Personality Disorders


 

Personality disorders are common, interesting, ambiguous to diagnose, and can cause significant distress to the individual. There are lots of types and every person will almost certainly find traits in multiple categories which they feel reflect their own personality. But when is it a disorder?

  • Inflexible thought patterns
  • Repeated episodes of behaviour, which may be destructive - those with a personality disorder may end up in the same problematic situations over and over again even though they know it is not good for them
  • Longstanding impairment of functioning as a result of these difficulties in adapting thoughts and behaviours.

 

To diagnose a personality disorder, the sufferer must display significant distress or impairment across multiple situations - including personal, social, romantic, and occupational.

The sufferer of personality disorders often lead reasonably functional lives, but struggle with maintaining stable jobs, relationships or friendships. They may not seek psychological help, as their personality vulnerabilities are so integral to them as a person that they don't realise that they have a condition or that they can be helped.

When a mental health professional meets a client who they feel might have a personality disorder, they consider whether the client has any of four criteria. The diagnostic criteria state that they must have at least two, and they must be "significant" (having a major impact) and "enduring" (lasting for a long period of time).

  • Distorted thinking patterns
  • Problematic emotional responses
  • Over- or under-regulated impulse control
  • Interpersonal difficulties

 

They must also consider the individual characteristics that form the criteria for each disorder in order to propose that the client has one of the 10 personality disorders. Often they might fit into more than one category and end up with multiple diagnoses.

Discussing personality disorders as "clusters" is a matter of preference ans varies between healthcare networks, but for the purposes of education they are quite useful. A cluster is a group of similar disorders that share common characteristics are:

Cluster A (the "odd, eccentric" cluster);
Cluster B (the "dramatic, emotional, erratic" cluster); and,
Cluster C (the "anxious, fearful" cluster).

 

 

Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders

The common features of Cluster A disorders are social awkwardness and social withdrawal.

 

The Paranoid Personality Disorder

  • Distrust and suspicion of other people
  • This can be a belief that people want to harm, abuse, take advantage of or defame them in some way
  • They often get into a habit of protecting themselves from others both physically and emotionally and may even pre-empt perceived attacks
  • Find it very hard to confide in others
  • Often hold grudges and feel people's intentions are malevolent
  • They may struggle with relationships due to pathological jealousy

 

The Schizoid Personality Disorder

  • Social detachment and isolation
  • Narrow range of emotions/expression
  • "Loners" who prefer individual to group activities
  • Find it hard to digest both criticism and praise
  • Others might describe them as "cold" or detached
  • Difficulties understanding social expectations and relations so struggle to integrate

 

Schizotypal Personality Disorder

  • Social and interpersonal limitations
  • Isolative and distant, struggle with close one on one relationships
  • Experience semi-psychotic symptoms, but not to the extent that they reach the criteria for acute psychosis. These can include seeing lights or shadows in their vision, or having odd beliefs such as the ability to read other people's minds or other beliefs outside of social norms

 


Cluster B: Borderline, Narcissistic, Histrionic, and Antisocial Personality Disorders

Common traits: poor impulse control and emotional regulation. Can be dramatic, emotional, and erratic.

 

The Antisocial Personality Disorder

  • Do not respect the rights of other people or societal laws
  • Can appear hostile and/or aggressive
  • Can be deceiving and manipulative, and this often starts in childhood (ie bullying, juvenile convictions such as graffiti, arson, property damage)
  • Often starts as Conduct Disorder
  • May be involved in crimes, accidents, financial and legal difficulties in adulthold
  • Put selves at risk through lack of consideration of the consequences of their actions, and poor impulse control
  • Often can feign remorse if it is beneficial for them to do so
  • May partake in victim-blaming

 

Histrionic Personality Disorder

  • Very emotional people who often require the attention of others to validate their own distress
  • Question their own self worth if they are not the centre of attention
  • Can be perceived as flirtatious, theatrical, flamboyant
  • Might not be very good at displaying specific emotions, making them seem "fake" to others
  • This makes it hard for them to engage in truly intimate relationships because they struggle to show empathy over their own feelings, and in turn the other person feels they are not being heard. However, they can feel uncomfortable when they are alone.

 

Narcissistic Personality Disorder

  • Very entitled and feel they are highly important or significant
  • One if the few states of mind where people experience an inflated sense of self worth
  • Feel they should be treated in a different way to others, which can often seem disrespectful to an outside perspective and can be viewed as arrogant
  • May appear obsessed with success or beauty
  • Can be devastated if they are faced with evidence that they are not as special, successful or well liked as they believed
  • Often require the admiration of others to fuel their self image. Can be very manipulative to achieve this

 

Borderline Personality Disorder

  • Tend to experience intense and unstable emotions and moods that can shift quickly
  • Reduced ability to self-soothe and so if they get upset it's difficult to calm them down
  • Others may see angry outbursts that they don't understand or don't seem proportional
  • Other impulsive behaviours may include drugs, alcohol, risky sex, self-harm, overspending and overeating
  • They often recognise that these behaviours are destructive in the long term, and want to stop, but the draw and short-term gain is too overwhelming to stop
  • Often have a very black-and-white view of the world. For example, people are either good, or bad; their circumstances are either great or terrible, and there is little room for the grey area in the middle
  • Struggle to moderate their emotional reactions toward others because of this all-or-nothing response
  • This view often extends to their opinion of themselves which ends up being very unstable
  • Tend to regularly change significant life events, like their job, romantic partner, friends, accommodation, goals, etc. This further reduces their self of stability

 

 

Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders

The common characteristics are feelings of anxiety, fear, social phobias and inadequacy

 

The Avoidant Personality Disorder

  • Feel inadequate and avoid social interactions at all costs
  • Very sensitive to criticism
  • Constantly anxious that others will mock them, dislike them, or think they are not good at what they are doing or not a good person
  • This can develop into severe social anxiety and can come across as distant or shy
  • Often don't have many friends

 

Dependent Personality Disorder

  • Feel like they need to be taken care of by other people
  • May come across as clingy because of their fear of not being looked after
  • The fear of losing a relationship may keep them attached to abusive or manipulative relationships
  • Struggle to disagree
  • Struggle to make independent decisions and actions
  • Being alone is incredibly frightening and they will actively avoid it

 

Obsessive-Compulsive Personality Disorder

  • Very attached to following rules, regulations, and orders
  • May sacrifice the ability to think flexibly in the pursuit of efficiency
  • Very organised but may struggle with change and find it hard to adapt in social situations
  • May find it very difficult to be satisfied with their own work due to their perfictionistic tendencies
  • Linked to this they may also be unable to delegate to others
  • May be very strict with money
  • Others often view them as strict, controlling or stubborn

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