Psychology Articles by Dr. Arthur Dingley - Personality Disorders Part II

Dr. Art Dingley

Two weeks ago, I described “personality” as the unique way in which each person interprets the world and responds to it. Personality is a blend of temperament, character, defensive strategy, and intelligence. Although we are all “one of a kind”, our personalities can be sorted into types. When personality becomes disordered, it can cause psychiatric symptoms all by itself.

Personality disorders are extreme personality styles. Like fun-house mirrors, these disorders cause distorted views of people and events. When someone’s perception of others is distorted, her responses are apt to be inappropriate as well. Mental health professionals group personality disorders into three categories. Last week, we looked at the odd or eccentric group. Today, we’ll take a look at the dramatic or emotional group.

Antisocial Personality Disorder is a pervasive pattern of disregarding and violating the rights of others. In the past, these people were referred to as sociopaths or psychopaths. (I have noticed a growing tendency for people who get anxious in crowds, and who prefer to stay home rather than go out, to refer to themselves as “antisocial.” As you can see, this mistake is worth avoiding.) Everyone who develops Antisocial Personality Disorder had serious behavior problems in childhood. As adults, these people violate the law repeatedly. They are irritable, and aggressive, and get into fights. They lie, cheat, and steal. They never feel true remorse, although they may appear very apologetic in order to avoid punishment. When apprehended, they will deny their guilt. If that doesn’t work, they will minimize the seriousness of their actions. If that fails, they will blame the victim by saying he had it coming to him. These people are impulsive and take risks, disregarding their own safety and the safety of others. People with Antisocial Personality Disorder are continually irresponsible, refusing to work for more than brief periods, and failing to honor financial obligations. Although people with this disorder do not feel love or loyalty, they may become adept at exploiting these emotions in others by using superficial charm.

Antisocial Personality Disorder is not “treatable” except by swift and sure punishment. This disorder is excluded, by law, from psychiatric conditions which may be the basis for reduced criminal penalties or a finding of “not criminally responsible” (not guilty by reason of insanity). This disorder is at least three times as common in men, although men may be overdiagnosed and women underdiagnosed because of gender stereotyping.

Borderline Personality Disorder is a pattern of intense unstable interpersonal relationships, mood swings, anger, and impulsivity. People with Borderline Personality Disorder are prone to idealizing others they have only recently met. They want to spend lots of time with the new person and will share intimate secrets quickly. Very often, however, a person with this disorder will suddenly come to believe that the new person “does not really care". This results in an abrupt, and often dramatic, change in her attitude toward the new friend whom she now devalues and “cuts off” completely.

Individuals with this personality disorder have rapidly shifting moods. These “mood swings” are a reaction to negative thoughts or external events. The moods, which may include anger, “depression”, and panic, are brief and intense. Inappropriate anger is a hallmark of this personality disorder and is seen as sarcasm, fits of temper, and even physical fights, usually followed by periods of shame. These moods often result from unfortunate interactions with others or the idea of being “a bad person”.

Impulsivity is common with this disorder, and the impulsive behavior is often self-damaging. They may engage in sex, drive, or spend money recklessly. This, in combination with the mood swings, may result in a misdiagnosis of “Bipolar Disorder” by an unsophisticated mental health professional. People with Borderline Personality Disorder often have thoughts of suicide, threaten suicide, or attempt suicide. They may deliberately injure themselves by cutting or burning as a means of getting relief from their emotional distress. People with this disorder often have trouble understanding who they really are. This may result in sudden changes in career goals, lifestyle, physical appearance, and even sexual orientation. Underneath all of the drama, they may feel profound emptiness, as though they really do not exist at all. Although men are underdiagnosed because of gender bias, about three-fourths of people with this disorder are female.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention-seeking. Individuals with this disorder demand to be the center of attention and become uncomfortable out of the spotlight. They learn to draw attention to themselves in numerous ways. They may dress in a provocative manner and be overly enthusiastic, friendly, or flirtatious. If this is insufficient, they will make up stories about themselves or throw a scene. Someone with Histrionic Personality Disorder may express strong opinions about people or events yet be unable to provide any real explanation for these opinions. Their speech is apt to be dramatic, yet merely impressionistic. People with this disorder give a strong show of emotion, but their emotions are really theatrical and shallow. They turn their emotions on and off abruptly. These people often consider relationships to be more intimate than they actually are. Everyone is their new best friend. They are immediately on a first-name basis with influential or powerful people they barely know. Ironically, people with this personality disorder have great trouble with true romance and true intimacy. They may be simultaneously manipulative and dependent. They alienate same-sex friends with their embarrassing displays of emotion, their seductive behavior toward the friends’ romantic partners, and their constant demands for attention. Men and women may be affected by Histrionic Personality Disorder equally often.

Narcissistic Personality Disorder is a pattern of grandiosity, a need for admiration, and a lack of empathy with others. People with this disorder have an exaggerated sense of self-importance. They expect to be recognized as superior even when they haven’t accomplished much. In addition, they may devalue the contributions of others. As a result, they appear arrogant, boastful, and pretentious. They spend a good deal of time imagining themselves as successful, powerful, and beautiful. They believe that they are special. These folks want the “best” school, the “top doctor”, the “nicest” things. They have unreasonable expectations of favorable treatment. People with Narcissistic Personality Disorder often form superficial friendships for the purpose of exploiting those relationships later to achieve their own ends. They have difficulty recognizing the feelings and needs of others. They are often envious of others and believe that others envy them. People with this disorder depend almost exclusively on the admiration of others for their sense of self worth. They are exquisitely sensitive to perceived criticism. Narcissistic Personality Disorder may be more common in men.

Again, Psychiatric illnesses such as depression are heavily affected by personality style, and personality must be taken into account by mental health professionals to get the best result from treatment. Antisocial people may fake symptoms to get certain drugs, or enlist the doctor’s help to get reduced punishment or some government benefit. A borderline person may believe that her new doctor is excellent and really cares about her in a way that others have not. Soon, however, she may interpret some aspect of treatment to mean that the doctor is uncaring. Suddenly, the medicine he prescribes is no good, and she begins skipping appointments and looking for a new doctor. A narcissistic person with depression will like his new doctor if the doctor went to a famous medical school or trained at a prestigious hospital. He wants the doctor to like him and will “fish” for compliments. He will be quick to interpret questions from the doctor as implied criticism. A histrionic person will talk dramatically of her depression, creating a sense of great distress, but providing no useful detail. Her symptoms, and her experience with treatment, will be heavily influenced by the opinions of others.

In the next column, we’ll take a look at the third group of personality disorders, the fearful and anxious group.

Dr. Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He may be reached at adingley@fchn.org