Category Archives: Personality Disorder

Are Wiccans Schizoid? Are African-Americans?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Who is Schizoid?

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 then we reenter the whole question of are any diagnosis real? This is the old Categories versus 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 and has 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 your 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 religious 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.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is Passive-Aggressive Personality?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Couple fighting by not fighting

Passive-aggressive.
Photo courtesy of Pixabay.com

Are you stuck with a passive-aggressive?

Passive-Aggressive Personality is another one of those things that may be hard to define but you know it when we see it. The Passive-Aggressive Person (PA) doesn’t say much, but they sabotage everyone else. They can be especially annoying if you are confined with one in close quarters, at home, or at work. PA’s are responsible for a lot of organization’s failure to meet goals. They create a lot of family pain.

The PA may smile and nod their head yes, but their behavior says “No! No! No!” Their way of disagreeing is indirect. Sometimes defined as “obstructionist” they seem especially skilled at snatching misery from the jaws of success. Their favorite weapon is inaction.

PA people are known for their hostility, unexpressed hostility which leaks out by getting even with others through “not doing.” They are frequently late and forgetful, resulting in not getting things done that they were expected to do. When you look back at the record you may find they never said they would do it, they just didn’t say no when you asked them.

This failure to express themselves, particularly about emotions results in a lot of misunderstandings. When confronted with the discrepancy between what everyone else thought they would do and what they, in fact, did not do, the PA is likely to deny they ever agreed to do that, assert they forgot, or all too often give the confronter the “cold shoulder” and say nothing.

PA is considered more a trait or a personality characteristic than a mental illness. It is not officially a DSM diagnosis, though it has moved in and out of the list of Personality Disorders over time. As a personality trait, PA can vary from a few rare occurrences to a characteristic pattern that someone uses most all the time.

Most people with PA traits often report “trust issues” but so do lots of people without PA traits. We think that developing PA characteristics is related to growing up in a home that was non-affirming or where it was not OK to express emotions. In this sense, it is like the “Attachment Disorders.”  They have learned to avoid criticism by avoiding action. They are good at excessive procrastination and other forms of learned helplessness. They go along with things but make sure that the project fails by withholding effort at a critical time.

In addition to highly critical parents, the PA person is also likely to have had painful disappointments in life. They have reduced their expectations for themselves and others to avoid disappointment. Setting low sights reduces disappointments. They become so afraid of being told no they stop asking.

People with strong PA traits will fear competition and avoid situations where they will be judged at the same time they avoid dependency. They tend to keep their distance from others and are especially hard to get to know. They often express the feeling that they are unable to please anyone no matter what they do. Others feel that they can’t depend on the person with the PA traits.

Lacking truly close relationships, someone with a lot of PA traits creates a lot of chaos, makes excuses for failure to meet other’s expectations, and chronically takes the victim stance. Rather than direct disagreement they use obstructionism and sabotage to undermine those they resent. Their sabotage is of the indirect “failing to do anything” in the face of an urgent need form.

A key characteristic of the PA person is a lack of assertiveness. Unable to directly confront others they use indirect methods to accomplish their aims.

In the workplace, PA’s can be hard to spot and can rise to the top ranks since they always seem to agree with superiors despite failing to meet goals. They always have excuses for why the goals were not attainable. Management does not always value the worker who openly disagrees even when their productivity is high. Working with someone with PA traits destroys teamwork.

In the home, people with PA traits can be hard to live with and often under function. We know from system theory that when one person in a family under functions another is likely to over function, the result is a dance that is hard to change.

The family member who is PA will be hypersensitive to criticism especially when they have let others down and may resort to telling the rest of the family that their expectations are unreasonable. The result is that the rest of the family takes on the PA person’s responsibilities.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Are creative people anti-social?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Original

Creative.
Photo courtesy of Pixabay.com

Are highly creative people, writers, and artists, also anti-social?

Some occupations require lots of time working alone. Artists and writers, in particular, need to spend a lot of time by themselves. Do these occupations attract people who want to avoid people?

Is there a mental health problem or personality type that is over-represented in the creative fields?

From a counselor’s perspective, people who work alone or prefer to spend time by themselves are not anti-social. We reserve the label of anti-social as in Anti-social Personality Disorder for people who have no empathy for others. An anti-social person takes advantage of others because they don’t care. They are the ones who get the label of psychopath or sociopath.

People who prefer to avoid others may have some form of anxiety as in social phobia or they may have an attachment style that results in avoiding others but neither of those personality features involves harming others on purpose.

