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Personality Disorders

 

In my Assessment and Diagnosis class last semester (for graduate school in Social Work), I had to spend a week studying the personality disorders. These are, at least for now, seen as the enduring pathological character traits people live with in their daily lives. The personality disorders are separated out from other mental health disorders because of their lifelong nature, and because, usually, the patient doesn’t see his or her behavior as problematic, which makes them very hard to treat. But more often than not, the personality disorders are used as epithets, by lay people and clinicians, to describe people who resist therapeutic help. The current list of personality disorders is broken into three clusters: the not-quite-schizophrenia-but-still-odd-and-occasionally-psychotic personality disorders; the criminal-manipulative-lacking empathy-selfish personality disorders; and the fearful-avoidant-dependent-obsessive-compulsive personality disorders.

 

 

020

“Are you diagnosing me, Mommy?”

This small strip of the DSM (The Diagnostic and Statistical Manual of Mental Disorders) has come up recently, in our public dialogue, as people struggle to explain the president’s behavior. We don’t know if he has dementia, or some other mental illness or medical diagnosis, but we can certainly see traits that fit Narcissistic (grandiose and exploiting of others), Histrionic (melodramatic and attention seeking), Paranoid (preoccupied with doubts of loyalty in others), and Antisocial (lying, intentionally harming others, and lacking empathy) Personality Disorders.

The value of the personality disorders is that they give us categories to put people into when they consistently behave in abnormal ways, and categories can help us feel like we have some control, and some understanding, about what’s going on around us. But, are personality disorders actually mental illnesses, or something else? The personality disorders attempt to describe the perpetrator of domestic violence (Antisocial personality disorder), and the victim (Dependent personality disorder), as equally ill, and/or equally character disordered. Meaning that as a society we have as little compassion for victims as for perpetrators, something that is objectively true, but still horrifying. Other personality disorders are just lower level, and more persistent, versions of mental illnesses we already have in the book, like Obsessive Compulsive Personality Disorder, which is seen as different from Obsessive Compulsive Disorder (and, yes, that’s weird).

The personality disorders are the most extreme example of what’s wrong with the DSM: it focuses only on the negatives, the weaknesses, and the disorders of human beings, and never on the strengths that mitigate illness. The same person who has Major Depressive Disorder may also have a great support system that keeps her going. The same person who obsessively washes his hands or checks the lock on his door, maybe also obsessively study or work or create and accomplish great things. The same person who lives daily with Social Anxiety Disorder may have an even stronger need and desire to connect with other people, which allows her to reach out despite her fear.

Miss Cricket has her own reason for thinking that the personality disorders are unnecessary: she knows, in her gut, who to spend time with and who to avoid, and she doesn’t think she needs a diagnostic manual to help her. For her, it’s all about a complicated internal set of calculations, based on how much you smell like someone who gives out chicken treats (she is doing her best to teach Miss Ellie this wisdom as well). I have seen no mention of generosity with chicken treats, or any other positive character traits, in DSM 5. Clearly they have more work to do for the next edition.

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(Cricket transmits a lot of information through her butt. Who am I to judge?)

 

About rachelmankowitz

I am a fiction writer, a writing coach, and an obsessive chronicler of my dogs' lives.

105 responses »

  1. The eyes and tail of a dog are their emotional indicators I think.

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  2. It’s too bad people aren’tmore like dogs.

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  3. I totally agree with Cricket on going with your gut. Sorry about the chicken, though; I’m vegetarian. You can have my treat, Cricket.

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  4. Which is why I most probably prefer the company of dogs – integrity, honesty, loyalty, consistency of behaviour and unconditional love not premised on how they feel on the day. I read an article recently that indicated that some of the best executives have psychopathic tendencies. People are very interesting creatures.

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  5. The entire DSM is based on disorders: what’s wrong with you. Curing disorders, the medical model. Separating things out and giving them a name. Definitely a very helpful way to deal with things, but at best an approximate description. Luckily human behavior is so varied and so brilliant that the DSM isn’t always so useful.

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  6. I wonder what disorder the “haters” have. Best just to stay away, I think. I just heard about someone who couldn’t have a dog because they didn’t understand or trust unconditional love. Sad, really.

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  7. Most presidents have problems.

