Personality Disorders

What is a personality disorder?

Our personality is our own unique qualities, traits, behaviours, emotions and characteristics.  It is what makes us ‘who we are’ and different from everyone else, it is how the rest of the world sees us.  We all know people who are outgoing, morose, demanding, happy, and casual and so on.  These are of course all personality traits.

Someone is said to have a personality disorder when their ‘pattern of thinking and behaviour is extreme, inflexible and maladaptive’.  In layperson’s terms, some people think and act ‘differently’ without ‘normal’ feelings, attitudes, behaviours and interactions.  I could quote the official terms from the DSM (Diagnostic and Statistical Manual of Mental Disorders) but that is meaningless to most of us.  It also really doesn’t explain what it is like to live with someone with a PD or how it actually manifests itself in their behaviour.

We just all know people who are a bit different, a little ‘crazy’, rude, nasty, abusive, manipulative, seem to have no morals, just not quite ‘normal’.  Another term often used is ‘crazy-maker’, someone who just makes us crazy and we can’t work them out.

We might all seem a little ‘crazy’ some of the time, and we will all sometimes show behaviours that are associated with personality disorders. The difference is just that, we all do it some of the time.  A person with a PD shows these behaviours much more often over a long period of time.  It is an extreme of ‘normal’.

There are of course a lot of people that might fit the description of ‘a little bit crazy’, but it could be for lots of different reasons, maybe another mental disorder.  So how do we know it is a PD?

How do I recognise a personality disorder?

This one isn’t easy.  Even professionals find it hard to diagnose PD (personality disorder) and a diagnosis can be quite controversial.  This is not a hard and fast science, it never is with human beings.  There is also a great deal of overlap between the different types of PD.  If you look up the DSM it is an official description Doctors to use in their diagnosis.  It might help you to recognise a person with a PD, especially if the person you know is really ‘crazy’.  However for many people with PD it isn’t quite so obvious.

The other thing is that those of us who have lived with a person with a PD can often recognise it better than the professionals.  Part of having a PD is lying and presenting a mask to the world.  So they lie and misrepresent themselves when with professionals too.  It really is only their loved ones who see how they behave behind closed doors, who see the real person behind the mask.  We are in actual fact in a better position to diagnose than the professionals!

What are the different types of personality disorder?

There are three groups or ‘clusters’ of PD, A, B and C.

These are the four Cluster B personality disorders:

Antisocial – sometimes called psychopathy or sociopathy.  The main distinguishing characteristics are: lack of empathy, lack of conscience, poor impulse control, highly manipulative, superficial and arrogant.

Borderline – emotional instability, fear of abandonment, highly sensitive to rejection, poor self image, mood swings, often with self destructive behaviours.

Histrionic –   characterised by the constant display of excessive levels of emotionality and seeking of attention and approval.

Narcissistic – is distinguished by the need for admiration, lack of empathy, self absorption, exaggeration of achievements, arrogant and a strong sense of entitlement .

There is a great deal of overlap between the different Cluster B PD’s, often referred to as ‘co-morbidity’ in psychiatric terms, meaning when someone is diagnosed with more than one disorder.  Diagnosis is not a ‘science’ but a label based on the official descriptions of the different disorders.  In the opinion of many, the disorders are not easily or neatly defined and are confusing even to professionals.

In a study in the USA the incidence of co-morbidities of another personality disorder with BPD were very high at 74% (77% for men, 72% for women)2.  This table shows the percentage of people with BPD who had a diagnosis of another personality disorder.

Men Women
Paranoid 17% 25%
Schizoid 11% 14%
Schizotypal 39% 35%
Antisocial 19% 9%
Histrionic 10% 10%
Narcissistic 47% 32%
Avoidant 11% 16%
Dependent 2% 4%
OCD 22% 24%

 

In men, Borderline Personality Disorder overlaps with Antisocial by 19% and Narcissistic by 47%.  This demonstrates why it might be difficult to ascertain which disorder someone might have.  The overlap in diagnosis is also related to the overlap in behaviours demonstrated by people with Personality Disorders.

What behaviours are associated with personality disorders?

There is a great deal of information that can be found on the internet and in books describing behaviours associated with personality disorders.  The one I found most useful was on the site ‘Out of the Fog3  It provides a really good description of 100 traits associated with all the different personality disorders.

Again, please remember as you read this, we all do some of these some of the time.  It is when someone does many of these things a lot of the time over a long period that it is possible that they have some sort of personality disorder.

ABUSIVE BEHAVIOURS

Passive Aggressive – the expression of negative feelings, resentment, and aggression in an unassertive, passive way (such as through procrastination and stubbornness).

Targeted Humour, Mocking & Sarcasm – any sustained pattern of joking, sarcasm or mockery which is designed to reduce another individual’s reputation in their own eyes or in the eyes of others.

Invalidation – the creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.

Threats – written or verbal warnings of intentional, inappropriate, destructive actions or consequences.

Baiting and Picking Fights – the practice of generating a provocative action or statement for the purpose of obtaining an angry, aggressive or emotional response from another person

Abusive Cycle – describes the characteristic rotation between destructive and constructive behaviour that typically exists in dysfunctional relationships and dysfunctional families.

Belittling, Condescending and Patronizing – a passive aggressive approach to giving someone a verbal put-down while maintaining a facade of friendliness.

TALK AND BEHAVIOUR GAP

This could also be categorised as  ‘say what you mean, mean what you say’.

Includes but is not limited to the following behaviours:

Chronic Broken Promises – Repeatedly making and then breaking commitments and promises.

False Accusations – False accusations, distortion campaigns & smear campaigns are patterns of unwarranted or exaggerated criticisms which occur when a personality disordered individual tries to feel better about themselves by putting down someone else – usually a family member, spouse, partner, friend or colleague.

