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