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  8. I just read a book about, OCD, anxiety and agoraphobia. It’s clearly hard when you suffer from those.

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  9. Interesting post. I have heard the term “personality disorder” but didn’t know what it entailed.
    I’ve been amazed at how well my two dogs communicate with each other. Without seeming to make noises at all Asta, the little, less bold one, will go over to Ginger, the larger one with some kind of herder in her. Then they both come over and Ginger talks to me. It usually means Asta wants to go out or they are out of water. I felt like we have made progress, Asta has gotten bolder and now comes on her own more often.

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  10. Love this post. And I am struck by Cricket’s wisdom. Trust the dog!

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  11. I think we have to all be a little bonkers to tolerate this bunch of miscreants in public office. It’s why I never told anyone I studied political science – it’s a study of personality disorders!

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  12. I must admit…personality disorders confused me in PSY 250-abnormal psych (and our instructor didn’t help, as he believed certain disorders, “dissociative identity disorder” was “Probably true, but rare,” Air quotes included. And this was a quote by Hooley, et al…in 2017. I agree it is rare, but I was willing to consider that it’s mis-classified and more likely an extreme experience of PTSD from childhood trauma. He also told the class that Borderline Personality Disorder was only experienced by 1% of the population, and they probably would never see it. However, you have made a great point of what Histrionic Personality Disorder might look like in a male (as it’s wrong in a female, but gets you a presidency if you’re a male????), oh, so many questions… Alas, Thanks for the clarification.

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  13. I love your informal observations about others’ disorders. I’m sure Cricket isn’t anywhere in the DSM!

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  14. A most enlightening, thought-provoking post!

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  15. I have always thought that anyone wanting to be the President of anywhere is in itself a personality disorder. 🙂
    Best wishes, Pete.

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  16. Congratulations on getting hold of this one

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  17. I have Borderline Personality Disorder and actually found my (very belated) diagnosis a huge relief. A name! A treatment plan! A reason! I am definitely aware that a lot of my behaviours are problematic, but mostly they are painful and difficult to manage. Doggos help a lot!

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  18. I appreciate your insight that the DSM focuses on pathology without considering the upside of many personality quirks. I also think it fails to recognize the reality of evil. May you have a good year!

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  19. Being on the receiving end of the DSM has been rather unpleasant! When you have labels this book assigns to you, it often means difficulty being a part of society. For me it has meant unemployment for a very long time. I decided to use a coping mechanism for my labels – numbers!
    The Diagnostic and Statistical Manual of Mental Disorders = 545/95/14/5
    Personality Disorder = 246/12/3 cycle
    Narcissistic = 143 + Histrionic = 124 + Paranoid = 78 + antisocial = 103 = 448/16/7
    President of the United States = 321/6/3 cycle
    Donald = 53 Trump = 88 = 141/6/3 cycle
    448 + 321 = 769/22/4/2/1
    321 + 141 = 462/12/3 cycle
    769 + 462 = 1231/7 (this was an interesting result)
    “It comes with the territory” = 325/10/1
    “It comes with the office” = 221/5
    325 + 221 = 546 (DSM = 545) = 15/6/3
    Madness = 75/12/6/3 cycle
    Mad = 17/8/4/2/1
    “You would have to be crazy to take that job” = 435/12/6/3 cycle
    “You would have to be mad to take that job” = 380/11/2/1
    “You would have to nuts to take that job” = 436/13/4/2/1
    Ego = 27/9 cycle
    “absolute power corrupts absolutely” = 434/11/2/1
    “living life with labels” = 216/9 cycle

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    • How do you come up with the numbers? Numerology based? Or something else.

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      • Thank you for asking Fiery K. What happened is I was having a combination of an episode and experiencing paranoia from taking a medication earlier this year. I didn’t trust anyone or anything! I needed someone or something I could trust that wasn’t about feelings, emotions or anyone or any particular thing. This system came to me. It felt like a bridge between worlds to me. At first it was just writing down the alphabet and assigning a number and then using a calculator to look at words, I began translating them from words to numbers and seeing patterns. Then I found out this sort of thing is very old and actually had a name “Gematria” and then I found the online calculator! People have called it numerology but to me it’s not. I don’t know anything about numerology. I don’t really know much of anything about Gematria either. In looking at this definition of Numerology, I guess some of what I’m experiencing in my processes is like it: https://en.wikipedia.org/wiki/Numerology
        Numerology is any belief in the divine or mystical relationship between a number and one or more coinciding events.[2] It is also the study of the numerical value of the letters in words, names and ideas. It is often associated with the paranormal, alongside astrology and similar divinatory arts.[3]

