PERSONALITY DISORDERS –A WAY OF BEING
So far, the disorders we have described have traditionally been considered syndromes, which – like physical illnesses – are not part of people’s basic character structure. When treated appropriately, these syndromes usually remit and people return to normal functioning, at least for a while. But personality disorders are different. They are disorders of people’s basic character structure – so there is no ‘normal functioning’ to return to. The personality disorders themselves are people’s ‘normal’ way of functioning, and appropriate treatment means learning entirely new ways of being.
Symptoms
All personality disorders have a number of things in common. They are: longstanding – i.e. begin at a relatively early age; chronic – i.e. continue over time; and pervasive – i.e. occur across most contexts. The thoughts, feelings and behaviours that characterize personality disorders are: inflexible – i.e. they are applied rigidly and resistant to change; and maladaptive – i.e. they don’t result in what the person hopes for.People with personality disorders usually don’t realize they have them. They experience themselves as normal and often feel that the people they interact with are the ones with the problems. The primary personality disorders and their key traits, as described in the DSM-IV (APA, 1994) are:
Cluster A – the odd and eccentric cluster Paranoid – suspicious, distrustful, makes hostile attributions Schizoid – interpersonally and emotionally cut off, unresponsive to others, a ‘loner’Schizotypal – odd thoughts, behaviours, experiences; poor interpersonal functioning
Cluster B – the dramatic and erratic cluster Histrionic – dramatic, wants attention, emotionally shallow Narcissistic – inflated sense of self-importance, entitled, low empathy, hidden vulnerability Antisocial – behaviours that disregard laws, norms, rights of others; lacking in empathy Borderline – instability in thoughts, feelings, behaviour and sense of self
Cluster C – the fearful and avoidant cluster Obsessive-compulsive – rigid, controlled, perfectionistic Avoidant – fears negative evaluation, rejection and abandonment Dependent – submissive, dependent on others for self-esteem, fears abandonment As you can see, this organization of the personality disorders puts them into clusters.
These clusters are thought to reflect disorders with common traits. Although the disorders within each cluster do show commonalities, it is also the case the there are high levels of comorbidity among disorders across clusters. Borderline personality disorder and antisocial personality disorder (similar to what is often called psychopathy) have received more attention than the others, as they tend to have some of the most negative consequences, including suicide and violence.
Causes of personality disorders and factors affecting their course
1 Genetic and biological factors
So far, the disorders we have described have traditionally been considered syndromes, which – like physical illnesses – are not part of people’s basic character structure. When treated appropriately, these syndromes usually remit and people return to normal functioning, at least for a while. But personality disorders are different. They are disorders of people’s basic character structure – so there is no ‘normal functioning’ to return to. The personality disorders themselves are people’s ‘normal’ way of functioning, and appropriate treatment means learning entirely new ways of being.
Symptoms
All personality disorders have a number of things in common. They are: longstanding – i.e. begin at a relatively early age; chronic – i.e. continue over time; and pervasive – i.e. occur across most contexts. The thoughts, feelings and behaviours that characterize personality disorders are: inflexible – i.e. they are applied rigidly and resistant to change; and maladaptive – i.e. they don’t result in what the person hopes for.People with personality disorders usually don’t realize they have them. They experience themselves as normal and often feel that the people they interact with are the ones with the problems. The primary personality disorders and their key traits, as described in the DSM-IV (APA, 1994) are:
Cluster A – the odd and eccentric cluster Paranoid – suspicious, distrustful, makes hostile attributions Schizoid – interpersonally and emotionally cut off, unresponsive to others, a ‘loner’Schizotypal – odd thoughts, behaviours, experiences; poor interpersonal functioning
Cluster B – the dramatic and erratic cluster Histrionic – dramatic, wants attention, emotionally shallow Narcissistic – inflated sense of self-importance, entitled, low empathy, hidden vulnerability Antisocial – behaviours that disregard laws, norms, rights of others; lacking in empathy Borderline – instability in thoughts, feelings, behaviour and sense of self
Cluster C – the fearful and avoidant cluster Obsessive-compulsive – rigid, controlled, perfectionistic Avoidant – fears negative evaluation, rejection and abandonment Dependent – submissive, dependent on others for self-esteem, fears abandonment As you can see, this organization of the personality disorders puts them into clusters.
These clusters are thought to reflect disorders with common traits. Although the disorders within each cluster do show commonalities, it is also the case the there are high levels of comorbidity among disorders across clusters. Borderline personality disorder and antisocial personality disorder (similar to what is often called psychopathy) have received more attention than the others, as they tend to have some of the most negative consequences, including suicide and violence.
