What is a Personality Disorder?
One way of thinking about personality disorders is that they are exaggerations of normal personality or temperament. Having said that, finding a consensus on what constitutes normal personality isn’t easy. It follows that any discussion of personality disorder is fraught with problems, not least the negative connotations associated with such a diagnosis. To be labeled with a diagnosis of personality disorder suggests some form of antisocial, manipulative, possibly criminal and most likely ‘defective’ disposition. Diagnosis is also problematic because at some time in our lives we all tend to exhibit some form of behavior characteristic of a personality disorder. It is however the longstanding and inflexible nature of personality traits that are considered to distinguish a personality disorder.
Diagnosed Personality Disorders
The most common personality disorders are clustered into three categories (known colloquially as mad, bad and sad):
Cluster A – Odd/eccentric (‘mad’)
- Schizoid distrust of others.
- Paranoid detachment from social relationships.
- Schizotypal cognitive disturbance & eccentricity.
Cluster B – Dramatic/emotional (‘bad’)
- Antisocial disregard & violation of others’ rights.
- Borderline interpersonal & emotional instability.
- Histrionic attention seeking & extreme emotionality.
- Narcissistic grandiosity & need for admiration.
Cluster C – Anxious/fearful (‘sad’)
- Avoidant social inhibition & anxiety.
- Dependent submissiveness & clinging behavior.
- Obsessive/Compulsive perfectionism & control.
A word of caution. These labels are not founded on any coherent theory of personality disorder and diagnostic practices do vary. For example, narcissistic personality is one of several theories to derive mainly from psychoanalytic theory. There is however no symptom-based narcissistic ‘illness’ as such.
Who Gets Personality Disorders?
Personality disorders usually become identifiable during adolescence or early adulthood. Some estimates put the number of common personality disorders as high as 13 percent of the adult population. More men than women are diagnosed with paranoid personality disorder and antisocial personality disorder and more women are diagnosed with borderline personality disorder. Some level of disquiet has always been present as to whether gender neutrality really exists when it comes to diagnostic practice.
To date, psychology has tended to be the dominant field in explaining personality disorder, yet they lack strong research support and precision. More genetic, biological and sociocultural contributions would be welcome.
Type of Dysfunction or Severity?
We find personality disorders intriguing because at one level we are able to associate ourselves with them yet at another they repel us. Some of the most popular movies have the 'troubled' central character. In the movie Taxi Driver, we watch Travis Bickle played by Robert De Niro exhibit the signs of schizotypal personality disorder. In Fatal Attraction, Alex Forrest, played by Glen Close, shows all the instability, impulsiveness and mood swings associated with a borderline personality disorder. These extreme forms of behavior do no real favors to people who may have actually received such a diagnosis.
One of the problems of describing the behavioral patterns of a given personality disorder is that it provides a sense of credibility and validity where none may actually exist. Personality disorders are easy to misdiagnose and this is partly due to the fact that the diagnostic criteria cannot be observed directly and rely heavily on the inferences made by the diagnostician. Great variation can be seen amongst clinicians as to when normality crosses the line into abnormality.
Within or between clusters of common personality disorders there is considerable overlap. The differences between avoidant and dependent personality disorder are less marked than might at first appear. The feelings of inadequacy, fear of disapproval and general anxiety common to both do raise questions as to whether they are so very different.
Clinicians continue to wrestle with such questions and make changes accordingly. For example, the category of ‘passive-aggressive personality disorder’ no longer exists but is just as likely to return with revisions. Many theorists suggest we should focus less on the type of dysfunction and more on its degree of severity as to how personality affects the individual or those around them.
Claridge, G & Davis, C. (2003) Personality and Psychological Disorders. Arnold Publishers.
Millon, T., Davis, R. (2000) Personality Disorders in Modern Life. New York, John Wiley.