An avoidantly attached person does not expect others to meet their needs and seeks to get their needs met by solitary activities. A creative person might be avoidant and prefer to avoid all contact with people but that is likely to be rare. To be successful at a creative activity as an occupation they will need to go out and spend time marketing and promoting their efforts. Avoidant people are not likely to be willing to do that and are likely to believe that others will not like them anyway.

Someone with social phobia would like to be around others but because of fear, they are unable to be in situations that trigger their anxiety.

Anti-social personality, avoidant attachments, and high levels of anxiety are not conducive to the risk-taking the artistic person needs to genuinely create something novel.

But an artist and those of an artistic temperament are more likely to have one particular emotional issue. Many artists are moody.

One mental health issue does appear to be correlated with creative temperaments. Kay Redfield Jamison in her book “Touched with Fire” describes the connection between Bipolar disorder and creative endeavors. Those episodes of above-average energy and times when the person is “in the zone” fuel creativity. Uncontrolled these episodes can turn into manic or hypomanic episodes and result in the creative person losing control and engaging in risky dangerous behaviors.

There are plenty of stories of famous artistic and creative people who had periods of high energy sometimes coupled with risky behavior followed by periods of deep depression. The energetic periods may fuel creativity but in the full-on manic episodes, the person is no longer able to stay focused long enough to complete projects.

The artistic fields have had a disproportionate share of individuals with mood swings who became alcoholics, addicted, or suicidal. The really productive artists, in the long run, learn to manage their moods with or without help and they keep their emotions in bounds.

See also posts on Hyperthymic Temperament, Bipolar Disorder, and Mania.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Bipolar Disorder or Borderline Personality Disorder?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

Bipolar or borderline personality disorder?
Photo courtesy of Pixabay.com

Bipolar Disorder or Borderline?

There are several differences between these two disorders. But it is important to remember that it is possible for someone to have both problems which greatly confuses the issue.

The largest differences between the two are sleep and time. Ego strength and character structure also play roles in this choice of diagnoses. I have exaggerated the differences to make the distinction clearer.

Sleep matters.

To be Bipolar you must have had a Manic or Hypomanic episode. The key characteristic of those episodes is long periods (time) of above-average energy and decreased need for sleep.

In hypomania, the person may be able to get by on a few hours of sleep, 3 or 4, and they feel fine. In full-out mania, they may even go all night without sleeping and still be just fine. At least they think they are fine. Others around them may notice they are irritable from lack of sleep but they think they are just fine.

Also in Bipolar when they are up they feel great, expansive. The same person may have episodes of depression and during those times they may sleep too much or too little but the telling point is that in the up times they will tell you they are on top of the world, full of energy, and can just do so much without needing to sleep like lesser people.

With those Bipolar manic episodes comes tons of energy. They like to go up in the attic and swing from the rafters. They might work all day then go to the casino and gamble all night only to go back to work the next day like nothing has happened.

Time.

People with Borderline have many moods within a day. The can be “touchy” easily set off and others may hurt their feeling without meaning too or even knowing why. People with Borderline Personality disorder are full of pain and rarely have a good day. They can be so bruised that a look or word can hurt them.

People with Bipolar have longer periods of up or manic feelings. When times are good for them they are really good. They may go weeks, months, or even years when they are on top of the world. But eventually, the crash comes and there will be long periods of time when they are depressed, possibly unable to get out of bed. Recurring episodes of depression is a common feature of Bipolar Disorder.

Ego strength.

Borderline Personality Disorder is pain based. Many borderlines were abused, neglected or deserted. They are needy in relationships but always distrustful that the person they are with will leave them.  Borderline may threaten to kill themselves if you leave them.

Bipolar people mostly don’t care what you think of them, at least not when they are manic. They know they are smarter than Einstein and better looking. They believe they can work miracles. This overvaluation of themselves and their abilities gets them in trouble a lot. The take excessive risks not because they want to hurt themselves like the borderline but because they really believe they will win.

Borderlines are anxious, Bipolar people could care less. Let this one leave and they will find another.

Sex.

People with Bipolar Disorder are often hypersexual. They can’t seem to get enough. This will lead to sexual indiscretions that ruin their established relationships. When manic they just can’t seem to stop themselves. When you’re manic the whole world looks good.

Borderlines are rarely secure in a relationship, fearful that if this partner leaves them, that confirms their fear, they don’t deserve a partner. They will stick with a partner, often an unworthy one, because they fear that if they were to break up they just could not take it.

Who loves their disease?

Someone with Bipolar disorder resembles a Vegas Gambler when they are on a winning streak they want to ride it forever. When the crash they hate themselves and can’t face the wreckage they have created. Bipolar people like being manic. They frequently quit taking their meds just so they can feel manic again. Mania is seductive like a new lover, but one who keeps treating you wrong. Still, you want to recapture that allure.

