Apex logo Apex Psychological Services
Providing quality psychological services to children, adolescents, adults, and seniors.
2110 McFarland Blvd. E., Suite F; Tuscaloosa, Alabama 35404              205-758-7710

 

Home

Our Office

Who We Are

Services

Office Policies

HIPAA Notice

FAQs

Do I Need Help?

Adjustment Dis.

Alcohol/Drugs

Anxiety

Attention/Learning

Child Behavior

Chronic Pain

Dementia/Memory

Depression

Divorce

Mania

Personality Dis.

Relationships

Schizophrenia

Stress

Suicide

Extras

Books, etc.

Links

Humor

Amazon.com (1243 bytes)

 

Personality Disorders

"Personality" is that central set of characteristics that defines who we are. It includes our attitudes, beliefs, emotional responses, values, ability to relate to others, behavioral tendencies, motivations, and so much more. It is relatively constant and predictable.

A "personality disorder" is some dysfunction in personality that is persistent and pervasive, and that significantly affects our ability to successfully handle emotions, self-regulate our behavior, maintain healthy relationships, accurately view the world, meet our responsibilities, and function effectively in work or school.

Understand this: We are not talking about the idiosyncrasies and vulnerabilities that we all have, but that do not greatly interfere with our lives. Someone with a personality disorder has very serious problems with handling one or more areas of life. Furthermore, these difficulties are fairly constant throughout most of their life.

People with personality disorders rarely are happy or satisfied with life. And, frankly, it is no picnic for other people to deal with them, either.

In the sections below, we discuss some general issues about personality disorders, describe what they are like, and review the role of psychologists in diagnosis and treatment. (By the way, someone can have a personality disorder that blends characteristics from more than one subtype.)


Some Important Notes

One important thing to keep in mind as you read about personality disorders is that these personality characteristics exist in all of us. In a healthy personality, problematic traits are not predominant. They are not so extreme, or are expressed only in limited circumstances.

It is also worth noting that traits that might be problematic in most situations can be adaptive if they emerge in certain other situations. For example, a salesman earns a better living if he convinces someone to pay more for his merchandise than it is really worth. The fact that this might involve some dishonest communication (at least by omission) and a willingness to take advantage of someone else does not, by itself, make the salesman personality-disordered.

It is a matter of degree and pervasiveness that determines if a given personality trait is outside normal bounds, and it is the combination of several out-of-bounds traits that defines a personality disorder.

Top of Page

The Seeds of Personality Disorders

The seeds of personality disorders are planted early in life, and you usually can see the potential for a personality disorder in adolescence.

However, the diagnosis of a personality disorder usually is not made until the person enters adulthood because adolescents are still defining who they will be. Adolescence is, after all, a time for sorting out behaviors, attitudes, feelings, values, and motivations; some instability and exploration of different styles are inherent to the age.

One thing is clear about personality disorders when you deal with them in most circumstances: They just don't make sense. The emotions, behaviors, and choices are just too costly and maladaptive to serve any useful purpose.

On another level, however, personality disorders do make sense. Since the patterns developed early in life, you have to look at them in that context.

For example, a child whose father is alcoholic and abusive might manage his anxiety by becoming perfectionistic (thinking, "If I am good enough, he will stop drinking and hitting Mom"). He might also try to make everything as predictable and controlled as possible, and manage his anger and fear by suppressing it. In reactions like these lie the seeds of obsessive-compulsive personality traits.

Now, the fact that these problems might make sense based on the past does not make them any easier to live with in the present. Unfortunately, changing these patterns is an extremely difficult and lengthy process, and many people with personality disorders never break the cycle of dysfunction.

Top of Page

Odd/Eccentric/Suspicious Personality Types

People who fall in the odd/eccentric/suspicious category tend to have significant problems relating to others.

They may lack any desire to have a relationship with others (except, perhaps, for their immediate family), and may be detached and seem emotionally cold or empty.

Others cannot trust people, may take a benign event and interpret it as an intentional slight, or may be certain that others are exploiting them or cheating them.

Some have a very eccentric take on life, and may strike others as quite odd or strange. For example, they might believe they can use telepathy or read special meaning into insignificant events (like seeing an ad on television and thinking it has special meaning just for them).

Not surprisingly, these people rarely seek treatment.

