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Personality Disorders

Posted: November 2005  

Approximately 10-15% of people have strong features of a personality disorder. There are a number of personality disorders, some of which are more dangerous and difficult than others. In general, characteristics of personality disorders include: lack of insight, poor response to psychotherapy or other therapeutic interventions, difficulty with attachment and trusting, sense of entitlement, the creation of a great deal of chaos and distress in family and friends and co-workers around the person, etc.

Personality disorders have a wide range of severity, from mild to very severe. They often flip between victim, rescuer, and persecutor. When they turn persecutor, they can be dangerous to the person that they have their sights set on. Personality disorder patients often create chaos and drama, which can vary from mild to severe.

In general, therapy only helps people with personality disorders over long periods of time. Seeing a therapist for 5-7 years may help to some degree. However, our goals and expectations are limited. The concept of “plasticity” of the brain is very important, as some people can improve naturally over time. One study of borderline personality disorder in adolescence indicated that by age 30, 1/3 of the people no longer had borderline personality. The following is a description of some of the more severe personality disorder types. Many people do not fit neatly into any of these categories, but have features of 2 or 3 personality disorder types.

Paranoid Personality Disorder: They tend to be non-trusting, suspicious, and they see the world as dangerous. They view themselves as constantly being mistreated. They are very secretive, and reluctant to confide in others. They doubt the loyalty of anybody around them, and believe they are being exploited or harmed, and these patients bear severe grudges against others. They become angry very easily and have a sense of entitlement. Paranoid personalities can become violent and dangerous, as most spree killers are paranoid personality disorders. Many terrible world leaders, such as Joseph Stalin or Saddam Hussein, were most likely paranoid personalities.

Antisocial Personality Disorder: These people generally have no regard for the rights of others; they are exploitative, they see themselves as better or superior, and are very opportunistic. They are deceitful, steal from people around them, and often have trouble with the law. They frequently engage in fraudulent activities, make very good ‘scam artists’, and tend to be irritable and impulsive. They often come in as a savior for a church, for example, and end up stealing everything. They generally have no remorse. Conduct disorder as a child often morphs into antisocial personality disorder. Examples include the Mafia ‘Dapper Don’ John Gotti, or Tony Soprano in ‘The Sopranos’. TV shows such as Dateline or 20/20 are replete with stories revolving around antisocial personality disorders.

Borderline Personality Disorder: They have instability of mood, poor self image, and pervasive abandonment fears. There is an identify disturbance and major boundary issues. Borderlines usually demonstrate impulsiveness, suicidal behavior, and very quick shifts from depression to anxiety to irritability. There are usually chronic feelings of emptiness or severe “malignant” loneliness, plus anger and temper. Under stress they can become somewhat paranoid. Drug abuse or other addictive behaviors may occur. There are often sleep disorders with severe insomnia. Severe borderlines will react with a level-3 severe drama and create chaos for everybody around them. They tend to split, which is, they see people as wonderful or as terrible, with nothing in between. Examples include Princess Diana, Adolph Hitler, Marilyn Monroe, and Glenn Close’s character Alex, in the movie “Fatal Attraction”. Borderline Personality can vary from mild to severe, and may become better, or worse, over time.

Narcissistic Personality Disorder: This is less common, and the people see themselves as being above others, they are grandiose, have a lack of empathy, and they feel self-important. There is a true sense of entitlement. They may be very vain and constantly require admiration. They are envious, arrogant, exploitative, and can be very angry. Examples include General George Patton, Nicole Kidman’s character in the movie “To Die For”, Michael Douglas’ character, Gordon Gekko, in the movie “Wall Street”, Kelsey Grammer’s character in “Frazier”, and the Chief of Medicine, Dr. Robert Romano on the TV show "ER".

There are a number of other personality disorders that are not as dangerous for the people around them or for health care providers. Personality disorder characteristics in people are often overlooked, and health care clinics may react and treat these patients in a dysfunctional manner. Many patients do not have all of the characteristics of one particular personality disorder, but it is a spectrum with several characteristics osede`f a number of personality disorders.

Treatment consists of maintaining limits and boundaries on the person, encouraging therapy with somebody who is experienced with personality disorders, and encouraging the therapy to go on weekly for a very long time. Medications may help the anxiety and depression aspects, but there are no specific medications that are very successful for personality disorder characteristics.

For more information on personality disorders, an excellent resource is Dr. Gregory Lester’s tapes and booklet “Personality Disorders in Social Work and Health Care”, available from:

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