Borderlines are more like characters from a soap opera, bad stuff keeps happening to them and they wish the pain would end. They live in a world of pain and hurt. They wish they could find a way to get things to change. They are often angry and feel others don’t treat them right. Frequently they are correct. They have been mistreated by someone somewhere and they keep trying to find a way to make it right, to make the pain go away.

Do they ever not have symptoms? – Character structure.

Someone who has Bipolar disorder has a “Mood disorder.” They have specific times (Periods) when they have mania or Depression but at other times they have no mood symptoms. These times of apparent “normal” behavior may last for months or years and then something kicks off another episode of mania or depression.

Someone with Borderline Personality Disorder has a “Personality Disorder.” The presumption here is that they learned to be this way and are like this most of the time. They learned to protect themselves, store their anger, and release it in bursts and other survival techniques. The trouble is that the way they handle emotion makes them and those around them miserable.

The younger you were when you learned basic ways of being with others the harder it is to change. Most people with Borderline Personality Disorder continue to have some symptoms even after treatment, though with good care they can and do get much better.

Please check out my other posts on Bipolar disorder and Borderline personality disorder the list of categories is to the right.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

DBT Treatment for Borderline Personality Disorder – Dialectic Behavioral Therapy

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

DBT therapy – mindfulness.
Photo courtesy of pixabay.

Does treatment for Borderline Personality Disorder work?

Lots of treatments for Borderline Personality Disorder have been tried over the years. One treatment, Dialectic Behavioral Therapy (DBT) has lots of evidence that it works and is effective.

The problem in treating Borderline Personality Disorder.

Lots of clinicians (Counselors and Therapists) do not use DBT and don’t want to learn it. In fact, plenty of clinicians I know don’t even like seeing BPD clients. Some clients don’t like going for DBT either, despite the glowing testimonials we hear from clients who say DBT changed their life.

If DBT is so effective for treating BPD, why do so few clinicians want to use it and why aren’t their lines of clients waiting for treatment?

BPD is a painful disorder. Treating BPD is like treating a burn victim. They are in terrible pain. Just touching them (emotionally) may cause them to feel the pain. Helpers don’t like to hear their clients scream in pain. Clients in pain tend to lash out. Clients with BPD are more likely than other people to lash out at the therapist, walk out of session, and even go out and try to hurt themselves.

Their pattern of unstable relationships is so pervasive that they have difficulty forming a healthy relationship with the clinician. Just when we think we are helping them they may quit treatment and blame the clinician for their increased pain. They are also more likely to file complaints with the licensing board or even a lawsuit because they feel therapy did not help them and now their pain is even worse.

Despite all these issues DBT does work and does help clients with BPD.

About Dialectic Behavioral Therapy (DBT.)

DBT was developed by Marsha Linehan (Ph.D.) at the University of Washington. Her book Cognitive-Behavioral Treatment of Borderline Personality Disorder is a classic in the field and her workbook has lots of useful exercises for clients to use. I have had the pleasure of hearing Marsha Linehan speak a number of times but can’t say I am fully trained on DBT. What follows is my horrifically oversimplified understanding of what DBT is and how it works.

DBT is a blend of Cognitive Behavioral Therapy, that change your thinking, to change your feelings, to change your behavior stuff that I like to use, and “stuff” Marsha Linehan calls mindfulness. The pain from BPD is so intense that the normal reaction would be to run away.

Mindfulness involves stress reduction, meditation, and ways to be able to reduce and tolerate that pain. By reducing the need to run from pain the pain can be shrunk to a manageable size. This skill is called “distress tolerance.”

Since many clients with BPD (maybe all) came from non-affirming environments they struggle with issues of self-worth and self-acceptance. Clients with the full-blown disorder not just some small level of BPD traits have lots of self-harming and self-destructive behaviors which they use to get away from the negative feelings.

Treating DBT has been described as “like driving a car with one foot on the gas and one on the brake.”  It makes for a bumpy ride for both the clinician and the client.

The client needs to learn to accept and like themselves just the way they are. The clinician continually tells the client that they are a worthwhile human just the way they are.

The client needs to change. They need to stop doing those self-destructive, self-sabotaging behaviors, which are keeping them stuck in an unhappy life. Now comes the tricky part.

When the clinician says “I want you to change” the client hears “I am no good and need to change to be accepted.” The clinician then says “You are accepted just the way you are, but I still want you to change.”

