NAMI: Don’t Overlook Personality Disorders

 

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.