Do YOU Have a Personality Disorder?

I imagine you will immediately say, “No, of course I haven’t!” and you will probably be right.  What about the people in your life? Do you find yourself bearing the brunt of weird, unusual, controlling, obsessional behaviour from people close to you? Only you will know if the people around you behave in ways that cause you a problem.

The purpose of this article is not to get you to start examining all your family, friends or work colleagues, looking for the tell-tale signs. Its purpose is to help you to firstly examine your own behaviour and secondly to learn more about this greatly misunderstood concept. Thirdly, if you have someone in your life whose behaviour is a cause for concern, then hopefully this article will help you to understand them better.

What’s in a Name?

I want to preface this article by saying that this is a huge subject and I couldn’t possibly cover all aspects of it here. During this “mission impossible” I have chosen to undertake, I will bring you the benefit of my experience as a Counselling Therapist in UK Mental Health Services and private practice and point you in directions to allow you to learn more. (This computer will not self-destruct in five seconds…..!).

A number of other words have been used to describe this “condition”, such as psychopath and sociopath. There’s no difference at all in the meaning of these words. It’s simply that someone objects to a name for some politically correct reason, and so it changes. The condition, however, remains the same. Personally, I don’t care what you call it. I will use “PD” in the rest of this article because it’s easier to type!

What is a Personality Disorder?

I guess the first place to look to get an idea about this means we should look at the medical establishments’ definition of PD. Below is a quote from the current “official” definition from the “Diagnostic and Statistical Manual for Mental Health Disorders – Fifth Edition” (or DSM-V) for the consideration of the diagnosis of PD:

“The essential features of a personality disorder are impairments in
personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose a personality disorder,
the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and
interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains or trait facets.

C. The impairments in personality functioning and the individual‟s
personality trait expression are relatively stable across time and
consistent across situations.

D. The impairments in personality functioning and the individual‟s
personality trait expression are not better understood as
normative for the individual‟s developmental stage or sociocultural
environment.

E. The impairments in personality functioning and the individual‟s
personality trait expression are not solely due to the direct
physiological effects of a substance (e.g., a drug of abuse,
medication) or a general medical condition (e.g., severe head
trauma).” (Note 1. DSM V)

The above quote merely scratches the surface of PD, and includes some words and ideas whose meaning might not be clear to the uninitiated, so let’s take a look at some of them in language that we can better understand:

  1. Pathological Personality Traits – It’s probably the word “pathological” that might cause some difficulty. It’s a word used as an all-embracing term for absolutely any diagnosable mental health disorder. Exactly what is regarded as “diagnosable” is described in detail throughout the entirety of the DSM-V document.
  2. Significant impairments in self (identity or self-direction) and
    interpersonal (empathy or intimacy) functioning – The patient has significant problems with how they see themselves, either who they are or how they progress through their life. There is the addition of having problems with understanding the feelings of others and the ability to have close personal relationships.
  3. One or more pathological personality trait domains or trait facetsif we translate this into English rather than medical-speak, this criterion for diagnosis explains that a patient must exhibit behaviour from at least one of any of the broad groups of PD, or one of the particular recognised behaviour patterns from one of those groups.
  4. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations – This is fairly self-explanatory. This initial definition doesn’t go into details about the timescales involved but is explained in more detail in the specific categories of PD within DSM V.
  5. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or sociocultural environmentIn other words, this is directed to child development and significantly different cultural environments. As regards children, and adolescents in particular, they can exhibit behaviour that, to adults, could seem unusual, challenging or even violent. Care needs to be taken in assuming there is evidence for a PD in such circumstances. As regards cultural environment, diagnosis of PD should take into consideration practices which are within the context of the patient’s culture or environment.
  6. The impairments in personality functioning and the individual’s
    personality trait expression are not solely due to the direct
    physiological effects of a substance (e.g., a drug of abuse,
    medication) or a general medical condition (e.g., severe head
    trauma)This is simply saying that the unusual behaviour has nothing to do with the effects of alcohol, drugs or any other medical condition.

So all of the above explains the basics of what psychiatrists are looking for when they are considering a diagnosis. I want to point out that the process of diagnosis is not the same as going to see a doctor for a medical complaint. It will involve several consultations with a psychiatrist over several months, as well as ongoing regular assessments by Mental Health Nurses (in the UK at least).

Personality Disorder Types (According to DSM-V)

The list below is taken from DSM-V and is the latest label for each diagnosable PD. There isn’t space in this article to look at them individually. If you want to read more about the specifics of each category, then follow the link at Note 1 at the end of this article.

