Psychology 101: The 101 Ideas, Concepts and Theories that Have Shaped Our World - Adrian Furnham 2021

Personality Disorders: ’Dark-Side Traits’

In graduate school, I learned this simple distinction: when people are driving themselves crazy, they have neuroses or psychoses. When they drive other people crazy, they have personality disorders. (Albert J. Bernstein, Emotional Vampires: Dealing with People Who Drain You Dry)

Many people with a personality disorder recover over time. Psychological or medical treatment is often helpful, but support is sometimes all that’s needed. (NHS advice)

Psychologists are interested in personality traits; psychiatrists in personality disorders. Psychiatrists are interested in personality functioning. They talk about personality disorders that are typified by early onset (recognizable in children and adolescents), pervasive effects (in all aspects of life) and with relatively poor prognosis (that is difficult to cure).

Over the years, psychiatrists have labelled various disorders: eating disorders, sexual and gender identity disorders, anxiety disorders, mood disorders. They have made great strides in clarifying and specifying diagnostic criteria and these can be found in the various Diagnostic and Statistical Manual of Mental Disorders (called DSM for short). They have changed over the years and it is now in its fifth edition.

Psychiatrists and psychologists share some simple assumptions with respect to personality. Both argue for the stability of personality. The DSM criteria talk of ’enduring pattern’, ’inflexible and pervasive’ or ’stable and of long duration’. The pattern of behaviour is not a function of drug usage or some other medical condition. The personality pattern furthermore is not a manifestation or consequence of another mental disorder. One factor does differentiate the two: dysfunctionality.

Both argue that the personality factors relate to cognitive, affective and social aspects of functioning. In other words, the disorder or traits affects how people think, feel and act. It is where a person’s behaviour ’deviates, markedly’ from the expectations of an individual’s culture that the disorder is manifest. The psychiatric manual is very clear that ’odd behaviour’ is not simply an expression of habits, customs, religious or political values professed or shown by people of particular cultural origin.

The DSM manuals note that personality disorders all have a long history and have an onset no later than early adulthood. Moreover, there are some gender differences: thus the antisocial disorder is more likely to be diagnosed in men while the borderline, histrionic and dependent personality more likely to be found in women.

The manuals are at lengths to point out that some of the personality disorders look like other disorders: anxiety, mood, psychotic, substance-related, etc. but have unique features. The essence of the argument is that ’Personality Disorders must be distinguished from personality traits that do not reach the threshold for a Personality Disorder. Personality traits are diagnosed as a Personality Disorder only when they are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.’ (p. 633)

The DSM-IV provides a clear summary:

’General diagnostic criteria for a Personality Disorder

A An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:

1 cognition (i.e., ways of perceiving and interpreting self, other people and events).

2 affectivity (i.e., the range, intensity, liability and appropriateness of emotional response).

3 interpersonal functioning.

4 impulse control.

B The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

C The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.

D The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early childhood.

E The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.

F The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).’ (pp. 633).

According to the manual there are ten or more defined and distinguishable personality disorders.

Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

Schizoid Personality Disorder is a pattern of detachment from social relationships and a restricted range of emotional expression.

Schizotypal Personality Disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour.

Antisocial Personality Disorder is a pattern of disregard for, and violation of, the rights of others.

Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking.

Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration and lack of empathy.

Avoidant Personality Disorder is a pattern of social inhibition, feelings of inadequacy and hypersensitivity to a negative evaluation.

Dependent Personality Disorder is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of.

Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism and control.

There is, however, another better-known method to categorize the personality disorders. All DSM recommendations are that the PDs may be formed into three clusters.

Cluster A (odd, bizarre, eccentric): Paranoid PD, Schizoid PD, Schizotypal PD.

Cluster B (dramatic, erratic): Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD.

Cluster C (anxious, fearful): Avoidant PD, Dependent PD, Obsessive-compulsive PD.

One of the most important ways to differentiate personal style from personality disorder is flexibility. There are lots of difficult people at work but relatively few whose rigid, maladaptive behaviours mean they continually have disruptive, troubled lives. It is their inflexible, repetitive, poor stress-coping responses that are marks of disorder.

Personality disorders influence the sense of self — the way people think and feel about themselves and how other people see them. The disorders often powerfully influence interpersonal relations at work. They reveal themselves in how people ’complete tasks, take and/or give orders, make decisions, plan, handle external and internal demands, take or give criticism, obey rules, take and delegate responsibility, and co-operate with people’ (Oldham & Morris, 1991, p. 24). The antisocial, obsessive—compulsive, passive-aggressive and dependent types are particularly problematic in the workplace.

People with personality disorders have difficulty expressing and understanding emotions. It is the intensity with which they express them and their variability that makes them odd. More importantly they often have serious problems with self-control.

REFERENCES

Furnham, A. (2016). Bullies and Backstabbers. London: Bloomsbury.

Oldham, J. & Morris, L. (1991). Personality Self-portrait. New York: Bantam.