What are personality disorder clusters?

By David Joel Miller.

What are the three main groups of personality disorders?

What is? Series

What are personality disorder clusters?
Photo courtesy of Pixabay.com

The newest addition of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders divides personality disorders into three categories based on their similarities.  Personality disorders are long-term or enduring patterns of behavior.  The old way of thinking about these issues was that this is just the way someone is and treatment was not likely to be successful.

Recently treatments for many of the personality disorders have become available.  Currently we think of many of these personality disorders as problems of living which may occur in varying degrees.  Someone who is low in self-esteem might be described as low in narcissism.  If they were high in narcissism they might be lacking in the ability to empathize with others.  Below are a list of the clusters of Personality disorders with brief descriptions of the disorders in that cluster.  For longer discussions of the personality disorders see separate posts on the specific personality disorder.

Cluster A personality disorders.

This group of personality disorders includes people who appear odd or eccentric.  Among the Cluster A personality disorders are Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

Paranoid Personality Disorder involves people who are more fearful of people, life and events that would be warranted.  They are especially likely to think that other people are out to get them.

Those with Schizoid Personality Disorder are detached from others and seem to have little desire to have close personal relationships. They have less ability to express emotions.

In Schizotypal Personality Disorder, people are very uncomfortable in close relationships, have eccentric behavior and may have thinking or perceptual difficulties.

Cluster B personality disorders.

Cluster B personality disorders include things like Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

Those with antisocial personality disorder seem to have little regard for others and their rights.  They don’t mind taking advantage of people around them.  This is different from those people who may make a life out of crime and intentionally steal from, or harm other.  Career criminals get a diagnosis of Adult antisocial behavior Z72.811.

People with Borderline Personality Disorder are likely to have poor self-image, low self-esteem, fluctuating emotions and often are very impulsive in their relationships.  Those with Borderline Personality Disorder may also self-harm.

Histrionic Personality Disorder might be described as the typical “Sarah Bernhardt” actress.  Someone with histrionic personality disorder is excessively emotional and is always looking for more attention.

Cluster C personality disorders.

Cluster C personality disorders include disorders related to relationships with other people.  These personality disorders in Cluster C are thought to begin in early childhood. They include unusual ways of relating to close people in their life. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.

People with Avoidant Personality Disorder avoid other people, feel that they’re inadequate, and are often very sensitive to criticism.

Those with Dependent Personality Disorder are the people likely to become co-dependents.   They are often submissive, clingy, with an excessive need to find someone who will take care of them and control their lives.

Obsessive-Compulsive Personality Disorder is different and separate from Obsessive-Compulsive Disorder.  When the pattern of being obsessive-compulsive becomes preoccupation with orderliness, perfection, control, having everything exactly the way they need it to be at all times, this moves from a single obsessive compulsive behavior to the level of a continuing personality disorder.

In addition to the three personality disorder clusters two other personality disorder characteristics are described in the DSM-5.  Sometimes a personality disorder can be the result of a medical conditions.  The DSM-5 also allows for other specified personality disorder or other unspecified personality disorder when one exists that does not fit this list.

Each of these personality disorders are described more completely in other “What is” posts about that specific personality disorder.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships your enjoyable activities or cause you personal distress.

Having mild forms of these disorders does not qualify unless it causes you problems.  In that case, you may have the issues, but you will not get the diagnoses. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem these characteristics need to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Personality Disorders

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Do you have Borderline Personality Disorder?

By David Joel Miller

What are the signs and symptoms of Borderline Personality Disorder?

Problems with identifying Borderline Personality Disorder.

Borderline

Borderline
Photo courtesy of Pixabay.com

Borderline Personality Disorder formerly called Borderline conditions has received a lot of attention recently. It is one of those troubling conditions that looks differently to different people.

If you have Borderline Personality Disorder you know the suffering having this disorder can cause. If you have lived with someone who has Borderline Personality Disorder you know how frustrating this can be. This difference in perspective is one of the problems with the increased attention to the disorder.

Many of the symptoms of Borderline Personality Disorder overlap or are the sane as symptoms of other disorders. So when should someone get a Borderline diagnosis and when should we call it something else? Sometimes those iffy cases get a notation put on their chart “Borderline traits” rather than the full diagnosis. Electronic medical records are making it harder to leave notes like that and this may result in more people getting the full diagnosis.

