People are different from each other; when these differences consistently cause problems, they may amount to personality disorders.
The Diagnostic and Statistical Manual
The Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association describes a wide variety of mental problems, including personality disorders. The book is organized into groups, or axes, wherein Axis I includes severe psychopathologies such as schizophrenia, and Axis II includes the personality disorders.
The DSM-IV attempts to make psychological diagnosis more objective and provides useful categories for various purposes, including research and billing. A new edition, the DSM-V, is due to be published soon.
Defining Personality Disorders
All personality disorders have two essential characteristics: (1) They are unusually extreme in a way that generally entails a distortion of reality, and (2) they cause problems for the self or others.
Most, if not all, personality disorders are also social and stable. In addition, some disorders are ego-syntonic, which means they are not experienced as problems by the people diagnosed with the disorder.
Bases for Diagnosis
Diagnosis of a personality disorder may be based on clinical impressions, self-report inventories, structured interviews, or informants’ reports.
The Major Personality Disorders
The DSM-IV lists 10 major personality disorders divided into three categories: Cluster A, the odd/eccentric disorders, include schizotypal, schizoid, and paranoid personality disorder. Cluster B, the impulsive/erratic disorders, include histrionic, narcissistic, antisocial, and borderline personality disorders. -Cluster C, the anxious/avoidant disorders, include dependent, avoidant, and obsessive-compulsive personality disorders.
Schizotypal personality disorder is characterized by odd beliefs, eccentric behavior, and inappropriate emotions, and problems in interpersonal relationships.
Borderline personality disorder is a serious affliction characterized by confused thinking, emotional vulnerability and instability, identity confusion, and dangerous patterns of self-harm.
Obsessive-compulsive personality disorder is a pattern of excessive devotion to rules, organization, and habits along with inflexibility or resistance to change.
For each disorder, the DSM-IV provides a list of characteristics and the minimum number that must be present to justify an official diagnosis. Thus, people with the same diagnosis may be quite different from each other, so each disorder should be thought of as a prototype rather than as a list of necessary and sufficient features.
Organizing the Personality Disorders
Several ways to organize the personality disorders along critical dimensions have been proposed. The most useful may be the familiar Big Five list of essential traits, which appears to apply to abnormal as well as normal personality.
Toward the DSM-V
The forthcoming DSM-V will aim to clarify diagnostic criteria and view personality disorders in terms of dimensions along which people can vary, rather than discrete categories.
The DSM-V retains six personality disorders from the previous edition and also prescribes assessing clients in terms of five maladaptive traits: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. These five can be thought of as extremes of the Big Five traits of normal personality.
Diagnosis according to the DSM-V is a multistep process that begins with assessing the client’s overall level of personality functioning, deciding whether she matches any of the six disorders, and then rating her on the five maladaptive traits.
Personality and Disorder
Pathologizing undesirable behavior can raise difficult moral issues, and also risks describing so many patterns as mental illnesses that the concept of illness begins to lose its meaning.
A list of psychological disorders does not imply a definition of mental health.
Labeling disorders carries serious risks, but also has helpful applications and may be inevitable.
The line between normal personality variation and personality disorder is fine and uncertain. Indeed, some personality disorders can be seen as exaggerations of traits that, in moderation, are desirable.