Personality Disorders.


Definition

The American Psychiatric Association provides a concise definition of personality disorder, but they are explicitly measuring the defect if you will against culture’s standards.

A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.

The DSM-5, which is a reference for psychologists and psychiatrists for diagnosing disorders, organizes it in terms of personality functioning and the presence of pathological traits and defines it as follows.

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:

  • Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
  • One or more pathological personality trait domains or trait facets.
  • The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.
  • 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 socio- cultural environment.
  • 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).

Pathology

So it’s best and most accurate to say that a personality disorder is one that has the features of impairments in personality as well as having the presence of pathological personality traits.  Well I usually think of the word pathological as meaning something that just doesn’t work for the situation at hand and is often extreme.  Let’s see what the DSM says about this.

characterized by adaptive inflexibility, vicious cycles of maladaptive behavior, and emotional instability under stress.

To define pathological correctly, it looks like it must have the features of not being able to be appropriate or adequate for the situation along with possessing an unstable pattern of it, especially when under stressors.


DSM-5 and Clusters

If you look at how the DSM organizes the ten personality disorders, then you’ll notice that they use key features to put them in groups called clusters.  The group that is of interest to us is cluster B, Figure 1 below, that uses the characterization of dramatic and erratic behavior to describe the four disorders: BPD, HPD, ASPD and NPD.

This behavior described seems to be similar to impulsiveness which means to have little control over behavior and emotions, but phrasing the behavior as dramatic and erratic seems to add nuances while avoiding unwanted connotations.

Those that show subclinical symptoms of Machiavellianism, narcissism and psychopathy may also benefit from reading this cluster, see the text in bold, since it describes the bold element to their behavior remarkably well.

The “Cluster B” personality disorders are characterized by dramatic or erratic behavior. People who have a personality disorder from this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous, or law-breaking behaviors.

  • Borderline Personality Disorder (BPD) is characterized by emotional instability, intense interpersonal relationships, and impulsive behaviors.
  • Histrionic Personality Disorder (HPD) features a need to always be the center of attention that often leads to socially inappropriate behavior in order to get attention. People with this disorder may have frequent mood swings as well.
  • Antisocial Personality Disorder (ASPD) tends to show up in childhood, unlike most other personality disorders that don’t appear until adolescence or young adulthood. Symptoms include a disregard for rules and social norms and a lack of empathy for other people.  [This “umbrella” term of Antisocial Personality Disorder includes the traits of sociopathy and psychopathy.]
  • Narcissistic Personality Disorder (NPD) is associated with self-centeredness, exaggerated self-image, and lack of empathy for others.
Figure 1: Cluster B

References:

[1] Salters-Pedneault, Kristalyn, PhD.  Introduction to the DSM Personality Disorders.  https://www.verywellmind.com/personality-disorders-a2-425427

Comments

  1. says

    Experiencing intense emotions is normal — why is that pathologized?

    Now, some ways people might cope with emotions can be anywhere from counterproductive to outright dangerous to themselves or others, and that extreme end of coping mechanisms needs to be addressed.

    But simply having very strong emotions is not a “disorder”. It’s normal.

    What’s not normal is denying feelings, and I think that, right there, is a lot of what’s wrong with modern society. We’re expected to be numb, to bottle up our feelings, and only express them to a minimal extent (and even then, only “appropriate” emotions.)

    (Yes, I do have some strong feelings about this, having been told quite explicitly that my emotions are “wrong” or that I “shouldn’t” feel whatever I’m feeling.)

  2. kestrel says

    OK this is interesting and I wish I’d noticed this series sooner, but I’ve now caught up on reading them.

    We had a family member diagnosed as NPD and that was the first I’d ever heard of that condition. For years we knew that *something* was badly wrong but had no idea what it was. I devoted a lot of time trying to wrap my head around that mindset, once we had a diagnosis. For those not familiar with NPD, rarely do you get an official diagnosis because these folks will not go to a doctor. You see, they’re perfect, and all the rest of us are just screwed up. That’s how they see it, and so they will only vanishingly rarely go to a doctor. However our family member was living at an assisted living facility and made death threats, which resulted in the police showing up. The facility had a rule of mandatory evaluation under those circumstances, so like it or not, our family member got diagnosed. In a way it was a huge relief to us to finally figure out why this person acted the way they did, even though there is really not much anyone can do about it.

    I’ll pay more attention now, and wait for the rest of the series!

  3. Just a lurker that writes too long comments says

    @1 WMDkitty

     

    It should be considered something you need help with when it stops you from functioning in your daily life on a regular basis. Like if you experience intense mood swings seemingly without external cause, from intense happiness to intense sadness, and even the smallest thing causes that extreme switch in your brain. That is not the same as deeply caring about what happens in the world, or getting angry at injustice, or loving someone, or feeling intense discomfort if you have an unpleasant experience.

     

    As a personal anecdote, I can get intensely sad to the degree of being unable to do anything else that day and struggling with work just by a minor incident like not getting the lunch I wanted. Then it might quickly swing around in the evening into an intense, just as distracting giddy happiness by listening to a song. Sometimes it’s not even external at all, it just switches unexpectedly in my head. The emotional response in my brain to this occurence is just out of proportion.

     

    Sure, I could get better coping strategies to deal with it, but I doubt the emotional response is that extreme to most people in the first place, and if you have to spend the whole day coping with a wide array of different intense feelings that you jump between, it leaves you exhausted in a way other people arent, and it might be good to be able to explain that particular problem in some way. I don’t really want to feel that much about nothing, it is just draining and it would be helpful to be more stable emotionally if possible.
    It’s to the point where it feels like a different part of my brain overrides what I really feel about an incident as a person.

     

    The answer might very well be that there’s nothing to be done, just learn to cope. But that doesn’t mean there’s no value in acknowledging some people have emotions to the degree it becomes a burden that it isn’t for most people.

     

    As usual with mental illness, everyone can identify with parts of diagnostic criteria, because mental illness is just an extreme form of the common human range of emotions. But that does not mean some people don’t need help with them. I see diagnosis as a tool to help you find how you could improve your wellbeing. It should not be stigmatized to seek help dealing with or changing certain mental states. Sadly, people don’t see it that way, and the history of mental illness is of course riddled with normative ideas of what is normal human emotions and behaviour. In a way, we can’t really escape that part, because we can’t compare mental states without looking at how most people feel and determine something is different.

     

    But saying emotions in themselves can never be the problem for anyone is a bit like telling a person with depression ”everyone feels really sad sometimes, it’s normal and healthy and should not be repressed, it should just be coped with in a good way.” It is a true statement, as both depressed and non-depressed people have to learn to cope with their feelings. But in a way that feels diminishing as a response to the struggles of dealing with depression. And sometimes coping is not enough, anti-depressants might actually help people by dampening their emotions, reduce anxiety etc. and for some people that is the best solution. It can be the same with other intense emotions, as having too much of them all the time can be exhausting.

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