For the record, diagnosis is not a do it yourself project. Mental Health as well as physical health diagnosing should be done by a professional. But so many people out there are being call Borderline these days and talking about it is so common, it is worth looking at the whole “what is Borderline Personality Disorder?” question.

There are efforts to come up with some kind of definitive test for borderline and other mental health conditions. At this time we can read research reports of “markers” and risk factors for many mental illness but we can’t be sure what is causing them. For example over 95% of people with Borderline Personality Disorder also have a sleep disorder.

Lacking a good test, mental conditions are diagnosed by looking at symptoms and seeing if someone has enough symptoms and if they are severe enough to need treating.

With so many Borderline symptoms overlapping or look just like symptoms of other mental illnesses, what name something gets called may depend on which symptoms are seen at any given appointment and the perspective of the viewer. We want to avoid normal problems of life being called diseases but this causes another problem.

Many mental illnesses are caused by identifiable life events. PTSD and other stress disorders need an identifiable stressor to get diagnosed. Many, but not all, people with Borderline Personality Disorder can point to some life event that started their symptoms.

As more people know about Borderline Personality Disorder more people are coming to believe that they have the condition. Family, Friends and relationship partners are likely to blame all the interpersonal or relationship problems on someone having Borderline Personality Disorder. I suspect that professionals are going along with this and giving the diagnosis out more often.

Is Borderline Personality Disorder an illness or a lack of mental wellness?

Symptoms of Borderline personality disorder can vary from person to person and they may vary in intensity. This has resulted in an increasing amount of discussion, and a past counselors soapbox blog post about whether there may be Levels or Types of Borderline Personality Disorder.  There has also been some professional discussion about whether some clients have been given the diagnosis because they angered the treating professional.

Some of you have noticed from my other writings that I believe strongly in Wellness and Recovery. (See post on Mental Illness or Mental Health.)

Many of the things we call “Mental illness” are on a continuum. Those problems get better or they get worse. Sometimes in life we get sad. When that sadness keeps you from working or enjoying life we call it depression and it deserves to get treated. The same thing is true of Borderline Personality Disorder. Many people with this condition do get better.

As we look at the symptoms of Borderline Personality Disorder below I will comment on some of the questions you might have about each symptoms. This discussion is based on the SAMHSA publication titled An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. This publication was written primarily for professionals but I include it here in case any of you want to see the original source. The SAMHSA publication draws on the DSM-5 (DSM is a registered trademark of the APA,which some of you may also want to consult. The paraphrasing and comments are mine so let’s hope I get this right. If you have or think you may have this condition please see a professional in your area.

Below are some of the typical features of Borderline Personality Disorder.

Borderline Personality is not common except in psychiatric hospitals.

Estimates of how common Borderline Personality really is vary. In the general populations it is estimated at around one to two percent. In inpatient psychiatric facilities the rate of Borderline Personality Diagnosis can reach 20%. That suggests to me that this is a very impairing condition.

Notice as we go through these symptoms that many of these are things that have been considered “female” characteristics. Turns out that three out of every four people who get the Borderline Personality Disorder Diagnosis are female. Also many of these symptoms are exactly what we would expect in someone with a Stress or Trauma Related Disorder as in Posttraumatic Stress Disorder or a Dissociative Disorder.

Borderline Personality Disorder is not simply a matter of being overly dramatic or wanting attention. Most, about 80%, attempt suicide and they die from suicide attempts at about 50 TIMES the rate of the general population. This does not need to happen as there are effective treatments for Borderline Personality Disorder available. Additionally about 80 percent of those with this diagnosis cut on themselves, which is often called Non-Suicidal Self Injury. Some people with this condition both cut and attempt suicide.

Symptom – Intense fear of abandonment and efforts to avoid it.

Many, not all, people with Borderline Personality Disorder were abused or neglected as children. Some had this experience in adult life. This suggests that these fears are both rationally based on experience and learned. If you learned to be fearful you can learn to not be fearful. But lessons learned very early in life may be much more difficult to unlearn. For many this fear of abandonment makes sense.

Borderline symptom – troubled, vacillating relationships with others.

