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

Is this the true meaning of love, bonding, coupling?

Do we simply get used to other human beings, pets, or objects?

Habit-forming in humans is reflexive.  We change ourselves and our environment in order to attain maximum comfort and well being.  It is the effort that goes into these adaptive processes that forms a habit.  The habit is intended to prevent us from constant experimenting and risk taking.  The greater our well being, the better we function and the longer we survive.

Actually, when we get used to something or to someone – we get used to ourselves.  In the object of the habit we see a part of our history, all the time and effort that we put into it.  It is an encapsulated version of our acts, intentions, emotions and reactions.  It is a mirror reflecting back at us that part in us, which formed the habit.  Hence, the feeling of comfort:  we really feel comfortable with our own selves through the agency of the object of our habit.

Because of this, we tend to confuse habits with identity.  If asked WHO they are, most people will resort to describing their habits.  They will relate to their work, their loved ones, their pets, their hobbies, or their material possessions.  Yet, all of these cannot constitute part of an identity because their removal does not change the identity that we are seeking to establish when we enquire WHO someone is.  They are habits and they make the respondent comfortable and relaxed.  But they are not part of identity in the truest, deepest sense.

Still, it is this simple mechanism of deception that binds people together.  A mother feels that her offspring are part of her identity because she is so used to them that her well being depends on their existence and availability.  Thus, any threat to her children is interpreted to mean a threat on her Self.  Her reaction is, therefore, strong and enduring and can be recurrently elicited.

The truth, of course, is that her children are a part of her identity in a superficial manner.  Removing them will make her a different person, but only in the shallow, phenomenological sense of the word.  Her deep-set, true identity will not change as a result.  Children do die at times and their mother does go on living, essentially unchanged.

But what is this kernel of identity that I am referring to?  This immutable entity which is the definition of who we are and what we are and which, ostensibly, is not influenced by the death of our loved ones?  What is so strong as to resist the breaking of habits that die hard?

It is our personality.  This elusive, loosely interconnected, interacting, pattern of reactions to our changing environment.  Like the Brain, it is difficult to define or to capture.  Like the Soul, many believe that it does not exist, that it is a fictitious convention.  Yet, we know that we do have a personality.  We feel it, we experience it.  It sometimes encourages us to do things – at other times, as much as prevents us from doing them.  It can be supple or rigid, benign or malignant, open or closed.  Its power lies in its looseness.  It is able to combine, recombine and permute in hundreds of unforeseeable ways.  It metamorphizes and the constancy of its rate and kind of change is what gives us a sense of identity.

Actually, when the personality is rigid to the point of being unable to change in reaction to changing circumstances, we say that it is disordered.  A personality disorderis the ultimate misidentification.  The individual mistakes his habits for his identity.  He identifies himself with his environment, taking behavioral, emotional, and cognitive cues exclusively from it.  His inner world is, so to speak, vacated, inhabited, as it were, by the apparition of his True Self.

Such a person is incapable of loving and of living.  He is incapable of loving because to love (at least according to this model) is to equate and collate two distinct entities: one’s Self and one’s habits.  The personality disordered sees no distinction.  He is his habits and, therefore, by definition, can only rarely and with an incredible amount of exertion, change them.

And, in the long term, he is incapable of living because life is a struggle towards, a striving, a drive at something.  In other words:  Life is Change.  The person who cannot change, cannot live.

by Dr. Sam Vaknin,

author of Malignant Self Love – Narcissism Revisited

They need to be respected for taking on these tasks. After all, we respect adults who can do these things. They are complicated and courageous actions.

But teenagers swing back and forth between dependence and independence as they work on these tasks. It’s easy for parents to get frustrated. And it’s easy for a parent to assume that if the teenager would simply follow the plan that makes sense to a parent, things would be all right in the end.

Life is not so simple, of course — not for teenagers and not for adults. In many ways, adults carry on the very same tasks of growth and development themselves — after adolescence. Adults, however, usually have a greater sense of who they are — what they value, what they need, and how best to get what they need — than do teenagers.

False starts, mistakes, poor judgment, or impulsive action are part of growing up. And like teenagers, adults encounter these same challenges. It’s just that adults are usually better prepared to meet the challenges.

The main tasks of adolescence require teenagers to learn, and this kind of learning is not just a matter of getting the right answer. Most important is to understand the meaning of the right answer. And maybe “the right answer” is something that teenagers need to build up, responsibly, from lessons of experience. This is truly difficult work and it absolutely requires support from parents, relatives, and neighbors.

To help adolescents grow up, parents need to be aware of their own growth. Everyone who is alive is changing, growing, and developing. It’s easy for a middle-aged adult to forget this fact, especially when confronted with a difficult teenage problem. But parents who are working on their own growth are in a good position to understand teenagers and to respect what they are doing in the struggle to grow up and become good people in their own right.