        Despite the long history of numerological ideas, the word “numerology” is not recorded in English before c.1907.[4]

        The term numerologist can be used for those who place faith in numerical patterns and draw pseudo-scientific inferences from them, even if those people do not practice traditional numerology. For example, in his 1997 book Numerology: Or What Pythagoras Wrought, mathematician Underwood Dudley uses the term to discuss practitioners of the Elliott wave principle of stock market analysis.
        https://en.wikipedia.org/wiki/Gematria
        Gematria

        From Wikipedia, the free encyclopedia

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        Gematria /ɡəˈmeɪtriə/ (Hebrew: גמטריא‬ גימטריה‬, plural גמטראות‬ or גמטריאות‬, gematriot)[1] are methods of assigning a numerical value to a Hebrew word or phrase based on its letters.

        Gematria originated as an Assyro-Babylonian-Greek system of alphanumeric code or cipher that was later adopted into Jewish culture. People who practice gematria believe that words with identical numerical values bear some relation to each other or to the number itself. The number may apply to Nature, a person’s age, the calendar year, or the like.[citation needed] A single word can yield multiple values depending on the method used.

        Similar systems, some of which were derived from or inspired by Hebrew gematria, have been used in other languages and cultures; for example, Greek isopsephy, Arabic abjad numerals, and English gematria. A well-known example of Hebrew gematria is the word chai (“alive”), which is composed of two letters that (using the assignments in the Mispar gadol table shown below) add up to 18. This has made 18 a “lucky number” among the Jewish people. Gifts of money in multiples of 18 are very popular.[2]

      • Thanks for explaining it to me … I wondered if it was some sort of numerology but wasn’t sure … you might be interested in reading Linda Goodman’s Star Signs book …. she’s got a chapter on numerology…but also… she’s got some really interesting material in there about words and their power, even the power of individual letters…. she says that letters…and words…are living energies, which I believe too… and just has some REALLY fascinating info in that book on the subject. I think you would love it!

      • ” People who practice gematria believe that words with identical numerical values bear some relation to each other or to the number itself. T” THIS is interesting..I hadn’t thought about the relatedness of words or entities with same numerical values!

      • you should do a blog post on this subject.

      • https://saymber.com/2018/02/09/9-feb-2018-gematria/ is one of the first times this system “had a name” for me. Before this it just came to me simply with numbers and letters and my trusty calculator. I have done several posts now, including even today where I am beginning to explore this system. The first sorts of patterns I think that stuck out were the 3 and 9 cycles I call them. When a word or phrase ends up as 3 or 9 is very interesting. I think of 3 cycles as a more natural cycle versus the 9 cycles that seem “hard” or seem to involve difficulty of some kind. Thank you for your interest! Come visit my blog sometime and see what you find for yourself.

      • I am interested in what sort of patterns you started noticing when you first started converting words to numbers…but I don’t want to clutter up this poor blog post…. if you feel like it, would you please email me at fiery.kaleidoscope@gmail.com and tell me more about this particular statement….”I began translating them from words to numbers and seeing patterns.” … i’m interested in what kinds of patterns…. thanks! And my apologies to the owner of this blog! For clogging the comment section a bit!

      • I will email you. I agree it would be polite to Rachel to take this offline so we aren’t clogging it up with our conversation! Although I’m sure with what the post is about, this probably is interesting to some lol!

      • I don’t want to offend Cricket!!!! lol!!!!!!!!!!!!

  20. Psychologists have have a field day with him. Besides a diagnosis, I also wonder about what was done to him as a child to make him the way he is. I also can only imagine what he has done to his own kids over the years.

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  21. I’m not schizophrenic and neither am I.

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  22. Thanks for sharing, it’s so important for informed individuals shining a light on mental health. I felt as though I knew nothing until I started having to act as a caretaker, and talking to others to unburden and learn more about it. And I even took an Adult Psychopathology course in undergraduate ages ago.

