**Personality Disorders, Similar Traits and Features What is a personality disorder?
The American Psychiatric Association (APA,) publishes The Diagnostic Statistical Manual of Psychiatric Disorders-Fifth Edition (DSM-5.) The DSM is the officially recognized guide for mental health professionals; it contains descriptions and diagnostic categories and criteria of the medically recognized psychological disorders. This includes hundreds of psychological disorders, such as the mood disorders (depression) and anxiety disorders (like panic attack or generalized anxiety disorders) and hundreds more.
In recent years, there may have been a slight increase in the level of awareness about specific types of mental illness that have also been referred to as Characterological Disorders. This elevated knowledge or exposure may have occurred because of more societal progression and evolving in general (more sensitivity and awareness about emotions, feelings, behavioral health, addictions, relationships, depression, anxiety etc,) as well as in reference to acceptance of mental health specifically, social media, self-help/publications, movie and general media.
Over the last 40 years or so, there were previously many more officially diagnosed personality disorders that have since been removed from the DSM’s later, revised editions and even more updates in the current DSM-5, released in 2013. The current DSM-5 contains 10 distinctly identified personality disorders.
Personality disorders are defined as a condition/affliction where there are pervasive presence of characteristics that profoundly deviate from a “middle-ground” average-range of predicted human behavior, traits and interactions. These characteristics (hence the sometimes former/alternative description of “Characterological Disorders”) are a fundamental part of the person who is sometimes labeled and referred to as “A Personality Disorder.” There is a tendency to label, which sometimes becomes a stigma and may ignore the fact that personality disorders are mental health conditions that are in fact treatable, even if they are complex disorders.
Personality Disorders are complex and often times may be more difficult, yet not impossible to treat; these diagnoses are essentially a description of a person and part of their personality, character or related social/interpersonal behaviors. In some regard, clinicians are actually treating the person and their personality traits as opposed to a more familiar and sometimes less involved more clearly defined condition such as depression, anxiety or addictions. Some of the more commonly known and relative personality disorders of today and also those that tend to surface for counseling and other mental health treatment are from what the DSM refers to as being a part of a specific “cluster,” There is a group of related personality disorders that are known as “the dramatic” types. The dramatic types include the following four personality disorders: Narcissistic, Borderline, Histrionic and Antisocial Personality Disorders.
Top 10 risk factors and associated conditions related to personality disorder development
Assumptions about Narcissistic, Borderline, Histrionic and Antisocial Personality Disorders: (NPD/BPD/HPD/APD) Diagnoses:
These are some of the related traits and reports that are often be present in clients that present with personality disorders as mentioned above. Some family history/ family of origin (F.O.O.) typical traits that will be seen in the history of a personality disorder (NPD,BPD,HPD,APD.)
*(This is a reference list of symptoms and experiences that are sometimes reported by those diagnosed with NPD/BPD/APD/HPD and are not exclusively absolute indicators of a personality disorder diagnosis.)
- Boundary-Violating by parents: Immediate environment is dismissive, invalidating and or abusive during childhood and adolescence. Ignorant, irresponsible, foolish, or self-centered negligent parents who don’t get it- they don’t realize the sense of urgency and causal links between their choices/actions/critical modeling that (should/could) occur(s) during their tenure as a parent while the child is a minor and the connection to what will happen later on for the child in their adult years/stages of development during the lifespan.
- Childhood History of problems: mental health issues, such as depression and anxiety, identity disorder and childhood adjustment problems or other more serious mental health conditions and diagnoses was present early on.
- Cultural Precursors Poverty/limited resources, neurotic or regressive “cultural norms.” Irrational, volatile religious or cultural beliefs that create negative impact and abnormal development. Generally coming from an inappropriate and chaotic environment.
- Dependency: Erratic relationships/lack of stability, frequent moving, etc. Being a product of some “system” such as child welfare/CPS or on welfare or various programs that may or may not be very constructive, (like a foster child.)
