ASSOCIATED PERSONALITY DISORDERS

Description

A Personality Disorder is an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Cluster A: Odd or Eccentric

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.

Cluster B: Dramatic, Emotional, or Erratic

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.

Cluster C: Anxious

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

Diagnostic Features

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, lability, 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 adulthood.

 

Listed in order of decreasing diagnostic importance as measured by relevant data on diagnostic efficiency.

The personality traits that define these disorders must also be distinguished from characteristics that emerge in response to specific situational stressors or more transient mental states.

Many people who are suffering from mental health disorders have more than one disorder. For example, one could be diagnosed schizophrenic or diagnosed paranoid schizophrenic. One could also be Borderline Personality Disorder and have Narcissistic tendencies as well. The following are the more common Personality Disorders and brief explanations of symptoms but they are not to be used as a form of self diagnosis. Information is provided on the following disorders:

 

Dissociative Identity Disorder

(formerly known as Multiple Personality Disorder)

What is Dissociation?

Dissociation is a mental process where there is a lack of connection between, thoughts, feelings, actions or sense of identity. This disconnection is termed splitting and exists at a sub-conscious level. The process of dissociation exists on a continuum. Mild dissociation experiences are common such as daydreaming or “highway hypnosis”, where a person drives from ‘A’ to ‘B’ but does not remember the details of the journey.

What is Dissociative Identity Disorder (DID/MPD)?

DID/MPD is the severe and chronic experience at the opposite end of the spectrum. The dissociative process may lead to discrete states that can take on identities of their own. These states are called “alternate personalities” or “alters” and are internal members of the “system”. Changes between these personalities, or states of consciousness, are described as “switching”. This behaviour was an originally adaptive, healthy reaction to intolerable situations. However, in adult life dissociative behaviours can be problematic. People living with DID/MPD have Post Traumatic Stress Disorder (PTSD), in fact it has been suggested that DID/MPD is itself a chronic form of PTSD.

What Causes DID/MPD?

DID/MPD is developed during childhood (pre-age 7) during the sensitive time that the individual’s personality is being formed. It is the result of:

Ongoing and severe neglect and abuse (emotional, physical and/or sexual)
Trauma (such as witnessing the death of a parent, war);
Ritual/Satanic abuse (the condition is deliberately induced by cults to produce compliance and amnesia).
Evidence suggests that people living with DID/MPD have a biological predisposition for auto-hypnotic phenomena (a high level of hypnotisability).

What are the Signs/Symptoms of DID/MPD?

Loss of time: “blackouts” unrelated to drugs, alcohol or neurological disorders
Inability to recall large portions of childhood
Spontaneous trance states: staring…even talking to oneself
Sudden and obvious changes in mood, behaviour, even appearance
Objects or new clothes appear without knowing where they came from
Flashbacks or abreactions in which they seem to be reliving the traumatic experiences.
Alcohol and drug abuse
Auditory and visual hallucinations
Somatic or physical complaints
Headaches, up to severe migraines
Abdominal pain
Chest pain
Vaginal or anal pain
Changes in vision
Choking sensation
Co-morbid Mental Health Problems
Depression
Mood Swings
Anxiety
Sleep disorders
Eating disorders
Suicidal ideation & self harm (cutting, burning)

Antisocial Personality Disorder

Antisocial Personality Disorder shows itself as a consistent disregard for others and the violations of others rights. The behaviors might include:

1. Lack of remorse. Being indifferent to having hurt, mistreated or stolen from another.
2. Deceit. Repeated lying and “conning” others for profit or pleasure.
3. Total disregard for the safety of themselves or for others.
4. Impulsiveness
5. Irresponsibility, not honoring financial obligations or failure to follow rules
6. Failure to adhere to social norms as in repeatedly performing acts which could lead to arrest.
7. Aggression, irritability as in repeated confrontations or fights with others.

Avoidant Personality Disorder

This is a persistent pattern of feelings of inadequacy, social inhibition and sensitivity to criticism. Behaviors include,

1. Is unwilling to be involved with others unless they are sure they will be liked.
2. Avoidance of work situations which might involve contact with a lot of people because of the fear of disapproval, criticism or rejection.
3. Is preoccupied with being criticized or rejected in social situations.
4. Is inhibited in new interpersonal relations because they feel inadequate.
5. View themselves as unappealing, social inept and as good as others.
6. Is fearful of taking personal risks or doing new things because they might prove to be embarrassing.
7. Show restraint in intimate relationships for fear of being shamed.

Histrionic Personality Disorder

A pattern of excessive show of emotion and attention seeking. Behaviors are as follows:

1. Wanting to be the center of attention and not feeling comfortable when not.
2. Consistently using their physical appearance to draw attention to themselves.
3. Prone to speak in a manner that is impressionistic and lacking detail.
4. Very prone to be suggestible or easily influenced by others.
5. Acts in a theatric manner with exaggerated expressions of emotion.
6. Often shows inappropriate sexually seductive behavior.
7. Shows rapid shifting of emotions that are often shallow.

