Personality Disorders 101

Louie; Season 1, Episode 7. “Double Date/Mom”
Louie’s narcissistic mother comes to visit unannounced.

What are personality disorders?

Personality is defined psychologically as the set of cognitive and behavioral traits that make us individuals.  Simply put, how we think and act define who we are.  A personality disorder is then when these thoughts and actions stray outside of societal norms.  These traits can stray to varying degrees, from small out of place occurrences to fully impaired interaction with others. There is a major problem in this definition though: behaviors are classified as “disordered” based on societal expectations.  Thus there is great subjectivity in determining the “oddness” of a behavior.  Some of these “disordered” behaviors are harmless, some are harmful only to the person with the disorder, and some can be very damaging to those around the disordered person.  So let’s talk specifics.

Personality disorders by cluster

Personality disorders are sometimes grouped into three clusters: odd, dramatic, and anxious.  These clusters contain three or four distinct personality disorders a piece, but broad generalizations can be made about them.

Cluster A (Odd)

  • irrational suspicion and mistrust of others
  • detachment from social relationships
  • restricted emotional expression
  • extreme social discomfort
  • distorted cognition

Cluster B (Dramatic)

  • disregard for and sometimes violation of rights of others
  • lack of empathy
  • instability in relationships, self-image, identity, and behavior
  • pattern of attention-seeking behavior and grandiosity
  • need for admiration
  • excessive emotion
  • inability to be self-critical

Cluster C (Anxious)

  • pervasive feelings of social inadequacy
  • extreme sensitivity to negative evaluation
  • pervasive need to be cared for by others
  • rigid conformity to rules, perfectionism, and control

It is important to note that personality disorders do not have to appear in isolation, meaning they can present side by side with other psychological and neurological differences.  For example, a person may have a personality disorder belonging to Cluster C and also Obsessive Compulsive Disorder (OCD), or walk the controversial line between some Cluster A disorders and schizophrenia.

While I have listed here descriptions of the personality traits of all three clusters of personality disorders, the cluster I will primarily write about will be Cluster B disorders.  Why?  Because this is the category I know most about.  I grew up with a parent with a personality disorder in this cluster, and I have encountered many other people in my life with these traits.  While it is possible to see less severe cases of Cluster B personality disorders, where self-reflection is possible and the person can work towards remission, many suffers of Cluster B disorders wreak havoc on the lives of people close to them.  This has certainly been my experience.

How and why do personality disorders develop?

While genetics may play a role in some personality disorders, it is largely believed that personality disorders are caused by suffering abuse during childhood.  Through a combination of learned behaviors and coping mechanisms gone wrong, an emotionally, sexually, and/or physically abused child can develop a complete personality disorder.  [1,2]

With disorders such as  Narcissistic Personality Disorder (NPD), the narcissist is created after a child suffers what is sometimes known as a narcissistic injury.  Very young children go through a phase of psychological development where they see the entire world as an extension of themselves.  When the child grows up with a narcissistic parent, the child is seen as an extension of the narcissist — typically either as the golden child, an extension of the narcissists’ perceived perfection, or the scapegoat, an extension of the narcissists’ self loathing.  A child raised in such an environment may never fully develop out of the psychological infancy that sees the world as an extension of themselves, that is, they forever see themselves as the center of the world.  Every narcissist was made by another narcissist: the cycle is vicious.

During the neurological critical period, when the child’s brain is acquiring the rules to things like language and social interaction, the child is extremely vulnerable to influence from personality disorders.  This neuroplasticity (the flexibility of a brain’s neurological structure) lessens as the child grows into a teenager and then into an adult.  If a child showing signs of a personality disorder is able to work with an adequate therapist, the disorder can be put into the aforementioned remission.  It is also possible for a child growing up in a home with these kinds of disordered parents to absorb the thoughts and actions of the parents as “normal” and repeat them without developing a full-blown personality disorder.  This is something that those of us who have grown up with parents with disorders like these have to be very aware of.

As it is relatively unheard of for personality disorders to be cured or put into remission after this teenage critical period, it seems to me that the personality disorder is in the process of being formed for the first 20 or so years of existence, and if enough normal behavior is not instilled, the disorder will take permanent hold.  This is in line with basic ideas of cognitive development; that is, the brain is more flexible to change during the early years, and decreases in neuroplasticity over time.  Just as it becomes harder to learn a new language after a certain age, it becomes more challenging to change one’s core personality the deeper into adulthood one is.

