For the past several weeks, I’ve been posting on commonly misunderstood psychological concepts and terms (See, for example: Mental Illnesses, Diseases, and “Disorders” and Addiction, Codependence, PTSD, Anxiety and Self-Esteem). In this week’s article, I’ll do my best to explain the difference between disorders of behavior and impulse control that stem from clinical conditions largely outside of a person’s ability to control and problematic behavior patterns that are part and parcel of a person’s preferred way of dealing with life (i.e. a manifestation of their character disturbance). Unfortunately, because of the way we officially classify mental disorders these days, making the above distinction accurately is not always easy. Most clinicians don’t make thorough personality/character assessments of their clients during their initial evaluations, so many times folks get diagnosed with various behavior or impulse control “disorders” simply because they meet the official behavioral criteria. As a result, they’re sometimes misjudged as to their actual or overriding pathology, and, as a result, receive improper intervention.
Certain primarily biologically-rooted clinical conditions can make an otherwise well-adjusted individual (i.e. a person without significant personality or character disturbance) quite unstable and unpredictable. For example, individuals who suffer from bouts of mania can, in their hyper-elated state, engage in reckless, impetuous, overly adventurous behavior, (sometimes losing all their money on a risky venture, going on a gambling spree, or engaging in high-risk daredevil acts even after several nights without sleep). They might even become uncharacteristically volatile and aggressive during their manic episodes And when such individuals are otherwise healthy in personality and character, their disorder-caused behavior not only troubles their family and friends but also is abhorrent to them, because their actions are so “out of character.” It unnerves a person of good character to think that they did and said things in their altered state that they would never even think of doing normally (This is equally true of those who become aware of problem behaviors they exhibited while under the influence of alcohol or other substances). They’re the first to want some help in getting back to normal and preventing future aberrant behavior. They would have a hard time living with themselves otherwise and see it as their responsibility to do what they can to make things right again.
Folks who have sustained brain injuries, or are afflicted with some other disease process that affects brain functioning can also display behavioral irregularities. They might blurt things out without exercising good discretion or even physically lash out with an uncharacteristic lack of restraint. And depending upon how the condition they have impairs their ability to recognize and appreciate the inappropriateness of their behavior (For example, persons in the early stages of Alzheimer’s Disease or some other form of Dementia might not even remember let alone have good awareness about the changes that have come over them and the aberrant behaviors they’ve displayed), most of the time, they’re likely to not only be concerned about their uncharacteristic behavior but also might experience some depression over feeling powerless to better control it. In some rare cases, brain trauma can even cause significant changes in personality. That is, a person might experience changes in brain functioning that affect the various functions (including impulse control), such as self-appraisal capacity, empathy level, frustration tolerance threshold, etc., that help comprise personality, thus producing a change in their coping style.
Behavior and impulse control problems that arise strictly from conditions outside a person’s ability to control (as well as brain conditions that alter personality) are really quite rare . And when they do occur, they can afflict both folks who are healthy in character and folks who already have some disturbances of character (in which case the “dynamic interaction” between the person’s clinical condition and their maladjusted personality can really complicate matters). But in my experience, many folks get diagnosed with various behavioral and impulse control disorders when their primary pathology is one of personality or character. A person who routinely berates his/her spouse, is habitually callous, inconsiderate, or abusive, pitches fits when things don’t go as desired, is financially irresponsible, etc. because he/she both has always felt entitled to do so and is perfectly comfortable with that way of behaving, might well qualify for an impulse control disorder diagnosis, but their real pathology most likely lies with their disturbed or disordered character.
Why does all this matter? It matters because of what needs to be done to rectify the problem. If someone’s behavior and impulse control problems are truly a problem of chemistry, then appropriate medication (and supportive counseling) is what’s indicated. But if the problem is primarily one of character, then the person’s way of looking at the world – the various ways they think about things, the attitudes they hold, etc. – all need to be confronted and corrected in within a highly specialized treatment framework (For more on this see the articles: Character Disturbance: Getting the Right Kind of Help and Getting the Right Kind of Help – Part 2 as well as the concluding two chapters in Character Disturbance). And while for a time it might indeed be necessary to intervene with behavior-altering drugs (in which case a behavior or impulse control disorder might have to be diagnosed for practical purposes even if it’s not the principal or more accurate diagnosis), strictly medical intervention is rarely the long-term solution.
Next week’s article will feature some vignettes of folks who were frustrated in their attempts to get the right kind of help for their out-of-control relationship partners and along the way learned some hard lessons about character disturbance.
This Sunday’s Character Matters program will re-visit dangerous ideologies and the kinds of disturbed characters who are drawn to them.