- Family Dynamics: Presence of erratic and chaotic family dynamics: such as alcoholism or drug addiction, more complex composition: less prepared, older or younger parents, divorced or non-traditional/blended families (that is not that well adjusted to the divorce/etc.) multiple different fathers; parents have little or no boundaries; may lack sense common sense/reality based thinking. May be very rigid and controlling or very dismissive, disinterested, incompetent or non-present family/parenting system.
- Family Mental Health History: Parent(s)/extended family have/has a mental health history themselves especially including/and or a presence of personality disorder(s) or other serious behavioral health pathology.
- Learning difficulties or being overly intelligent/ particularly lower IQ or higher IQ; not being properly stimulated or directed particularly scholastically or in life in general- again- foolish incompetent parenting doesn’t help. Dysfunctional inadequate parents will tend to perpetuate the cycle if they cannot intervene from their own pervasive, unresolved dysfunctional history- patterns.
- Self-Esteem Issues, family creates sense of invalidation, lacking empathy, remorse and cultivation of low self-esteem.
- Sexuality/Gender Identity issues and or being gay or trans (LGBTQ,) which is subject to challenge, shame and abuse from a hetero-sexist/hetero-presumptuous environment. For example, the default assumption is that all children and everybody is/are all heterosexual, when some are absolutely not,. There is likely an ignorant environment which is not capable or only marginally able to meet the LGBTQ child’s needs.
- Trauma/PTSD/Abuse History various forms of physical, sexual, verbal or emotional abuse, neglect or similar violations.
**Cluster B Personality Disorders
The “Cluster B” group is identified as such by the Diagnostic Statistical Manual by The APA and is group of related similar personality disorders known as “the dramatic types.” The Cluster B personality disorders tend to be seen more frequently in outpatient therapy treatment. While each one of the technically total of four different cluster B personality disorders is distinctly different, the titles in this group of Borderline, Narcissistic, Histrionic and Anti-social (Sociopath) Personality Disorder are closely related; there is a portion or “piece” of each one of these in all of the other ones within this cluster.
There is extensive information about these complex disorders readily available online and in professional books, articles, studies, literature and journals. This is critical information for anyone struggling with these disorders personally or if there are close friends, family or other associations that have been diagnosed or are exhibiting some of the likely indicators, traits or features of these disorders.
**This website is an abridged version and address a fairly general overview of these conditions. Please consult directly with a mental health clinician, specialist, related professional or physician for more thorough official diagnosis and treatment.) You can also read much information about these formerly called “characterological disorders,” online. Start with a general search by name.
Narcissistic Personality Disorder
NPD is a frequently misunderstood title of a personality disorder. In short, a person with NPD is in an emotional paradoxical trap of uber-self love, covering for deep emotional wounds and insecurity and suffers from a perpetual lack of empathy. A common misperception of NPD in the first place is that the term “narcissism” is used to describe someone who is selfish, vain and dismissive of others. Granted, those types of behaviors, attitudes and actions are definitely observed in some capacity in those with NPD. However, there is a lot more deep-rooted psychopathology.
It’s one thing to be inclined to be overly self-focused, self-absorbed etc but this is different from literally not having the capacity to feel for others; some diagnosed with NPD instead will ultimately suck the life out of their victims. Sometimes, the victims of NPD are their significant others friends, families, co-workers or similar.
- Anger-can become extremely angry “Narcissistic Rage,” or shut down emotionally depending on the circumstances.
- Believes only certain other persons or establishments can understand them or should associate with them.
- Demanding of a certain caliper of response, mirroring commendation, usually for no warranted reason.
- Grandiose sense of self-importance in general.
- Lacks empathy- Unable to emotionally connect with others because they are unable to anticipate Person-B’s needs or existence.
- Manipulating- can become exploitative and opportunistic, or thus “sucking you dry” to meet their needs.
- Substance abuse including a preference for Cocaine and getting amped up.
Borderline Personality Disorder
Perhaps equally or more common to NPD, Borderline Personality Disorder (BPD) is a similar, but definitely distinctly different condition. BPD has gotten more exposure in the press and media over recent decades. Some claim that it got it’s “name” from a presentation of symptoms that were “on the borderline” between psychosis (losing touch with reality) and neurotic (also a disconnect from reality that is more consisting of severe anxiety and or depression.)