The struggle here is to have clients accept that the goal is not for them to be a certain way to be acceptable, but that what we are looking for is “progress not perfection.”  Any good coach or teacher wants to see their student’s progress and do better, that does not mean there is anything wrong with them if they do not become the best at their discipline.

There is a second challenge for those with BPD and those who treat them which DBT seeks to address.

People who have BPD do not live in the meadow full of flowers in the springtime, they live in the hurricane. If they are ever in a calm place, they know this is the eye of the hurricane and the next blast of the storm is a moment away.

Because the volume on their emotions is turned up so loud, there is always the crisis of the day, hour, or minute. When you are living in an emotional hurricane it is hard to think about disaster preparedness.

The clinician who does DBT has to limit the time they spend on today’s crisis so they can work on developing skills to prevent or cope with future crises. This “let’s not talk about your urges to cut on yourself or use drugs right now, let’s work on your skills” attitude is hard for clinicians and clients who are used to that warm fuzzy empathetic listening stuff.

Clients can leave a skills-based session thinking that the counselor didn’t listen to them and doesn’t care. The counselor may worry “what if they do cut or self-harm? Will it be my fault because I wanted to work on stress reduction skills?” Sticking to the skills-building curriculum can be difficult for both.

One ethical principle that clinicians have learned is that it is not helpful to keep the client dependent on their counselor to cope with life. Our goal should be to get the client to the place where they can function without the clinician. Sometimes that is uncomfortable for both client and counselor.

So DBT is very useful in treating BPD because it increases the client’s self-confidence and self-esteem while teaching them the skills to believe they can cope with life’s problems without having other people do it for them.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

If any of you have been to someone for Dialectic Behavioral Therapy or have had another treatment for Borderline Personality Disorder, would you be willing to leave a comment and tell us how it worked or didn’t work for you?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Lady Diana, Bipolar and Borderline Personality Disorder

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Lady Diana’s headstone.
Photo courtesy pixabay.

Did Lady Diana have Bipolar disorder, Borderline Personality Disorder, or what?

Some interesting questions from reader Gledwood about Bipolar, Borderline Personality Disorder, and Lady Diana. See the comments after Levels or Types of Borderline Personality Disorder.

I never met Lady Diana and am not so much a follower of royalty, so I can’t give you a specific diagnosis about her. In fact, it is considered unprofessional for therapists to give opinions on someone they have not assessed. But maybe I can give you some general answers on these two conditions and on how psychiatric labels may not fit celebrities very well.

1. Borderline Personality Disorder (BPD) and Bipolar are very different conditions.

There may be some small similarities and someone could have both but my thinking is there are quite different conditions.

BPD is like a volcano erupting. Huge uncontrollable emotions. They love you – then they hate you, sometimes the emotions change in the same hour. BPD has a huge pain component. Most people with BPD were abused, molested, or had a non-affirming childhood. People with BPD often self-harm and they do it to relieve the pain not to find pleasure. They have trouble coping with negative emotions and will frantically try to find ways to stop having to feel bad.

Medication may help BPD and so will therapy but it is a slow process.

Bipolar is like a ride through the mountain in a car.

Sometimes down in the valleys in the shade and other times up near the top in the sun. Bipolar also involves some irresponsible impulsive behavior when manic but it is more about impulsive over-seeking of pleasure than anger-driven. The ups and downs happen more slowly and someone with Bipolar can have years of depressed behavior and mouths or years of overactive pressured behavior. Bipolar Disorder often responds to medication. Over-responding to antidepressants is one characteristic that makes us think – Bipolar.

Someone with Bipolar can be trapped by depression for long periods of time and stay stuck there.

Diana Spencer and Lady Diana were probably very different people.

Public figures are often very different in their personal lives than their public lives. The Royals can’t very well hang out at the local bar (or Pub.) Take that press about what someone is like based on their public appearances with a lot of salt. Many comedians and singers are very shy in small groups but once on stage, they can assume a whole other “persona.”

Fans need to be careful to not confuse the person with the character they play. Celebrities have the same problem and start thinking they are their character. There is a difference between being “typecast” and always portraying the villain and those performers who play themselves while on stage. My guess is that having to play the role made it hard for her to maintain old friendships and relationships.

The diagnostic criteria professionals use and the popular meaning of terms are not the same.

I see way too many people who are being called “Bipolar” who are moody, irritable or just plain hard to get along with but they do not necessarily have periods of either depression or mania.

The DSM descriptions are a lot longer than the oversimplified description in most blog posts. There are 11 factors listed for mania and mania is only one factor needed for a diagnosis of Bipolar I Disorder. Professionals need a lot of information before making these decisions.