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  23. I think that anyone who attempts to diagnose someone without personal contact is a fool, but that’s just my opinion. Also, Cricket is amazingly smart. 🙂

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  24. I have to say that my foster daughter was diagnosed by so many different experts and given so many types of treatments and basically put through so much trauma only to find that none of them really knew what was wrong with her. They were all very well meaning but good intentions nearly led to this little girl being permanently placed in a mental facility.

    Now she’s off all meds and attending a public school. She’s still weird, occasionally too dramatic and triggered by Halloween but those labels almost destroyed her life so I say we should always proceed with caution when labeling.

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    • Diagnoses are a crapshoot on the best days, but with children? It’s worse. Ideally, children would be offered therapy and other human supports instead of medication, so that a specific diagnosis becomes less necessary. I’d prefer that for adults too, but insurance companies would never agree to it.

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      • It’s funny that kids in the system almost have unlimited access to meds and mental facilities which leads to its own sorts of abuse. Certain places had an incentive to keep kids in because they were making a ton of money off each kid. Very eye-opening.

        But I agree that so many people would benefit more if their problems were dealt with through some kind of therapy vs automatic drugs.

  25. Fascinating data but I’m not sure there is any explanation to accurately describe the current White House resident. *Sigh*

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  26. Besides the study, Cricket is enjoying you di., shes adorable!

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  27. ” not-quite-schizophrenia-but-still-odd-and-occasionally-psychotic ”

    This would be me.

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    • I can’t tell if you’re serious or joking.

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      • i’m serious. I think that describes me accurately. Except that if I take my prozac every day it cuts out the psychotic episodes, I don’t get triggered over the edge. I’m considered odd, nobody really understands me they just tolerate me is how I feel (in “real life”, you know).

        God only knows. I know I have PTSD from several different big traumas. It may just all be PTSD because that can cause psychotic rages too.

        I’ve never been diagnosed because every time i go to a therapist, they want to teach me (a pagan who has been meditating etc for decades) … how to do deep breathing exercises lol so they aren’t useful to me so I stop going. I’d love to see an actual psychologist and find out, but haven’t had (made) time to hunt one down and make an appointment.

      • If the Prozac is helping then the ptsd makes more sense than psychosis. We, as a society, have real trouble recognizing the serious and complicated after effects of trauma. Many, many women with complex ptsd used to be diagnosed with schizophrenia, because no one wanted to know about the abuse the women had suffered, or the lifelong damage abuse can cause.

      • yeah it’s just a simple 40 mg dose and i’ve gotten by on 10 and 20 before too. 10 takes the rages away. 40 takes away ALL the fear and wanting to hide (and therefore making it difficult to earn a living lol!), and helps me live the best life i am capable of.

      • mine’s ptsd then. Yeah i feel like if i was bipolar…i didn’t think prozac would just clear that up so easily.

        and ptsd … especially if it’s a huge trauma followed by more. I’ve got the initial childhood traumas … the new ones from my first marriage… then another issue from losing a baby in a shocking and abrupt way… getting groped by a library patron added to the sexual abuse trauma…. and now I noticed too that my grieving over my ex isn’t just grief…it’s ptsd because the last six months were stressful and potentially threatening to our safety… he refused to leave, was sneaking people into the house, etc.

        I just figured that out today when I looked out exactly what ptsd is. I thought I was just taking 2 years to get over a break up. I wasn’t thinking of all the extra trauma he caused.

        That’s why I”m now looking up ways to counteract ptsd (the others are as much in the background as they’ll ever be)…. but this one..needs some healing. I found a great site that I’ll blog at some point. You would probably love it.

      • It turns out that Prozac can be dangerous for people with manic tendencies, because the extra serotonin can actually activate the manic episodes. That’s one of the reason’s why primary care doctors shouldn’t be prescribing antidepressants, unless they know how to take a thorough psychiatric history.

      • they really shouldn’t. And you know how I got prescribed ? (and then accidentally found out it really works for me) … was just because I told my primary care that i experienced stress and anxiety. No questions asked, just threw prozac at me. I spent decades trying to control my “psycho” episodes and trying to figure out out what caused them and how to rewire my brain … I still work to rewire my brain but the prozac def helps. Also helps me not be afraid to interact with people. Feels like it helps me be my real self.Which is somehow buried when I’m not on it.

