When I went to P&S, one of the great features of its curriculum was its Psychiatry requirement which spanned a full two and a half years of our time there. It was among my favorite experiences from medical school. In that first year, among other things, we discovered how really crazy we all were, each of us, in our own special way. It was then I discovered the DSM Personality Disorders, which is kind of an “interesting personalities” index. Rather like a Zodiac sign, my pals and I immediately set about viewing those around us through the lens of their particular personality disorder. People rubbing shoulders in large cities brings out these personality disorders like rubbing oregano brings out its spicy aroma.
According to the DSM-IV-TR Axis II (the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders), the person with the personality disorder has to meet first the general criteria of having “an enduring pattern of inner experience and behavior deviating markedly from the expectations of the individual’s culture.” This is a very interesting criteria because it implies the existence of whole cultures that are crazy and where that flavor of crazy is normative (think Klingons before the Khitomer Accords). It also implies that whole families may be crazy, but within the confines of that family, one’s crazy behavior may seem “normal,” and children from such families only realize how abnormal their families are once they leave for college. This is not a personality disorder if the individual realizes that yelling their frustrations is not normative and corrects that behavior. This is an important feature of the general diagnostic criteria -that two out of four deviations go unrecognized in terms of cognition (self perception and interpretation of others and events), affect (range, intensity, lability and appropriateness of emotional response), interpersonal functioning, and impulse control.
Also in this definition, this personality pattern is inflexible and persists along a broad range of personal and social situations, leading to distress or impairment in personal, social, and occupational functioning. This pattern is persistent and present for a long period of time, and not secondary to another primary mental disorder, substance abuse or medical condition. It means the person affected by a personality disorder may or may not be aware of their “deviation from the norm.”
The personality disorder list is then grouped into three clusters with subcategories.
Cluster A (odd or eccentric disorders)
-Paranoid personality disorder
-Schizoid personality disorder
-Schizotypal personality disorder
Cluster B (dramatic, emotional, or erratic disorders)
-Antisocial personality disorder
-Borderline personality disorder
-Histrionic personality disorder
-Narcissistic personality disorder
Cluster C (anxious or fearful disorder)
-Avoidant personality disorder
-Dependent personality disorder
-Obsessive-compulsive personality disorder
Appendix B -for further study
-Depressive personality disorder
-Passive-aggressive personality disorder
Deleted from DSM IV but present in DSM III-R
-Sadistic personality disorder
-Self-defeating (masochistic) personality disorder
The key point in personality disorders is that their conditions are considered out of the norm but not completely incapacitating. Most people have some degree of the above characteristics, and the differences in the ingredients results in the person. The PD-afflicted individual has one of the above characteristics in superabundance, resulting in flawed social interaction. Through this year, we’ll go through the personality disorders and figure out why some people behave the way they do.