Symptoms of both these and other disorders are normal traits that get out of control.

Despite the fact that I get paid to treat people with mental illnesses and substance use disorders I think we are trying to turn a lot of normal human emotions into diseases.

Everybody gets sad sometimes. Most of us do impulsive things. If you have never acted on an impulse we think you may have a problem with being obsessive or compulsive. Lots of us get into disagreements and don’t want to be around or talk to others who annoyed us. Someone who has BPD has a pattern of lots of unstable relationships their whole life.

The labels Bipolar and BPD apply to people with severe forms of these conditions; there are a whole lot of other people who have a few characteristics, sort of like one of these conditions. If you have just a few symptoms, counseling or other preventative measures may help you avoid developing a full-blown disease.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Hope that helped with the case of Lady Diana, Bipolar, and Borderline Personality Disorder.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Levels or types of Borderline Personality Disorder

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65

By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Are there different types of Borderline Personality Disorder?

personality disorder

Are there types of Borderline Personality Disorder?
Photos courtesy of Pixabay.

People with Borderline Personality Disorder (BPD) differ so much there might be more than one type of BPD or that we may be placing several different mental illnesses together under one label. Gunderson in his book Borderline Personality Disorder describes three levels of functioning in people with BPD. Hotchkiss appears to enlarge this idea into three types of borderlines.

Diagnostic criteria for mental health disorders are largely normal characteristics that have grown so large that they begin to interfere with everyday life. Everyone has sadness sometimes and we all are or should be anxious occasionally. That same concept of degree rather than nature is applicable to BPD.

Masterson wrote about Narcissistic Personality Disorder and described this as coming in low, medium, and high levels. I think the use of that same sort of yardstick for measuring BPD might be useful.

Low Borderline characteristics or traits.

People with low BPD or beginning Borderline traits have or are able to sustain a primary relationship. This relationship may be rocky but the low borderline trait individual is able to have satisfying interactions with a partner. They will perceive this partner as supportive.

What brings a low symptom Borderline into treatment will be feelings of emptiness, loneliness, or depression despite having a supportive partner. They may also suffer from chronic boredom or masochism. They want both a close relationship and fear that relationship because needing someone exposes you to becoming dependent on them.

As a result of the presence of that supportive person in their life, a mild BPD individual may go undiagnosed. They may lack the intense anger and have fewer and milder mood swings than those that appear in more severe cases. Their self-destructive behaviors will be fewer and less frequent and may be ascribed to life experiences like layoffs or fights with their S. O. rather than being recognized as BPD traits.

What tips the clinician off to the BPD traits is not the current relationship but a history of previous unstable relationships and a pattern of over-rapid entry into and speedy exit from relationships, as well as a history of being the victim of abuse or neglect.

Medium BPD.

As the symptoms of BPD become more severe you may experience more anger, more worries about losing your partner, and more frantic efforts to keep your partner in the relationship. People with medium BPD are described as having difficulty seeing things from other’s points of view and devaluing others. They may manipulate as a way to get their needs met. They have the belief that asking will not get them what they need and that they need to force others to stay with them.

This level of borderline functioning is full of break-ups and make-ups, drama from current and previous relationships, and recurrent self-harm or suicide attempts to force the partner to stay. Someone with medium intensity BPD may plan suicide with the thought that this will punish the other for not loving them enough.

High Borderline Personality Symptoms.

When BPD reaches this level the person with Borderline Personality Disorder is unable to maintain a relationship with a significant other. They are without a functioning support system and become increasingly lonely and angry. They may develop distorted thinking, delusions, and eventually hallucinations. They may have episodes of panic involving various anxiety-provoking possibilities.

At this level of BPD symptoms, the most likely coping mechanisms are efforts to distract the self by using drugs and alcohol, abusing food, and acting out behaviors. Fights, promiscuity, self-mutilation, or suicide attempts will be common.

Are relationships a cause or the result of the level of BPD?

There is some question as to whether having a significant relationship reduces the level of borderline traits or if people low in traits can maintain better relationships than those who are high in BPD traits.

One thing that seems clear is that if you have a supportive other in your life, especially in your primary relationship, you are more likely to be able to cope with your mental illness. Learning life skills can improve your functioning and increase the likelihood of finding a supportive partner. Healthy people attract healthy partners.

Are you doing all you can to create good relationships with others and to become the kind of person who can have happy supportive relationships?

