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Personality Disorders


Here we are at personality disorders. This lesson offers an introduction to personality disorders, and it includes some of the most important take home information. I would say it serves as a good starting point. And it might even be sufficient on its own. So I'm trying to pack in as much information as I can.

And I'm going to have to discipline myself to hold back a little bit cuz I want to give you as much as I can in a relatively brief lesson. But I could talk about this for hours, so. A lot of people don't understand what personality disorders are, so we can think of them basically as labels. Personality disorders themselves are labels.

They're used to describe people. And specifically, to describe people who consistently react to life in extreme ways that cause difficulties for themselves and the people in their lives. Personality disorders are fairly common, and in the U.S. about 9% of people are thought to have one or more personality disorders. Most of these people never receive diagnoses, and that's largely because, as we'll see, people with personality disorders don't readily seek treatment.

There are some common misconceptions about personality disorders. And so, I'm gonna clear up some of those right here. They are not categories of delusion or hallucinations, so they're not considered psychotic ailments. They're also not mood disorders, which are very commonly diagnosed, such as depression, anxiety, bipolar, OCD.

However, many people with personality disorders also have mood disorders. Sadly, PDs are not easily treated. Not with Psychotherapy, not with medications, although both can help. And they're even more difficult to actually cure. The general prognosis is that people can get better. Being cured is not expected.

What therapists can do is teach the individual more adaptive ways of living, less extreme reactions to life. Personality disorders are longstanding. They're usually evident by somebody's late teens or early twenties. And they're almost always linked to some kind of childhood trauma, often neglect. Another common scenario is that caregivers of an individual have personality disorders, and that individual grows up to have a personality disorder themselves.

One reason that PDs are difficult to treat is because individuals with personality disorders often think their approach to life is just fine. They're doing okay, they might even say that their approach to life is justifiable, and if anything other people should be more like them. This isn't true across the board, but people with extreme personality disorders are often very resistant to changing the way they act and interact.

Personality disorders are extremely controversial. And that's because they're basically defined as just extreme versions of what we can see as relatively common ways of being. And you'll recognize that right off the bat as we go into the different clusters, ABC. Many people ask, and rightly so I think, what is the line anyway between normal and disordered?

And I really wanna emphasize that point, because the tendency when people first learn about personality disorders is they diagnose themselves, they diagnosed their friends. I'd said before that about 9% of people probably have personality disorders, more like 90% of people have characteristics that are very similar to personality disorders.

And so this line is really a judgement call. And it's something that psychiatrists are in a position to differentiate. So let's go through the three clusters. Cluster A. I think of it, A for awkward or A for alone. It's usually defined as socially withdrawn, but I try and give you mnemonics when I can.

And there are three types of Cluster A. But I'm going to show you these two at once because they look very similar and it's helpful to think about them alongside one another. People with schizoid personality disorder are detached, emotionally cold, isolated, usually don't want a lot of social companionship, don't crave it. It's not the same thing as being introverted or shy or afraid of social interactions.

People with schizoid personality disorders are very content to just live alone. People with schizotypal personality disorder are often also kind of socially isolated, but not necessarily. Their manifestations are more along the lines of magical thinking, outlandish, odd habits. And the thing that makes this a disorder instead of just being eccentric is that it's very difficult for other people to relate to them.

And it's difficult for them to relate to other people. They might have a social group that likes to dress up in Medieval wear and stage sword fights. And all of them might be a little bit on the margins, but somebody with Schizotypal Personality Disorder might decide they just wanna live that way everyday.

And they might even start to believe the fantasy themselves, but they're not actually psychotic. If someone asked them point blank what year is it, they would know it's 20, I'm recording this in 2017, for instance. A person with Paranoid Personality Disorder has a pervasive mistrust of others.

Usually not along the lines of conspiracy theories, but more like they carry and perceive vendettas. They hold grudges, and they just have a very negative orientation towards others. All three of these types often look a little bit odd. Might have poor grooming habits, and that's because they're kind of resisting social interactions, resisting the realities of social interactions.

Now, this is a good opportunity to introduce the word prodrome. A prodrome is an early symptom or sign of a disease that will eventually manifest. Looking at these three types, it's hard not to at least think about schizophrenia. The question is are any of these types related to schizophrenia. And it turns out that actually one of them is, and I encourage you to just take a guess really quickly, which of these three types would you guess turn into possibly schizophrenia?