In a single session with a therapist someone high in borderline traits may tell the therapist that they love them and they are the only on that ever understood them and then later they will say that they hate the therapist and “you just don’t understand at all.”

The same thing happens in their personal relationships. They fall in love quickly and they fall out just as rapidly. They have over inflated views of their potential partners and then they feel tricked, deceived and angry. Relationships with someone who has Borderline Personality Disorder can include fabulous sex followed by violent fights.

Don’t know who you are and who you are keeps changing.

People with borderline conditions have more difficult than others in telling you what they like, who they are and they look to others to define themselves.

Impulsive acts are common in Borderline Personality Disorders.

Risky sexual behaviors are the most commonly noted behaviors. Over-spending and reckless driving are also included in this definition. Frequent conflicts with others are common.

Suicidal Behaviors or Self-Mutilation.

People with borderline personality disorder are often overwhelmed by emotion and then hurt themselves rather than express their anger towards the person that angered or hurt them. This kind of sudden flip in their feelings towards others and then their impulsive behavior can look a lot like Bipolar and turns out that many people get both diagnosis or they are moved back and forth. It is of course very possible for someone to have more than one disorder.

Borderline make people feeling empty.

Since people with Borderline do not know who they are and they fear being abandoned, this makes sense. If you look for your self-worth from others and then feel empty or nothing at all when you are not getting positive interactions from those others you can feel empty. Some of these characteristics may sound like an immature or selfish person. If you did not get enough food as a child you may be physically stunted. If you are abused or neglected as a child or abused drugs and alcohol, then you may not have learned the lessons you need to learn back then. The result is continuing to use coping strategies that may have kept you alive or got some of your needs met as a child but they are not working now. This is true of some people with Borderline Personality Disorder but not all.

Remember that these explanations are ideas about how things could happen but not precise formulas for how it did happen to any one particular person.

Episodes of strong, excessive anger.

There is no specific diagnosis for “anger issues” despite how common referrals to therapy for “Anger Management” are. Anger is a symptom reported in many other mental or emotional issues. What further clouds this picture is the high rate of Bipolar Disorder and Substance Use Disorders among those with Borderline Personality Disorder. Depression can also lead to irritability and then anger. What is looked for in Borderline Personality Disorders is sudden explosive anger often with fights and violence, that come on unexpectedly with someone who shortly before was a close friend or loved one.

Borderline may include Stress related Dissociation or Paranoia.

This can be a problematic symptom in practice. Part of the way we identify paranoia is that the fear is excessive. Men are taught to approach things they fear. Kill it if possible. This results in men getting acting out, violence related diagnoses. Women are taught to avoid danger and if you have been victimized in the past you recognize danger coming. So if you have been abused once the fear that your new boyfriend will abuse you sounds reasonable not paranoid. See how this can be an issue?

It is also possible that “dissociation” gets pathologized. Some dissociating or “spacing out” is normal in children or those who are overwhelmed. People who suffer trauma may well dissociate. So it seems to me that cases of excessive dissociation may get swept into the Borderline Personality Disorder category rather than being recognized for what they are. As before someone could have both Borderline Personality Disorder and Dissociative Disorder.

Those are my thoughts on recognizing Borderline Personality Disorder and how it and other conditions may be getting mixed together. If you or someone you care about may have this condition consider professional help. If they do not have this problem please stop calling everyone you dislike Borderline. You may also want to check out other counselorssoapbox posts on Personality Disorders.

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Why are sleep disorders listed as mental illnesses?

By David Joel Miller.

What are Sleep-Wake Disorders?

Dream or Nightmare

Dream – Photo courtesy of Flickr (Melody Campbell)

Are problems with sleeping or staying awake making a mess of your life? Then you may have a sleep-wake disorder on top of all your other problems. Why does this matter? Because an untreated sleep-wake disorder will make all your other problems worse.

These issues turn up in the therapist or mental health counselor’s office when people start talking about their concerns with both the quality and the quantity of their sleep. Often this is because those sleep issues are impacting their wide awake life. When sleep issues start interfering with your job, relationship, or just plain making you not care anymore it needs attention.

This group of disorders sits at the intersection of mental and physical problems and reminds us that the distinction between body and mind is not all that clear-cut. The nervous system connects with the limbic system so your thoughts and feelings impact your immune system. You bodies physical aliments affect your mood.

