Personality disorders

Visualization of narrower problems
Impairments of temperament
A personality disorder exists when the habits that constitute a personality are inflexible and damaging. Inflexible and maladaptive personality traits can cause significant impairment in social or occupational functioning or subjective distress.
It is not easy to distinguish the influence of personality from that of more transient states and situations. One source of confusion is social roles. Family therapists have suggested that some apparently individual characteristics are best thought of as features of the 'family system' - a result of relations among family members not attributable to any one of them. Certain situations seem almost designed to bring out behaviour that is easy to mistake for a personality trait. Famous experiments by Stanley Milgram show that most people can bring themselves to behave sadistically under the influence of a person claiming authority. According to some sceptics, the sullen compliance combined with deliberate dawdling identified as a feature of passive-aggressive personality is simply the way people act when they are under compulsion and resisting demands for adequate performance because they have little to gain from it. Historians and sociologists have described slaves and army privates as behaving this way.

Another complication is the influence of emotional states and mental illnesses. Anyone may seem utterly transformed by chronic depression or alcoholism. Professionals who did not take sufficient notice of this once spoke of the alcoholic personality. The difficulty of distinguishing personality traits from states of mind and the demands of social roles is so serious that a few researchers have even denied the existence of individual patterns that persist in every mood and social context.

In the first two editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-I and DSM-II), personality disorders were relegated to a secondary place along with a mixture of other conditions; symptom disorders had priority. The third edition (DSM-III), published in 1980, gave equal prominence to personality disorders for the first time. The diagnostic scheme was strongly criticized from the start and has already been revised once, in the new edition published in 1987 (DSM-III-R). It will certainly be revised further, but the main outlines drawn a decade ago remain. DSM-III-R still dominates the field and provides at least a starting point for many mental health professionals in their consideration of personality problems.

DSM-III Personality Disorders< A. Odd or eccentric< 1. Paranoid: tense, guarded, suspicious, bears grudges.

2. Schizoid: socially isolated, with restricted emotional expression.

3. Schizotypal: disconcerting peculiarities of thought, appearance, and behaviour; emotionally detached and isolated.

B. Dramatic, emotional, or erratic< 4. Antisocial: manipulative, exploitative, pervasively dishonest and disloyal; lacks guilt, habitually breaks social rules, often has a criminal record.

5. Borderline: intolerant of solitude, intense and unstable moods and personal relationships, suicide attempts, chronic boredom or anger, drug and alcohol abuse.

6. Histrionic: seductive, demands constant reassurance and immediate gratification; rapidly changing, shallow emotional expression.

7. Narcissistic: self-absorbed, fantasies of perfection, preoccupied with envy, demands adulation, expects special treatment.

C. Anxious or fearful< 8. Avoidant: reticent, easily hurt or embarrassed, few close friends, afraid to abandon routines.

9. Dependent: allows others to make decisions, needs constant advice and reassurance, fears abandonment.

10. Obsessive-compulsive: stiff, perfectionistic, overconscientious, indecisive, preoccupied with details, unable to express affection.

11. Passive-aggressive: resents demands and suggestions, procrastinates, sulks, avoids obligations by 'forgetting' or deliberate inefficiency.

Added in 1987 (DSM-III-R)< 12. Sadistic: takes pleasure in cruelty, fascinated by violence, controls others by intimidation and humiliation.

13. Self-defeating: feels exploited and mistreated; creates situations bound to cause disappointment and rejection; excessive unsolicited self-sacrifice, rejects help and opportunities for pleasure.

(D) Detailed problems