This has been on my to-do list for a long time. The last of my ‘what the heck is this’ series. I would like to get into self-help and coping techniques for various issues. I know a few things that work and have discovered a lot that does not, so there might be some wisdom in that. Anyway, here is one of the more nebulous topics.
What the heck is a personality disorder?
Is it a quirk, oddity, or simply being a jerk? All of those attributes can be part of a personality disorder, by itself it is not enough to be diagnosed.
According to the American Psychological Association, it is defined as: “Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected.”
It also has to negatively affect two or more of the following. The way one thinks about themselves and others. The emotional response. How they relate to others. How they control their own behavior.
That is pretty vague and useless. Who decides what is expected? The behavior might be considered normal in one part of the world, it might “significantly differ from what is expected” somewhere else. The subjectivity and lack of rigor in psychiatry are maddening. Objectivity is impossible. It is both scientifically and diagnostically invalid.
Paradoxically, if approached with extreme caution, it can be useful.
Are they really innate qualities?
I don’t know. Maybe. I was always shy but not so avoidant. Personality disorders can definitely get worse over time.
In the military, if you get diagnosed with a personality disorder that is severe enough that you can not adapt to military life, you will get discharged. Also, you will not get disability benefits based on it from VA because they consider it innate. Except for the fact that there is research that show that abuse and trauma can bring them out. If you are being shoved out because of a personality disorder, get a military lawyer to help you. A mental illness diagnosis is better if you qualify for it, even if it still results in a discharge. A medical discharge will be more useful to you than a discharge that says you couldn’t adapt to military life.
I think that events in one’s life can make it much worse if you were born with it. Perhaps, it would be barely detectible, but something terrible happened and brought it out further. I think that could apply to me as I am definitely worse today than as a teen.
It is fair to say that they are real and once present, does it really matter how it got there?
Are they helpful labels or just stigmatizing?
Stigmatizing is what the APA does, but it could be helpful under the right circumstances.
It can be helpful knowing because you might be able to do something to help yourself, or at least work around it. Well, most of the disorders.
Shrinks love to put people into rigid little boxes and try to pretend that they do not leak. That is to say, some diagnoses rule out others even if you have lots of symptoms of others. Even if those two diagnoses are so similar that the differences are trivial, and the treatment for both are identical. Why? Who knows? I would put up a lot of money that even those people who made up these conditions could not adequately explain the difference.
For personality disorders, they are placed into clusters: A, B, and C with a general description of each.
Cluster A: Odd or eccentric - a fairly appropriate description.
Cluster B: Dramatic and Erratic - that is underselling these often dangerous disorders.
Cluster C: Fearful and Anxious - I think that is the wrong characterization to use.
Each cluster has 3-4 different disorders.
Current Disorder List
Some personality disorders magically disappear after an update of the DSM. Poof!
Some will be merged into others, but some do disappear. Why? Who knows?
Much, if not all the DSM is made up in committee with zero research or tests to back them up. They claim that they are science but do not meet any of the criteria for science.
Could you imagine astronomers declassifying Pluto from planet to a dwarf planet without any justification, except political groupthink?1 They would be laughed out of the room, yet people take these non-scientific psychiatrists as a scientific authority.
To get a personality diagnosis, there is a much longer list of symptoms than listed here. A good chunk of them has to be persistent. Just because someone fears being abandoned, for example, does not mean that they have borderline or dependent personality disorder. It might just mean that they are lonely a lot and dislike it, or have abandonment PTSD
Cluster A disorders:
Paranoid Personality Disorder: It is pretty much what you would expect. I would be unsurprised if most if not all of those that believe in the Qanon nonsense were all paranoids. Many mental disorders can contain a paranoid element, but that is not enough to be diagnosed as PPD.
Schizoid Personality Disorder: This has nothing to do with schizophrenia. A schizoid is not likely to be schizophrenic, but the opposite is more likely to be true. Some of the symptoms are present in people with autism. This disorder means that you have a lack of interest in personal relationships. Can’t find pleasure in activities or hobbies and are often cold and indifferent to everything. It is not a happy disorder, but they are typically not dangerous either.
Schizotypal Personality Disorder: Again, this is not the same as schizophrenia but share many of the symptoms. Odd, even magical thinking. Odd habits in dressing. Emotionally flat and socially anxious. Constantly respond inappropriately to others, including being suspicious with no cause - paranoia. Hearing voices, especially your own name.
Cluster B disorders:
Antisocial Personality Disorder: This is not being socially awkward or disliking social interaction. In fact, they are often very adept at socializing to the point that they are master manipulators. ASPD is characterized by not having empathy for others, aggressive and violent behavior, lying, cheating, stealing, and a disregard for others. All of that, plus they have no remorse for their behavior.
Borderline Personality Disorder: Impulsive and risky behaviors. They are unstable and have very fragile self-esteem. Intense fear of abandonment, along with an unstable and volatile mood, especially with relationships. Quick to anger and will sometimes threaten suicide when things do not go their way.
Histrionic Personality Disorder: Easily manipulated people with emotions that change quickly but are very shallow. Seeks attention and can act overly dramatic to get it.
Narcissistic Personality Disorder: Thinks that they are special and way more important than others. Failure to recognize others’ needs and feelings. Expect constant praise and admiration and exaggerates their talents or achievements.
