It’s all too easy to categorize people by their personalities. Your mother is passive-aggressive. Your co-worker seems somewhat antisocial. Your friend likes to hit the casino whenever he can. You have to admit that you are bit obsessive-compulsive. We all have certain personality traits. But when do those traits cross over into a personality disorder, a recognized mental illness?
“Personality traits are the relatively enduring normal dimensions of temperament and character that we are born with or develop at a very early age,” says Samuel A. Ball, professor of psychiatry at Yale School of Medicine. Personality traits such as negativity and agreeableness exist on a continuum from high to low and can be considered normal or abnormal depending on one’s culture, he says. However, Ball explains that “the more extreme the personality traits, the stronger the positive or negative reactions from parents and one’s culture.”
When a personality trait becomes “inflexible” and causes “personal distress and social dysfunction,” such as a damaged relationship or job loss, that constitutes a personality disorder, says Dr. Petros Levounis, professor and chair of the department of psychiatry at Rutgers New Jersey Medical School. An estimated 10 to 20 percent of the U.S. population has a personality disorder, he says. Sex and race do not appear to be associated with personality disorder prevalence, according to the National Institute of Mental Health.
[Read: When Your Personality Is What Ails You.]
Basic temperament may be biologically determined. “It has been shown that introversion and extroversion have a genetic basis,” Levounis says. Personality disorders may share genetic components of these traits, and environmental factors or events may be how traits progress to disorders. “Extreme or maladaptive personality traits in combination with adverse childhood experiences put people at risk for developing a personality disorder,” Ball says.
Childhood abuse or neglect, for example, has been directly linked to antisocial and borderline personality disorders. And behavioral theorists think that at least some personality disorders are related to “an impaired capacity for social learning,” Levounis says. “Patients with personality disorders may have greater difficulty learning from their mistakes and thus develop maladaptive coping strategies,” he explains.
Making a Diagnosis
A personality disorder is a diagnosable psychiatric condition involving several extreme personality traits: paranoid, antisocial, narcissistic, obsessive-compulsive and others. There must be “clear evidence that these symptoms cause clinically significant distress or impairment in the person’s life,” Ball says. “Personality traits, emotional responses, thought processes, behavioral patterns or relationship styles can become a personality disorder when they cause significant personal distress or impairment in the person’s functioning, for example, in work, family or social roles.”
The sooner that someone realizes a personality trait is causing such distress and impairment, the quicker he or she should see a health care professional. “Almost all disorders are better treated sooner than later,” Ball says. “Unfortunately, most people minimize or deny their need for treatment when they first become ill, either out of embarrassment or a hope that symptoms will go away on their own.”
For many medical or psychiatric conditions, family members are very important in influencing the person to seek help. “Oftentimes, the earlier the onset of a psychiatric disorder, the more severe the problem will become if untreated. Because the person with symptoms may not seek help on their own until it becomes a major problem, the family and other concerned people are very important in seeking and supporting treatment,” Ball says.
[Read: Personality and Mental Illness: What’s the Link?]
An accurate diagnosis is based on a face-to-face diagnostic interview with the patient and consultation with family members. “Structured diagnostic interviews involve detailed questions about the severity and circumstances of each symptom, and this is especially important in evaluating the distress or dysfunction caused by certain traits necessary to diagnose a personality disorder,” he says. “Research has shown that the diagnosis of personality disorders can be very inaccurate when based only on a self-report questionnaire, observation of behavior or an unstructured clinical interview, resulting in the under- or overdiagnosis of these serious conditions.”
Indeed, there is a risk that a diagnosis of personality disorder unfairly pathologizes normal types of personality, Levounis cautions. “Most individual personality styles should be considered part of the normal variety of human life,” he says. A personality disorder diagnosis “should be reserved for patients whose personalities clearly fall in the pathologic range because of the distress and disability they experience,” he explains.
[See: Is It OK to Talk to Yourself?]
Disorder or Disease?
Is a disorder different than a disease? Not really. In fact, Ball thinks classifications such as unhealthy behavior, disorder and disease only confuse the general public — or worse. “They leave people feeling blamed for their mental health or addiction problems, as if they are less real or more controllable than other medical problems,” he says. “The words disorder and disease apply equally well to most serious psychiatric conditions, for example, schizophrenia, mania, depression, addiction, antisocial and borderline personality disorder.”
One of the definitions of disease is that it requires treatment to get better or at least stabilize, and that holds true with most serious psychiatric disorders. “They do not get better on their own without some combination of medication, psychotherapy, and peer recovery support,” Ball says.
There are no drugs that specifically target a personality disorder, Levounis says. Instead, different medications are prescribed to combat different symptoms. For example, mood stabilizers can treat aggression and impulse control, while antidepressants may help social anxiety and obsessive-compulsive actions. On the therapy front, he says, cognitive behavioral therapy has also been proven helpful in treating many types of personality disorders.
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When Do You Cross the Line Into a Personality Disorder? originally appeared on usnews.com