  1. Antisocial Personality Disorder.
  2. Avoidant Personality Disorder.
  3. Borderline Personality Disorder.
  4. Narcissistic Personality Disorder.
  5. Obsessive-Compulsive Personality Disorder.
  6. Schizotypal Personality Disorder.
  7. Personality Disorder Trait Specified.

I assume you’ve had a scan through the online document I recommended and no doubt you were bemused and bedazzled by the vast array of criteria for each of the categories.

As you look through each category (and you really should to be able to get a grasp of each category) you will notice some common features, despite the fact that each category describes markedly different overall behaviour.

Here are some of those common features:

  • Anxiety
  • Low self-esteem
  • Very self-centred
  • Inability to empathise with others
  • Emotional instability
  • Problems with intimacy
  • Depression

But these common features don’t paint the whole picture. Looking at PD from the academic perspective only allows for a more objective and remote picture. It doesn’t provide us with what it’s actually like to have a PD, nor do we get any sense of how the real-life effects of their behaviour manifest itself in the lives of others.

The Real World of Personality Disorders

So let us change our approach now and start to look at PD from a more subjective perspective, such as one who observes the behaviour and recognises it for what it really is.

I’ve had the privilege of working with a great number of clients over the years as a Counselling Therapist. When I began all those years ago, I had no intention of singling out any one type of issue for greater interest or scrutiny. It just happened.

Over time, I started to notice a pattern. Working with many clients in any given week, I noticed that there were one or two clients who were experiencing anxiety or depressive reactions which were directly connected to how a significant other was treating them. During my work with those clients, it became clear that the perpetrator was usually someone close to them (e.g. husband or wife) and they were behaving in a way that was strange or cruel.

After maybe a couple of years of working I began to realise that there were some common features in the people my clients described. But what was more troubling for me was that all this started to have meaning for me on a more personal level, but I just couldn’t place it at first.

My training as a Person-centred Therapist baulked at the idea of categories and labels. It was the antithesis of my training. However, I was working within a “medical model” setting, so I had to get used to the conditions and disorders as I played along so I could keep my job!

Little did I realise when I began, that I would now turn to the medical model’s journals and “bible” (DSM-IV, an older version) in order to try to piece together what I was seeing and feeling. What I discovered was quite an eye-opener.

I began to scan read the criteria for PD of the various “types” and as I did, something else came to mind which I will explain because it has a bearing on that sense that all this had some meaning for me that I just couldn’t place.

One day it suddenly dawned on me that for many years I had been struggling to understand the strange and cruel behaviour of my father. I was gradually learning more and more about various so-called “mental illnesses” but I just couldn’t place him in any particular category, that is until I discovered information about PD.

I could see the pervasive traits he demonstrated throughout my lifetime and it became abundantly clear to me that he was to all intents and purposes an undiagnosed sociopath.

Ok, so things started to become clearer for me as I worked with my clients. I was beginning to recognise certain tell-tale traits that indicated PD. I kept these things to myself. You could call it a kind of private study. Until one day, when I finally took the risk.

I had been working with a man who was being psychologically tormented by a woman (an unusual occurrence in itself). He described her behaviour extensively to me, and I saw his immense struggle to just try to put some logic or sense into the way she was treating him. It was after a number of such sessions that I finally said to him, with great trepidation, “Have you considered that she might be a psychopath?”

“What’s that?” he asked. So I just laid out a basic run-down of some of the real-world behaviour of a psychopath. It went like something like this:

“Usually someone with a psychopathic personality will have or be:

  • Totally self-oriented. That means that they put their own agenda before anyone else’s, even to the point of causing others emotional or physical harm.
  • They will have an agenda (or agendas) which play out in such a way that does not relate to any idea of logic or common sense that the rest of us follow. In other words, their ways do not follow accepted societal norms.
  • Usually very intelligent people.
  • Extremely adept at deception. Excellent and well-practised liars.
  • Feel little if any remorse for their actions.
  • Often have pleasant or outgoing personalities in the world, but change completely behind closed doors.
  • Will go to extreme lengths to maintain the “cover” of their double life.
  • Usually, any signs of emotion are fake unless it comes about as a result of harm to themselves or discovery of their own misdeeds.
  • Highly manipulative. 
  • Create for themselves their own “reality” within which they see themselves as master. The reality of the world as seen by everyone else is something to be tolerated and dealt with. They have their own set of rules.
  • They deal with the real world by stealth, knowing that their own urges and beliefs violate societal laws or norms, and do not want to get caught. Yet their own higher “morality” provides the impetus for their behaviour.”

I’ve added a few extra things to the list above that I have seen over the years since, but you get the idea.