Other posts on Borderline Personality Disorder are:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What Causes Borderline Personality Disorder?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

What Causes Borderline Personality Disorder?
Photo courtesy of Pixabay.com

Suggested causes for Borderline Personality Disorder (BPD)

Since this is a condition that is diagnosed by the presence or absence of a group of symptoms rather than any one specific test our understanding continues to change. Some authors have suggested that there are several levels or types of Borderline Personality Disorder. People with milder BPD symptoms can be described as having Borderline traits. It is possible that various levels of BPD symptoms may have different causes.

Like most other mental illnesses, Borderline Personality Disorder (BPD) appears to have both a genetic risk factor and an environmental risk factor. Having a risk factor does not mean that you are going to develop the disorder but the more the risk factors the more the risk.

Genetics is a risk factor for mental illness.

NIMH (National Institute of Mental Health reported some time back (2008,) that there appears to be a genetic risk factor for BPD. This study found that a particular mutation on chromosome nine created an increased risk for BPD. At some point in the human past, the characteristics we think of as Borderline traits may have been helpful in certain situations.

Experience has made any one research report linking a particular chromosome and a disorder highly suspect. It would be nice if this study were correct and we could do a simple test for BPD, but with other disorders, we find that it is not one gene or chromosome that creates mental illness. It is the influences of several or a combination of large numbers of the many possible genes that result in an increased risk.

In this study, the contribution of genetics was 40%. Meaning that the environment contributed the other 60% or put another way, your relationships and experiences increase the risk of developing BPD 150% as much as your genetics.

The environment can increase the risk for Borderline Personality Disorder.

One factor seems to contribute a huge amount of this environmental risk.

Growing up in a non-affirming place with people who did not validate you, is a hugely important cause of many of the symptoms that make up BPD and Borderline Personality traits.

Many people with borderline traits report that their family was not supportive. Their caregivers were either absent or constantly frustrating.

Many people with BPD grew up in homes that did not create the feeling of being valued as a human being. People with BPD may have been neglected, abused, or simply did not have their emotional needs met. They may have found that direct requests for things did not work and that the only way to get their needs met was to engage in behaviors that forced the family to notice them. In adult life, their behaviors will be described as manipulative.

A borderline can be both clingy and distant, wanting a close intimate relationship but also fearful that to let someone get in close to them invites another abandonment.

People with BPD may associate any accomplishment with an increased risk of abandonment. They often quit school a week before finals or fail to show up for a job on the first day.

People with Borderline characteristics may end up slipping into a relationship with someone who has difficulty being close. Just like the co-dependent person who keeps marrying the alcoholic trying to get it right, someone with BPD may continue to enter a relationship with a partner who is unable to provide any warmth and closeness.

The classic expression of this feeling becomes “If I become fully me, will you stop loving me?” The recurring fear is that the significant person in their life will abandon them and they will fall apart without someone to support them.

One issue people with BPD may need to tackle is the inability to have and enjoy happiness or other positive feelings. If you came from an environment that said it was not OK to have or display feelings, it can be terrifying to allow yourself to feel happiness of any sort.

The person with PBD may feel empty, numb, or bored without someone else in their life that provides for their needs. The theory here is that the more the person was let down by their support system, the less able they have been at becoming an independent person, the more likely they will be to develop borderline traits.

Learning to act Borderline.

Those with BPD often come from homes where the caregivers themselves had poorly regulated emotional lives. Parents can and do frequently provide genetic risk factors, environmental factors, and learned behavior that support the continuation of BPD.

Is seems likely that living with or around a caregiver with BPD is likely to alter the way in which someone handles emotion.

The takeaway from all this is that whatever the reason someone has BPD there are treatments available that can help manage, reduce, or eliminate the symptoms of Borderline Personality Disorders.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is Borderline Personality Disorder?

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25

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

What is borderline personality disorder?
Photo courtesy of Pixabay.com

Bipolar or Borderline Personality Disorder?

People with Borderline Personality Disorder (BPD) experience intense emotional pain and lots of loss in their life. They never feel the faint breeze or the warmth of the sun in the springtime. For the Borderline the world is a place of hurricanes and scorching heat. Life is one horrific storm. They experience terrible loss. BPD may result in interrupted education, ruined or unstable relationships, and frequent job loss.

BPD can look like Bipolar Disorder but while the Bipolar person may have months of depression and long periods of elevated mood or irritability the BPD person has all those mood changes in a single day.

Borderline Personality Disorder (BPD) is an often overlooked and misunderstood mental health issue that gets placed under the heading Personality Disorders. BPD is coded on Axis II and viewed as long-standing and difficult to treat. Personality disorders often co-occur with other mental health challenges such as depression and Bipolar disorder. Because of the notion that a personality disorder is difficult, if not impossible to treat, there is a reluctance to give clients this diagnosis.

