What is a “personality disorder”

I keep reading news reports about the Sandy Hook shootings that describe the shooter as having a “personality disorder”. No explanation is given and no effort is made to enlist the help of mental health professionals to define “personality disorder”. Here is my attempt to provide that much-needed explanation.

Personality disorders are personality traits that are rigid and self-defeating, interfering with functioning and may lead to psychiatric symptoms. They are typically classified as Axis II disorders. Axis II is reserved for life-long problems usually appearing in childhood. Mental retardation is also considered an Axis II disorder. Axis II  disorders are viewed as having a primarily genetic or environmental cause, as compared to Axis I disorders that can be treated to the point that a person no longer meets the criteria for that diagnosis (i.e. Depression, Anxiety, etc.). There are medications that help manage the symptoms of many Axis I disorders, but very few that treat Axis II disorders. People who suffer from these disorder are often considered difficult, if not impossible to treat.
Below is a summary of the Personality Disorders recognized by the DSM-IV-TR, the professional guidelines for diagnosis mental illnesses.

Cluster A – Odd or eccentric disorders
Paranoid Personality Disorder

  • pervasive mistrust of others’ motives
  • tendency to hold grudges
  • perception that others are “out to get me”

Schizoid Personality Disorder

  • often detached from social connections
  • restricted range of emotional expression
  • NOT TO BE CONFUSED WITH AUTISM OR ASPERGER’S which have a genetic and/or environmental component

Schizotypal Personality Disorder

  • odd thinking and speaking patterns
  • odd beliefs
  • lack of close friends
  • chronic paranoia
  • confused with Schizophrenia which typically present in young adulthood.

Cluster B – Dramatic, emotional or erratic disorders
Antisocial Personality Disorder
Individuals with this disorder experience stigma due to society’s perception that anyone with this disorder is a “killer”. While these individuals do frequently break the law, most are non-violent.

  • sometimes referred to as a “sociopaths”
  • does not conform to social norms regarding laws and rules
  • engages in chronic lying, conning, and use of aliases
  • repeated physical fights or verbal aggression
  • chronic impulsivity
  • lack of remorse
  • inability to demonstrate compassion or mercy

Borderline Personality Disorder
This diagnosis is very controversial as it is sometimes confused with several other Axis I disorders by even the most skilled clinician. Some even believe that it isn’t truly a personality disorder because successfully treatments are available.

  • frantic efforts to avoid abandonment
  • a chronic pattern of intense and unstable personal relationships
  • a tendency to idealize or devalue others to the extreme
  • self-damaging impulsivity in response to emotional stressors (spending, sex, substance abuse, dangerous driving, binge eating)
  • recurrent suicidal or self-mutilating behaviors
    NOTE: Not all cases of self-injury indicate Borderline Personality Disorder.
  • extremely reactive mood (sometimes confused with Bipolar)
  • chronic feelings of emptiness often described as “feeling like an imposter”
  • intense inappropriate expressions of anger/rage
  • possible paranoia or dissociative symptoms (not to be confused with Schizophrenia or Dissociative Identity Disorder).

Histrionic Personality Disorder

  • insatiable need to be the center of attention
  • engages in inappropriately seductive or provocative behaviors
  • displays rapidly changing,  shallow emotional expressions
  • uses physical appearance to draw attention to self
  • overly dramatic (“drama queen”)
  • suggestible, gullible
  • often misinterprets the level of intimacy desired by others

Narcissistic Personality Disorder

  • grandiose sense of self
  • exaggerates their achievements
  • expects to be recognized as superior without proving it
  • preoccupation with fantasies of success, love, beauty, intelligence, etc.
  • believes that he/she is special and misunderstood
  • requires excessive admiration
  • has a great sense of entitlement
  • takes advantage of others to achieve personal goals
  • lacks empathy
  • envious of others
  • often projects arrogance and disdain for others.

Cluster C – Anxious or fearful disorders
Avoidant Personality Disorder

  • avoids interpersonal contact due to fears of rejection/criticism
  • fearful of not being liked
  • chronic fear of being embarrassed
  • socially inhibited
  • poor self-image
  • reluctant to take risks.

Dependent Personality Disorder

  • requires excessive advice/reassurance from others in order to make decisions
  • pathological need for others to assume responsibility for major areas of his/her life
  • difficulty expressing disagreement
  • difficulty initiating projects, or acting independently.
  • excessively pursues nurture from others
  • feels helpless when alone (believe unable to care for self)
  • urgently pursues relationships as source of care/support
  • terrified of being alone due to exaggerated fears of abandonment

Obsessive-Compulsive Personality Disorder 

  • preoccupied with lists, rules, order, schedules to the point that nothing gets accomplished
  • extreme perfectionism interferes with task completion
  • excessively devoted to work to the exclusion of recreation and relationships (not explained by cultural, religious, or economic reasons)
  • unable to discard worthless or worn-out objects
  • reluctant to delegate
  • extremely frugal and hold others to the same standard
  • often perceived as rigid and stubborn

These are normal personality traits taken to the extreme that interfere with a person’s ability to function effectively in society and for healthy relationships. Every one of these traits is a part of the normal human experience when viewed in isolation. True personality disorders are difficult to diagnose and very controversial. Mental health professionals disagree strongly on the origins and treatment of these disorders. Unfortunately some clients are labeled with these disorders when treatment fails as a way of “blaming the patient”. Within the mental health community these disorders are sometimes used as derogatory labels to describe individuals who are difficult to treat. Patients can improve or recover with the right therapy. It is a slow, lengthy process not readily available in our “quick fix” society. These individuals are not necessarily dangerous or violent. Their condition is not due to some moral failing or character flaw. They deserve our compassion and effective treatment, not derision or fear.
For more information…
BehaveNet | Personality Disorders
TARA Association for Personality Disorders
NAMI | Mental illnesses
Behavioral Tech
APA | Help for Personality Disorders
APA | What causes personality disorders?

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