Saturday, February 12, 2011

What IS a Personality Disorder?

What IS a personality disorder?

SHORT version:

A personality disorder is identified by a pervasive pattern of experience and behavior that is abnormal with respect to any two of the following:  Thinking; Mood; Personal relations; Impulse control.

"When people are driving themselves crazy, they have neuroses or psychoses. When they drive other people crazy, they have personality disorders." ~Albert J. Bernstein

What IS a personality disorder?
MEDIUM version:
 A personality disorder is "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." 

Everyone has personality traits. Traits that are extreme, inflexible and resistant to change, and do not mature normally, might denote a personality disorder. A key indicator of a personality disorder is the belief that one's behavior is normal or 'right', despite feedback from other people or conflict with social norms.

DISCLAIMER: Only a qualified clinician can diagnose a personality disorder. The fact that many people with personality disorders refuse to see a psychologist (they see nothing wrong with the way they think, feel and perceive) means the rest of us make an informed guess. We educate ourselves to understand to better understand the other person and our reactionsto their frustrating and confusing behaviors. Personality traits indicating a personality disorder are: 

Conflict with others
Lack of empathy
Social impairment (this includes the larger social context) 
Pervasive and chronic behaviors
Self-centeredness; self-preoccupation 
Chronic blame of others and society 
Behaviors are maladaptive to the situation 
Distorted perceptions of the ‘self’ and of others 
Manipulation and exploitation of others 
Inability to sustain long term relationships 
Unhappiness, anxiety and depression 
Behavior interferes with occupational functioning 
Unable to take a broad perspective 
Fails to achieve to their potential 

Note:  Hallucinations, delusions and thought disorders are not indicative of a personality disorder with the exception of brief psychotic episodes with Borderline Personality Disorder.

What IS a personality disorder?
LONG version:

Personality Disorder : DSM-IV and DSM-IV-TR
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

1) cognition (i.e., ways of perceiving and interpreting self, other people, and events; 
2) affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response;
3) interpersonal functioning;
4) impulse control. 

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. 

C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. 

E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. 

F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma). (article link

American Psychiatric Association
A literature review indicated that personality disorder implies pervasive disorganization in personality structure and functioning that is manifested as a broad failure to develop important personality structures and capacities needed for adaptive functioning. These adaptive failures are manifested as:

     1) the failure to develop coherent sense of self or identity
     2) chronic interpersonal dysfunction (Livesley, 1998) 

Evaluation of self pathology will be based on criteria indexing three major developmental dimensions in the emergence of a sense of self:

1) differentiation of self-understanding or self-knowledge (integrity of self-concept);
2) integration of this information into a coherent identity (identity integration); 
3) the ability to set and attain satisfying and rewarding personal goals that give direction, meaning, and purpose in life (self-directedness)

These dimensions capture important aspects of self and identity problems described in the clinical literature (Cloninger, 2000; Howowitz, 1979; Kernberg, 1984; Kohut, 1971) in a format that is consistent with cognitive approaches to personality. Interpersonal pathology is evaluated using criteria indexing failure to develop the capacity for empathy, sustained intimacy and attachment (labeled intimacy in the proposal), prosocial and cooperative behavior (labelled cooperativeness in the proposal) and complex and integrated representations of others). This component reflects a second emphasis in the clinical literature (see Rutter, 1987; Benjamin, 1996). (article link)

Definition of a personality disorder: InFocus
Wikipedia: DSM-V


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