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    What Is A Personality Disorder?

    What Is A Personality Disorder?
    by Linda Lebelle, BA, MEd

    A personality disorder is identified by a pervasive pattern of experience and behavior that is abnormal with respect to any of the following two: thinking, mood, personal relations, and the control of impulses.

    The character of a person is shown through his or her personality - by the way an individual thinks, feels, and behaves. When the behavior is inflexible, maladaptive, and antisocial, then that individual is diagnosed with a personality disorder.

    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 DSM-IV: Diagnositc and Statistical Manual of Mental Disorders (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:
    o 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.
    o Avoidant Personality Disorder: Marked social inhibition, feelings of inadequacy, and extremely sensitive to criticism.
    o 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.
    o 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.
    o Histrionic Personality Disorder: Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.
    o 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.
    o Obsessive-Compulsive Personality Disorder: Characterized by perfectionism and inflexibility; preoccupation with uncontrollable patterns of thought and action.
    o 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.
    o Schizoid Personality Disorder: Primarily characterized by a very limited range of emotion, both in expression of and experiencing; indifferent to social relationships.
    o 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, author of Malignant Self-Love: Narcissism Revisited, individuals with personality disorders have many things in common:
    o 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
    o Lack of perspective-taking and empathy
    o Manipulative and exploitative behavior
    o Unhappiness, suffering from depression and other mood and anxiety disorders
    o Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks
    o 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
    o Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs
    o 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, 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.

    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.

    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 medications can 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, for that which is not acted upon is not learned.

    Then, with a support system (e.g., therapy, self-help groups, friends, family, medication), they can free themselves from their imprisoned life.

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    Re: What Is A Personality Disorder?

    This from the Mayo Clinic dated 2010. Much the same information but I think more in depth.

    Personality disorders - MayoClinic.com

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    Re: What Is A Personality Disorder?

    Can a person have two personality disorders at the same time? The reason I ask is that Narcissistic describes my mam really well, but there are also things in what I have been able to read about Histrionic that fit.

    Thanks,

    BB

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    Re: What Is A Personality Disorder?

    It's really not a good idea to try to diagnose anyone, including yourself, by reading about diagnostic criteria.

    The criteria are usually clear enough. The problem is that differential diagnosis - the process of distinguishing between one or more diagnoses which may have some overlapping features - requires a thorough knowledge both of diagnosis and of psychopathology.

    The current released version of the diagnostic manual is DSM-IV-TR, which uses a multiaxial system. In this system, Axis I lists diagnoses for an individual like mood disorders, anxiety disorders, etc. Axis II lists any applicable diagnoses for personality disorders. A person may have diagnoses on both Axis I and Axis II. A person may also have more than one diagnosis on Axis I or Axis 2, although it is less common to have multiple diagnoses on Axis II.

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    Re: What Is A Personality Disorder?

    From my own experience, I have been diagnosed with two personality disorders... Both BPD and AvPD. But when the psychiatrist writes down the diagnoses number and letter from the DSM (?) they don't write them separately. There is a code for someone who has multiple personality disorders. I asked my psychologist and she said the letter and number means multiple personality disorders. I'm not totally in knowledge so maybe Dr Baxter could shed some more light on this.

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    Re: What Is A Personality Disorder?

    Many countries tend to use the ICD classification (International Statistical Classification of Diseases and Related Health Problems aka ICD9 or ICD10) rather than DSM, which is favored more in North America. ICD has a slightly different classification system.

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    Re: What Is A Personality Disorder?

    I just found the discharge letter from the last time I left the hospital. It says my diagnoses codes are 'F33' and 'F60.31'. Does that make any sense in correlation to the North American way of doing this?

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    Re: What Is A Personality Disorder?

    Quote Originally Posted by David Baxter View Post
    Many countries tend to use the ICD classification (International Statistical Classification of Diseases and Related Health Problems aka ICD9 or ICD10) rather than DSM, which is favored more in North America. ICD has a slightly different classification system.
    Yes those are ICD10 codes.

    F33.x is Depressive Disorder, Recurrent
    F60.3 is Emotionally Unstable Personality Disorder - subtypes include Aggressive PD, Borderline PD, or Explosive PD.

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    Re: What Is A Personality Disorder?

    That's very interesting. Thanks for the info.

    A couple of things. Has there been a recent release of a new DSM? I ask this because instead is saying Borderline Personality Disorder, you said Emotionally Unstable Personality Disorder. I read that they were discussing renaming the disorder.

    And 'recurrent' Depressive Disorder - meaning that it comes back again and again or is some chronic disorder? To be honest, I'm terrified that I'll have depression all my life like my mum and grandmother have/had. My psychologist said to me the other day that it will most likely be something I'll have to deal with for the rest of my life. Wow, that really gets me down and I'm worrying a lot.

    Thanks.

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    Re: What Is A Personality Disorder?

    Quote Originally Posted by AmZ View Post
    That's very interesting. Thanks for the info.

    A couple of things. Has there been a recent release of a new DSM? I ask this because instead is saying Borderline Personality Disorder, you said Emotionally Unstable Personality Disorder. I read that they were discussing renaming the disorder.

    And 'recurrent' Depressive Disorder - meaning that it comes back again and again or is some chronic disorder? To be honest, I'm terrified that I'll have depression all my life like my mum and grandmother have/had. My psychologist said to me the other day that it will most likely be something I'll have to deal with for the rest of my life. Wow, that really gets me down and I'm worrying a lot.

    Thanks.
    It just means that you have had 2 or more episodes of depression. It's historical rather than predictive so it doesn't in itself have anything to say about the likelihood of future episodes.

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