Personality disorders (Pd’s) and why we need to know about them

We have all been in situations with people who are toxic. Sometimes it gets out of hand and can cause deep psychological distress or can even be dangerous. The critical and belittling spouse (obsessive- compulsive pd), the girlfriend who manipulates with suicide attempts (borderline pd), the boss whose own advancement is at your cost (narcissistic pd). These kinds of situations are repeatedly set up by the same ten percent of the population. The ten percent who suffer from personality disorders. People with severe personality disorders seem incapable of maintaining honest, mature relationships and seem hell bent on self-serving justifications.

Considering the wake of damage they can leave in your life, it would seem that an awareness of personality disorders and how to navigate them should be a school leaving subject. Maybe if we understood them better, then our own disordered traits would get less hooked. That would leave us more capable of acting with dignity and respect and containing the fallout.

Prof Cloninger is a psychiatrist and noted authority on personality and personality disorders. He makes the point (Cloninger and Svaric 2000) that we all have personality traits to varying degrees. The most commonly listed are 1) openness to new experiences, 2) conscientiousness, 3) extraversion, 4) agreeableness and 5) neuroticism (often listed as OCEAN). Our personalities are formed by the biology we are born with and the environment in which we find ourselves. It defines us and how we interact with the world. That said, it is not static and entrenched. Well adapted individuals are able to learn from their mistakes and allow life experiences to mellow and mature them. Becoming a parent might increase conscientiousness, traumas could increase neuroticism. It’s supposed to be the rich, layered process of growing older. For this reason, personalities are hard to define, beyond descriptive traits.

On the other hand, personality disorders are per definition enduring and inflexible patterns of thinking, feeling and behaving. A person with an identifiable personality disorder pretty reliably follows the script of that personality disorder.

In South Africa, Australia and America doctors and psychologists diagnose mental illnesses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) This manual is constantly revised and revolutionised; we are currently in the fifth revision (DSM 5). The DSM 5 general criteria for a Personality Disorder (revised 2011) is as follows:

The essential features of a personality disorder are impairments in
personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose a personality disorder,
the following criteria must be met:
A. Significant impairments in self (identity or self-direction) and
interpersonal (empathy or intimacy) functioning.
B. One or more pathological personality trait domains or trait facets.
C. The impairments in personality functioning and the individual‟s
personality trait expression are relatively stable across time and
consistent across situations.
D. The impairments in personality functioning and the individual‟s
personality trait expression are not better understood as
normative for the individual‟s developmental stage or sociocultural
environment.
E. The impairments in personality functioning and the individual‟s
personality trait expression are not solely due to the direct
physiological effects of a substance (e.g., a drug of abuse,
medication) or a general medical condition (e.g., severe head
trauma)

There are ten specific personality disorders according to the DSM 5 and allocates them according to 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

This criterion is useful for clinicians. It ensures that we all speak the same language. There are questions that you can ask yourself as a layman. Questions less interested in making a diagnosis and more interested in alerting your “spidey” senses that a personality disorder is at play. Questions like: (modified from Stuart Yodofsky’s Fatal Flaw Scale, 2005)

1. Do I trust this person?
2.  Has this person “come through” on important commitments?
3.  Do I feel better about myself as a consequence of this relationship?
4. Does this person consider my needs equally to his or hers?
5. Is this person sensitive to and supportive of me?
6. Will this person communicate with me honestly on significant issues affecting our relationship?
7.  Is this person honest with other people and trustworthy in his or her other relationships?
8.  Do I, and ( if applicable) my children, always feel physically safe with this person?
9.  Does this person respect rules and laws?
10.  Do other people whom I love and trust the most believe this person is good for me?

If the score is coming in at more than 5 “No” answers, you are alerted to a personality disorder. Then you can ask yourself more questions to confirm your suspicions:

• Does the person persist in engaging in activities that are unnecessarily dangerous or self-destructive?
• Does this person deny that he or she has a problem?
• Does this person’s problem remain unchanged, despite many courses of professional help?
• Is there a good chance that, in the future, this person may well physically injure my child or me?
• Does this person persist in engaging in illegal acts?

These questions aren’t there for you to make a diagnosis, or to be pejorative. They are there so that you walk into a relationship with open eyes, or so that you can begin to figure out why you are struggling with a particular relationship.

When someone shows you who they are, believe them the first time. Maya Angelou

Knowledge of what you are dealing with will then give you options of how to respond, lest you get trapped in an endless reactive drama.