Eventually, as is the case in everyone’s life, whether it be a family member, co-worker, neighbor, or friend, you will come across a person with a personality disorder (PD). Although it can usually be hard to discern if a person has a PD at the beginning of the relationship, its presence will soon come to light. Having an accurate understanding of both what a personality disorder is and where it may be coming from is essential to keep the frustration of navigating them to a minimum.
What is a personality disorder? It helps to begin with the visual image of a bell-shaped curve. If you were to map empathy as a personality characteristic on this graph, you would see the standard deviation at the highest point, and the larger part of the curve in a range of plus one or minus one in either direction of the standard deviation. This is the curve’s largest range, representing those who have a normal amount of empathy, and the majority of the population resides within it. Those, with a standard deviation of greater than one but less than two, have either too much or too little empathy compared to the average person(this is the medium range of the curve in between the largest and smallest sections). More than two deviation points in either direction place empathy at the dysfunctional level. This is the point on the graph where too much empathy or a lack thereof becomes part of a disorder (this is the smallest range of the curve). This same procedure or method can be applied to each one of the traits identified as personality disorder characteristics.
Where does it come from? This question is the topic of many scientific studies. With the information currently available today, it is believed that half of a personality disorder’s origin is biological, and half is environmental. It is in my opinion that a third component comes into play at a later time, which is choice.
The biological component means that someone in the family tree also has a PD, and similar characteristics were passed down through genetics. To be considered a biological trait, the ancestor’s PD does not need to be the same exact PD as the descendant’s. There are several characteristics which apply to more than one PD and they can all manifest differently. The PD just needs to be there in the same way a person inherits other personal traits from their ancestors such as sensitivity, compassion, determination, or perfectionism.
The environmental component can come from a variety of sources. A parent who has a PD may model the behavior as being the “correct” way to live. A traumatic event, severe childhood illness, or repeated abuse can also trigger the development of a PD. This does not mean that everyone who has one of these events will develop a PD, rather that it is part of the current explanation for the existence of one. A parent can also encourage the development of a PD through incorrect use of discipline, inconsistent and unsafe environments, and over-giving to the point a child feels entitled.
The third component that I believe to play a factor, is choice. At some point a person, usually in the teen years, makes a conscious decision to be or not be a certain way. This decision then becomes an integral part of who they are transitioning to the subconscious level. For instance, a teen might despise an overly emotional parent (biology) because their discipline was never consistent (environment) and therefore decide to never show emotion. This is an over-simplification, but it serves the point that choice could also be a factor.
When does it develop? Technically, a PD cannot be diagnosed in a person until they reach eighteen years of age, but for many people with PDs evidence of it must exist in the early teens. Sometimes the traits of a PD are seen in the very early years but not the PD itself. Traits are not the same as a disorder. Think back to the bell-shaped curve: a trait is in the medium range whereas a disorder is in the smallest range. A trait is not as intense as the disorder. Rather it is a milder version. So, a child can display the traits but not actually ever develop the disorder.
The reason for the delay in diagnosis is best explained through Erik Erikson’s Eight Stages of Psychosocial Development. The fourth stage from twelve to eighteen is Identity vs. Confusion. During these years, a teen is experimenting with a variety of personalities from family and peers to see which is most like who they want to be. If all goes well, they don’t formally develop their identity until eighteen at the earliest. Therefore a PD can’t be diagnosed until a personality is established.
What is the technical definition? According to the DSM-V, a PD must meet the following criterion:
- An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture (think of the bell-shaped curve). This pattern is manifested in two or more of the following areas:
- Cognition (ways of perceiving and interpreting self, other people and events)
- Affectivity (the range, intensity, ability, and appropriateness of emotional response)
- Interpersonal functioning
- Impulse control
- The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
- The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The pattern is stable and of long duration, and its onset can be traced to adolescence or early adulthood.
- The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
- The enduring pattern is not attributable to the physiological effects of a substance (drug abuse) or another medical condition (head trauma).
What are the different types of PDs? The DSM-V lists the following as specific PDs:
- Cluster A: Paranoid PD, Schizoid PD, Schizotypal PD
- Cluster B: Anti-Social PD, Borderline PD, Histrionic PD, Narcissistic PD
- Cluster C: Avoidant PD, Dependent PD, Obsessive-Compulsive PD
Other PDs which did not make the DSM-V are:
- Sadistic (usually considered to be part of Anti-Social PD)
This summary is just a basic introduction to the concept of PDs to help you understand what they are and where they come from. The first step to having a successful relationship with someone who has a PD is to educate yourself and be aware of what the PD looks like and what it means.