Given the comments on the last few blogs, I realized I should probably put in some introductory comments, just to ensure we’re all on the same page.
Personality disorders have been defined as the cause of long term patterns of inner experience and outer behaviour that deviate from the expectations of society. They are all-encompassing, rigid and rarely change over time. They may lead to distress or impairment.
If we look at the terms of this definition we see:
Inner experience: Persons with a personality disorder see the world differently than the rest of us.
Outer Behavior: they behave differently than the rest of us. Because behaviour is usually determined by our inner world, this is to be expected.
All encompassing: these behaviors affect all areas of their lives
Rigid: behaviour is predictable because it is what it is and doesn’t change
Rarely change or time: Personality disordered people don’t understand what all the fuss is about. They think their view of the world is the correct one, so what’s your problem. And why would they change if they’re right?
This area of the Diagnostic and Statistical Manual continues to evolve and change. Certain disorders move into the DSM and then move out and sometimes they move back in. Or, more often, their names are changed to confuse the rest of us. For example, Psychopathic personality Disorder became Antisocial Personality Disorder and now is Antisocial/Psychopathic Personality Disorder. They’ve been called psychopaths, sociopaths and ASPD’s and no one is sure which is which, except the psychiatrists.
The other confusing thing about Personality Disorders arises because they deal with personalities (and we all have one). ALL of the symptoms in this group are found in the general population. It is a matter of degree, duration, and debilitation. Ironically, this is complicated because there are many definitions of personality, many acceptable degrees and ranges of behaviour and little agreement on a working definition of a healthy person.
According to
http://thecriticalthinker.wordpress.com/2008/10/10/list-of-personality-disorders/
the DSM-III included 3 clusters of Personality Disorders:
Eccentric Personality Disorders: behavior may appear strange or peculiar to others.
- Paranoid Personality Disorder –generally tends to interpret the actions of others as threatening.
- Schizoid Personality Disorder – generally detached from social relationships, and shows a narrow range of emotional expression.
- Schizotypal Personality Disorder – uncomfortable in close relationships, has thought or perceptual distortions, and peculiarities of behavior.
Dramatic Personality Disorders: intense emotional mood swings and distorted perceptions of themselves along with impulsive behaviors.
- Antisocial Personality Disorder – a pervasive disregard for, and violation of, the rights of others.
- Borderline Personality Disorder –a generalized pattern of instability in interpersonal relationships, self-image, and observable emotions, and significant impulsiveness.
- Histrionic Personality Disorder – displays excessive emotionality and attention seeking in various contexts. They tend to overreact to other people, and are often perceived as shallow and self-centered.
- Narcissistic Personality Disorder –a grandiose view of themselves, a need for admiration, and a lack of empathy that begins by early adulthood and is present in various situations. These individuals are very demanding in their relationships.
Anxious Personality Disorders: fearful and anxious.
- Avoidant Personality Disorder – socially inhibited, feels inadequate, and is oversensitive to criticism
- Dependent Personality Disorder –extreme need to be taken care of that leads to fears of separation, and passive and clinging behavior.
- Obsessive-Compulsive Personality Disorder –preoccupied with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency.
Others Not Specified: In layman’s terms this was the category for everybody else that we knew had a disorder but there were no psychological criteria to diagnose and label the behaviors.
In the soon-to-be-released DSM-V the categories are:
- Borderline Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Avoidant Personality Disorder
- Schizotypal Personality Disorder
- Antisocial Personality Disorder
- Narcissistic Personality Disorder
- Personality disorder Trait Specified
You’ll hear all of these terms in day to day use. They are not incorrect, but their meaning has changed in the halls of medicine and education. But for the general public, not so much.You can see over two revisions of the manual that we’ve gone from 10 to 7 categories. Some are combinations, some are refinements but they are the latest and greatest terms in use in the journals and ‘formal’ world of psychiatry and psychology. And the ones that don’t appear in this version of psychiatry’s bible are likely being held for ‘additional study’ and clearer definitions. It isn’t that they don’t exist, but rather, how they are assessed is being fine-tuned.
At this time, to the best of my knowledge, there is no cure for any of these; rather there is therapy and medication and meditation.
We’re going to take a look at these personality disorders, in no particular order, over the next few weeks. If there’s one or two in particular you’d like to discuss sooner rather than later, leave me a note in the comments and I’ll work on it for you.
So what do you think? Do you feel like some of these quick descriptions mark you friend/ex/MIL/ or …? Remember we aren’t going to diagnose anyone but we can talk freely about signs and symptoms and behaviors. Too often we’re afraid to trust our instincts and we keep trying to play nice with people who don’t understand the concept. I’m hoping this series will help you understand some key points to look for and keep yourself out of the hands of an emotional vampire. If you know, or have a sense of what to be aware of, you can make good decisions about the people you let into your life.