With the introduction of the DSM-5 clinicians in the mental health area are getting a chance to take another look at the connections between sleep and mental health. One rule for therapists is to not be practicing medicine. If a therapist has any doubts, they should refer you to a medical doctor to get a purely medical cause of your issues ruled out or treated before using a primarily talk method to help you.

Some sleep disorder problems can best be determined by sleep specialists. These issues look differently when you try to describe them the next day verses when you are being monitored in a sleep lab and they can be detected right then and there. You diagnosis may depend on whether the problem occurs during REM sleep or non-REM sleep. Even medical doctors can’t get this part sometimes without sleep tests. The International Classification of Sleep disorders – 2 is a far more exhaustive than the DSM or other possible lists, but it requires a sleep specialist to run tests to get this right.

Poor sleep can be a symptoms of a mental disorder. Changes in sleep and appetite are one of the things that professionals look for in diagnosing depressive disorders. But poor sleep is not specific to depression or any one particular mental disorder. Sleep-wake cycle disorders affect a host of mental, emotional and behavioral disorders.

Poor sleep, especially distressing dreams, bad dreams and nightmares have been connected to depression, anxiety disorders, panic attacks, ADHD, borderline personality disorder, dissociative disorders, substance use disorder, substance withdrawal, an increase in suicide risk, PTSD and non-suicidal self-injury also known as cutting.

While poor sleep is found in conjunction with a lot of mental illnesses, it has also been suspected to cause mental illnesses. For example nightmares are a key factor in maintaining Posttraumatic Stress Disorder (PTSD.) Having frequent distressing dreams in childhood predicts the development of an anxiety disorder 5 years later. While nightmares and bad dreams may change and decline as you age, the majority of people who will get diagnosed with an anxiety disorder will have symptoms in middle school at just the time disturbing dreams are at their worst.

Sleep problems are also connected to behavioral problems. Children who are treated for behavioral issues also have nightmares or bad dreams on a regular basis. People with insomnia are at risk to have more nightmares and more nightmares increases the risk of developing a stress related disorder like PTSD.

It is easy for a therapist or counselor to overlook sleep wake disorders. If you have depression or anxiety, those sleep issues may be considered symptoms of your depression or anxiety. Make sure you mention the sleep problems to your therapist. If you have sleep-wake cycle problems, whether they are caused by another mental illness or not, if they bother you they should get diagnosed and treated along with the other issue.

Some Nightmares are harder to treat than others. The ones found in PTSD about things that have really happened to you are harder to get rid of than other bad dreams, but there are treatments for these nightmares that do work. Bad dreams based on generalized anxiety have been treated in children with as little as one therapy session. There will be more on treatments for sleep-wake cycle issues in upcoming posts.

Here is the list of Sleep-Wake disorders based on the DSM with their most current numbers.

Scary list isn’t it? For a full discussion you would need to check out the APA’s book DSM-5. I will try to give you the short plain language versions of these issues in upcoming posts.

Sleep-Wake Disorders

Insomnia Disorder 780-52 (G47.00)

Hypersomnolence 780.54 (G47.10)

Narcolepsy (subtypes/specifiers have different numbers.)

Breathing –Related Sleep Disorders

Obstructive Sleep Apnea Hypopnea 327.23 (G47.33)

Central Sleep Apnea (subtypes/specifiers have different numbers.)

Sleep-Related Hypoventilation (subtypes/specifiers have different numbers.)

Circadian Rhythm Sleep-Wake Disorders (subtypes/specifiers have different numbers.)

Parasomnias

Non-Rapid Eye Movement Sleep Arousal Disorders

Nightmare Disorder 307.47 (F51.5)

Rapid Eye Movement Sleep Behavior disorder 327.42 (G47.52)

Restless Legs Syndrome 33.94 (G25.81)

Substance/Medication-Induced Sleep Disorder (you need a number chart for this one)

Other Specified/ Other unspecified – Insomnia/ Hypersomnolence or Sleep Wake Disorder (6 total)

Which sleep-wake disorders are mental health issues?