Those that are dealing with a friend or family member, co-worker, neighbor, etc who is likely diagnosed or has been officially diagnosed with Borderline Personality Disorder (BPD,) commonly report that they feel like they are “walking on eggshells.” These kinds of feelings are largely in response to the nature of BPD and the corresponding traits of idealization and devaluation or “splitting.” BPD reacts to life in rigid all or nothing perceptions, most of which are distorted and incorrectly learned conclusions that have been regrettably developed. They are in response usually to an abusive or profoundly dysfunctional inappropriate childhood.
Sometimes BPD may look like Bi-Polar Disorder, however there are distinct differences. The main difference is that BPD is a pervasive pattern of behavior and an actual part of the person’s core personality. Bi-Polar Disorder is specifically referring to one’s mood that is predominantly a result of chemically driven factors and physiological changes in the brain.
- Abuse History:
Frequent history of abuse, trauma and or grossly inappropriate boundary violating, dysfunctional family of origin. Conflict and erratic boundary violations with family members is a common occurrence with BPD, and frequently continues and persists in to adulthood.
- Behaviors that are compulsive and impulsive in nature: engaging in compulsive behaviors and poor impulse control. This might be manifested as drug and alcohol abuse, compulsive shopping, severe or volatile codependency, eating disorders/compulsive overeating, binging and purging.
- Boundary Violations: Little or no boundaries or concept of what a normal, appropriate boundary consists of.
- Emotional Intensity and Mood Instability: “Acting-out” with sometimes explosive emotions, such as anger and rage, rants, tantrums and meltdowns; may influence efforts to seek revenge or outward destructive efforts or cutting off the relationship.
- Hypersensitive and Reactive: Easily offended or often feels slighted and invalidated for typically trivial over-exaggerated perceptions of human behavior/interactions (i.e. a friend is running late or someone cancels appointments.)
- Legal Issues: Frequently drawn in to legal conflicts, lawsuits with employers/supervisors, neighbors, authority figures; always acting like a victim.
- Relationship Conflicts: Potential for abnormal relationships: Such as those that are codependent, inappropriate, volatile erratic interpersonal relationships. Hot and cold, black or white, love/hate; “Splitting” between idealization and devaluation commonly occurs. This leads to a constant flow in and out of various types of relationships vs. establishing even basic let alone healthy, functional relationships with friends, family, significant others/dating, co-workers, neighbors etc.
- Splitting leads to a potential for constant change in mood and attitude towards current relationships/friends. “Borderlining” behavior implies a tendency towards idealizing and then devaluing a friend, family member, significant other, or any person, acquaintance or co-worker etc.
Sometimes a person may be observed to be a “difficult personality,” or frequently accused of “having an attitude,” or being “crazy” or scary or irrational or may be incorrectly stigmatized with a generic “Bi-Polar” of “Psycho.” A Borderline Personality Disorder may be a person you want to get very far away from and keep them very far away from you since their behavior can be very irrational and outrageous at times. However, after careful professional clinical assessment is made, it may be determined that this person could have BPD, which would be an advantage for obtaining proper treatment.
Also, sometimes people are just difficult, obnoxious or offensive by nature, but are not necessarily personality disorders; although it is admittedly tempting to conclude that they are capable of being diagnosed.
Antisocial Personality Disorder (APD) also known as “SOCIOPATH”
The primary generalized feature seen in persons diagnosed with APD is a profound lack of remorse for their actions or even just in general. The terms Sociopath or Psychopath are sometimes utilized interchangeably as a reference for APD. One source suggests that while they are similar terms by definition, "sociopath" refers to a serious problem with one's conscience and "psychopath" is even more severe and indicates a complete lack of any conscience. Regardless, APD encompasses serious deficits in remorse and conscience and is a very distressing pathological disorder. So, where NPD involves a related feature of not being able to empathize, APD is a lacking sense of remorse, responsibility, personal ownership, or functional capacity to feel a sense of guilt.