Narcissistic Personality Disorder

A persistent pattern of grandeur, need for admiration and lack of empathy which might include :

1. “Needs” excessive admiration and adoration.
2. Has a much greater than normal perception of self importance often exaggerating their achievements.
3. Belief that they are “special” and can only be understood or associate with others who are special or in an elite social class.
4. Is exploitive of others, using them to achieve their own ends.
5. Is preoccupied with fantasies of success, power, brilliance, beauty etc.
6. Has a unreasonable sense of entitlement, feeling that others should comply with their expectations.
7. Is often arrogant in behavior and attitude.
8. Lacks empathy for others and is unwilling to recognize feelings and needs of others.
9. Is often envious of others or feels that others are envious of them.

Obsessive Compulsive Disorder

A preoccupation with order, perfection, mental and interpersonal control. The symptoms include:

1. Is preoccupied with rules, details, lists, order to the extent that the main point of their activity is lost.
2. Is excessively devoted to work or productivity nor accounted for by economic need.
3. Is over conscientious and inflexible about matters of morality, ethics or values not accounted for by religious belief.
4. Is so preoccupied by perfection that it often interferes with completing a task because their own strict standards are not met.
5. Is unwilling to delegate any tasks to others unless that person complies with their way of doing things.
6. Inability to throw things away, even things of no value.
7. Is reluctant to spend money on self or others. Wealth is a thing to be horded.
8. Stubbornness.

Paranoia Personality Disorder

A pervasive distrust of others is shown in this personality disorder. Symptoms might include:

1. Suspects, without a solid basis, that people are deceiving, exploiting or harming them.
2. Reads demeaning or threatening meaning into remarks or events.
3. Has pervasive doubts about trustworthiness of friends or co workers.
4. Is reluctant to confide in others for fear that information will somehow be used against them.
5. Perceives attacks on their character which are not apparent to others and are quick to react angrily.
6. Bear grudges and is unforgiving of insults or perceived malignment.
7. Has suspicions without justification regarding the fidelity of spouses or sexual partners.

Post Traumatic Stress Disorder

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

a) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
b) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
c) Inability to recall an important aspect of the trauma.
d) Markedly diminished interest or participation in significant activities
e) Feeling of detachment or estrangement from others
f) Restricted range of affect (e.g., unable to have loving feelings)
g) Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following:

a) Difficulty falling or staying asleep
b) Irritability or outbursts of anger
c) Difficulty concentrating
d) Hypervigilance
e) Exaggerated startle response
f) Duration of the disturbance (symptoms in Criteria B, C and D) is more than 1 month.
g) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Schizoid Personality Disorder

An individual with Schizoid Personality Disorder is generally detached from social relationships, and shows a narrow range of emotional expression in various social settings. This pattern is indicated by four (or more) of the following (from DSM-IV, American Psychiatric Association, 1994):

1. neither desires nor enjoys close relationships, including family relationships
2. often chooses activities that don’t involve other people.
3. has little interest in having sexual relations with another person
4. enjoys few activities
5. lacks close friends other than immediate family
6. appears indifferent to praise or criticism
7. shows emotional coldness, detachment, or little emotional expression

A diagnosis of Schizoid Personality Disorder would not be made if the criteria only occurred during the course of a Pervasive Developmental Disorder (e.g., Autism).

Schizotypal Personality Disorder

A person with Schizotypal Personality Disorder is uncomfortable in close relationships, has thought or perceptual distortions, and peculiarities of behavior. This disorder is indicated by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. ideas of reference, i.e., believes that casual and external events have a particular and unusual meaning that is specific to him or her
2. odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (e.g., belief in superstitions or clairvoyance, telepathy, or “sixth sense”
3. unusual perceptual experiences (e.g., hears a voice murmuring his or her name; reports bodily illusions)
4. odd thinking and speech (e.g., unusual phrasing, speech which is vague, overly elaborate, and wanders from the main point)
5. excessively suspicious thinking
6. inappropriate or constricted emotions (reduced range and intensity of emotion)
7. behavior or appearance that is odd or peculiar (e.g., unusual mannerisms, avoids eye contact, wears stained, ill-fitting clothes)
8. lack of close friends or confidants other than immediate family
9. excessive social anxiety that remains despite familiarity with people and social situation. The anxiety relates more to suspiciousness about others’ motivations than to negative judgments about self.

In addition to the exclusions described above, this disorder would not be diagnosed if the pattern described above only occurred during the course of a Pervasive Developmental Disorder (e.g., Autism).