Monday, May 9, 2011

The (Extremely) Quick and Dirty on Personality Disorders

What do you guys know about personality disorders? My guess: not a whole lot. And not because you're not a well-informed bunch of people, because of course you are! It's just ... I think there's a lot of confusion out there about them.

First, let me explain something. When we diagnose (using the DSM-IV, which is not the only diagnostic system, but is the most commonly used among American mental health professionals), we do so on five "axes". I'll explain the whole system in a future post, but basically:
  • Axis I disorders are considered "clinical" disorders, that is, in need of clinical attention. Things like anxiety, depression, schizophrenia, and bipolar disorder are Axis I disorders.
  • Axis II disorders are of two types: mental retardation and personality disorders.

Personality disorders signal that a person is showing a relatively inflexible pattern of behaviors, thoughts, and emotions across most of his/her environments, and that inflexible pattern is almost certainly causing the person some trouble in terms of occupational, personal, and relational functioning.

There are three "clusters" of personality disorders outlined in the DSM-IV (and a few more identified in other diagnostic systems, but I won't get in to those today). Below is a tiny snippet about each--keep in mind that, to be diagnosed with a personality disorder, the behavior has to cause impairment, AND it has to be out of the norm for one's culture and society.

Cluster A (the odd or eccentric patterns):
  • Paranoid Personality Disorder--irrational suspicions and extreme distrust of others
  • Schizoid Personality Disorder--extreme lack of interest in other people and relationships
  • Schizotypal Personality Disorder--odd behavior and thinking

Cluster B (the dramatic, emotional, or erratic patterns):
  • Antisocial Personality Disorder--pervasive disregard for the law and rights of others
  • Histrionic Personality Disorder--pervasive attention-seeking behavior (i.e., inappropriate sexual seductiveness and shallow, exaggerated emotions)
  • Borderline Personality Disorder--instability in self-image, relationships, and identity often resulting in impulsivity and self-harm (I'll bet nearly all of y'all have heard of this one)
  • Narcissistic Personality Disorder--grandiosity, need for admiration, lack of empathy

Cluster C (the anxious or fearful patterns):
  • Avoidant Personality Disorder--social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation
  • Obsessive-Compulsive Personality Disorder--precoccupation with orderliness and interpersonal control at the expense of flexibility, openness, and efficiency
  • Dependent Personality Disorder--extreme psychological dependence on other people

These disorders really shouldn't be diagnosed until late adolescence or adulthood. The prognosis depends on the disorder. Most people with these disorders don't seek treatment until their behaviors have caused them some real suffering and turmoil in their lives. Studies show that adolescents with personality disorders are twice as likely to develop an Axis I disorder (like depression or anxiety) in adulthood when compared to their non-personality-disordered peers.

In other words, personality disorders make a person more vulnerable to other bad stuff. And also harder to treat.

I'll be doing posts on nearly every one of these personality disorders at some point. Although these disorders are not pleasant in real life, they could really make for some powerful, interesting characters in a novel, and you'll see an example of this Wednesday, when I will post about Obsessive-Compulsive Personality Disorder.

So ... are you familiar with the term "personality disorder"? Were you aware it was actually numerous disorders? Which ones have you heard of, and which ones are new to you? Are there any in particular you'd like to know more about sooner rather than later? Have you ever written a character with a personality disorder (either intentionally or unintentionally)?

Today's Monday, so remember to visit Lydia to read her Medical Monday post, and Laura for her Mental Health Monday post.


  1. This all sounds familiar to me. I took an abnormal psychology class back in college ... uh, a couple decades ago. But I'm pretty sure those categories have been updated since then. :)

  2. Very interesting post. To have these disorders, do they have to be "full blown"? Or can there be "low grade" forms of these? My protagonist has a bit of OCD, but not too much, just enough to be funny (I write humorous women's fiction). But is that being true to the disorder?

  3. I've got a character with traits of both of these:
    Histrionic Personality Disorder & Narcissistic Personality Disorder in my WIP. Sadly I'm familiar enough with both to write someone who exhibits signs. To her, there's nothing about her behavior that's out of the norm, but she creates strife and havoc for the rest of her family.