Causes of personality disorders and factors affecting their course
1 Genetic and biological factors
There is evidence of modest genetic transmission for some personality disorders, especially antisocial personality disorder, although environmental factors also play an important role (e.g. Cadoret et al., 1995). There is also evidence that children are born with different temperaments, which may serve as vulnerability factors. For example, inhibition – which predisposes children towards shyness and anxiety – may put them at risk for personality disorders characterized by those traits. Disinhibited children are outgoing, talkative, impulsive and have low levels of physiological arousal. These children may be at risk for personality disorders characterized by impulsivity, erratic or aggressive behaviour, or lack of empathy. Biological factors are also being explored as causes of somepersonality disorders, such as antisocial personality disorder. For example, research suggests that people with antisocial personalitytraits show low levels of physiological arousal, which may account for their ability to engage in behaviours that normally cause people to feel anxious (e.g. Raine, Venables & Williams, 1990).
2 Psychosocial factors
Cognitive, psychodynamic and attachment theorists all suggest that negative early experiences in the family put people at risk for developing personality disorders. The assumption is that this happens, at least in part, through the cognitions that people develop. Early experiences with people who fail to validate a child’s self-worth may be internalized and result in a deep-seated set of severely rigid and dysfunctional thoughts about the self, others and the world, which then translate into rigid behavioural patterns.For example, if parents are not available to help a child cope with stress but are critical or abusive instead, the child will learn that she can’t rely on her parents, even though she may desperately want to. She may learn to hide her feelings, to expect that she will be criticized and rejected by others, and so to avoid close interpersonal relationships, even if she secretly yearns for them. If this pattern continues to develop and becomes rigid as the child grow up, she may eventually develop an avoidant personality disorder.
Research is beginning to suggest that temperamental and psychosocial factors interact. Kochanska (1995) found that children of different temperaments show more adaptive moral development in response to different qualities of the parent–child relationship. For example, fearful children respond better to gentle discipline, whereas non-fearful children respond better when they are securely attached to a parent. This suggests that the closer the parenting style matches the needs associated with that particular children’s temperament, the more adaptive their children will become. When a mismatch occurs, children may develop compensatory coping strategies, possibly leading to the rigid patterns that are associated with personality disorders.Marsha Linehan (1943– ), Professor of Psychology and Director of the Behavioral Research and Therapy Clinics at the University of Washington, is best known for her contributions to the understanding and treatment of suicidal behaviour and borderline personality disorder. Linehan proposed that borderline personality disorder can be best understood from a biopsychosocial approach, which bases the disorder in the interaction of an underlying biological dysfunction and an invalidating, non-accepting family environment. Linehan developed dialectical behaviour therapy (DBT) as a treatment for borderline personalitydisorder and suicidal behaviour. DBT is an empirically supported treatment, which combines traditional Western approaches with Eastern Zen approaches.
2 Psychosocial factors
Cognitive, psychodynamic and attachment theorists all suggest that negative early experiences in the family put people at risk for developing personality disorders. The assumption is that this happens, at least in part, through the cognitions that people develop. Early experiences with people who fail to validate a child’s self-worth may be internalized and result in a deep-seated set of severely rigid and dysfunctional thoughts about the self, others and the world, which then translate into rigid behavioural patterns.For example, if parents are not available to help a child cope with stress but are critical or abusive instead, the child will learn that she can’t rely on her parents, even though she may desperately want to. She may learn to hide her feelings, to expect that she will be criticized and rejected by others, and so to avoid close interpersonal relationships, even if she secretly yearns for them. If this pattern continues to develop and becomes rigid as the child grow up, she may eventually develop an avoidant personality disorder.
Research is beginning to suggest that temperamental and psychosocial factors interact. Kochanska (1995) found that children of different temperaments show more adaptive moral development in response to different qualities of the parent–child relationship. For example, fearful children respond better to gentle discipline, whereas non-fearful children respond better when they are securely attached to a parent. This suggests that the closer the parenting style matches the needs associated with that particular children’s temperament, the more adaptive their children will become. When a mismatch occurs, children may develop compensatory coping strategies, possibly leading to the rigid patterns that are associated with personality disorders.Marsha Linehan (1943– ), Professor of Psychology and Director of the Behavioral Research and Therapy Clinics at the University of Washington, is best known for her contributions to the understanding and treatment of suicidal behaviour and borderline personality disorder. Linehan proposed that borderline personality disorder can be best understood from a biopsychosocial approach, which bases the disorder in the interaction of an underlying biological dysfunction and an invalidating, non-accepting family environment. Linehan developed dialectical behaviour therapy (DBT) as a treatment for borderline personalitydisorder and suicidal behaviour. DBT is an empirically supported treatment, which combines traditional Western approaches with Eastern Zen approaches.
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