.

Lack of parental support, monitoring, and communication have been significantly related to frequency of drinking, heavy drinking, and drunkenness among adolescents.  Harsh, inconsistent discipline and hostility or rejection toward children have also been found to significantly predict adolescent drinking and alcohol-related problems.

It has been estimated that over three million teenagers are out-and-out alcoholics.  Several million more have a serious drinking problem that they cannot manage on their own.

Annually, more than 5,000 deaths of people under age 21 are linked to underage drinking.

The three leading causes of death for 15- to 24-year-olds are automobile crashes, homicides and suicides — alcohol is a leading factor in all three.

Peer drinking and peer acceptance of drinking have also been associated with adolescent drinking.

The most common and effective way for an individual to combat his or her addictive behaviors is through a self-help support group, with advice and support from a health care professional.  Treatment should also involve family members because family history often plays a role in the origins of the problem and successful treatment cannot take place in isolation.

The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), offering various resource information. Through this service you can speak directly to a representative concerning alcohol and other drugs, request printed material on alcohol or other drugs, or obtain local substance abuse treatment referral information in your State.

Information provided by the U.S. Department of Health and Human Services, Office of the Surgeon General and the National Clearinghouse for Alcohol and Drug Information.  To learn more about alcohol and other drugs of abuse, contact NCADI  at 1-800-729-6686.

There are so many concerns surrounding the diagnosis and treatment of ADD/ADHD that parents must be knowledgeable and cautious.  It is usually the school that approaches parents to have an assessment for ADD/ADHD and parents often feel pressured in having the traditional drug treatment to ‘correct’ their child’s behavior.

What should parents do if the school identifies a child with potentially having ADD/ADHD?

• Have the school put their concerns and directions in writing.  Hold them accountable.

• If the school tells you that your child needs medication to control his or her behavior, remind them that medical help does not necessarily mean taking medication.

• If you are told to sign a release for your child’s medical records, ask to see that law in writing.

• Whenever you have a school conference or go before a school review board, record that meeting on a tape recorder.  The recorder should be in plain sight.  If you are told that the meeting is confidential, remember that confidentiality is your child’s right — not the school’s right.

• Children who have an ADD/ADHD diagnosis normally have an above-average IQ.  Ask the school why it is so difficult for them to teach the smartest kids in school.

• The federal government allots over $2 billion to local school systems under the Individual Development Assistance Act of 1985.  Ask the school officials how much money their school and school system gets when a child is coded as needing special education services.

• Find out what percentage of students in the school system are taking ADD/ADHD medication.  The average number is between 3-5%.

Although no chemical imbalance has ever been proven, health professionals prescribe psychostimulant medication (such as Ritalin, Strattera, Adderall) as the primary treatment in correcting the ‘chemical imbalance’.  In 2000, more than 19 million prescriptions for ADHD drugs were filled, a 72% increase since 1995.

However, with the known side effects of these drugs and without knowledge or evidence of long-term results on growth and development, is medication really the best option?

Parents should know that the psychostimulants normally prescribed for ADD/ADHD help all people — with or without an ADD/ADHD diagnosis — to focus attention more easily, depending on the dose.

However, these drugs are not without serious risk.  Between the years of 1990-2000, over 569 children were hospitalized, 38 of them were life-threatening hospitalizations, and 186 died from Ritalin.

It is well known that psychostimulants have abuse potential.  Very high doses of psychostimulants, particularly of amphetamines, may cause central nervous system damage, cardiovascular damage, and hypertension.  In addition, high doses have been associated with compulsive behaviors and, in certain vulnerable individuals, movement disorders.  There is a rare percentage of children and adults treated at high doses who have hallucinogenic responses.  Drugs used for ADHD other than psychostimulants have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion at high doses can cause seizures, and pemoline is associated with liver damage.  (Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, National Institute of Health)

Many parents do not realize that if their child takes Ritalin or other psychostimulant medication past the age of 12, according to the 1999 Military Recruitment Manual, that child may not join the Army, Air Force, Navy, Marines, Coast Guard, or National Guard until after a doctor has signed a paper stating that the person has been off the medication for four years.

Also, if a child uses Ritalin or other psychostimulant medication, the state or federal government cannot hire him or her if the job involves state secrets or national security, because that child is a Class 2 drug user.

If a child uses Ritalin or other psychostimulant medication, some insurance companies will turn down that child for being a Class 2 drug user, and may even turn down the entire family.  Other health insurance companies will raise rates and write in a pre-existing condition clause, excluding some coverage for the ADD/ADHD child.

Psychostimulant medication are drugs that are commonly abused.  Some unprescribed users of Adderall, an amphetamine, and methylphenidate, more widely known as Ritalin, are adults.  But experts say many are young people, as young as 11, who get the drugs from peers being treated for ADD.  Users often crush the pills and snort them to get a cocaine-like rush, as these drugs and cocaine have more similarities than differences.

Students who take ADD/ADHD medication are often asked to sell or trade their drugs, and many know students who have given away or sold their medication.

According to the Substance Abuse and Mental Health Services Administration, a study of students in Wisconsin and Minnesota showed 34% of ADHD youth, ages 11-18, report being approached to sell or trade their medicines, such as Ritalin.

There are so many concerns surrounding the diagnosis and treatment of ADD/ADHD that parents must be knowledgeable and cautious.  It is usually the school that approaches parents to have an assessment for ADD/ADHD and parents often feel pressured in having the traditional drug treatment to ‘correct’ their child’s behavior.

Although health professionals often state that ADD/ADHD is a brain-based biological disorder caused by a brain chemical imbalance, there is simply no reliable test to prove this — no physical or chemical abnormality validates ADHD as a medical disease.

Before accepting a diagnosis of ADD or ADHD, parents should rule out other conditions that show similar behavior symptoms.

Attention Deficit Disorder describes the characteristics

of inattention, impulsivity and hyperactivity

that may be present in some children and adults.

Although health professionals often state that ADD/ADHD is a brain-based biological disorder caused by a brain chemical imbalance, there is simply no reliable test to prove this — no physical or chemical abnormality validates ADHD as a medical disease.

Since there can be no diagnosis without a disease, what is there?

There is a description of behaviors — symptoms — that health professionals use as a checklist in deciding whether your child has an attentional disorder.

However, symptoms do not necessarily mean there is a disease. To determine disease, there must be an objective test (such as blood text, X-rays, CAT scans, etc.).

There is no independent valid objective test for ADD/ADHD.  Instead health professionals rely on:

• a list of behaviors (primarily, inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems),

• diagnostic interviews,

• anecdotal information from family and school staff.

ADD/ADHD behaviors are found in the The Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition, Text Revision that forms the accepted guidelines for what are considered to be ‘mental illnesses’, or as they are more recently referred to, ‘mental disorders’.  This reference text is the “bible” of the mental health industry.  ADD was added to the DSM-IV in 1980 and ADHD in 1987.  Read the American Academy of Pediatrics’ guidelines for diagnosing ADHD.