What is a Personality Disorder?
By Dr. Griffith
The current scientific literature suggests that all animals may have personalities. Animals ranging from minks, mice, dolphins, monkeys, snakes, spotted hyenas and bears all have been studied and found to exhibit a range of personality traits. Personality traits are those behaviors or characteristics that are exhibited in a consist manner and help define the person (or perhaps animal) as we know them.
Psychology researchers have found that some personality traits are also cross-cultural and appear to be universal. These include traits such as those in the Five Factor Model of personality: openness, conscientiousness, extroversion, agreeableness and neuroticism. (OCEAN is the acronym). The factor part of this model comes from a statistical technique employed by researchers called factor analysis.
Of course, a person who is extroverted in Japan, may express his or her extroversion differently than a person who is extroverted and living in the Appalachian Mountains in the US. We would expect some similarities between these individuals, but would also find that cultural demands and socialization may modify the expression (or inhibition) of such a trait.
The definition of personality I first learned as an undergraduate was from the prolific writings of Gordon Allport. It is as follows:
"Personality is the dynamic organization within the individual of those psychophysical systems that determine his unique adjustments to his environment." (Gordon Allport, 1937)
The Diagnostic and Statistical Manual Fourth Edition Text Revision, defines personality as "...enduring patterns of perceiving, relating to, and thinking about the environment and oneself... exhibited in a wide range of important social and personal contexts."
Dan McAdams, a personologist, (a psychologist who specializes in personality research) has recently encouraged us to think about personality in evolutionary terms. Human personality has a long history of adaptation and species survival has been dependent on successful traits. For example, getting along with others (perhaps extroversion or agreeableness fit in here) and getting ahead in a competitive environment (perhaps add dominance) are such adaptive traits that help insure survival. Additionally, McAdams also notes that each of us has a dispositional and unique signature and these are best represented in the traits that we exhibit. Additionally, many of our personality traits begin in childhood and are exhibited throughout the life span.
When psychologists discuss any type of disorder, they refer to behavior (emotional, thinking and behaving) that has interfered significantly with an individual's life or the people associated with that individual, to the point it is causing distress in some form. At some point, it becomes apparent that a person with a disorder is at odd with themselves, with their social niche (or perhaps not having a social niche is part of the problem) or with their environment (chronic authority problems, for example).
A person with a personality disorder has significant difficulties in two areas: self and other.
With regard to the self, a person may be chronically anxious, worried, fearful, tense and distressed. The person may worry about being worried. In other words, their ability to regular their emotional well being is challenging to the point it is dysfunctional for that person.
The person may have long term difficulties controlling anger in their relationships. Regulation of emotion is particularly difficult for people with personality disorders. In some people, fear may play a decisive (and chronic) role and prevent them from getting closer to others while in others, high levels of anger keeps people away. At the same time, the person may be painfully away of their need for others.
Some psychologists believe taxonomy of personality is important, while others reject it, in favor of looking at each person as a unique individual who may have similarities to others, but who does not fit into any prescribed mold.
Classifying personality traits and disorders is clearly useful for both scholastic and clinical purposes. The Diagnostic and Statistical Manual-IV has a multi-axial classification system. It divides personality into three clusters on its Axis II; the Anxious/Fearful, the Dramatic and the Eccentric. The DSM is a manual that describes mental health difficulties, including personality disorders. Other approaches look at dimensions of specific personality traits. For example, some people can be rated (by themselves or others) as having high levels of extroversion and low levels of conscientiousness, while others may have high levels of both or low levels of both.
Another approach is that used by the Psychodynamic Diagnostic Manual. The PDM also uses a classification system, but bases its system on psychodynamic theory and allows the clinician to view various personality dynamics from the client's experience and subjective point of view. The PDM is also rich in brief and useful case presentations to illustrate how a particular disorder or symptom might be experienced. I think this approach is in line with the late Paul LernerÕs admonition that dynamic theory demands an experience-near approach, one that puts empathy in the front line as a useful tool in diagnosis and of course, in treatment.
Just as clinicians have more than one manual to understand and diagnosis personality disorders, treatment of personality disorders has also become more diverse in the last few years. As an example, many community agencies have counselors trained in a form of structured therapy called Dialectical Behavior Therapy to treat Borderline Personality Disorder as well as other people, including those in the criminal justice system. People with BPD are people who have typically have dramatic shifts of mood and/or goals and significant problems with work and/or love. Twenty five years ago, there DBT therapy did not exist and counselors and therapist relied on theories, such as psychoanalysis or cognitive behavioral therapy, to treat people with Borderline Personality Disorder. Now, there is a specific form of therapy that has given many people access and a chance at intervention.
People with the fearful dimension (or if you prefer, the fearful/anxious category), often stay in therapy longer than others, but estimates are the only 20 percent of social phobics, for example, seek any kind of treatment at all. Anxiety generally appears to be a motivating force to keep people in treatment and for these folks, therapy from the great traditions of psychotherapy (psychodynamic, cognitive therapy) usually appear to be quite effective.
Counselors should keep in mind less severely compromised people, make better gains in counseling in the early phases, while folks with more severe personality deficits make gains in treatment, though it takes longer and is dependent on the cumulative effects of the treatment. Problems that are common among personality disordered people, such as major problems in the area of work or love relationship take much longer.
People with some forms of Antisocial Personality Disorder, particularly the people without a variation of APD called psychopathy and who tend see counselors for behavioral disturbances, can possibly be treated in therapy. People with psychopathy very likely are not responsive to most conventional treatment and indeed, treatment may cause additional difficulties.
Allport, Gordon (1937). Personality: a psychological interpretation.
H. Holt Company: New York
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Washington, DC: Author
McAdams, D. P., & Pals, J. L. (2006). A new Big Five: Fundamental principles for an integrative science of personality.
American Psychologist: 204-217.
For further information, the Psychodynamic Diagnostic Manual can be located at PDM1.org