Episode 108: December 5, 2012
by Sanaz Majd, MD
More likely than not, you have had to deal with someone who just seemed a little “off” at some point in your life. Maybe a frustrating coworker who makes everyone’s lives miserable? Or an estranged family member who is often considered the “black sheep” that no one can really handle being around? Did you ever wonder if there was something actually wrong with that person, but you just couldn’t quite pinpoint what it was?
Believe it or not, “personality disorders” are actual clinical disorders. And more than likely, someone you know suffers from one. Let’s learn about them so we can best acquaint ourselves with how to handle those people in our lives.
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What is a Personality Disorder?
Believe it or not, up to 15% of people have at least one clinical personality disorder. Clinical personality disorders need to meet the following criteria for diagnosis:
The pattern of behavior is inflexible/unchangeable.
The pattern of behavior is pervasive across a broad range of personal and social situations (for instance, it’s not only at work or only at home).
The pattern of behavior leads to significant distress and/or decrease in social or occupational functioning.
The behavior often begins in adolescence.
Types of Personality Disorders
Personality disorders are divided into three categories or clusters:
Cluster A - Characterized as odd or eccentric
Paranoid: These patients have a pervasive distrust of others. They often feel as though others are trying to hurt them and frequently question the loyalty of people in their lives. They often interpret benign interactions and remarks as malicious and threatening.
Schizoid: Patients with schizoid personality disorder don’t enjoy other people. But beyond that, they really don’t enjoy any social interactions whatsoever, not even with family members. They couldn’t care less about what others think of them. They prefer to be alone and take pleasure in very few social activities if any. They often appear cold, without emotion.
Schizotypal: Not only do these patients suffer from interpersonal deficits, but they also have eccentric beliefs. They may have “magical thinking” (like superstition) or believe they are clairvoyant. They are often described as being “odd” or “peculiar.”
Cluster B - Characterizedas emotional, dramatic, or erratic
Histrionic: Patients are often very emotional and overly dramatic. They have an intense need to be the center of attention and may use their sexuality to do so.
Narcissistic: Narcissistic patient have a delusion of grandiosity, meaning that they believe that they are more important than others. They believe that they are special and feel quite entitled. They demand that others go above and beyond for their needs and often belittle others. They have a great need to be admired, which is usually driven by low self-esteem. Think celebrities.
Borderline: They are often considered unstable or impulsive. They believe that people are either really great or absolutely horrible. Everything is up and down. They often threaten to hurt themselves to gain attention. They have very black and white thinking. They have issues with self-image and identity. Without treatment, sometimes in extreme situations their behavior can lead to suicide attempts (really scary).
Antisocial: This doesn’t mean that they are simply “not social,” but that they have a complete disregard for the rights of others. They will lie, cheat, and con others into getting what they want. They often have anger management issues, as well. Criminals are often described as being antisocial.
Cluster C - Characterized as fearful or anxious
Dependent: These patients have an intense need to be taken care of. They often become submissive and passive and look for relationships in which they are controlled. They are clingy and fear separation.
Obsessive Compulsive: The obsessive compulsive personality disorder is actually a different diagnosis than Obsessive Compulsive Disorder (or OCD), so don’t confuse the two. These patients are preoccupied with order and are often described as perfectionists, so much so that they sacrifice efficiency and may take longer to complete projects as a result. They may be difficult to work with, demanding that tasks are completed just as they’d want them done. They are rigid, stubborn, and sticklers for the rules. Unlike patients with OCD, those who have obsessive compulsive personality disorder may not necessarily display obsessions or compulsions per se.
Avoidant: They avoid social interactions, not because they don’t have the desire (unlike in cluster A), but they just have a great feeling of inadequacy. They fear rejection and cannot handle not being liked. They are hypersensitive to any criticism.
When interacting with someone who has a personality disorder, the important point to remember is that these characteristics are pervasive and often difficult to change. Recognize that their behavior is the result of a disorder, rather than a choice, and try to manage your interaction with that person keeping that fact in mind.
Treatment of personality disorders are quite tough – because personality is so embedded and thought to be the cause of both genetics and environment, it’s not easy to change, unfortunately. The only real hope to make any changes is through therapy and intense counseling, but as you can imagine it’s sometimes difficult to convince someone with a personality disorder to seek “help.”
Do you know someone with a personality disorder? How did you successfully handle your interactions? Share it with us on the House Call Doctor’s Facebook and Twitter pages!
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.