Some of these disorders are pretty straightforward, some are medical issues, some are psychological and a few are mixed, other sleep wake disorders are even more complex. Nightmare disorder is a good example of the confusion. In common speech nightmares are those bad dreams you have that upset you. In technical terms, bad dreams, nightmares, night terrors are all different things, sometimes. Even the researchers use different definitions in their articles.

In coming posts let’s look at the various sleep-wake disorders and treatments for them. Until then sleep well or consider getting help.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Nonsuicidal Self Injury – Cutting to stop pain

By David Joel Miller

What is cutting – Non-suicidal Self Injury?

Cutting

Non-Suicidal Self Injury
Photo courtesy of Pixabay.com

Non-suicidal self-injury, often called cutting, is another of those troubling conditions that send people to hospitals, physical and mental hospitals. Intentional self-burning, head banging, hair pulling, hitting yourself and repetitive skin picking are other examples of this thing we call Non-suicidal self-injury. Non-suicidal self-injury causes a lot of suffering for those who do it and for those around them, and yet this problem, like anger, does not get the recognition of a separate diagnosis. FYI Hair pulling has gotten its own diagnosis called Trichotillomania.

Deliberate self-injury is a behavior. Like many behaviors it can be misunderstood. If someone waves at you, they may be calling you over, they may be telling you to get away from where you are or it may be a way to say hello. It might even have another meaning. Self-injury is like that, a behavior, which may have different meanings.

Non-suicidal self-injury is a condition that has been researched and has been proposed for inclusion in the DSM as a recognizable mental illness. Currently it is not a “stand alone diagnosis.” Non-suicidal self-injury is listed in the back of the DSM-5 as a “condition for further study.”

If someone engages in non-suicidal self-injury, the kind we think is a mental illness, the most likely way it gets categorized is as a symptoms of Borderline Personality Disorder. Sometimes it is a symptom of Borderline Personality Disorder or Borderline traits, sometimes not. Borderline Personality disorder is the only mental health condition that lists both suicide and Nonsuicidal self-injury as symptoms despite the high or increased rates of self-harm in other disorders like depression, bipolar and alcohol use disorders. First the things Nonsuicidal self-injury is not and then what we or I think it is.

What Non-suicidal self-injury is not.

Non-suicidal self-injury is not simply a teen thing.

The kind of thing we mean when we talk about Non-suicidal self-injury, the one that gets diagnosed and treated is not a fad or a rite of passage. I know there are those who cut, tattoo or brand themselves because they want to scar their body to look cool or to impress their friends. This is not what we are talking about when we say Non-suicidal self-injury – the disease.

Nonsuicidal self-injury is not a request for attention.

Yes some people do this behavior to get noticed or to get something they want. One way to differentiate this is to ask where they self-injury. Most people who seek attention cut in places that are clearly visible. Those who do it as a result of an emotional or mental issue cut or otherwise self-injure in places that are not visible, the stomach or the thighs and they often wear long sleeves, even in the heat of the summer, to cover the cuts. The distinction is that those who develop the illness Non-suicidal self-injury often try to hide their cutting.

What Nonsuicidal self-injury is.

A way to cope with emotional pain.

Transforming emotional pain into physical pain can seem like a way to escape that emotional pain. While it does work, at least some of the time it is not a desirable way to cope. Good coping mechanisms need to be not only effective but safe also. Treatments for Non-suicidal self-injury include lots of learning and practice of alternative coping skills sometimes referred to as recovery tools.

A way to cope with dissociation

Some people report they self-harm to feel or to feel real. This numbing out is a symptom of dissociation and related disorders. Dissociation is not always recognized for what it is. Dissociation needs treatment for what it is not just for the behaviors like anger or cutting.

If you live in chronic emotional numbness then the only time you may be able to feel anything is when you substitute physical pain for the constant numbing emotional hurts.

Non-suicidal self-injury is a way to regulate emotions.

Some people have difficulty regulating their emotions. They may have suffered traumas, grown up in a dysfunctional home or have personality characteristics that make them more prone to be over loaded with emotions. Take a look at the post Emotional Avalanches and Feelings Landslides which discusses how people can be suddenly swept away by feelings floods.

Cutting or other types of non-suicidal self-injury is one way some people cope with these feelings avalanches. Violent outburst is another way. The topic of violent outbursts and emotional regulation is covered in the series on “Anger Management.”