It's actually this one. Schizotypal personality disorders, those individuals have about, it's still less than 10% likelihood that they will develop schizophrenia. But it's much higher than these others. Okay, moving on to Cluster B. I think of B for brash.

Usually it's define as dramatic. But again, I'm trying to find a B word. This cluster is very much about social interaction. They're not necessarily developing good relationships, and in fact that's one of the problems with personality disorders across the board. But they engage other people a lot.

They're pushing and pulling people, unpredictable and dangerous to themselves and or others depending on the person, depending on the condition. Somebody with borderline personality disorder usually has a history of extreme pushing and pulling in relationships. I love you, I hate you. You're the best, you're the worst thing that's ever happened to me.

And sometimes those sentiments will just flip-flop within the period of minutes. They have black-and-white thinking, things are all good or all bad. Usually manipulative, especially if they feel like somebody's going to leave them or abandon them. And a very incidence of self-harming. A lot of people who attempt suicide, a lot of people with eating disorders, people who cut themselves, have or are diagnosed with borderline personality disorder.

People with borderline are more likely to be female by about a 3-1 ratio. Narcissists are more likely to be male. And when we're talking about narcissism here, we're not talking about vanity. I think the best word to describe it is somebody who is grandiose. And there's sort of an irony built into this, in that they actually wind up blocking out the perceptions of others.

Their whole goal is to get fanfare. And so you'd think that they'd be very, very attuned to what others think of them. But the truth is, it's so hard for them to see any signs of rejection or belittling that their tendency becomes to just block out other people's perceptions altogether. What makes a narcissist a narcissist is that they don't really read the cues when other people are actually annoyed, or other people are hurt.

It doesn't matter to them on some level. Somebody who's histrionic is attention seeking. Might be seductive, might feign illness, might even lie about something that's happened that never really happened to get attention and sympathy from others. The word histrionic, like the word hysterical, comes from the Greek word hystera.

And hystera means uterus. And the picture that comes to mind for a lot of people is maybe the aristocratic women of the 19th century who would faint for attention. And kind of a titular way of sort of belittling the expression of that woman. And then the last one here is antisocial, and this one really stands alone. Antisocial individuals lack empathy.

Extreme antisocial people would even be called sociopaths. They often don't feel any guilt, they don't feel remorse. Somebody with mild anti-social personality disorder would just not really care at all about the suffering of others. Somebody who is a sociopath is actively trying to harm others. And last, we have Cluster C.

I think of cautious, constrained, contracted. These are individuals who have a kind of fearful, tense reaction to life. Avoidant personality disorder. This is someone who is very sensitive, feels inferior, fears humiliation, has an unrealistic sense of other people's reactions to them. Extremely insecure.

It's easy to think that Avoidant refers to characteristics that are more like schizoid, if you remember Cluster A, our very first type. Schizoid and Avoidant are quite different. Schizoid is just a loner. Somebody who is Avoidant is hyper attuned to any slight clue or perception that somebody else might think poorly of them.

Somebody with Dependent PD is very submissive, clingy, fear, separation, wants to be the child in a relationship. This is different than borderline because people who are Dependent just kind of want to hide behind another person. Whereas people who are borderline very much want to define who they are, want to express who they are.

And last on our list, we have Obsessive Compulsive Personality Disorder. This is someone who has an extreme need for order, perfection. They tend to be very rigid, and righteous. It's not the same as Obsessive Compulsive Disorder. This P in the name makes all the difference. Both types, OCPD and OCD, and both individuals might do something like always line up their shoes by the front door.

And maybe not even leave their house until their shoes are lined up perfectly. The difference is that people with OCD feel plagued by this habit. They feel anxious. They wish they didn't have to do this. They feel compulsion. They feel sort of trapped by the behavior.

Somebody with OCPD thinks they're right. Their way of acting is right, and other people should do the same thing they do. People with OCPD are often very shaming of other people and their lives. So it's hard to be a child or a spouse of someone who has OCPD. And the gender breakdown of these three, we see women more diagnosed among these categories, and more men diagnosed as OCPD.

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