Hi, i think that i saw youu visited my web site so i came too “return the
favor”.I’m trying to find things to enhance my web site!I suppose its ok to use a few of your ideas!!
glad you found some things here you liked.
The confusing thing about Personality Disorders arises because they deal with personalities (and we all have one). ALL of the symptoms in this group are found in the general population.
Well shoot. My response disappeared so, in case it eventually shows up again, I’m not going to repeat it. I will say yet another great post, Louise. And yes, I do know some people who would fall into those categories (even me with some OCD symptoms…according to other people anyway). 🙂
for some reason it went into pending because it didn’t recognize you. weird.
I think we all know people who resemble some of these descriptions (to one degree or another). Would a thing about hand cleanliness fall into OCD…because I’ve been accused of that on more than one occasion. I can’t help though-if someone is going to be handling food or getting into my cupboards…WASH YOUR HANDS. Even if it is an OCD thing, too bad. Like someone trying to help me over my fear of snakes…not happening. I love clean hands, and I hate snakes. Some things are never gonna change, lol. 🙂
OCD can include hand washing but it’s usually more complicated than that. and somethings shouldn’t change – I’m with you on the snakes. LOL
Glad I’m not the only one who hates snakes! 🙂 LOL…and I probably am a little over the top about hand cleanliness. I go through about a quart of hand sanitizer (that I mix 50/50 with alcohol) every month, plus I buy big boxes of disposable and food service gloves (but only so I don’t have to wash my hands 50 times a day). I’m still okay with that though. My son was in intensive care for 2 months after he was born and I learned a whole lot about germs then. 🙂
just remember that gloves are not guaranteed – most of them have flaws that lalow germs in and the best cleaning is soap and water. How do I know that? We just had a hand hygiene workshop. LOL (I work in health care, you know.)
Hehe, I like to joke that I’m an OCD nurse; have to line up my supplies in a certain way before I start an IV, have to line up the empty syringes so I can see at a glance how much medication a patient’s been given, etc. But once I get home, I let all that go, so I guess it’s not a true disorder….right? 😉 Having a husband in the entertainment industry, I get to see a lot of narcissistic and histrionic types, and that’s always a good time! Thank you for this quick reminder of type, Louise. Think I’ll bookmark it for character development. Good work!
thanks for stopping by, Serena. And by the way, I’ll take your type of nursing over some of the others I’ve seen, any day. I know I won’t be injured by someone as thorough as you.
Keeping people safe is always at the forefront when I work, nothing else is acceptable. 🙂 As always, a pleasure to read your blog.
I love your series on behavior. Not only is it interesting in a real world context, it is great fodder for fiction. Your style is easy to read and understand, and that makes all the difference in the world.
I strongly suspect my late MIL had some sort of personality disorder. She was a conscious-free manipulator. I’ve never met a more cunning or nasty individual. And she knew her behavior could get her socially ostracized. She treated family terrible but treated people she knew socially with a great deal more respect. I could tell a million stories. But I won’t do it here on your blog. 😀
And that should be conscience-free, not conscious. Durn auto-correct.
Catie, your MIL sounds like a woman with a personality disorder – the ability to present an image to the people ‘who matter’ while treating family so terribly is one of they keys.
I am so glad you are finding these posts informative and easy to read. that’s my goal. So often information of this sort is relayed thru a plethora of $5 words, with a sprinkling of $10 ones (just to show the intelligence of the author) that the meaning gets lost. And in my view of the world, this is good information for stories and character building
Wow Louise, some of those disorders are so close. How do mental health professionals keep up with all these disorders? But I think it’s great to learn about this. As Debra said above, some of those would make great characters, just not in real life. Thanks Louise for putting this information together for us. And thank you for stopping by to see me. I hope you and your friend enjoy your trip to England! 🙂
Some of them are very close – which is why the psychiatric association keeps changing them and updating the diagnostic criteria. and because some were so close they were merged.
I enjoy writing about this material – it’s a fun part of my life, if that makes any sense at all.
england next year is the plan.
Not only do you really know your stuff, but you’ve written it out clearly. Thanks for all of this info.
thanks so much. I’m glad it makes sense. I have strived to keep it simple and readable but accurate.
Awesome stuff, Louise. I liked when you included that bit about no facial expression. It helps to see what disorders look like from the outside as well as the inside. Looking forward to your new series.
thanks for stopping by Joan. Hope you enjoy the series.
LOL. nah, not you, IMO. thx for stopping by.
If denial is a component, I’m afraid I might have all of those! 😉 Thanks for sorting all of these out for us, Louise. Fascinating stuff. I do hope people affected get the help they need.
Very good information and an intriguing series, Louise. I’m sending an email of this to a friend. Good job and thank you! Looking forward to all of it!
thanks Heidi. Hope you enjoy.