Rumination plays a major role in depression, anxiety, and anger as well as in causing emotional landslides.

Some of the links above may not be active yet. The bold-underlined terms mean that a post is up or will be coming shortly. I will try to get the links in here as the new articles post. If any links (the ones in blue) do not work let me know and I will work on fixing them.

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Why do people act in Passive Aggressive way?

By David Joel Miller.

Why must they act Passive Aggressive?

Passive Aggressive Sign

Passive Aggressive Sign.
Photo courtesy of Flickr (nedrichards)

Passive Aggressive Personality Disorder used to be a recognized mental illness. Then in the DSM-4 it was reduced to a condition that may need more study and most recently it has simply disappeared from our way of thinking of mental illnesses.

Remember that there are times when a person gets criticized for adopting this form of behavior, maybe even referred for psychiatric care and then other people may be praised for adopting some form of passive reaction to an injustice.

So let’s look at why some people may adopt Passive Aggressive Behavior and why we are no longer so sure that it should qualify as a mental illness.

There are legitimate reasons people do not just come out and say what they mean. There are also reasons people may choose to say nothing but fail to carry through on things they were told to do. Passive-Aggressive behavior can be the result of some of those reasons.

People become Passive Aggressive when they have no power or control.

Children, especially if they are in an abusive or non-loving home, may not feel they can say no to their parents. They get out of things, not by saying no or discussing things but by taking excessive time or doing things wrong. If they break enough dishes mom may stop asking them to do the dishes.

The same behavior makes sense in the boss and employee situation. Sometimes you can’t tell the boss no, so you just do not get around to doing things that would be a waste of time anyway. Not everyone does this. Some employees are very conscientious, but the worse the boss in terms of giving arbitrary orders and not allowing people to disagree the more likely this becomes.

Some people use Passive-Aggressive behavior more often than others.

If you came from a family where it was not acceptable to disagree with the parents or worse yet where you were not supposed to have any feeling unless they were sanctioned by the adult, you are more likely to hide your anger and then express it in Passive Aggressive ways.

Mental health clinicians used to think that there were things we called “Personality Disorders” and the presumption was that people who had these were always like that and that they were hard to treat and never changed. These premises have recently been called into question. Turns out that people can change their behavior when the situation changes.

One other thing that cuts against the validity of there being such a thing as Passive Aggressive Personality Disorder is that it is mostly used in situations where there is a weaker person who is unable to disagree with a stronger person or in a close situation like marriage where sometimes we want to avoid both doing what the other person told us to do and also avoid making this into an argument.

One characteristic that has been used to differentiate Passive Aggressive behavior from something like passive nonviolence is the level of anger or hostility that the person using passive aggressive behavior is experiencing.

When the non-doing stops being a way of avoiding conflict and becomes a way to harm someone else without having to accept the responsibility that hidden or veiled aggression can drive the most rational person to open hostility.

One aspect of Passive aggressive behavior that has received a lot of attention is the times when it appears to be motivated by contrariness or oppositional motives. When a youth adopts the position that they will avoid doing whatever the adult asks them to do just for the sake of asserting that the adult cannot control them this can escalate to severe problems.

Frankly much of what was getting called Passive aggressive Personality disorder looks way more like Oppositional Defiant Disorder when we see it in youths.

Passive Aggressive Personality Disorder shared so many features in common with other personality disorders and with depression and anxiety most professionals only used it when a parent or spouse said that was what the client was doing.

Most of the things we have been thinking of as personality disorders, include a lot of antagonism towards others. Sometimes this is because the persons life experiences tell them that they will not be treated fairly if they openly disagree or resist the will of others.

So while you will still read about Passive Aggressive people, mental health has largely concluded that this is not a mental illness but is a way that some people cope with not being able to express disagreement. In other words Passive Aggressive behavior is a symptom of some other problem rather than being a particular treatable disease.

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Are you the Passive Aggressive type?

Who is the Passive-Aggressive?

Passive Aggressive

Passive Aggressive.
Photo courtesy of Flickr (Matt From London)

There has been some discussion recently on the internet and elsewhere about people who are “Passive-Aggressive” how you deal with someone who is Passive-Aggressive and so forth.

What exactly is a “Passive-Aggressive Person” and how might this passive aggressive personality be affecting you?

