Demystifying Personality Disorders

Reader’s Question

As a child, I was treated for personality disorder. I was wondering if it ever goes away? And how can I get my doctor to check to see if I still have it? I told my doctor that when I was a child I was treated for it and she said she didn’t see how. But it has been over 20 years, so I cannot get my old medical records to show her.

Psychologist’s Reply

Unlike other mental health disorders, personality disorders can only be diagnosed when someone exhibits long-term, stable personality traits that impede healthy functioning or cause the person distress. Because of this, they are only rarely diagnosed in adolescents, and always with the understanding that the disorder may not persist into adult life. I have never heard of anyone diagnosing a child (i.e. non-adolescent) with a personality disorder, and I would seriously question that diagnosis for a young patient.

Given the above, it sounds to me like your doctor is correct in questioning any personality disorder diagnosis you were given as a child. However, as you seem quite concerned about this past diagnosis and its meaning, it might be helpful to demystify what it means to have a personality disorder.

Your unique personality is made up of many different traits, or ways of experiencing the world. The way we process and interpret stimuli, and our interpersonal relational strategies and beliefs are all examples of these traits. Our gender and culture will typically heavily influence how our personality traits are developed. While no one can be held up as a perfect example of a ‘normal’ personality, someone with a personality disorder possesses traits which are maladaptive — they interfere with that person’s ability to function in their culture or society and/or cause the person significant internal distress.

There are 10 identified personality disorders in the DSM-IV-TR, broken into three major clusters.

• Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders — these people may seem odd, unusual, or bizarre to others.
• Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders — individuals with these disorders may seem dramatic, overly emotional, unreliable, or self-centered.
• Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders — these people are often anxious, worried, or apprehensive.

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What does this mean? Well, notice that someone does not have to feel personal distress in order to receive a personality disorder diagnosis. For example, someone with an Obsessive-Compulsive Disorder is very distressed by their symptoms. They are most often aware of how disruptive their obsessions and compulsive thoughts are and how they are interfering with their functioning; moreover, they are disturbed by their symptoms. In contrast, someone with Obsessive-Compulsive Personality Disorder might drive people around them up the wall with their rigid and meticulous attention to detail, but their behavior feels right and natural to themselves. Treatment for the two disorders would also be completely different, and have different prognoses. Someone with OCD would most likely be very motivated to find relief from their symptoms, while the person with OCPD is less likely to desire change and might need to be brought into treatment by a family member or a directive from a boss.

Of course, this is not to say that people with personality disorders cannot feel distress as a result of their inflexible and maladaptive traits. For example, a person with Schizoid Personality Disorder generally avoids any intimacy with others and shies away from social interaction. At least in part, however, this is because their inability to engage with others in a ‘normal’ way is a source of great pain.

Should you and your doctor determine that your symptoms meet the criteria for a personality disorder, be aware that there are treatments designed specifically for some of these diagnoses that can be extremely helpful. For example, Dr. Marsha Linehan developed Dialectical Behavior Therapy as a treatment for people with Borderline Personality Disorder. You should ask your doctor if she has experience working with your specific diagnosis and is familiar with treatments for it. You might be served well by seeing a therapist who specializes in treating clients with your diagnosis.