Really looking forward to this series, Louise. I’m especially interested in OCD and borderline personality disorder. I thought that was one that had been merged with another? Or am I thinking wrong? That’s always possible, lol!
Stacy, there was lots of back and forth about which disorders remained in the book and which were relegated for further study. at this time OCD is still a ‘live’ one. but it’s possible there was contrary discussion at some time. Heaven knows there’s been lots of talk. Borderline is fascinating and will probably take a couple of posts to describe and discuss – it’s very complex. Stay tuned.
Hi Louise, what do you think about people with anxiety disorders, is there scope for recovery, If they are prescribed with anti depressants will they have to stay on them for life? If they have therapy and get to the root of their anxiety i.e. from childhood abuse will they have the chance of a normal life without medication ? Also if they have an accompanying Thyriod Disorder (underactive) will this complicate matters. The person I am thinking of is attending CBT and doing very well.
There has been great success with Anxiety Disorder but every client is different and so outcomes can vary lots. sometimes people do have to stay on them for life. It depends on why they are prescribed. this sounds like PTSD but I obviously can’t say specifically. If that’s the case, it will depend on the individual’s abuse, time before diagnosis and treatment, their personal resilience (as built into their brain) and a host of other factors. We are so marvelously complicated – what works perfectly well for one person is a detriment for the next. but there are worse things than being on meds for life – going off them too soon so that the brain is thrown back into deep chemical imbalance could be very detrimental in the long run. Anything to do with our hormone system complicates everything. Every woman knows this, right? but if this person is attending CBT and doing well, we have to assume they are doing the work and we really can’t ask for much more.
It helps me to think about this like a stroke – the seriousness of the stroke, the time before treatment and the work completed, along with the mindset and attitude of the client all contribute to long term recovery. 2 clients can do the very same work and get very different results, unfortunately.
I’m sorry if I’m not being helpful, but there is no simple answer to your question. CBT works well for your friend and that’s wonderful. but for some people, it doesn’t work at all. we are so complicated and each of us is different. keep in touch and let me know how your friend is doing. I have the utmost hope that he/she will do well and recover fully. with support like yours, his/her chances are much better.
At last, I’m commenting.
Coming from a disfunctional family where physical violence/abuse and emotional control were normal behaviour I think something to realise is that when we’re in the middle of it and know nothing else, this is normal. Of course, as a child, we’re unable to fight therefore we endure and escape in our head to cope with the behaviour. Always living in fear of doing something ‘wrong’ or not being ‘good enough’.
I’m really interested in understanding(!) why a person behaves in such a way. Although I suspect there is no answer and I need to find acceptance for his behaviour. I look at the sociopath/narcissistic personality and can see my step father quite clearly. Even now, in his late seventies, he can cause mayhem and will strike the vulnerable without compunction. There is no conscience within him. And yet he appears, socially, an incredibly charming and wonderful man.
The other thing I’d like to see you deal with is the ‘guilt’ the victim lives with. Why do we take responsibility for this person’s actions? Even after talking therapy, for me personally, the guilt of not honouring my father and my mother (as the church says we should) is something that (if I let it) could consume me. Intellectually I understand that I’m not responsible for his behaviour and have gone on to have a wonderful, fulfilling life with my own husband (who’s the antithesis of my step father) and my own children. But when I was ill with cancer and vulnerable, again this person has impacted the family in a way that’s caused mayhem. He’s now no longer a part of our lives. So why do I feel guilty? And yet I don’t want to change the person I am and have worked hard to become.
There are days when I’m fine and can totally cope and not even think about him. But the time will come when he dies and I dread it because of the other extended family members who think he’s wonderful and I’m the bad daughter because I don’t have contact with him.
You are absolutely right, Christine. and the fact that children define this as ‘normal’ is what makes it so insidious and so difficult to change. Often, our abusers have personality disorders. That is not to excuse them, because this behavior can be changed if it’s recognized, but so very often it isn’t.
Your description of your stepfather typifies both these personality disorders. – without a conscience and yet socially charming. No one outside of his closest circle will ever realize how destructive he is.
The guilt you mention is a big deal for those of us who grow up feeling responsible for others’ happiness (another gift of the destructiveness of those disorders – they make everything our fault). We are given two strong messages all through childhood: our parents say I am angry, raging, raping you and it’s your fault. you make me do it. and then the church tells us we have to honor our mother and father, forever. It is so hard to make that transition.
I went for 10 years where I had a goal to talk to my mother 4 times a year. nothing more. as long as I called her that often, I felt i was being a good daughter, because my family sounds alot like yours. Mom has Alzheimer’s and I’m in charge of her health care – but I can do it because i have no emotional connection with her and I know it and I don’t have any guilt about it. Continued work on letting go of the guilt was the only answer for me. it took a long time.