Turns out there are at least two somewhat different activities going by the name of Passive-Aggressive behavior.  On the subject of Passive-Aggressive Personality, psychology and mental health are not on the same page. There are not just separated and divorced on this one but living in different time zones.

Psychology has studied the way people may behave and do they have Passive characteristics, or Aggressive characteristics. They used to think of these two as on opposite poles of the same axis.

Then it was suggested that some people combine both into a Passive-Aggressive style of dealing with conflicts. There were also some studies of whether these were stable traits, people did this all the time, or were these states, that the person might use a particular way of behaving in response to a specific situation and at one time but not another.

Mental health started looking at this as a potential mental illness, Passive-Aggressive Personality Disorder, which was causing problems in people’s social lives or in their work settings. The result of these two different perspectives is that the two fields came to differing views about Passive-Aggressive personality.

How did we get to a place where some professionals are writing about Passive-Aggressive people as if we all know what that is and why, while other groups have told us to drop the idea altogether?

Is a passive aggressive person all bad or are their times when this is a useful way of behaving?

The idea that there are “Passive-Aggressive people” seems to have originated during World War Two when officers noticed, and then they complained, that they might give orders but the men just did not get around to doing what they were supposed to do. The result of this behavior was that the men got out of doing things and sometimes they communicated to a superior officer that they did not like that officer.

One example of this might be an officer who had the men dig a ditch one day and then had them fill it in the next. I suppose that the officer could argue that this is teaching discipline and is keeping the men active and fit, but the men soon caught on and found that there was no reason to put much effort into this ditch to nowhere.

This concept, of the person who is told to do something but then deliberately does it poorly or not at all, has also been applied to employees in the work setting. Some bosses like to think of themselves as generals or in other military terms. They talk about commanding their employees. You can make a good argument for the need of people in the military to carry out an order regardless of whether they agree with the order or not. It is harder to see why bosses give some orders that just make life harder for their employees and do not create any extra production.

The result of these irritating directives from management can be work slowdowns, stoppages or people who just forget to do things. Sometimes it is hard to tell the difference. Some jobs take longer to do than planned. Sometimes people do forget. So the interpretation of “is this a Passive-Aggressive act” has to do with the motivations or intent of the employees not with the resulting action or inaction.

This Passive-Aggressive idea was expanded to include children who did not do what adults asked. I still see this version in articles about our educational system. The student is told to move something but they drop and break it. Or they get the instructions wrong and go to the wrong place. Sometimes is as simple as them saying yes to doing something but then just sitting in their seat and doing nothing. The complaint by teachers is that the student may be saying yes but their actions are sabotaging the outcome.

One other place this is coming up, and here we are bordering on the mental health arena is in the field of marriage counseling.

One partner will refer to the other as passive-aggressive. Say the wife has a job interview the next day, she is busy getting ready and she asks the husband to stop at the grocery store on the way home.

He gets home late that night and reports he had a problem at work and “forgot” to stop at the store. This may lead to an argument and then either they eat leftovers or he goes to the local fast food for dinner. She is annoyed.

Next morning she goes to use the car for the job interview and finds that gas tank is empty. She is now furious at him. Her conclusion is that he was late and left the gas tank empty to sabotage her efforts to get a job. Before long both partners may be “not doing” and “forgetting” to get their revenge on the other partner.

So from these examples we can see why some people may do things that look Passive-Aggressive and that this can be really annoying if you are on the receiving end of this behavior.

This is also a hard thing to cope with because the person who is behaving in a Passive Aggressive manner has all kinds of excuses for why they did not get things done or why they made a mistake.

Does that mean that someone who is acting in a Passive Aggressive manner has a mental illness? Why do they do this and how can you get them to stop? And can passive Aggressive behavior sometimes be a good thing, at least for the person who is using it?

Let’s take a look at all those issues in an upcoming post about the reasons people might adopt passive aggressive behavior.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Are Wiccans Schizoid? Are African-Americans?

By David Joel Miller

Who is Schizoid?

Which is which?

Wiccan House?

These kinds of search questions come up periodically. Sometimes I feel like these questions need to be answered even at the risk of making some people mad. I think we need to look at Schizoid personality disorder and other psychosis and its relationship to religious and racial minorities even at the risk of making a whole lot of people angry.