      • P.s. Meditation and deep breathing are generally contraindicated in cases of complex ptsd, because the flashbacks fill the silence. After a significant amount of healing time it can be worthwhile to give those things a try, but always trust your own judgment about what you can tolerate.

      • Thankfully, I don’t experience flashbacks anymore, I just have the intrusive thoughts that like to come and revolve and revolve and revolve lol .

        I think I have just made the mistake of finding regular therapists/counselors when I probably should have looked for a psychologist. Nice people and trying to do their jobs but they never bother to ask if you already have knowledge of something, they just start lecturing about deep breathing lol

      • There are social workers, mental health workers, psychologists, and psychiatrists who specialize in trauma. That’s the direction to go in, if you can.

      • Thanks for the tip, I’ll make sure to look for that specifically then, if I do look for someone. I’m ok dealing with it on my own but wow it would be nice to know exactly what IS going on, and to have more support if it’s possible.

      • I am capable of (in the past anyway, not on meds now) … of disassociating far enough out to produce a “fuzziness” of memory of the time I was … not absolute amnesia but I wasn’t fully in charge of my actions, just sitting back in my head and watching.

      • Dissociation is a common symptom of ptsd, because it helps people to survive through the unsurvivable.

      • so that might just be from the PTSD too then. I am pretty sure everything I am challenged with is just simple PTSD but my daughter in law thinks i’m bipolar. I don’t think I am but she does. lol

        the rages … i tried for decades to learn how to control them, recognize the warning signs i was triggered, etc…and had some success in averting some… but eventually realized it was always going to be hit and miss, and got tired of telling my children “when mommy gets like this lock yourselves in the bathroom and don’t come out” (because i’m so verbally nasty and scary) … so I made the decision to stay on prozac. It works and helps me be the real me and gives my children a decent childhood and me fewer regrets.

  28. and this “This small strip of the DSM (The Diagnostic and Statistical Manual of Mental Disorders) has come up recently, in our public dialogue, as people struggle to explain the president’s behavior” made me laugh even though it wasn’t intended as funny. lol but it was. Ohhh he’ s narcissist all the way! Narcissist not dealt with properly in his youth.

    My youngest has strong narcissist traits … it is a struggle to provide a balance of the support he desires and even needs sometimes, and the reality check that he also requires sometimes.

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    • Gentle reality checks, over and over again.

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      • I hope its enough to mitigate it, and it does seem to be. I think no matter how we’re naturally wired, environmental conditioning has a lot of power and I’m trying to use it for Good with him. He’s a sweet boy and genuinely does care about other people, he just can get lost in his “I’m the Pharaoh” moments sometimes and I have to help him consciously shift to a different mindset that is less self absorbed.

        But the negative side of it is… he might naturally want to take all the power and control…but this leads also to when something goes wrong…he automatically takes all the responsibility also and feels like he’s a horrible person. So I have to pull him back from that edge too. It’s interesting. I’m so glad I know enough to be able to give him the support he needs as well as to help mold a Not Trump in his coming adult years lol.

      • Having a loving, aware Mom is most of the battle. He’s very lucky.

      • Thanks : )
        I’m lucky to have all three of my punkins. They’ve all taught me so much.

      • Thakns *hugs* i love them all so much.

    • Don’t people wish they could pin a mental illness on El Presidente. It would be so simple to compartmentalize him. “He’s depraved on accounta’ he’s deprived.” –Officer Krumpke, West Side Story.

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  29. “I have seen no mention of generosity with chicken treats, or any other positive character traits, in DSM 5.” OH MY GOSH RACHEL I’M ROLLING LAUGHING THANK YOU SO MUCH ! Beautifully written post also!

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  30. Reblogged this on The Spinsta Life and commented:
    Too funny not to share!

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  31. I like your patients just be care both may be diagnosing you. LOL!

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  32. “…I had to spend a week studying the personality disorders.” Really?!?! …I say smilingly. Is that the extent of in-depth analysis required to be a social worker? And the jumble/mish-mash of the 3 general categories. Oh my. No wonder we can’t figure who we are. (Perplexed.)

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  33. Fascinating post, and you’ve asked some great questions that have gpt me thinking

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  34. Very interesting post. You provide balance to the disorder. The glass can be half full as well! 🙂

    Reply

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