Top of Page

Unstable/Chaotic/Dramatic/Self-Serving Personality Types

This section is by far the largest. That is partly because these personality types are the most disruptive and visible in day-to-day life. They also are more common. Because there is so much to convey about this group, this section is broken down into several subsections.

General Characteristics

People who fall in unstable/chaotic/dramatic/acting out group get the most attention. In fact, they cannot get enough of it, and can act in dramatic, outrageous ways in order to become the center of attention. Sometimes, these people are described as "bottomless pits" because their needs are so great that no one could ever satisfy them regardless of how hard they try.

Emotional distress is common in this group. You can see a pattern of rapid mood swings and emotional volatility. Often their emotional reactions are extreme, beyond what the situation would provoke in most people. They sometimes are diagnosed with Bipolar Disorder because of their mood swings and impulsivity, or with depression when they become despondent and suicidal after they suffer a loss or get into trouble. The personality disorder usually can be distinguished from the mood disorder if you have an adequate, accurate history. Of course, things can get really complicated -- the person can have both.

These people often make a good first impression. Indeed, they can be quite flirtatious and seductive. Often, they are very attractive and put a great deal of effort into appearing so. Sexual promiscuity is often seen, since it serves to attract attention and draw people in. It also is common to see substance abuse.

These people might seek treatment, sometimes during a crisis and sometimes because they are coerced into it by the criminal court or their family. However, they often do not stay actively involved in treatment for long, and the prognosis for change is quite poor.

Top of Page

Relationship Issues

It is easy to get into a relationship with someone in this group, but it is usually quite unpleasant to stay in the relationship. Once the relationship is established, you often see dramatic changes, with increased volatility, impulsivity, dishonesty, unpredictability, and excessive demands.

This pattern of problematic relationships tends to be pretty pervasive, whether the relationship is a personal one, or as an employee, or as a student. However, sometimes the person shows problematic traits primarily in personal affairs and can maintain appropriate behavior in other situations.

When a relationship ends, these people can unravel. Sometimes they will plead desperately to continue the relationship. They might become self-injurious, or make suicide threats, gestures, or attempts. They might make threats of violence or commit actual aggression (like the murder-suicides you hear about). They might engage in acts of vengeance, like lawsuits or slander. If there are children involved, they might pursue a custody battle that is pursued simply to cause their ex-partner grief, without regard for the actual well-being of the children.

Top of Page

"Playing by the Rules"

One thing that makes these people especially hard to deal with is that they do not "play by the rules" (socially, emotionally, or behaviorally). Instead of an honest response, they lie. Instead of accepting responsibility for a mistake, they give irrational accusations and blame others. Instead of an emotional response that is tempered by the actual significance of the situation, they display a dramatic outburst and acting out.

These patterns lead to a great deal of distress for everyone in their wake, especially if those other people have a tendency to be fair, accept responsibility. and be considerate and understanding.

Top of Page

Society's Response to these Traits

Oddly enough, as a society we sometimes glorify or normalize these types of behaviors. Some daytime talk shows put on daily examples of people with personality traits that, at best, are flaky (okay, that's not a professional term, but as soon as you read it, you knew what we meant, right?).

Soap operas also treat personality-disordered behavior as the "normal," expected way to handle life, and some sports stars and other celebrities are glaring examples of dysfunctional personalities. You know, aggression, public tantrums, impulsive marriages and divorces, and cross-dressing for the news photographer really are not normal behaviors.

Fortunately, there are plenty of celebrities who act in reasonable ways and serve as good role models. But which do you see in the media more often?

Top of Page

Subsets of Personality Traits in this Group

There are several subsets of personality traits that fit into this general category, but people can have a blend of characteristics from the different groups. Remember, we can all have these traits to some extent; they have to be severe, pervasive, and problematic in our lives to qualify as a personality disorder.

One subset acts habitually in antisocial ways. You see behaviors like cheating, conning, exploitation of others, lying, theft, violence, inability to maintain a job, and failure to meet responsibilities (like child support and other bills). Criminals and gang members often fall into this category, but so do some professionals and everyday folks. When caught, they might express remorse, but this is rarely genuine and rarely leads to behavior changes. They might also claim to be depressed and suicidal but this usually is in response to facing the consequences of their behavior, and resolves when they get off.

Another subset has an enormous sense of entitlement and narcissism. They think they should get what they want, no matter how it affects others (whose needs do not even enter into the equation). From their point of view, it is okay to use others without any concern for reciprocity. They see themselves as more important and capable than others and can seem extremely arrogant. They might even think they are doing others a favor by allowing them to bask in their glory and be part of their life. Ironically, under the surface usually lies rather poor self-esteem, about which they have little insight.