Wow, religion and race in one post, guaranteed to piss someone off!

Particular religious groups have been connected with various mental illnesses from time to time. In fact even in professional trainings Wiccans, members of a particular recognized religion, get connected with mental illness especially Schizoid personality disorder or Schizotypal disorder frequently. There was a time that minority races were mostly considered to suffer from mental illnesses also.

So first let’s look at what is Schizoid personality disorder and then why races and religions get connected to particular disorders.

At this point, before the hate mail starts arriving, I would like to point out, for better or worse, that I do indeed know people; some yes are even friends, of both the Wiccan and the African-American persuasions. As an aside I have also made the acquaintance of a few assorted Muslims, Christians, Atheists, Israelis, Palestinians, an Icelander and one person who might be described as a genetic Republican. Most of whom I consider more or less friends through no fault of theirs. I have left a few others out of this post because I could not spell their race or religion.

This issue of who or what is Schizoid is somewhat clouded by the way in which classification of personality disorders will change when the DSM-5 comes out in May. Some disorders stay, some go and they we reenter the whole question of are any diagnosis real? This is the old categories verses dimensions controversy. Some people clearly have enough symptoms to get a diagnosis but what about people with only a few symptoms are they normal? Do they have a slight disorder? Or will we need to create a billion or so individual symptom severities to fit each and every one. I will leave that one to the authors of the DSM-5.

DSM-5 update.

Mostly they left the personality disorders alone.

What we currently think of as Schizoid personality characteristics is a person who:

Is detached from social relationships, have a restricted range of expressing emotions in interpersonal situations, and this has been going on since they reached adulthood. (I am crudely paraphrasing from the DSM-4-TR here) and they have 4 or 7 characteristics listed below and they do not have another mental illness that explains their symptoms.

You math majors out there will note that 4 of 7 symptoms allows for 840 possible combinations of symptoms. We clinician types also get to interpret whether you have or do not have any one of these symptoms which can result in a lot of disagreement between clinicians.

The seven symptoms to choose from are:

1. Does not enjoy or want close relationships including being part of a family

In addition to schizoid personality disorder this might fit people who have faced abuse or discrimination and as a result avoid close relationships.

2. Almost always chooses solitary activities

These criteria could also fit gamers and those who are addicted to the internet.

3. Has little interest in having sex.

This could be the result of past aversive experiences.

4. Takes pleasure in few if any activities

This sounds a bit like depression so does the lack of interest in sex above, this will make it harder but not impossible for gamers to get this diagnosis.

5. Lacks friends other than first degree family members.

Lots of victims of discrimination and immigrants could fit this criterion.

6. Appears indifferent to praise or criticism of others.

This fits lots of people with learned helplessness and those who live in non-affirming environments. Why seek praise or affirmation if when you expose your emotional self you will not be liked for who you are.

7. Shows emotional coldness, detachment or flattened affect.

People who face discrimination may hide their true selves and restrict their emotions in public situations. If you get abused for your differentness you may keep you feelings inside even at home.

Now someone with a true personality disorder has these symptoms, most or all of them all the time and not just when in social settings. But can you see how someone who has faced discrimination or is a member of a religion with unusual beliefs could try to avoid expressing those feelings around others who might attack or punish you for being who you are?

Can you see how mental health could be used to punish people who were different racially or religiously and then when they try to keep who they are a secret to avoid that discrimination they could be labeled withdrawn and uninterested in others?

Sure some people with certain mental illnesses could be attracted to certain religions or political causes, but to move over into thinking that people of any one religion or race are probably suffering from any one mental illness is wrong and potentially dangerous.

Besides I think the people who wrote these search terms probably had Schizoid personality disorder and Schizotypal personality disorder confused. Schizotypal probably fits some rock and rollers and celebrities better than it fits Wiccan and African-Americans but it also gets thrown on anyone who is different way too often.

Schizotypal people wear funny clothing like straw hats and suspenders – or are those farmers? See how easy it is to think that people who are different from you must be sick in some way?

Before we start thinking that people who are different must somehow be mentally ill, think back to those basic criteria. Does this person’s problem or behavior interfere with their ability to work, have friends and family or does it upset them? If not they shouldn’t get a mental health diagnosis just because they are different.

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books