Contents
Where is the boundary beyond which character traits end and personality disorder begins?
There are three main characteristics that are necessary for a doctor to diagnose a patient with a “personality disorder” according to the international classification of diseases ICD-10. All three must be present at the same time.
- The patient has a disturbed sense of “I”.
- His communication with other people is noticeably difficult.
- He has one or more pathological personality traits (listed below).
In addition, these characteristics must be:
- relatively stable over a noticeable time and in different situations,
- inexplicable as a stage in the development of this particular person or a feature of his sociocultural environment,
- unexplained by exposure to any chemicals or general health.
The ICD-10 lists 10 personality disorders (abbreviated PD). They are divided into three clusters.
Cluster A: strange, bizarre, eccentric disorders – paranoid, schizoid, schizotypal.
Cluster B: theatrical, fluctuating disorders – antisocial, borderline, hysterical, narcissistic.
Cluster C: anxiety and panic disorders – avoidant, dependent, obsessive-compulsive.
Most people with personality disorders do not seek medical attention
Before going into details, it is worth mentioning that these disorders rarely occur in their pure form: their features overlap. Most people with personality disorders do not seek medical attention. And those who do convert do so due to more severe mental illness or during an identity crisis, often after they have harmed themselves or others.
1. Paranoid disorder
People suffering from it experience a constant distrust of others, including friends, relatives and life partners. They are extremely sensitive to violations of their personal rights, are easily offended or ashamed, and carry grievances in themselves for a long time. They are unsociable and have difficulty establishing close relationships.
The main psychological defense mechanism is projection: they attribute to others those thoughts that they consider unacceptable to themselves. In part, paranoid personality disorder is associated with heredity, genetic risk factors are common to the entire cluster A.
2. Schizoid disorder
Those who suffer from it are immersed in the exploration of their inner world, partly created by their imagination, they are not interested in social or sexual relations. They are considered low-emotional, although there is a theory that explains the schizoid disorder precisely by high sensitivity: they have a strong intimacy deficit, but close relationships are too difficult or painful for them, so they withdraw into themselves.
Otherwise, they tend to successfully adapt to social life, despite personal oddities, and rarely seek medical help.
3. Schizotypal disorder
Everything about these people is strange: the way they look, speak, behave, perceive the world and think. The strangeness of their thinking is somewhat similar to the strangeness that is observed in schizophrenia: bizarre superstitions, magical beliefs (for example, they may seriously believe that “say “damn” and he’s right there”), suspiciousness and obsessive thoughts. They may feel that their thoughts influence events.
They perceive other people as a potential danger. They, like schizoids, avoid social interactions, but for a different reason: they are afraid of other people, while schizoids find relationships too laborious and energy-consuming.
More common in men than in women. A person with this disorder does not care about the feelings of others, does not take into account the rules of behavior, shows aggression, acts impulsively, is not familiar with feelings of guilt and does not learn anything. He can be very charming and most often easily enters into a relationship, but for all their ardor, they do not last long. This type of disorder is closely associated with criminal tendencies.
5. Borderline Disorder
Those suffering from this disorder lack a sense of “I”, they suffer from inner emptiness and fear of rejection, they are characterized by impulsiveness, as well as outbursts of anger and cruelty (especially in response to criticism). They can establish rich but unstable relationships. There is often a risk of suicide.
This disorder is called borderline because it sits between neurotic (anxiety) and psychotic disorders such as schizophrenia or bipolar disorder. It has been suggested that this is the result of childhood sexual abuse and that it is more common among women. The latter claim is disputed by feminists: perhaps the fact is that women who show anger and sexual promiscuity are more likely to be diagnosed with this particular diagnosis, and men with the same behavior are more likely to be considered antisocial.
6. Hysterical disorder
Low self-esteem and extreme dependence on the attention of others are its signs. It often seems that people suffering from it play the role they have assumed, so that everyone looks at them and listens to them.
They care a lot about their appearance and try to be incredibly charming or extremely seductive, including in inappropriate situations. Since they dream of winning the admiration of others, they often act on impulse, risking an accident or breach of their trust.
The greater the risk of rejection, the more theatricality in their behavior and the less trust in them and the higher the risk of being rejected.
Their manner of communication comes across as insincere or superficial, which is not very good for long-term social or romantic relationships. And this hurts them painfully, because they are sensitive to criticism and afraid of failure.
It turns out a vicious circle: the stronger the danger of rejection, the more theatricality in their behavior and the less trust in them and the higher the risk of being rejected. However, there is an opinion that this kind of vicious circle is always at the heart of any personality disorder, and even more than that, any mental disorder.
7. Narcissistic disorder
Its “owner” has a highly developed sense of self-importance, he considers himself extremely significant and needs admiration. He is jealous of others and sure that others are jealous of him. He does not understand the feelings of other people and does not care about them, easily using others for his own purposes.
From the outside, he seems selfish, authoritarian, insensitive. Vengeful. He does not tolerate disagreement with himself and does not forgive ridicule. May fall into destructive anger because of this, which is also called “narcissistic rage”.
8. Avoidance disorder
People with this disorder avoid relationships and encounters with others. They feel inferior, unattractive, unable to communicate, and fear disapproval and humiliation from others. Perhaps the cause of this personality disorder is rejection by caregivers or parents in childhood.
Research shows that people with avoidant disorder try to control their internal reactions, both their own and those of others. This does not allow them to communicate freely. Here, too, there is a situation of a vicious circle: the more they try to control their reactions, the more constrained they feel in society – and the more they try to control their reactions.
9. Dependency disorder
Lack of self-confidence, desire to receive instructions and care – these are its characteristic features. A person completely transfers responsibility for himself to others and allows them to make any decisions for themselves, from daily to vital ones. He is afraid of loneliness and is ready to make many sacrifices for the sake of relationships.
To himself, he seems inadequate and helpless and is ready to obey those who could protect him – he idealizes these people, considering them smart and powerful. With them, he behaves modestly. People with dependent personality disorder are childishly naive and have little idea of what they and other people are like. This reinforces their dependency and makes them a target for abuse and exploitation.
10 Compulsive-Obsessive Disorder
Details, rules, lists, order, organization, schedule are key words for understanding this disorder. People with him are obsessed with perfectionism. Their desire for excellence makes the job almost impossible, despite the fact that for the sake of work they are ready to sacrifice both rest and relationships.
Most often, people with this disorder are cautious, full of doubts and fears, little inclined to change and lack a sense of humor. Behind all this, anxiety is visible, the fear of losing control over a world that eludes understanding. He demands from himself and others strict adherence to rules that seem unreasonable to others – and this spoils his relationships with colleagues, friends and family members.
About the Author: Neil Burton is a British physician and writer who has authored several books including The Meaning of Madness (Acheron Press, 2015).