Pathological Lying – is persistent deception to serve one’s own interests with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.

Joseph Carver 1 summarises this category well.

We know how people are by two samples of their personality – their talk and their behaviour. A person who is honest has talk/conversation/promises that match their behaviour almost 100%. If he/she borrows money and tells you they will repay you Friday, and then pays you Friday, you have an honest person. When we observe these matches frequently, then we can give more trust to that individual in the future. The wider the gap between what a person says/promises and what they do – the more they are considered dishonest, unreliable, irresponsible, etc. Due to the shallow emotions and situational morality often found in a Personality Disorder, the gap between talk and behaviour can be very wide. A Personality Disorder can often assure their spouse that they love them while having an extramarital affair, borrow money with no intention of paying it back, promise anything with no intention of fulfilling that promise, and assure you of their friendship while spreading nasty rumours about you. A rule: Judge a person by their behaviour more than their talk or promises

MORALS/VALUES

Cheating – sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Lack of Conscience – often preoccupied with their own agendas, sometimes to the exclusion of the needs and concerns of others. This is sometimes interpreted by others as a lack of moral conscience

OWNERSHIP

Not My Fault Syndrome – in an attempt to hide their own sense of worthlessness or inadequacy they will go to great lengths not to apologize or take ownership for their own mistakes or actions.

Projection – attributing one’s own feelings or traits onto another person and imagining or believing that the other person has those same feelings or traits.

Blaming – the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Denial– believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.

RELATIONSHIPS

Stunted Emotional Growth – Stunted Emotional Growth is a difficulty, reluctance or inability to learn from mistakes, work on self improvement or develop more effective coping strategies.

Push-Pull – Push-Pull is a chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

What is High Functioning versus Low Functioning Borderline PD?

There is some controversy over whether there are in fact ‘High functioning’ and ‘Low functioning’ people with BPD.  That controversy is amongst professionals only. Just come and ask those of us who have lived with a high functioning person with BPD if they exist and you will get a resounding yes.

Low functioning borderlines are the ones that often end up with a diagnosis because they are the ones more likely to self harm and attempt suicide, thereby ending up in the care of a psychiatrist.  The high functioning people with BPD do not accept there is anything wrong with them and can function quite normally in most areas of their lives such as work and social situations.  It is only their loved ones that can see something is ‘off’.

High-functioning borderlines act perfectly normal most of the time.  Successful, outgoing, and well-liked, they may show their other side only to people they know very well. Non-borderlines involved with this type of BP need to have their perceptions and feelings confirmed. Friends and family members who don’t know the borderline as well may not believe stories of rage and verbal abuse. Many non-BPs told us that even their therapists refused to believe them when they described the BP’s out-of-control behaviour. 5

There is a whole range of people with BPD – From “high functioning” to “low functioning”.

Those who are “high functioning” are able to fool everyone, to dupe people closest to them, because from the outside, nothing seems to indicate they are suffering from a disorder. They are able to have a family, children, hobbies, hold down a rewarding job,.

High functioning Borderlines may rage only in front of their significant other. In fact many keep it so well hidden that Non’s (people without a personality disorder living with someone with a personality disorder) are not believed when they tell friends and family what is happening.6

Are there different levels of personality disorders?

Personality disorders, like many things are on a continuum.  There is a full spectrum of behaviours and intensities, some people having some PD traits while others are at the end of the spectrum with a ‘full blown’ personality disorder who match all or most of the diagnostic criteria.  ‘High functioning Borderlines’ have traits or symptoms that might be quite subtle.

Is it important to have a diagnosis?

Although some people may have a diagnosis of a PD, for those of us living with someone who demonstrates these behaviours, a diagnosis isn’t always all that important.  It is the person’s BEHAVIORS that count, not the label they may or may not have.  If you were to go to a therapist, it would do no good to say ‘I think my partner has a personality disorder’ you would have to tell the therapist the behaviours your partner exhibits and then you could both work from there.  If you go to court during a marriage breakdown, you will have to have evidence of the BEHAVIOURS that concern you (and what happens in court is a whole other book which I will write after this one).

In addition of course, the ‘high functioning’ pwPD will in all probability never get a diagnosis anyway, they will pull the wool over the diagnostician’s eyes – only you will really know they probably have it!

What is it like living with someone with a personality disorder?

Who are these people? In romantic relationships they are controlling, abusive, manipulative partners who can ruin not only the relationship, but our self-esteem, finances, and reputation. As a parent, they can put the “D” in Dysfunctional Family and be the parent that abuses, neglects, ignores, or psychologically damages their children. As a friend they may be irresponsible, selfish, unreliable, dishonest, and often create significant problems in our life. As a neighbour, they spread rumours, create disharmony in the neighbourhood, and steal our lawnmower. As a family member, they maintain themselves as the centre of attention and keep the family in an uproar or they may be the 45 year old brother who has never worked and remains dependent on the family for his support. They may be the brother or sister who verbally bullies and intimidates others with their temper tantrums. As a co-worker they are manipulative, unethical, dishonest, and willing to damage co-workers to achieve their employment goals. On the street they are the criminals, con-artists, and people-users who purposefully damage others then quickly move on to avoid detection. 1

References

  1. http://www.drjoecarver.com/
  2. http://bpdfamily.com/message_board/index.php?topic=90388.0
  3. http://outofthefog.net/CommonBehaviours/Top100Traits.html
  4. http://www.boomeranglove.com/asp/redflags-20.asp
  5. http://ivy_league0.tripod.com/rhyme_of_the_ancient_wanderer/id114.html
  6. http://www.aapel.org/bdp/BLsyntheseUS.html
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