Personality disorders

The 'Bible' of the mental health profession's, is called 'The Diagnostic and Statistical Manual of Mental Disorders' - the current issue being number four ( D.S.M.4) All the Doctors, Psychiatrists, Hospitals, Courts etc (in the English speaking world) recognise the D.S.M. Classifications. The D.S.M.4 recognises ten main personality disorders; Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependant, and Obsessive-Compulsive.

The Borderline Personality Disorder
In simple terms, a person could be described as "borderline" when their compensatory activities (compulsive symptoms) become reckless or dangerous. It could be viewed as a combination of 'oral compulsive activity' and a large chunk of hysteria' D.S.M.4; "A pervasive pattern of instability of interpersonal relationships, self image, and emotions, and marked impulsivity beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following;"

1. frantic efforts to avoid real or imagined abandonment
2. a pattern of intense and unstable relationships
3. persistently unstable self image (and attempts to control it)
4. impulsivity in at least two areas that are self damaging e.g. spending, substance abuse, sex, reckless driving, binge eating
5. recurrent suicidal behavior, gestures, threats or self mutilating behavior
6. affective instability due to a marked reactivity of mood.
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger
9. transient stress related paranoid ideation or severe dissociation. This personality disorder is called 'borderline', because (20 years ago) the person was thought to be on the border between a neurosis and a psychosis - that belief isn't held anymore, but the term has stuck.

The Narcissistic Personality Disorder
A pervasive pattern of grandiosity (fantasy or reality), need for admiration, and lack of empathy, beginning by

1. has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, and expects to be recognised as superior - without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he (or she) is special and unique and can only be understood by, or should associate with, other special or high status people
4. requires excessive admiration
5. has a sense of 'entitlement' (e.g. expects automatic compliance)
6. is interpersonally exploitative (e.g. takes advantage of others to achieve his own ends)
7. lacks empathy
8. is often envious of others (or feels others are envious of him)
9. shows arrogant, haughty behavior's or attitudes. It is generally considered impossible to take a true Narcissist through therapy, because of their inability to develop a transference. Prevalence; 2-16% in a clinical setting, 1% in the general population.

The Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention seeking, beginning again in early childhood, and indicated by five (or more) of the following:

1. is uncomfortable in situations in which he or she is not the centre of attention
2. interaction with others is characterised by inappropriate sexually seductive or provocative behavior
3. displays rapidly shifting and shallow expressions of emotions
4. consistently uses physical appearance to draw attention to self
5. has a style of speech that is excessively impressionistic and lacking in detail
6. shows self-dramatisation, theatricality, and exaggerated expression of emotion
7. is suggestible
8. considers relationships to be more intimate than they actually are

In the general population, it is estimated that about 2-3% of people have a 'full blown' Histrionic Personality Disorder (as opposed to being a little bit hysterical)

The Antisocial Personality Disorder
(formerly The Psychopathic Personality Disorder, or 'Sociopath') A pervasive pattern of disregard for and violation of the rights of others since age 15 years, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behavior's as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility
7. lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from others

Prevalence is about 3% males and 1% females Someone with APD is unlikely to present themselves for therapy - for obvious reasons. Out of interest, it is estimated that about 30% of the directors of Britain's' top 100 companies have APD.

Dependent Personality Disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
2. needs others to assume responsibility for most major areas of his or her life
3. has difficulty expressing disagreement with others because of fear of loss of support or approval.
4. has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
7. urgently seeks another relationship as a source of care and support when a close relationship ends
8. is unrealistically preoccupied with fears of being left to take care of himself or herself.

NOTE - A person with this disorder is rarely able to make any decision on their own. They are willing to submit to others demands - even if the demands are unreasonable - if it gains the person support or nurturance. These people tend to have a very low opinion of themselves, often thinking themselves 'stupid'.

Often they will seek relationships where they feel overprotected or dominated, and they tend to avoid responsibility.

Avoidant Personality Disorder
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
2. Is unwilling to get involved with people unless certain of being liked
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. Is preoccupied with being criticized or rejected in social situations
5. Is inhibited in new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personally unappealing, or inferior to others
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Schizotypal Personality Disorder
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior - beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (e.g., superstitions, belief in clairvoyance, telepathy, or a 'sixth sense'; in children and adolescents, bizarre fantasies or preoccupation's)
3. Unusual perceptual experiences, including bodily illusions · Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over-elaborate, or stereotyped)
4. Suspiciousness or paranoid ideation
5. Inappropriate or constricted affect
6. Behavior or appearance that is odd, eccentric, or peculiar
7. Lack of close friends or confidants other than first-degree relatives
8. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Schizoid Personality Disorder
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment, or flattened affectivity

Paranoid Personality Disorder
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges, is unforgiving of; insults, injuries, or slights
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

NOTE - A paranoid P.D. is basically a Paranoid Neurosis - effecting mainly the Anal/obsessional personality type. Nearly always will you find that the Paranoid P.D. also has Obsessional Symptoms (counting/checking/hand washing etc) Paranoid P.D. often appears in childhood, with visible symptoms being; poor peer relationships, social anxiety, hypersensitivity and underachievement - sometimes the children appear 'odd' or 'eccentric'. This disorder seems to effect more males than females, and prevalence is estimated to be from 0.5 - 2.5% of the general population.

Obsessive Compulsive Personality Disorder
Analytical Hypnotherapists would tend to view OCD really as an Obsessional Neurosis - because there is often very little 'compulsive' content: A compulsion is a sudden immediate impulse to do something, when the activity has been performed the person feels some sense of reward, the impulse doesn't return (at least no straight away) An obsession is something that is thought about continually, is never far from the persons mind, never brings a feeling of reward (though a feeling of 'deferment' is sometimes felt), and the activity is soon being brooded about again.

For the record then, the D.S.M.4 criteria for Obsessive Compulsive Disorder 'A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. is preoccupied with details, rules, lists, order, organisation, or schedules to the extent that the major point of the activity is lost.
2. shows perfectionism that interferes with task completion - e.g. is unable to complete a project because his or her own overly strict standards are not met.
3. is excessively devoted to work and productivity to the exclusion of leisure activities and friendships.
4. is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values.
5. is unable to discard worn out or useless objects even when they have no sentimental value
6. is reluctant to delegate tasks or work to others unless they submit to exactly his or her way of doing things
7. adopts a miserly spending style toward both self and others; money is something to be hoarded for future catastrophies
8. shows rigidity and stubbornness.