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Since the beginning of In Transition we have covered quite a bit of territory. The material we've covered has not been excessively controversial among professionals. However, there exists a serious schism among psychiatrists over the cause of personality disorders. Consequently I must discuss both: what personality disorder is and the three different explanations of its cause. The three explanations are termed: the environmentalists, the biologicalist and my own synthesis). Consequently this article and the follow up articles may elicit more disagreements from our readers than our previous ones.
We're moving to an area of psychopathology that deals with personality dysfunction. Until recently this has been the central question which the core of psychiatric theory and treatment attempted to answer. The literature is voluminous and this article is not a review of the field. My purpose is to introduce the idea that personality can be abnormal. To do so I must explain first what is normal personality. Harold Kaplan and Benjamin Sadock (editors of a highly regarded psychiatry text) consider personality to be "the totality of emotional and behavioral traits that characterize the person in day-to-day living under ordinary conditions". Traits encompass all of our personal interactions - those which make us kind, jealous, mean spirited, forgiving or those that can be characterized by any of the hundreds of other adjectives that describes who we are. Personality traits are enduring characteristics, formed in childhood and early adolescence, and persist throughout life.
We can see certain traits in a 3-year-old that characterize their behavior even as adults The stubborn 3 year old will almost certainly become the stubborn 80 year old curmudgeon. The range of normal personalities equals the range of humanity. This makes a short pithy definition difficult or impossible. But all normal personalities have at least these two characteristics in common. They are adaptive and have a variety of psychic defenses.
So what is an abnormal or mal-adaptive personality? People with an abnormal personality have difficulty changing and/or are psychically vulnerable. Consider individuals that are their own worst enemies. They keep making the same mistakes over and over and have horribly circumscribed lives with tremendous amounts of emotional pain. They rely on a limited range of psychic defenses and do not adapt to life's changes. They can be overly shy, braggarts, cruel, impulsive, and/or liars. Other examples include people who are on their fifth marriage and are still unable to find a suitable spouse; or persons who keep getting fired time-after-time and cannot figure out why; or persons who are consumed by rage because they feel that they are entitled to some benefit, but are continually denied it.
People with normal personalities adapt to difficulties. So while we can all have an intimate relationship that does not work out or be fired or be denied a benefit, we recover from the pain and the same self-imposed problem does not reoccur. Individuals with a personality disorder forever feel the pain of old blows and repeat the same mistake over and over again. They would change if they could because they are in so much emotional pain - but they are trapped. How do these complex personality disorders develop?
One camp feels very strongly that personality is the sole result of the person's upbringing; that is what their family life was like, were they treated nicely and were they respected. Let us call them environmentalists. On the other hand the biological camp feels just as strongly that personality is the result of only the hard wiring in the brain. To illustrate these points of views let's look at two examples.
The first is that of a child who is beaten, ridiculed, and given inconsistent parenting. In many cases when these children grow up they'll have maladaptive psychic defenses to life stresses and as adults lead tragic lives, recreating the chaos of their childhood. One colleague refers to these individuals as psychically bludgeoned. They will never reach their personality potential.
The second example is that of a child born with a genetic mutation causing severe behavioral problems such as Downs Syndrome or Autism. In both cases, the brain is severely damaged resulting in altered behavior and personality.
Given these two examples which illustrate the two ends of the personality spectrum, what causes what? If you believe the early childhood experience (environmentalist) camp, personality - good or bad - was the result of parenting. If you believe the biologist camp, parenting had nothing to do with the outcome.
Personally I find both positions lacking. Research and treatment in this area have been limited by the isolation of the two camps who often exhibit inflexibility and expound worthless rhetoric (almost sounds like a personality disorder) when talking to each other. To deal with this unsatisfying situation I will leave the etiology of personality to others. But clearly from my two examples I believe both environment and genetics play a role. Here rather we will concentrate on describing what happens when personality goes awry.
If we agree that personalities can be maladaptive, the next issue is how are they described? The guide used by psychiatrists in the United States divides personality disorders into three groups. They are cluster A (paranoid, schizoid and schizotypal), cluster B (histrionic, narcissistic, antisocial and borderline) and cluster C (avoidant, dependent, obsessive-compulsive, and passive aggressive). These names represent the historical understanding of the breakdown or lack of development of normal psychic defenses.
As we will see in upcoming columns cluster A individuals are characterized by being odd or eccentric, cluster B individuals are often overly dramatic and cluster C individuals can be overly anxious and fearful. These traits are not the only traits patients can have but are the predominate ones.
© 1998 Peter Melgaard Thompson
Last Modified: January 27, 1998
I would like to give special thanks to Gregg F. Thompson, M.B.A. for his help in preparing this article. PMT.
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