    So long as you don't make the person a caricature based on something you may have seen on TV once, psychological issues can make for an added layer of tension, even if they aren't the focus of the story.

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  5. Whoah, horrible typos in my last comment. Let's start again! I said:
    Such interesting stuff, Sarah. Yeah I did know there were different types of personality disorders but no so many! Wow. I'd be really interested to know about Schizoid Personality Disorder. It's made me wonder what kind of behavior you'd have to have in order to be diagnosed of it. Would the person have to, for instance, constantly talk about themselves and ignore others, or would they just show a complete lack of connection to other people? And what actions define this? It seems like a really tough thing to diagnose. Surely there are plenty of people who behave like this naturally? Interested to find out!

  6. This is an extremely helpful post, as I'm currently trying to diagnose my main character. Thanks for the info!

  7. Wow, this is a blur from my abnormal psych course I took back in university. I'm looking forward to all your posts, Sarah. This is way more interesting than it was back when I took psych xx years ago. :D

  8. I didn't realize there was such an intricate breakdown of it all. Very interesting. Personally, I've never written a character who is that extreme in their instability, but now you've got me itching to....

  9. Wow - great post. Bookmarking this one as a great character reference should I need it.:)

  10. with these has to be difficult, especially if a diagnosis shouldn't be determined until adulthood. There are many that are so similar. It's got to take time to sort out the differences and every case is so different.

  11. This is a very useful post. I have a character in my WIP who suffers from Paranoid Personality Disorder and Obsessive Compulsive Personality Disorder. It's interesting to note, though, that he's a privileged teen, and hasn't experienced significant life disruption as a result of it...which makes it more plausible that nobody but is brother really knows about his problems. Nice to have some confirmation of the plausibility of that. I'll be passing on the link!

  12. What really gets me are the people with more than one personality disorder, hehe. O.o

  13. Thanks for the interesting post. I never realized how much psychology can assist in character building (as in a novel - not my own). I am working on other's perspectives of my MCs behavior and this may be helpful.

  14. first, i want to say that i ADORE the picture accompaning this post! so cool!

    second, yep! i've actually heard of ALL of these! whoohoo for me! usually, i'm so behind! :) but i've heard of them in a completely bad way. there was this silly little online quiz, that was going around that stated very clearly that it was NOT to be used as a diagnostic tool, but was supposed to tell how likely you were to have one of those. and i SWEAR, it actually came pretty close to what i would guess people were. :)

    third- i really HATE the term personality DISORDER... i think it carries with it a negative connotation, that there is something WRONG with people who have a certain personality. i'm more of the opinion (however uninformed i may be!) that people are people- persons and what makes them up- their personalities- doesn't have to fit all in one bubble of what is socially optimal or "right." i don't think that's what most mental health professionals are going for- seriously they chose their professions to help people be able to function optimally, they care (for the most part!)- but i do think the terminology is unfortunate, if that makes sense!

    sarah! i just love your posts! better than coffee for getting the brain rolliing in the a.m.! :)

  15. Hey Sarah,
    Great post as usual. When I find myself reacting emotionally to people in a negative but strong way, I wonder if they may have one of these. Then again, maybe it's me, ha ha.

  16. I usually hear people refer to "a personality disorder" so I was aware there were multiple types. Some were new to me, in name. Many were not. Looking forward to your specific posts! This is great info for us writers.

  17. I agree with aspiring_x on the great pic. What I got after reading this great post, Sarah, is that I really need to read a book on psychology! Thanks for all the learning going on over here at The Strange Situation.

  18. Had no idea there were so many types. I read something with a case of hebephrenic schizophrenia once and that made me think twice about what I knew. I think the author just liked the sound of the diagnosis, because there wasn't that much info about the disease. I had to look it up later. :)

  19. Really interesting, as always. Some I have and some I have not heard of. And although I'd heard of Borderline, I really have a hard time grasping that one for some reason. So I guess I'd like to hear more on that. They all sound interesting though.