Untreated BPD is viewed as a “pervasive” or inflexible pattern in life and includes four characteristics, unstable relationships, fuzzy self-image, impulsivity, and lots of negative emotions. The DSM lists 9 “criteria” or symptoms the client might have but only requires 5 of those nine symptoms to make the diagnosis. In practice, this means a lot of judgment calls.

Most people with Borderline Personality Disorder have some but not all of the “criteria” for the disorder. Gunderson suggests in his book that there are three distinct Levels of Borderline Personality Disorder based on the nature of your relationships with others.

Children experience some mood instability as a normal part of growing up. We expect some BPD characteristics that will go away as they mature. As a result, children are almost never given a personality disorder diagnosis. When the BPD picture seems to be developing, the child may be described as having “Borderline traits.”  Those with untreated BPD generally do not get better with age, the pain they experience grows.

BPD begins in early adulthood and those “characteristics” or “traits” need to occur in multiple situations. This disorder, when treated, generally fades as the person gets older. Women make up 75% of those who get BPD diagnosis and frequently had a diagnosis of Bipolar Disorder prior to being diagnosed with BPD. This disorder is probably underdiagnosed in men because men act out, break laws, and get caught abusing substances more often than women. These other problems get diagnosed first and become the focus of treatment.

Treatment for Borderline Personality Disorder is effective in reducing symptoms. Ten years after treatment half of those diagnosed with BPD no longer have enough symptoms to receive the diagnosis though they may continue to have some Borderline “traits.”

There appear to be a number of Causes of Borderline Personality Disorder. Some of the symptoms of BPD are adaptive behaviors that may have worked to protect you and get your needs met when you were younger but as you grow up these behaviors no longer work.

Abandonment is a key issue for those with BPD. They need someone in their life and can’t stand being alone but fear being rejected and abandoned. They are constantly on the lookout for signs of potential abandonment. As a result, they may appear needy and drive people away. Their impulsive behavior creates exactly what they most fear.

Someone with BPD is very sensitive to their environment. When things do not go well in relationships they blame themselves and may “take it out” on themselves. Self-mutilating, cutting, burning, and suicide attempts are common.

Because of their terrible need for a supportive relationship BPD individuals tend to jump into very close intimate relationships without getting to know the other person. As a result, they over-trust people who should not be trusted and expect more from partners than another person can provide. Once disappointed they become furiously angry. They are often demanding in relationships and need lots of time with their partner. They may have violent emotional reactions when their partner attempts to leave for work, school, or errands.

Sudden changes in their opinions of others are common. When let down by those in their life they respond with lots of anger, sarcasm, and bitterness which only drives others farther away.

Many individuals with BPD report they don’t know who they are other than by adopting the values of those around them. They may have sudden changes or difficulty identifying values, goals, or career plans. They often self-sabotage. It is not uncommon for someone with BPD to quit school just before finals or leave a job just as they were about to get a raise or promotion.

Living with Borderline Personality Disorder is a horrific challenge for those with this condition and it challenges those who would like to be in a relationship with the person with a Borderline condition. While treatment is never easy it can be effective and result in creating a happy, fulfilled, and connected life.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What are Personality Disorders?

Posted on by
14

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What are personality disorders?
Photo courtesy of Pixabay.

Update.

In the new DSM-5, the five-axis system was eliminated. Personality disorders are now included in the full list of mental, emotional, and behavioral disorders, just like any other mental health issue. I have left this post here, as originally posted because much of this information remains relevant. Not all of the changes we expected in the DSM-5 took place. For the current status take a look at some of the newer posts.

How many Personality Disorders are there?

Personality Disorders are a special class of mental illnesses that are considered different in kind and nature from other mental health problems. Mental illnesses in all their shades are recorded on Axis I. There are currently over 300 recognized Mental illnesses. Most mental illnesses have several standard treatments and if severe enough are likely to be covered by insurance or public funding. Not so with personality disorders.

Personality Disorders are kept separate. They are recorded on Axis II in a separate and small class of problems that just don’t seem to ever change or get better. They have long been considered like mental retardation, something we need to help with, but something that just won’t change. Personality Disorders are a short list, rarely over a dozen labels, though the list changes over time.

Personality Disorders are conditions in which the person to be diagnosed “deviates from expectations of their culture.” There are different. But that is not enough for the diagnosis to be imposed.

This pattern of “differentness” is “Pervasive and inflexible.” They stick to their irritating pattern no matter what. This pattern starts in adolescence or early adulthood and they just don’t change, “grow up” or “grow out of it.” So this pattern of differentness is “stable over time.” It is as if people with a personality disorder get stuck in one way of behaving and then can’t change their approach when they are in a different time or place.

