A 2.7 Minute Post About Personality Disorders

[I am being excessively pedantic. The average adult reads at 250 words per minute. This post is 670 words long.] 

I talked a little about my feelings on personality disorders and PDs as a whole at Chicago Skepticamp (So. FUN.) and in the last post.  Then I realized that few people get as into psych as I do, and as personality disorders are far too marginalized as it is, y’all might be missing some background. So here it is!

Personality disorders are on Axis II of the DSM

The DSM classifies using a five axis system. In a “full-workup” a client would be analyzed in terms of all axes. The idea is to include all factors of how behavior could be manifesting. For instance, if the patient is displaying disordered eating behavior, but hyperthyroidism hasn’t been ruled out…maybe they don’t have an ED? If they’re exhibiting erratic behavior that’s not responding to therapy or meeting criteria for something like schizophrenia, have you ruled out a brain tumor?

This doesn’t always happen in practice–which is incredibly frustrating. In a perfect world, psychiatrists and psychologists would have time to do these things, and clients would be able to afford it.

Wishful thinking aside, these are the axes.

Axis I: All the stuff you probably think of in terms of mental illness. Mood disorders, anxiety disorders, eating disorders, all of that. Also autism, a categorization location I have some quibbles about.
Axis II: Personality disorders and mental retardation. Autism diagnoses used to be located here.
Axis III: Stuff that is non-mental medical issues. Could be having migraines, cancer, etc.
Axis IV: Pyschosocial factors. For instance, the client could be in an unstable family environment, suffering abuse, in foster care, unable to get regular sleep due to work, imprisoned etc. All of those can contribute to manifesting a more severe version of a disorder, or major mood changes.
Axis V: Global Assessment of Functioning. This actually just a number from 0-100, based on the rater’s impression of how well the client can cope with day to day life tasks. Further elaboration here.

There are three categories of personality disorders. And there’s probably more PDs than you’ve heard of.

Cluster A (odd or eccentric disorders. I’m serious, that’s what they’re called)
-Paranoid Personality Disorder
-Schizotypal Personality Disorder (This isn’t schizophrenia.)
-Schizoid Personality Disorder (This isn’t schizophrenia either.)

Cluster B (dramatic/emotional)
-Antisocial Personality Disorder (ASPD)
-Borderline Personality Disorder (BPD. Here’s one experience of BPD.)
-Histrionic Personality Disorder
-Narcissistic Personality Disorder.

Cluster C (fearful/avoidant)
-Obsessive Compulsive Personality Disorder (OCPD. This isn’t OCD–we just like to make things confusing for you.)
-Avoidant Personality Disorder
-Dependent Personality Disorder

And Then These Conditional Diagnoses: (Which may or may not get added to DSM-5)
-Depressive Personality Disorder
-Negativistic/Passive-Aggressive Personality Disorder

There’s really very little research on personality disorders

This, as far as I can tell, isn’t actually because researchers don’t want to study PDs. But firstly, few people go in for treatment of their personality–because few people are distressed by their own personality. So there’s a small pool to begin with, often of people who have been jabbed into getting treatment by family or friends. (Borderline seems to be the only regularly studied one, but that just could be because DBT was developed for BPD and I read a lot about DBT.)

Secondly, research usually tries to use ‘clean’ patients, that is, people who have just one diagnosis. So, to avoid confounding data, research on OCPD is going to only want patients who have Obsessive Compulsive Personality Disorder and only Obsessive Compulsive Personality Disorder. Except…that doesn’t really happen all too often. PDs are, almost by definition, maladaptive to living in society, which results in increased stress, which can then up the risk of other disorders and suddenly….you don’t have lots of ‘clean’ patients wandering about. (Add in the complication of finding clean patients who live close enough to participate in your research and are interested and suddenly you have a very messy project on your hands. Probably better to make the psych undergraduates do Stroop tasks.)