  20. hi miss sarah! my brother works with mental ill people. he says for him the most hardest is those ones with those personality disorders specially that borderline stuff. i dont know so much bout this mental stuff but for sure youre a good teacher and im learning lots from on your blog. my brothers gonna be just real surprised on how much i been learning from you.
    ...hugs from lenny

  21. Great info. I didn't know about the link between teens with personality disorders and Axis I disorders later.

  22. Great breakdown, as usual, Sarah!

    I was once diagnosed with Oppositional Defiance Disorder (because that "educational consultant" was getting a kickback from the institution he was trying to send me to), which basically just meant that I wouldn't listen to people in positions of authority if I thought they were fuckocked. That actually sounds pretty wise to me, now.

    Also, I was 15, and I don't know many teenagers who do well with authority.

    But I feel much better now!

  23. It will be hard, but I can't wait until Wednesday. OCPD has always been fascinating to me.

  24. Great post Sarah. . . a lot of this stuff I think I've always incorrectly labeled in my own mind. Seeing your explanations and descriptions is really eye opening!

  25. I use my DSM IV to help me create interesting characters. Sometimes its hard to get the right mix.

    I have two brothers with bi-polar II - I wanted them mostly functional, and one has a drug addiction also. He is so much fun to write :)


  26. Great information! I'd heard of all of these, but I didn't know how they were classified. OCD is the one I'm most familiar with. I'm looking forward to your post on it. I'd like to learn more about the Schizotypal Personality Disorder too.

  27. I love this stuff, I have to admit. So much so that I've made a study of some of it, and I'm so glad you asked if there's more we'd like to know because here's my question! (bear with me, it's long and has backstory): I have an important character in my WIP who has a personality disorder--a cross of narcissistic and histrionic, with anxiety and addiction thrown in. He's an antagonist, but plays an important and revered role in his societal group. My problem: I hate him. I can't seem to find the compassion or empathy for him that I can usually come up with for about anyone. If my own block here remains a given (and yes, I do know why it's there), what kinds of positive characteristics can I look for in him that will soften my attitude so I can write him fairly?

  28. I'll just stick with "personality disorder". It's easier to understand.


    Now at least I know what's wrong with me!

    It's no wonder your characters are so indepth, you are amazing.


  29. This was way interesting. I have a question though. How do you know when someone has a "paranoid personality disorder" and isn't just paranoid?

  30. ah, you and Lydia! You crazy-smart gals. I think I'm related to someone with that narcissistic personality disorder. He was the cause of my panic attack...

    Tah dah!!! :D full circle. <3

  31. Well I definetly have odd behavior and thinking, but I have to say that's an incredibly vague way to describe a disorder.

    I want to respond to what aspiring_x said about the term "disorder." I think it's an appropriate word. Disorders cause problems, making it much harder for the person to live their life, therefore the disorder is something that is wrong with them. Yes, I said something is wrong with people who have disorders, namely, their disorder. How is it not something wrong?
    I don't hesitate to say I have a lot of things wrong with me. Everyone has something or other wrong with them, obviously not always a personality disorder. These are things we must overcome in order to function 'normally'. Why is it a bad thing to call it what it is?

    On a semi-unrelated note, I have asperger's syndrome. Is that in the DSM-IV? Seems like it'd fit in cluster C, but not under the three personalities you have listed under cluster C.

  32. I didn't realise there were so many different types of personality disorders. It's good to know a little more about them.

  33. lightingliramor, Asperger's is in the DSM IV, where it is under the category of pervasive developmental disorders (these include Autistic Disorder and Pervasive Developmental Disorder, Not Otherwise Specified). It is coded on Axis I and is not a personality disorder.

  34. I've known people with a couple of these disorders. I think it must be very hard to write a character if you don't know someone personally. Recently, someone queried about a mentally ill protagonist on Query Shark. It came off as inauthentic and the comments were harsh. I bet it's hard to put a person unfamiliar with these types of people in a research position.

  35. So when this guy sauntered into my office a few years ago, with a thick mustache and wearing a velour tracksuit (yes, really), and told me he liked his coffee like he liked his women: sweet and blonde, did he have the histrionic personality disorder, or was he just a jerk? :-P

    Great post, as always! I love this stuff. :-D