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In Transition

Personality Disorders, Part 2


Dr. Peter Melgaard Thompson

There are many ways to describe personalities. Hippocrates' described four temperaments or personalities: the pessimistic melancholic, the overly optimistic sanguine, the irritable choleric, and the apathetic phlegmatic. Since Hippocrates' time each generation has renamed and added or subtracted to the list. If you are a pop psychologist you will list names like introvert or extrovert. If you are a job councilor you might use terms like "works better alone" or "works better in a team". Regardless of the names used we all have consistent feelings and responses that are generated from specific life experiences. For example, if it is snowing the snow might remind me of Christmas. I feel warm and content even though it is cold outside. Another situation that is less pleasant may be a problem that I am having with my boss. If my boss is unappreciative of my work, I feel disappointed. My responses to these situations may be to start a fire, call a family member and try to improve my performance at work. These responses are consistent and reflect my temperament or personality. These responses do not necessarily say that I am normal, rather they are examples of how one might respond.

In the world of psychiatry we deal with psychopathology or when the feelings and behavior to life's stresses are hurtful to the patient. Psychiatrist use descriptions that are helpful in describing and treating these individuals. That's where the categories of personality disorder clusters A, B and C come in. I have described the general characteristics of these groups and now will look at them more specifically. For each personality disorder I have also included how these people with the disorder may react to my examples in the first paragraph. The first cluster (A) is the group that is called odd or eccentric. The sub-groups are the paranoid, schizoid and schizotypal personality disorders.

Paranoid personality disorder: These individuals are overly concerned with issues of suspiciousness. They believe that other people's motives are sinister. They have recurrent suspiciousness without justification, often regarding the fidelity of a spouse, or government conspiracies. In general they feel others are exploiting and harming them. To use my examples above these persons may feel that the snow is the result of a government experiment or that the boss has singled them out for harassment.

Schizoid personality disorder: In this group of individuals there is a consistent pattern of detachment from social relations. These are the loners and they enjoy being alone. Their response to my examples would be to start a fire and not to ever be in a situation where they work with anyone.

Schizotypal personality disorder: Here individuals use odd and magical thinking to explain the world. These people may believe in magic, clairvoyance, and telepathy. They may react to our examples by believing that they wished for and caused the snow and may place a hex on their boss.

Antisocial personality disorder: This group of individuals is often confused with people who are without social interactions (schizoid, schizotypal and paranoid). The core of the antisocial group is a disregard for the rights of others. These people are the liars, cheats and criminals who do anything to get what they want. They have little or no remorse for their behavior. This group would not necessarily include people addicted to drugs who steal to support their habit although there is a high level of alcoholism and drug use within the antisocial category. These people start as youngsters with truancy, fire starting, vandalism, drug use, aggression and taking pleasure in acts of cruelty. How would this group react to our two examples? Well, they probably would feel that the snow is an inconvenience preventing them from accomplishing whatever they wanted to do that day and in the case of the problem with their boss, they would lie and blame someone else.

Borderline personality disorder: The main features of this disorder are "instability of interpersonal relationships, self-image, and affects (expression of emotion), and marked impulsivity". These individuals are often overcome by real or imagined fears of abandonment. They tend to see other people as all good or all bad and are unable to tolerate the shades of gray. When faced with difficult life situations, they act impulsively or will hurt themselves by self-mutilation. They feel empty inside and are very emotionally sensitive to what is going on around them. Their response to the examples might be to remember a painful situation that occurred when it was cold, feel empty and cut themselves to feel alive. With the boss they would start screaming, leave the meeting and do some impulsive act like driving recklessly.

Histrionic personality disorder: This group has "excessive emotionality and attention-seeking behavior". Individuals can be flirtatiousness and want to be the life of the party. They dress and act to draw attention to themselves and often have shallow emotions. They might react to the snow example by going to the store to buy an expensive outfit suitable for a winter wonderland, kissing and hugging the store clerk and telling him about the wonderful experience they had. With their boss they would dramatically start crying, possibly make some flirtatious remark and then stalk out of the meeting.

Narcissistic personality disorder:-"Grandiosity, need for admiration, and lack of empathy" are the cardinal features of this disorder. Individuals with this disorder have an inflated estimation of their own abilities and devalue the contributions of others. They feel entitled to special treatment and are overly hurt when they do not receive it. They may react to the snow example by remembering how great a skier they are. To the boss the narcissistic personality would feel devastated by criticism and feel that no one understands how important he/she is.

The final cluster, (C), is characterized as anxiety or fearfulness. There are three subgroups: the avoidant, dependent, and obsessive-compulsive personality disorders.

Avoidant personality disorder: These individuals struggle with wanting to be involved in social interactions but feel inept and stay away from close situations. Starting in childhood they have a "pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation". In the snow example they may long to be with friends and family but are preoccupied with fears of criticism and thus they refrain from contacting anyone. In the example of the boss, they feel crushed. Instead of explaining the situation they may retreat and vow never to place themselves in a situation where they are criticized - even going so far as to turn down promotions.

Dependent personality disorder: "These individuals are convinced that they are incapable of functioning independently and present themselves as inept and requiring constant assistance." In contrast to someone with a serious medical illness who requires the assistance of another to function, people with dependent personality disorder can function adequately as long as they think they are being supervised. Individuals with dependent personality disorder often seem clingy and have difficulty making decisions. In the snow example they may seek out their spouse and follow him/her around the house. In the workplace if they are criticized they will ask for explicit instructions to complete a task and refuse to initiate work without the supervisor directly overseeing all details.

Obsessive-compulsive personality disorder: These individuals have a "preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency". These individuals do not have obsessive-compulsive disorder (I discussed this illness under anxiety disorders) which is characterized by having intrusive, repetitive thoughts or behaviors. Rather they feel that they are out of control unless there is are a strict routine that must be followed. They find themselves focused on the details while loosing sight of the overall task. In the snow example they may worry that the snow will interrupt their house cleaning routine. With the boss they will return to work to once again to focus on the trivial - thus delaying completion of the task.

As we come to the end of this column, I hope you have noticed that we all have some of these characteristics. When we are being unduly berated, we have to stand up for ourselves; and at work we have to pay attention to the details of a projects. Only when the individual characteristics become the sole focus and interfere with our lives do they become a disorder.

Next time I will talk about treatment of these disorders.

© 1998 Peter Melgaard Thompson

Last Modified: July 10, 1998

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