The Sad Case of Personality Disorders

Personality Disorders are psychological conditions whose severity earned them a place in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. These severe psychological conditions are characterized by maladaptive and stable over time patterns of thoughts, emotions, and behaviors, which cause chronic psychological distress and even functional and relational impairment.

What is Personality?

Personality is an organized psychological structure composed of inborn temperament, thoughts, beliefs, emotions, attitudes, and behaviors. The system of the human character is divided into four areas that reflect one’s development from early childhood to the present. They are attachment (how do I relate to others), individuation (how do I see myself), integration (how do I deal with life and myself), and adulthood (how competent I am).

Causes of Personality Disorders

A combination of neurobiological and environmental factors is the leading cause of personality disorders. Neurobiologically, there are certain personality traits inherited from parents (e.g., temperament) and certain variations of brain chemistry and organization (e.g., in the extreme case of psychopathy). Environmental factors refer to the environment one grew up in and how one related to that environment (e.g., the family of origin, significant events during childhood, family and social relationships).

Types of Personality Disorders

Personality disorders have four core enduring characteristics across time:

  1. Distorted thinking patterns

  2. Emotional dysregulation

  3. Impulsiveness (over and under)

  4. Relational difficulties

The DSM-5 lists ten personality disorders divided into three clusters:

  • Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders Disorders listed in this cluster are characterized by distorted thinking. People with these disorders are usually considered odd and eccentric because of their social awkwardness and withdrawal.

  • Cluster B: Borderline, Narcissistic, Histrionic, and Antisocial Personality Disorders Disorders in this cluster are characterized by emotional dysregulation, impulsiveness (over or under), low or absent emotional empathy, and black-and-white thinking.

  • Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders Disorders listed in this cluster are characterized by anxious and fearful thinking and behavior.

Diagnosing Personality Disorders

Andrew Skodol explains that the Alternative DSM-5 Model for Personality Disorders uses the five-factor model of personality but measuring its pathological opposites in a dimensional rather than a categorical approach.

  1. Negative affection– frequent and intense experiences of negative emotions and their behavioral expressions.

  2. Detachment– intentional avoidance of socio-emotional experience and limited capacity for pleasure.

  3. Antagonism– self-enhancement behaviors that put an individual at odds with other people.

  4. Disinhibition– impulsive seeking of immediate self-gratification with no regard for past negative experiences or consideration of future consequences.

  5. Psychoticism– incongruent, odd, eccentric thoughts, beliefs, and behaviors.

Diagnosing personality disorders is neither an easy endeavor nor a pleasant one. The process requires clinical interviewing, testing, and observation. Even though the results of the assessment process may point to a particular personality disorder, most mental health professionals would agree that avoiding such labeling may be more beneficial to the client/patient for two reasons:

  • the impact of such a lifelong label in the individual’s fragile psychological structure, and

  • the possibility that the individual might have a pathological personality trait without necessarily having a full-blown personality disorder.

The TV show Dr. Phil presented a case some years ago, Anger Intervention, where a young man, a veteran with two tours in Iraq, denounced that his most brutal battles and scars didn’t happen at war but at home with his abusive wife. He said that her emotional outbursts and violence left him emotionally and physically wounded. The young man’s wife seemed angry at him, her parents, child, in-laws, neighbors, and herself. As she acknowledged her anger and emotional problems, although arguing excuses and blaming others, Dr. Phil asked her a critical question, “What are you, a victim or a perpetrator or both?” The answer was both.

Those who had the misfortune of having in their life or knowing someone with a personality disorder can paint a portrait of these people that it’s far worse than that of the typical villain. The projection of their self-hatred onto those close to them especially loved ones, is hard to endure. But the truth is that people with personality disorders inflict pain on others because they find themselves in a perpetual inner conflict that causes them acute emotional distress. Their outbursts of rage or fear cease only when they make someone else the object of blame, someone who will be responsible for triggering the pain they are experiencing.

Simply put, people with personality disorders are children trapped in their broken childhood.

In the young woman’s case, she displayed emotional dysregulation, uncontrollable impulsivity, and self-destructive and aggressive behaviors. Those symptoms might indicate a possible Borderline Personality Disorder (BPD), the most diagnosed personality disorder. Dr. Phil never even wondered about this possibility, and rightfully so, because of the negative connotation of this condition. He asked the young man instead to be a little more patient and wait for his wife as she embarked on 45-day inpatient treatment for her anger and emotional issues. It’s doubtful that 45 days would be enough to help this young woman’s drastically damaged psychological structure. But there’s hope when one is willing, and the best way to help people with this condition in psychotherapy is by setting short-term goals, as Dr. Phil did, to keep the individual engaged in the therapeutic process.

People with personality disorders are consistently avoided, sidelined, or just ignored. It’s hard not to take personally derogatory language, demeaning attitudes, unjustified aggression, and wild accusations and criticism coming from nowhere. However, it’s essential to consider that the primary reason for their rage, isolation, depression, and need to self-medicate is a painful shame and ensuing fear of rejection and abandonment.

Having a personality disorder is one of the saddest conditions of our humanity.