In the future, I will write more about NPD, the contradictory self perceptions of the narcissist, narcissists as parents, in other positions of power, and in the media.  I’ll also write more about the neurological critical period and neuroplasticity.

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13 thoughts on “Personality Disorders 101

  1. I must completely refute your idea that personality disorders cannot be cured or fully removed. I was diagnosed with Borderline Personality Disorder at age 18, suffering from all 9 of its symptoms. Today, at age 28, after working for many years on my issues in therapy, I have been completely free of all borderline symptoms for the last several years. I really enjoy my life now, am hardly ever depressed or anxious, and am essentially a “normal” person. People like me are living proof that personality disorders can be cured.

    On my blog, I list many examples of books that illustrate similar outcomes for formerly borderline patients. Maybe it’s time to update your beliefs about what is possible for patients with personality disorders. I do not shy away at all from how difficult recovery is and how much work it takes. But it happens.

    I have also read extensively about schizoid PD and narcissistic PD. There are many case studies available about patients with those conditions who recovered fully to live satisfying, healthy lives. If you read authors who treat personality-disordered individuals for years in intensive treatment, like Ralph Klein, Jeffrey Seinfeld, James Masterson, Gerald Adler, Otto Kernberg, Peter Giovacchini, Lawrence Hedges, Harold Searles, Vamik Volkan, and many more I could name, it’s clear that people with personality disorders can “be put into remission” and “do not take permanent hold”.
    I write much more on my blog about how I was able to recover.

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    1. Thank you for your comment!

      You’ll notice if you read my post carefully that I do talk about Personality Disorder Remission. I have a very dear friend who was also diagnosed with BPD and has been in remission for years. The point I make about remission is that it is very possible when a diagnosis is made early enough (under age 20-25) as the brain has the most neuroplasticity then, but less heard of in later years.

      There is also the hypothesis that those diagnosed at such a young age may not have completely cemented disorders and thus have the best chance at recovery. As many people with personality disorders come from difficult childhoods and childhood trauma is a known cause of some personality disorders, it is also worth entertaining the idea that children of personality disordered parents mimic their parents dysfunctional behaviors without adopting the entire disorder.

      It is not my intention to assert that all people with Personality Disorders are the same, so I appreciate your input.

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      1. Those are reasonable sounding thoughts. However, I have read many cases of BPDs who were diagnosed in their 30s or 40s and recovered fully to live good lives. In books by Masterson, Seinfeld, and Volkan (e.g. The Search for the Real Self, Psychotherapy of the Borderline Adult, The Bad Object, Six Steps in the Treatment of Borderline Personality Organization), several of these cases are described in great detail. Their symptoms were more ingrained, but that doesn’t mean they were unable to be “cured.” It just took more time and work. There are also several cases of Narcissistic PD that I’ve read about who recovered fully. I would recommend to you James Masterson’s book, “The Emerging Self,” and his case of Frank, a 52-year-old narcissist who recovered fully from his disorder.

        I also believe your view contains the common mistake of viewing personality disorders as valid medical diagnoses. There is abundant evidence against that conclusion; some of it is described in the “Unicorn” post on my blog. It is ironic and paradoxical that I would hold this position, considering I was once “diagnosed” with a PD, but there you go. Many therapists, including several I’ve talked to personally, would support this anti-DSM position. They use the DSM reluctantly, not believing in the validity or reliability of personality disorders. At the deepest level, they don’t believe PDs “exist” as distinct syndromes, although all the symptoms supposedly comprising them certainly do.

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        1. Apologies for taking quite a while to write back.

          In my previous comment and in my post, I acknowledged that there are indeed cases of people with Personality Disorders going into remission. However this blog is targetted towards children of people with Personality Disorders, and typically by the time people are far gone enough to abuse their children, they’re not going into remission. All the professionals I have spoken to on this matter think it is best that children of parents with Personality Disorders not hold out hope for their abusive parents to go into remission.

          As far as the question of the DSM, I have stated in this article and others on my blog that I know there are major problems with DSM’s categorization of PD and many, many other disorders. The DSM is not perfect, but it’s what we have to work with in the field of Psychology at this point. And from a neurobiological standpoint, PD is very much a real, diagnosible, medical condition. I’ll be posting about the neurobiology of PD very soon, including hard evidence from fMRI and other neuroimaging methods.

          I think I’m going to let this comment chain go after this, since these seem to be issues we fundamentally disagree on.

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