This differentness needs to also cause them problems getting along with other people, holding a job or make them unhappy to get the diagnosis. They are not just a little different some of the time but a lot different all the time.

Some people could care less if they have a personality disorder or not. But most people who have a Personality Disorder are suffering, want, and need help, no matter how we label or understand their problem.

Currently, there are ten recognized Personality Disorders in three groups or “clusters.” The DSM-5 due out next year probably will reduce that list to six personality disorders and a new “Personality Disorder Trait Specified.” Not sure what will happen to the people who have a disorder now when their diagnosis is abolished. Will they be declared cured? Or maybe we just give them a new mental illness to compensate them for their loss.

When I was in Grad School I though these personality disorders were interesting, did extra research, and even wrote some papers on the topic. I considered specializing in treating these disorders. But what I discovered is that most people with a personality disorder come to the therapist for Depression, Anxiety, and relationship problems just like anyone else. Also since these are “inflexible” patterns, only two of these disorders end up in treatment with any regularity.

Here are the clusters as they stand now with the included diagnosis. The descriptors are mine with my apologies to the APA. Clusters A and C first as Cluster B is the biggie.

Cluster A: These are the “Weird” people.

Paranoid Personality Disorder – They are scared all the time. Most are NOT Schizophrenic. We don’t see many of these people unless family or police call us as they are so afraid they never leave home. This diagnosis disappears with the DSM-5. Lots of luck on that one.

Schizoid Personality Disorder

Loners. They do not like being around other people even family. They don’t have or want friends. They would make great hermits. When the DSM-5 arrives they are all cured and free to head for a cave in the hills. Just watch out for the zoning enforcement people as those dudes like to talk.

Schizotypal Personality Disorder.

Odd, superstitious, and believe in signs, spirits, and the supernatural. They may not have friends outside the family or only one close partner. If they think about something that needs to be done, say doing the laundry and then you go do it, they will believe that their thought caused you to do it. They often dress in odd ways. This description has been applied to people who look like “witches” etc. The DSM has an exemption here if they belong to a group that agrees with their beliefs. For the record Modern “Witches” who call themselves Wiccan do not wear funny clothes all the time and do not qualify for the diagnosis of Schizotypal. This is more common than the last two Personality Disorders and stays in the new DSM-5.

Group C Scared People

Avoidant Personality Disorder – they would like friends they are just sure no one will like them and so they avoid people. They are also sure people will criticize them or put them down so they don’t try. This one stays.

Dependent Personality Disorder.

Needy, clingy afraid they will be abandoned. They always need help and what to be told and what to do. This diagnosis goes. Find yourself a dominant partner before your diagnosis is repealed or get help and become less needy.

Obsessive-Compulsive Personality Disorder.

This goes beyond everyday OCD. They want everyone else to do things just so. They are often stingy with money, needs to control everything and they have the rule book to do it. Often they cannot get anything done because their rules are so complex they can’t follow them. This one stays.

Cluster B personality disorders.

The people who cause others problems. Cluster B diagnoses are the most common diagnosis in prisons.

Antisocial Personality Disorder.

They disregard the rights of others and violate those rights. This is the number one diagnosis of men in prison. This one needs a whole post all by itself.

Borderline Personality Disorder – The main ingredient here is lots of pain. Unstable interpersonal relationships, poor self-image, unstable mood, often impulsive with a chaotic life. Most people who are diagnosed with Borderline Personality Disorder are women. This traditionally is the number one diagnosis of women in prison. Many women with this diagnosis have been victims of one kind or another at an early age. They did what they had to do to cope in a bad situation but now the way they cope is not working. There are some really good treatments for this, especially DBT, but it takes a time to heal.

Histrionic Personality Disorder.

Excessive emotionality and attention-seeking sometimes referred to uncomplimentary as “Drama Queens.” Not common in practices and we are doing away with this diagnosis when the DSM-5 comes out. Most of these folks have their own T. V. shows by now so they can pay for therapy even without a diagnosis.

Narcissistic Personality Disorder.

We’re keeping this one. Not sure why. First, we treat you for low self-esteem and then we tell you that you are Narcissistic. Most people who come for marriage counseling tell me their partner is Narcissistic.

This should be on a continuum. Is this a political season? How can we tell the Narcissists from the candidates? Don’t you need to be a lot Narcissistic to think you should be running the show? Does the top Narcissist get to run a Bank or Wall Street?

Running out of time and this post is going long. More on Personality Disorders to come. Do any of you have any thoughts on the topic?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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