The last two posts have discussed the many misconceptions about personality and character, how personality and character have been traditionally defined, how these concepts are best defined in the light of the latest research, and what it means for someone’s personality to be so problematic it is rightfully considered a “disorder.” These articles set a backdrop for understanding the various personality and character disorders and how they can best be dealt with. But before launching into that discussion in earnest, I thought it might be helpful to summarize, compare, and contrast the traditional and more current, multidimensional perspectives on personality and personality dysfunction:
- The various personality types are defined by the kinds of “defenses” people unconsciously construct to ease their fears and anxieties.
- Personality is an unconsciously constructed facade or “false-self.”
- Underneath the false-fronts we present to others, everyone is the basically same and “good.”
- Environment is primarily what shapes our personality and our earliest experiences have the greatest influence.
- Traumatic experiences and inadequate coping defenses are the causes of personality dysfunction.
- The “cure” for personality dysfunction is healing the wounds of early trauma and gaining insight into unconscious fears.
- Personality types are defined by the unique ways (i.e. “styles”) in which people perceive and relate to others and the world at large.
- Generally speaking, a person’s “style” of relating is a genuine representation of their conscious and preferred way of coping.
- Everyone has a unique set of adaptive (i.e. “good”) and maladaptive (i.e. “bad”) traits, both innate and acquired.
- Many factors (e.g., innate predispositions, environmental factors, and dynamic interactions between the two) shape our personality throughout our lifetime but certain developmental variables and milestones are critical.
- Personality dysfunction is caused by erroneous ways of thinking and problematic but habitual ways of behaving.
- Personality dysfunction can be “modified” by prompting and reinforcing more adaptive thinking and behavior patterns. The more longstanding our thinking and behavioral “bad habits” have been in place and reinforced, the harder it is to modify them.
From the comparisons above, it’s easy to see how some radically different opinions developed on how to treat personality and character disturbances. All these things will be important to keep in mind as we begin our discussion on personality and character disorders.
When a person’s preferred “style” of perceiving and dealing with the world deviates from the norm to too great an extent, reflects a degree of rigidity that makes it impossible for the person to consider or try out alternate ways of coping, and persists despite the fact that it causes distress for the person and/or problems in relationships and for society at large, it is rightfully considered a “disorder.” When a personality disorder reflects weak personal ethics, and deficient social conscientiousness, it can be considered a “character disorder. ”
A Huge Cultural Problem
Defining a personality disorder in this day and age is no easy chore. One reason is because for the better part of the last century there’s been a bias in the professional community against recognizing personality disorders and their role in psychological problems. And that bias is greater today than it ever has been. In fact, the latest incarnation of the official diagnostic manual of the American Psychiatric Association (the DSM) has all but done away with one of the most troubling personality disorders (Narcissistic Personality Disorder). Another reason is that by definition a personality style has to deviate from the norm substantially and prove significantly dysfunctional in order to be considered a disorder. In many modern cultures, some styles once widely regarded as problematic and disordered (and which were frequently viewed with disfavor) are actually closer to the norm than ever before. And in some environments, these styles can even seem quite adaptive. The cultural climate of many large corporations and the social climate of many permissive societies actually seem to foster and encourage many personality patterns we once used to universally regard as dysfunctional and socially harmful.
An Even Bigger Problem in Mental Health
Now much of what I have to say next necessarily has to be oversimplified for popular consumption. But because of how important it is for understanding the material on personality disorders to come, I’ve got to take a stab at it.
Truth be told, there are relatively few problems that come to the attention of mental health professionals that are strictly the result of disease processes, biochemical abnormalities, extreme and unusual circumstances, or involuntary factors. Personality disturbances, and especially character issues, are often at the heart of things, even though they’re rarely diagnosed or given the appropriate focus of attention in treatment. A person whose habitual “style” of relating is marked by impulsivity, hot-headedness, interpersonal contentiousness, exploitation, and abuse might be dragged into a psychiatrist’s office and given medication that moderates some of his/her impulsiveness. The person might also be diagnosed as “bipolar,” (in no small measure to justify the type of medication they were given), even when the real underlying problem is the person’s antisocial personality.
It’s really hard to find a case where personality is not a major player in a person’s difficulties, regardless of the clinical label they might be given. In mental health, there are 5 dimensions of functioning (called diagnostic axes) not all of which professionals are required to to factor into their diagnostic formulations but all of which really should be considered to arrive at the most accurate assessment of person’s problems. Personality patterns and disorders (as well as developmental conditions) are diagnosed on Axis II, clinical syndromes on Axis I, complicating physical medical illnesses on Axis III, severity of environmental stressors on Axis IV and level of adaptive functioning (at highest point within the past year and currently) on Axis V.
Let’s say a person is rightfully diagnosed with an Adjustment Disorder on Axis I. This means that he/she is exhibiting a pattern of unhealthy and abnormal emotional and behavioral adjustment to situational stress that is in excess of what one would normally expect, given the nature of the stressor. If in fact she/he has no personality disturbance (i.e. the person has a generally a very healthy, well-balanced personality) and no diagnosis is warranted on Axis II, one would expect the situational stressor in his/her life to be very significant, for his/her normal level of overall functioning to be quite high, for that level of functioning to be only temporarily lower, and for that person to be “back to normal” and functioning at her/his usual high level when the stressor abates or he/she has learned to cope. In short, there is an inextricably intertwined relationship between all these diagnostic dimensions, all of which should be part of the official assessment scheme. But rarely is this kind of thing done. The problem is that many times, the PRIMARY diagnosis (or the most significant issue requiring attention and treatment is the really the person’s personality dysfunction, even though it’s rarely even cited. And in those cases where personality is the major problem, even an “adjustment disorder” picture would look entirely different. The person’s level of functioning would be chronically marginal, might have gotten a bit worse when the stressor appeared, but would be expected to only get back to moderately impaired once the stressor abates. It’s also likely that it didn’t take much of a stressor to make the usual bad behavior pattern worse in the first place, and the stressor might even have come about as a result of personality dysfunction (e.g., the person cussed at his/her boss and offended a co-worker for the umpteenth time, and got fired again).
We’re now ready to look at the various personality and character disturbances and disorders and what we can do about them both in relationships and professionally. Hopefully, these first 3 posts in the series have set a proper background for a the discussion that will inevitably ensue.