Psychology Articles by Dr. Arthur Dingley - Personality Disorder Part III

Dr. Art Dingley

Three 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. Personality disorders are grouped into three categories. Last week, we looked at the dramatic or emotional group. Today, we’ll take a look at the anxious or fearful group.

Avoidant Personality Disorder is a pattern of avoiding contact with others for fear of embarrassment, criticism, disapproval, or rejection. This fear makes it hard for the person to hold a job which involves interacting with others. These people fully expect others to be shaming and scornful. They anticipate that others will not like them and they require a good deal of convincing that this is not the case. Because they scan for signs of rejection, they are quick to interpret neutral remarks or behavior as evidence that others think ill of them. Seeing themselves as inept, inferior, and unappealing, people with Avoidant Personality Disorder shy away from meeting new people and are extremely inhibited in social situations. These folks are reluctant to take personal risks or to “put themselves out there” socially because their fear of embarrassment is just too overwhelming.

People who develop Avoidant Personality Disorder were very shy children. Although most shy children seem to “grow out of it”, these folks get even more shy and avoidant as they move into adolescence and adulthood. Only about one-half of one percent of the population has Avoidant Personality Disorder. It seems to be equally common in men and women. There is some evidence that this disorder gets slowly better with the passage of time.

Dependent Personality Disorder is a pattern of submissive and clinging behavior. The person has tremendous fear of separation and an excessive need to be taken care of. This results in difficulty making even simple, everyday decisions without advice and reassurance. Someone with this disorder will have difficulty expressing disagreement from fear of loss of support or approval. He needs others to assume responsibility for everything. Although he may have energy and motivation, his lack of confidence in his own judgment and abilities will keep the person with this disorder from initiating projects or doing things on his own. For the person with Dependent Personality Disorder, the idea of being alone is terrifying. She feels helpless and unable to care for herself. As soon as one close relationship ends, she will frantically start looking for another as a source of care and support. These folks often refer to themselves in derogatory ways, calling themselves “stupid”. They are not particularly stung by perceived criticism - it fits with their view of themselves as worthless. Children who are chronically medically ill, or who have great separation anxiety, may be more predisposed to developing Dependent Personality Disorder as adolescents. This is one of the most frequently diagnosed personality disorders in mental health clinics. Men and women are probably affected equally often.

Obsessive-Compulsive Personality Disorder should not be confused with Obsessive-Compulsive Disorder (OCD). They are very different. The similarity in the names results in confusion as people mistakenly use the characteristics of these disorders interchangeably. In the column on anxiety disorders, OCD was described as a condition in which people learn to dispel disturbing intrusive thoughts (obsessions) by performing acts or rituals (compulsions) such as washing, counting or checking on things repeatedly. Obsessive-Compulsive Personality Disorder, on the other hand, is a preoccupation with orderliness, perfection, and control, at the expense of efficiency and flexibility. These individuals are more devoted to rules, details, lists, and procedures than to getting the job done. They are so concerned with perfection that their work suffers. Ironically, these folks would much rather work than relax or socialize. They have great difficulty delegating a task unless they are certain that the person will do the work in exactly the “right” way. People with Obsessive-Compulsive Personality Disorder are very inflexible in matters of values, morality, and ethics. They see things as “black or white” and do not accept “shades of grey.” Someone with this disorder will be very reluctant to discard worn-out worthless items. He will be miserly with money and hoard it for future catastrophes. Although uncommon, Obsessive-Compulsive Personality Disorder occurs twice as often in men.

Again, it is worth reviewing the ways in which someone’s personality style affects their perception of other psychiatric difficulties and their treatment. As we did with other personality disorders, let’s look at how each of these three personalities might experience depression and its treatment.

A woman with Avoidant Personality Disorder, who also became depressed, might see her depression as one more example of how she is inferior to others. She will approach mental health care with the expectation that her doctor or therapist will judge her to be inadequate, that she will say the wrong things in therapy, that she will be the least appealing and hopeless patient in the clinic. She will be unable to relax with her therapist for fear of looking foolish, and is sure that her therapist holds her in contempt. She will be afraid to describe the effects of her antidepressant medicine for fear of using the wrong words. She will be afraid that she is not getting better fast enough and that her doctor will be angry at her.

A man with Dependent Personality Disorder, who also became depressed, might have a difficult time getting better. Giving up his symptoms of depression might result in losing his supportive relationship with his doctor or therapist. He would be convinced he could never survive without them. He will have to walk a tightrope between improvement, which he thinks will make his therapist happy, and too much improvement, which might result in the expectation that he assume more independence. He will resist every suggestion by his therapist for ways to decrease his depression if it means using increased self-reliance, or taking any initiative.

Someone with Obsessive-Compulsive Personality Disorder might have trouble getting over his depression if meant stepping outside his rigid routine, or approaching relationships, work, or recreation in a different way.

He will want the cheapest medicine and the least expensive therapy. He will drop out of treatment before he gets over his depression in order to save money, even if he can afford to pay for it.

Although medicines may be of limited help, on an occasional basis, to people with personality disorders, the most effective and durable treatment is psychotherapy. Good therapy identifies the unconscious beliefs which determine how we see the world, how we see ourselves, and how we respond to others. Then, the therapist can help the patient challenge those beliefs by looking at other explanations. When he is able to use this knowledge in daily life to increase his control of thoughts, feelings, behavior, self-image, and interactions, someone with a personality disorder may recover completely. He may always have the same personality style, but it will simply be the basis for his individuality, and perhaps even a source of strength.

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