Mind Matters - August 2006
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Personality Disorders 101
by Ron Sterling, M.D. -- August 2006

    In last month's column, I answered two out of three questions from Optimistic Personality. The questions related to whether we get set in our ways as we get older and what is a personality disorder? Since the subject of personality disorders is very complex, I promised to write about it in a future column. This column should be considered an introduction to personality disorders. For more information, I recommend reading the Internet version of this article which includes many resource links.

    Simply put, "personality disorders" is one of 16 categories of disorders that were defined by the authors of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ("DSM-IV"), published in 2000. There are three "clusters" of personality disorders and about ten disorders (1) Cluster A -- paranoid, schizoid, and schizotypal; (2) Cluster B -- antisocial, borderline, histrionic, and narcissistic; and, (3) Cluster C -- avoidant, dependent, and obsessive-compulsive personality disorder (not to be confused with the anxiety disorder obsessive-compulsive disorder). Dissociative identity disorder (formerly multiple personality disorder) is not categorized as a personality disorder but, rather, a dissociative disorder.

    The general definition of a personality disorder is "Enduring subjective experiences and behavior that deviate from cultural standards, are rigidly pervasive, have an onset in adolescence or early adulthood, are stable through time, and lead to significant difficulties in life such as with social interactions, criminal behavior, and employment."

    Professionals should not be casual about making a personality disorder diagnosis and should not make such a diagnosis when a client is in the midst of being treated for, among other things, a substance abuse disorder, schizophrenia and other psychotic disorders, mood disorders or anxiety disorders. A passing set of personality traits that may be associated with clinical depression or attention deficit hyperactivity disorder, for instance, cannot be said to be part of a personality disorder.

    Because of the rigidity of personality disorder behavior and the lack of recognition by those with the disorder regarding the consequences of their behavior and thinking patterns, many researchers began to investigate the possibility of a genetic predisposition to personality disorders. Studies so far seem to confirm significant genetic associations, but are not conclusive. Because typical psychiatric medications that have positive effects on moods, thinking processes, and behavior seem to have very little effect on the symptoms of personality disorders, many professionals believe that the symptoms may be structural and brain-based.

    People with personality disorders have been shown to be less likely to seek counseling or psychiatric help and are less likely to accept that their behavior or thinking patterns are problematic. Thus, often, it is employers, friends, teachers, or family members who are impacted more by the person with a personality disorder than the person with the disorder. For instance, someone with a narcissistic personality disorder may cause significant emotional pain for many people in their lives, but generally do not seek treatment and often automatically find ways to blame others for their problems.

    To me, personality disorder diagnoses are real and distinct complexes of identifiable symptoms that are yet to be fully understood in terms of whether they exist due to brain-based irregularities or the consequences of certain intense experiences that set the brain and mind into these significantly skewed states of thinking and behaving. It is likely that we will discover that many of the current personality disorder diagnoses are clusters of symptoms that are related to structural elements in the brain and are likely genetic or congenital.

    Does that mean that those with personality disorder diagnoses cannot change? No. Although it takes work, and lots of it, to change certain personality disorder traits, it can be done. The brain has been shown to be very plastic and capable of re-routing, creating new circuits, and even budding new nerve cells in response to many learning techniques. I hope this helps. -- Best wishes, Dr. Ron.

    Links to more information and resources regarding personality disorders:

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