A third subset is primarily desperate for attention and pursues it with great drama. They are often seductive and use physical appearance (both attractiveness and their style of dress) to draw attention. Their relationships generally are quite shallow and unrewarding. They can be quite hostile toward someone who is seen as competition.

Another subset is marked by broad problems in identity, emotional self-regulation, and impulsivity. They suffer frequent mood swings, feelings of emptiness, and episodes of rage. Their relationships are marked by extremes -- they are frantic if alone or feeling abandoned, but act in ways to push people away if they get too close. They see people as either all good or all bad. They may shift from idolizing someone to hating them based on some minor event. They may drive wedges between people, a process called "splitting." They may engage in chaotic behavior, such as self-mutilation and suicide gestures.

Top of Page

Anxious/Dependent/Perfectionistic Personality Types

In this group, the person feels considerable anxiety and discomfort.

One subset of people has extreme anguish regarding the possibility of rejection or humiliation. They see themselves as inferior and inadequate. As a result, they avoid situations where they have to interact with others, and may go into jobs that allow them to work in isolation. Despite a desire to have personal relationships, they often do not because they cannot risk being rejected.

Another subset is beset by perfectionism and the need to reach impossible standards. Whatever they accomplish is rarely good enough. They are extremely conscientious and organized, but can lose productivity because they get lost in the details. They find it difficult to trust anyone else to do a good job, so they often take on more than their share of work. They may be moralistic and excessively rigid about standards of behavior. They may neglect their personal life in pursuit of academic or career goals.

A third subset feels so inadequate to handle life on their own that they hand over responsibility for most decisions to someone else. In doing so, they tend to be submissive and often end up in abusive relationships. Because they fear being left alone and helpless, they tolerate very harmful situations. If they do end up alone, they frantically search for another partner to meet their needs.

Top of Page

The Role of the Psychologist

Diagnosis:

Psychologists can work to establish the diagnosis and to differentiate it from other treatable disorders that can have similar symptoms (like Bipolar Disorder).

However, diagnosis of personality disorders can be very difficult. A person with a personality disorder often cannot describe their personality in clear and accurate terms. Unless the disorder is quite severe and "in-your-face," the psychologist rarely has a lot of the data that would clarify the diagnosis. Sometimes, psychological testing can help provide some of the necessary data.

Top of Page

Treatment of the Individual:

There are different schools of thought regarding the treatment of personality disorders, and we cannot claim to be experts in this area.

One approach involves working with the person to identify patterns of thinking and behavior that create problems in the person's life. The process of treatment involves learning to catch these patterns and abort them. The person also has to learn to tolerate and manage anxiety and internal distress. It is a long and extremely difficult process.

Top of Page

Treatment for Significant Others:

Another area where psychologists can be helpful has to do with people who are close to individuals with personality disorders. These people often face considerable distress and confusion. They may be looking for ways to fix the relationship, or to straighten out their partner, but they really need to come to terms with the personality disorder and what it means for them and the relationship.

The psychologist can help them identify the personality patterns, clarify what is and is not their responsibility, elucidate their values and goals, and guide them in making choices and decisions that they can live with. The psychologist also can help them learn ways to minimize the negative impact of the personality disorder on their own life.

Top of Page

 

Home    Our Office    Who We Are     Services    Office Policies    HIPAA Notice
FAQs    Do I Need Help?    Books, etc.    Links    Humor

Send mail to feedback@apexpsych.com with questions or comments about this web site.
Copyright 2000, 2001, 2004 Apex Psychological Services
All Rights Reserved

Disclaimer:  You know, we see a disclaimer like this in every ad that lawyers put out, and it probably is a good idea for us to use one, too:  "No representation is made that the quality of the psychological services to be performed is greater than the quality of psychological services performed by other psychologists.  The outcome of assessments or psychotherapy, or individual client satisfaction, cannot be guaranteed and is dependent on many factors.  Material on this site regarding symptoms, disorders, and treatment is informational only.  Diagnosis and treatment of mental disorders requires the expertise of a trained professional."

The information on this site regarding psychological disorders and treatment comes from many sources that cannot be credited, simply because they have been integrated over the years into our general knowledge base. However, one important source is the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) published by the American Psychiatric Association.