Cluster C Disorders:
Avoidant Personality Disorder: Sensitive to criticism or rejection. Feels inferior, inadequate, or unattractive. Avoids work that requires contact with people and difficulty in social situations. Socially inhibited, can feel isolated around people. Very shy. Fear of ridicule. The difference between this and schizoid is that avoidants struggle with relationships but want them. Sometimes, they desire relationships too much and will excuse their partner’s bad behavior, to not lose the relationship. Schizoids don’t care about relationships at all.
Dependent Personality Disorder: Dependent on others to an excessive amount. They need to be taken care of. They are clingy and submissive to others. Fear living alone or caring for themselves. Low self-confidence that needs constant reassurance. That low confidence makes it difficult to start projects without help. Need approval and agreement of others, will even agree with someone they disagree with. High tolerance for abusive behavior, and when one relationship ends, they need to quickly find a new relationship. It seems to me that this is similar to borderline, without the mood swings and threats of violence to others and self. I might be wrong on that point.
Obsessive-compulsive personality disorder: This is different than a person with obsessive-compulsive disorder(OCD) which is a mental illness, not a personality disorder. Obsessed with details and rules. Everything has its place. Gets upset when perfection is not achieved. Needs to be in control and can not delegate tasks. Commitment to work or projects leads to neglect of fun activities and friends. Very stubborn and inflexible when it comes to morality and ethics. Basically, they need to control everything in their lives.
Like many things in psych, there is also a “personality disorder, not otherwise specified(NOS)”, which is about as descriptive and useful as it sounds.
It should not be a surprise that these can be misdiagnosed as mental illnesses. Conversely, mental illness can be misdiagnosed as personality disorders because of the massive overlap of symptoms. Often, someone saying that you were misdiagnosed is merely an opinion, and objective testing is mostly impossible in this “science.” So you can end up with a useless conflict of diagnoses.
So, are these classifications helpful?
Despite being pulled out of someone’s backside, there can be some value to it.
Being aware of unusual personality tics can help someone who cares enough to try to work around it. Of course, some of them, by definition, make it impossible to help get the person to see their shortcomings. *cough* cluster B *cough*. An infamous and anonymous sufferer of the orange persuasion, who has several cluster B disorders, possibly all of them, is a prime example of someone who completely lacks the ability to accept or care about their severe personality defects and the damage they inflict on others. In fact, this person revels in inflicting damage on others.
If you can not see it and accept the problem, it is impossible to treat. In this way, it is much like an addiction.
Is help necessary?
Like most things, the answer is “it depends.”
Is it making your life harder than it should? Is it hurting others? It would be a good thing to keep an eye on lest it becomes a problem for you or others.
Most people can get help. Even those in cluster B can improve themselves if they can see that the problem exists. However, it is famously difficult to do for people with cluster B disorders.
Luckily, dangerous psych meds do not typically help with any of them. That is a very good thing. Talking it through with a neutral third party and staying self-aware of it can certainly help.
So yes, it can be helpful with the right therapist and the right outlook on oneself.
Talking it through with a good, neutral third party can help you assess if they are becoming a problem that is negatively affecting your life.
Fess up, what are you?
Is it that obvious?
I suppose it is. As much as I have been writing specifically about myself in the past 18 months, I am not a narcissist. I was once worried about being one and was told that a) a narcissist would not worry about being a narcissist and b) “You hate yourself too much.”
So that is good, I suppose.
Since some disorders are relatively similar, I have bits and pieces from clusters A and C, except cluster A is pretty much a no since I am more strongly cluster C. If I didn’t enjoy being around my family, and a few select others, I would definitely be schizoid. Since I do, I am simply avoidant. To the surprise of no one.
Officially, I just have “cluster C traits”, but I don’t think I have traits in all of them. I have some dependent traits, but I am definitely not needing to be taken care of. I don’t freak out when I live alone, which is always. In fact, I freak out a little when I am not alone. I have no OCPD traits at all.
I dropped my shrink like a bad habit before they could narrow down what box(es) I fit into.
When I am introduced to someone, I can feel myself pull back inside and start looking for the exits. Even when I was a graduate student and software companies sent reps over to meet us, and I really wanted to find a good job, I would still feel that way and leave as soon as I could. Sometimes, faster than would be considered polite. It is not really panic. Sort of like the same polarity on two magnets near each other. Does that make sense?
Oddly, or perhaps not oddly, I feel like I am being pulled towards certain people with no desire to push back. That is very rare for me. I used to think that it meant something, it doesn’t seem to.
That’s all I got
Hopefully, this little survey was helpful to someone, the links scattered through it are probably more help.
I talk smack about the profession a lot, and they deserve worse, but they also can help if you can find the right fit. If any mental or emotional issue is causing you problems in your life, please seek out good help. And please, do not hesitate to fire one that is making you worse - that is different from one that is pushing you hard out of concern. Admittedly, it is sometimes tough to discern between a toxic therapist and one that is putting a healthy boot against your backside.
I still need to write up what happened when I had a cruel therapist that was constantly against me and even gaslighted me a few times. I wrote a little about it in some of the very earliest essays on this site, but never got too specific. I was curious a few years ago and looked her up, and to my horror, she is still licensed as a psychologist.
Love it or hate it there are legitimate reasons to declassify Pluto. If they hadn’t, your kids would be learning the names of perhaps 100 new planets. That is not the reason for the change, it is that Pluto did not fit the definition of a planet. Pluto is different from the 8 planets in that it requires a lot of hand waving to call it a planet. Unlike psychology, where hand waving is the norm. A shrink can have the ear of most of the room and can make up a pet theory with no scientific or clinical basis and can get said pet theory voted on, and bam! It is in the DSM, and everyone is expected to take it seriously. groan ↩