Because of the lacking presence of remorse (as well as empathy,) those with APD seem to have a frightening level of disregard for other people in many capacities. APD brings with it a general disregard for rules and boundaries. Instead there is a preference for manipulation and conniving efforts to exploit others to the sociopath's own end. Sociopaths come in different packages and varieties so to speak. Some may be housed in a more classic criminal type of persona where there is a long history of conflict with authority and the law. Perhaps the more common duplicitous version could sometimes pass as "normal" and may not have any legal troubles or actually look like a stereotypical (jailed) criminal; Most ADP sufferers can exhibit behaviors and intentions that are just as cunning.
APD/Sociopaths can be smooth and charming but also overly aggressive, arrogant, confrontational, devious, dishonest and sometimes violent, all the way up to being a murderer or serial killer type of characterization. Because of the powerful force that an absence of feelings and remorse can perpetuate, some sociopaths are able to disregard just about anything. This may include impulsive unpredictable behavior, violating the rights and boundaries of others. Sometimes sociopaths/psychopaths will act-out because it is an egotistical (like narcissistic) charge for them, but usually it is motivated by personal self-serving gain.
General approach for Cluster B Personality Disorders, particularly NPD and BPD and APD
This office assumes that personality disorders are the likely result of a combination of factors and causes. There are various influences from either biological/predisposed at birth but also and sometimes more the case, the environmental factors. Therapy may include a “client-centered,” psychodynamic and cognitive-behavioral element.
Treatment is heavily influenced and infused by the therapeutic impact of creating a sense of empathy, validation and clearer boundaries. Personality disorder diagnoses are treatable conditions, even though they are negatively stigmatized.
This means that there is a reason for the development of personality disorders. There are influences from nature (biological,) and nurture (environmental,) components; Also, often times, there is inappropriate family of origin/parenting/abuse or similar dysfunctional environment that a PD grows up in. The family of origin may include severe mental illness, alcoholism, divorce/broken homes and varied forms of abuse such as emotional, sexual, physical and verbal abuse.
An intake and individual tailoring of the therapy will help determine the relevancy of the above factors. There is a strong likelihood that there was some type of inappropriate parenting/family history. This type of history is a set up and strong precursor for development of mental health issues down the road.
Therapy will be individually crafted depending on each client; it will focus on behavior modification and developing an increased understanding/personal insight about what a PD diagnosis means and how it manifests in your life. Behavioral improvement of empathy, remorse and strengthened boundaries would lead to some degree of improved personal accountability and insight.
Educating about boundaries and modeling a sense of boundaries, even in an intellectual capacity is a tentative initial starting point for assisting someone diagnosed with APD. In other capacities, clients may need to be advised about how to deal with a person in their lives with APD. Other than boundaries and intellectualization of various presenting scenarios, how do you make someone have remorse or feelings if they aren’t capable of this ability?
In the infamous popular cable show, “Dexter,” the lead character was a severely traumatized child born with APD who was adopted by a policeman/detective. The father knew well enough what he was dealing with and that there really was no “cure” per se. Instead, the father spends most of the child’s younger life cultivating at least some degree of an understanding of sociopathy and somehow (even though it is a fictional television drama,) re-directing this knowledge to form a more constructive skill-set. Granted, this was a fictional show that focused on encouraging and perfecting skills to train a sociopath to become a vigilante murderer. A character and a show like "Dexter" may not be the best or realistic expected outcome or method to manage APD. However, what was remarkable about the end result of how Dexter's disorder was re-programmed, so that he essentially learned to use his deficiencies in a paradoxical manner; the end result was that he brought others to justice, who committed (sociopathic) atrocities and piggy abusive violations.
Therapy may not be a guaranteed cure that will cultivate a sense of remorse or empathy when those components are inherently not present. That being said, much of the treatment for APD will typically involve behavior modification. For example, even if the person struggling with APD doesn’t literally emotionally feel that what they are doing is wrong, they may be able to intellectually conclude that when they do, say or act in certain ways, there are undesirable repercussions. Ideally empathy and remorse are modeled to encourage an APD client to modify behavior. The goal is to achieve a decreased severity of their consequences, (such as losing employment or severing relationships with family, friends co-workers etc.)