Personality
disorders are as common as clinical depression, bipolar, and schizophrenia, and
can be as devastating to their holders as are these mor recognized mental
illnesses—although personality disorders are more overlooked, as their
sufferers seem more “normal” than those afflicted with depression, bipolar, or
schizophrenia. The Mayo Clinic’s website
gives a good, concise overview of personality disorders, which are classified
as mental disorders rather than, like depression, bipolar, or schizophrenia,
mental illnesses. The Mayo Clinic’s
link, “Personality Disorders,” can be accessed here: https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463. 2014’s state-of-the-art handbook on what is
currently known about personality disorders, Handbook of Personality
Disorders: Second Edition (Livesley and Larstone, eds., Guilford Press;
available both in hardback and paperback), notes that personality disorders are
about 55% genetic and 45% environmental, and, in line with what the Mayo Clinic
states above, can result both from parents with personality disorders, as well
as abusive or chaotic childhood social environments. There are many varieties of personality
disorders, as both the Mayo Clinic and the Handbook of Personality Disorders
attest, and sufferers from personality disorders can have problems with
relationships, with employment and employability, and with schooling and
graduation. As a sufferer from
personality disorder myself, I can attest to having struggled over my lifetime
with all of these. As persons with
personality disorders get older, however, many of their symptoms are attenuated
and they become more “normal,” though usually with ongoing relationship
problems (for example, while I now have an intimate network of friends, they
are paltry in number), problems with unemployment and underemployment (again,
in my case, although a college graduate, I work a steady blue-collar labor
job), and problems in schooling and graduation (it took me 11 years to finally
complete the requirements for graduating with a Bachelor’s degree). Sufferers from personality disorders are also
troubled by extreme, over-the-top, emotional overreactions (I suffered these
too, especially with anger, which triggered angry outbursts).
While
personality disorders were described in the psychiatric literature as early as
1938, for a long time they were considered incurable; however, that has
changed, and a variety of long-term psychotherapies have successfully been used
for treatment (medication is not regarded as effective, except for symptomatic
relief). The Handbook of Personality
Disorders list several psychotherapies that have proven effective; among
them are Cognitive Behavioral Therapy, Dialectical Behavioral Therapy,
mentalization, and an eclectic approach that combines techniques from several
of the successful therapies (while the various schools of psychotherapy that
are useful have differing theoretical perspectives, in practice, their
techniques are overlapping and similar).
Personality disorders are also comorbid with other mental illnesses,
particularly with depression and bipolar, according to the above-cited Handbook. The point of psychotherapy in treating
personality disorders is to enable the patient to see underlying defects in
his/her thinking, and to replace wrong thinking with more realistic thinking. This is a process that involves regular
psychotherapy for a year or two, although in my case, successful psychotherapy
has taken considerably longer, probably because
for 47 years (1965-2012) the psychiatric
therapy I was subject to at CMHCs was considerably wrongheaded and malfeasant, leaving
me chagrined as a desperate, dependent outpatient—something that did not change
until I started in 2014 with a private psychotherapist who used his particular
version of Cognitive Behavioral Therapy
As
for childhood social environment as a cause of personality disorders, the ACE
study (Adverse Childhood Environment), based on a sample base of 17,000 clients
of California’s Kaiser Permanente health insurance program, provides important
clues to the kind of parents who are more likely to have children with mental
health issues. Specifically, there are
four kinds of parents who are high-risk for creating such children: parents who abuse, belittle, curse, or berate
their children; parents who are mentally ill or have personality disorders
themselves; parents who are alcoholics or drug abusers; and parents who have
been imprisoned, or who engage in illegal activities. In my particular case, both my parents definitely
fell into the first category, and may also have fallen into the second, as they
were both given to over-the-top outbursts of rage that would go on in tirades
for 10-15 minutes at a time.
However,
based on my experience as the holder of a personality disorder, with proper
psychiatric treatment, with a stable job and a solid friendship network, even
if small, the prognosis for recovery is solid and strong, even at a later
age. Given the prevalence of personality
disorders, it is a shame that NAMI and other mental health advocates don’t
recognize and educate on them nearly as much as they need to.