I’ve made a note of your request about the guilt and I will get to it. stay tuned. thx for the heads up about being in spam hell.
Personaltiy disorders are Axis IV diagnoses and are generally difficult to diagnose.
After all is said and done, mindsets, thought patterns, and behavior patterns are capable of change, given the right kind of therapy e.g. Marsha Linehan’s dialectical behavioral therapy for Borderline Personality. Prayer for healing will also make a big difference. In face, Linehan herself got healed of her BPD while praying in the chapel.
Yes, they are difficult to diagnose and Marcia has had great success with her work. thx for stopping by.
I think I need to print this out and put it in my reference book. It’s a great guide for characters. As long as you aren’t trying to diagnose me. 😉 LOL. Even your comments and responses are extremely helpful and enlightening.
Thanks Debra. I’m glad you’re finding this useful information. And no, i wouldn’t diagnose you – not even if you paid me
Great post as usual, Louise. Really useful for writers, too.
Thx Alicia. Glad you stopped by.
I look forward to the new series of posts, Louise. You’re doing important work.
Hope you’re enjoying, Pat. Thx for stopping by
I’m curious – is Paranoid Personality Disorder the same thing as paranoid schizophrenia? And what about Schizoid Personality Disorder? I have a character in my WIP who may be paranoid schizophrenic – or whatever the correct term is nowadays 🙂 – so any info there would be great! Thanks for your informative and interesting posts!
Personality Disorders are quite different than Schizophrenia. In a few words, Schizophrenia is a complex set of symptoms and problems, which many think is actually a multitude of diseases, all called Schizophrenia. There is no definitively known cause of this illness, but many think that chemical imbalances in the brain cause delusions and behavior problems. Eventually this leads to structural problems in the brain which usually cause a worsening of symptoms and a shortened life.
A Paranoid Schizophrenic has delusions (hears/sees things the rest of us don’t hear/see) but they are typically obsessed with the threat to themselves and their families. So you’ll see the tinfoil on the windows to protect them from ‘mind invaders’ etc. These poor souls are usually terrified of anything and everything. It is interesting to me that they are often shown as being violent when the statistics show they are more likely to have violence done to them than to do it. But that doesn’t mean your character can’t be a bad one .
Paranoid personality disorder does not have the delusions of schizophrenia. It is ‘simply’ a way of seeing the world and interacting with it. Schizoid personality disorder shares some of the emotional symptoms of Schizophrenics (mostly lack of emotion showing on the face and lack of emotional connection with others) but they do not have the biological causes of these problems as do Schizophrenics. Rather it is an issue about how they go on in the world.
Those with personality disorder can often be treated and helped. The odds for someone with schizophrenia to overcome their illness and live a full and productive life are much lower. Whew! long answer to a short question. Did I answer you Jennette? If not, post another quesiton and i’ll try again.
It’s really confusing with the similarity of the terms and the fact that they keep changing. But yes, you answered my question! I’m looking forward to future posts. Thanks!
it is very confusing and I imagine worse for the patients and health care professionals who work with them. Glad I answered your question.
This is fascinating Louise. My cousin has been diagnosed with schizophrenia and is a psychopath. At the worst of times she believes the radio talks to her, sees angels walking beside her and has set fire to two houses. She refuses to believe there is a problem but, happily, stays away from the family because she has a particular hatred and jealousy of me, her brother and our general children/family happiness. I wonder how the breakdown of particular personality disorders would look in this person if she ever submitted to therapy.
For this poor soul, the diagnosis of Schizophrenia makes everything else extraordinarily difficult. Eventually I will include some posts about mental illnes – what the shrinks call the Axis I diseases. But for right now, what you’re describing (exclusive of the fires) is fairly typical of schizophrenia. Hearing things, seeing things and strange beliefs are commonly part of that illness. But I can’t say about your cousin, of course. I’m speaking in generalities only. Stay tuned, we will get to a discussion of all this information.
What a fascinating subject, Louise. I hope I can make it to all of them.
I hope you can too, Sandy.
This series is both informative and timely.
I’m cooking up my story’s ‘bad guy’ and wanted to make him believable. This series is a supermarket of disorder ingredients. I’m going to load up my cart!
That’s good, Dianna. My goal with this information is 3-fold: To provide information about difficult topics that affect most of us, in an easy-to-read manner; 2) to reduce the stigma around mental illness – as understanding grows, so does acceptance and treatment; and 3) to help writers build accurate characters. It’s a win-win-win
I’m looking forward to this series too. I’d particularly love to learn about borderline personality disorder and histrionic personality disorder.
Those two are on the short list, Marcy. Happy to provide a bit of information.
This promises to be a fascinating series of posts, Louise. I’m looking forward to them.
Thx Roxy. I’m hoping to make it interesting wihtout being offensive.