Questions & AnswersPersonality Disorderss

QUESTION: What does "personality disorder" mean?

ANSWER: Personality Disorders are chronic patterns of experiences and behaviors that deviate from the norm and that cause the individual marked impairment and/or distress. There are currently 10 main types of Personality Disorders and one additional category for idiosyncratic personality disorders. The 10 main Personality Disorders and their primary features are:

  • Paranoid: distrust and suspiciousness of others.
  • Schizoid: detachment from others and restricted range of emotions.
  • Schizotypal: extreme discomfort with others, eccentric behavior and cognitive or perceptual distortions.
  • Antisocial: disregard for and violation of the rights of others.
  • Borderline: instability in interpersonal relationships, self-image and emotions, coupled with impulsive behaviors.
  • Histrionic: excessive emotionality to gain attention.
  • Narcissistic: feelings of grandiosity, need for admiration and difficulty empathizing with others.
  • Avoidant: social inhibitions, feelings of inadequacy and hypersensitivity to criticism.
  • Dependent: submissive, clinging behavior and an excessive need to be taken care of.
  • Obsessive-Compulsive: preoccupation with orderliness, perfectionism and control.
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QUESTION: My best friend cuts herself. She says she's not suicidal and that she's not sure why she does it. Is there anything I can do to help?

ANSWER: The best thing you can do is encourage her to get help. Hurting yourself not only has the potential to be dangerous or even fatal, but it can also reinforce negative opinions of oneself. Also, self-harm can become addictive, causing the individual to feel they have to do more and more each time in order to get the same effect. Your friend needs understanding and support - not criticism — but more than anything, she needs professional help.
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QUESTION: I've heard that there's little hope for people with personality disorders — that you'll be that way your whole life. Is that true?

ANSWER: I am a firm believer that many people with personality disorders can be helped to lead normal or near normal lives. While it's true that our overall personality structure stays fairly constant throughout our lives, there's a huge difference, for example, between a person who has tendencies toward Avoidant Personality Disorder but who's able to set them aside and function well, as opposed to someone who is emotionally crippled by the disorder.

Treatment for personality disorders is long and involved and the individual has to be highly motivated to stick with it. Often, as the initial pain that brings the person to therapy begins to subside, they see themselves as "cured" and leave therapy. This tendency may be what causes some to say people with personality disorders don't change.

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QUESTION: I've been told I have Borderline Personality Disorder. What's that?

ANSWER: The hallmark feature of Borderline Personality Disorder is the lack of a solid sense of self. This leads to the extreme mood shifts, impulsive behaviors and difficulties with relationships that Borderlines are known for. Because of the lack of self, persons with BPD have difficulty in relationships and tend to feel either abandoned or engulfed by the other person. I often feel that Borderlines get a bad rap, because people focus on the behaviors and fail to see the underlying pain, disorganization and terror.

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QUESTION: How do you tell the difference between personality disorders and PTSD (Posttraumatic Stress Disorder)? I've been given both kinds of diagnoses and I'm not sure what to believe.

ANSWER: First of all, it's entirely possible to have both diagnoses. However, psychiatric diagnoses are not an exact science so it's also entirely possible that you have both types of disorders, one but not the other, or neither of them. I've known some people who've seen 5 or 6 different therapists and ended up with 5 or 6 different diagnoses. The good news is that it may not really matter. The important thing is to find a therapist you like and whom you feel understands you and go from there. It's not essential to have an accurate diagnosis to get excellent treatment.

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QUESTION: What's the difference between someone with a personality disorder and someone who's just depressed or anxious or has other kinds of psychiatric symptoms?

ANSWER: That's an excellent question because most people with personality disorders do indeed have depression or anxiety or other kinds of psychiatric symptoms. One thing to watch for is that the characteristics of someone with a personality disorder will be present in more than one area of their life. For example, they may exhibit similar beliefs or characteristics at work or school and also in relationships. They also tend to have trouble relating to others. This could range from not having relationships at all to having really intense, chaotic relationships that don't last long, to only having superficial relationships. Similarly, people with personality disorders typically have a disturbance in the way they feel about themselves. Often, there's a great deal of self-hatred, although the self-hatred is sometimes masked by feelings of superiority or detachment.

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QUESTION: How can therapy help someone with avoidant personality disorder?

ANSWER: Therapy can be extremely helpful to individuals with avoidant personality disorder because the relationship with the therapist can help the person build the self-confidence they need in other types of relationships. Often people who have avoidant personality disorder find it easier to relate to a therapist than to an ordinary person because they can distance themselves from the therapist by seeing them as a "doctor". Also, the therapeutic relationship is prescribed, e.g., 50 minutes once a week or whatever and the therapist generally gets paid for their services. Boundaries such as these are much easier for an individual with avoidant personality disorder than a more open-ended kind of relationship. As with all the personality disorders, therapy for people with avoidant personality disorder is lengthy. The main things that can derail the therapy that therapists should stay on the lookout for are 1) if the client never adequately attaches to the therapist or 2) if the client does attach to the therapist but is not able to transfer those feelings of safety to other relationships.