I realise that offering such information might seem quite judgemental within the context of therapy, but quite honestly, I felt that I would be a fraud (incongruent) and totally disrespectful to watch my client run around in circles, while I knew full well that he would never come to this conclusion on his own. After all, I reasoned that it had taken me a whole lot of years as a therapist to come to understand even the rudiments of this problem.

Needless to say, that client was stunned by what I said to him. Not because I had the audacity to say it, but that I had described his protagonist female to a tee! I am bound to say that this knowledge allowed him to examine his relationship and also more about his own choices and attitudes.

The Sliding Scale

The psychiatrists have their diagnostic methods, rules and treatments, but the fact

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remains that personality disorders are far more common than most people realise. The vast majority of them are never diagnosed. In fact, the UK National Health Service only started to recognise Personality Disorder as a treatable “illness” in around 2004.

 

I don’t particularly hold with the diagnostic methods of the medical model, although I can see how they can be of use. What I hold in greater stead is the recognition that PD not only comes in all shapes and sizes, but also in a huge range of intensity.

If you are like me and hate the idea of being labelled as “mentally unstable”, then the stigma of being diagnosed with a PD will be a very heavy burden to carry. So let’s just ditch the “I have a PD/I don’t have a PD” notion or diagnosis and think differently. So let me say this:

Most, if not all of us, have a personality disorder of one form or another.

It’s all just down to scale. For example, you might be someone who is a non-conformist. Maybe you don’t agree with the politics that surround you, and so you have your own ideas. Does that mean you have a PD? I doubt it, but there may be a hint of abnormality in your personality depending on what lengths you go to defend your beliefs.

What about internal anger? Perhaps you are someone who has a reasonable disposition normally, but when you have a couple of drinks, another side of you materialises. Does that count as a PD? If this is a consistent factor that you exhibit throughout your life, then yes, once again, there may be a hint of personality abnormality.

I could go on with many other examples of varying degrees of behavioural intensity, but what it all comes down to is that there is no such thing as a “normal” personality. It just doesn’t exist, which is why we are all unique.

We all have quirks and even eccentricities that are part of our natures. We accept these differences to a degree. We may assess a person to be “emotional” or “angry” or maybe “awkward” or even “obnoxious”. Much of our own assessment of others comes down to our own set of core beliefs, which are purely subjective in themselves, and highly variable from person to person.

Sometimes, those differences we see in others can often be some aspect of their personality that has been formed from indoctrination, abuse, trauma etc. from an early age. We rarely give them a second thought as we grow up into adulthood and forge our way through life.

Also, it is very important to realise that we all try to cover up our behaviour so as not to be seen as “abnormal” to some degree or other. All this (and more) makes it incredibly difficult to recognise a PD in another person when you remember that some of the highly developed skills of the person with a PD are to deceive, lie and manipulate others.

Make no mistake though. The sliding scale of abnormality will move into a danger zone quite markedly once attitudes of control, manipulation, lies and especially violence emerge. People don’t have to be “axe-wielding maniacs” to have a PD. They are like the chameleon lizard that changes its colour with each new environment. They can be quiet and unassuming, yet have hidden motives and agendas. Their violence can take many forms and may remain dormant.

I Have a Personality Disorder

To finish this incredibly interesting and difficult topic I will tell you that I myself have had to come to terms with my own personality “quirks”. I most certainly don’t think I come anywhere near the criteria for PD as set down in the medical model diagnoses. But I have had my problems.

I’ve had to work very hard indeed to first accept that when I was younger, I had incorporated into my personality, behaviour that was inappropriate. I’ve worked hard to determine which parts of me I want to accept, and those that I want to change.

I’ve been lucky. I have worked with a lot of people who have helped me to overcome the bad parts (mostly). What I have become is still so different from most people, but those differences are things that I have chosen to accept and even develop.

So finally, how can we tell if we have hints of PD in ourselves? Well as I have discovered for myself, there is only truly one way and that comes through self-examination. Self-awareness is key. Gradually coming to terms with who you are will help you to start the weeding process, and as we know, removing the weeds allow the plants to grow and bloom.

Weeding involves getting down on your knees. It requires effort, dedication and humility. Even more, it takes time and patience to be able to see the bigger picture of the beautiful garden that you want to create. It’s worth it in the end.

Note 1: (DSM V – General Criteria for Personality Disorder)

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stevechriscole

Steve Chriscole is a former Counselling Therapist (Psychotherapist) turned teacher and freelance writer for hire on a wide variety of mental health matters. Both in person and in his writing, he is passionate about raising awareness of anxiety and depression in particular, as well as growth in self-awareness and self-confidence in order to help people lead happier and more productive lives.

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