Personality Disorders in Greater Detail (Part 2 of 2)

In our previous article, Part One on Personality Disorders, we gave an overview of personality disorders, then focused on one of the more common ones: Borderline Personality Disorder.
This article will cover some of the other personality disorders, specifically:

Narcissistic Personality Disorder

Avoidant Personality Disorder

Obsessive Compulsive Disorder (OCD)

Before diving into those specific conditions, though, let’s talk a little more about the nature of personality disorders, what it means to have one (ore more), and what patients and loved ones can do to mitigate and even reverse the damage caused by these unfortunate conditions.

More about personality disorders in general

Personality disorders are, as the Mayo Clinic describes, a “a rigid and unhealthy pattern of thinking, functioning and behaving.” How will you know if you or someone in your life has a personality disorder? It’s not always apparent or obvious, especially to the person afflicted with the disorder. Why? Chances are that the patient has lived with this condition for many years, quite possibly their entire adult life or even longer than that. After a while, the symptoms and patterns that objective observers would see as “erratic” and “concerning” become “normal” to the patient, and even normalized to or accepted by family and friends.
It’s important to bear in mind that diagnosis is made if two or more of the following patterns are presented:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

Personality disorders are more often seen in adult years, or perhaps in one’s late teens. It would be less common (though not unheard of) to see these in childhood or early teens. Personality disorders cause distress to the patient and to those around then. Having a disorder can be terribly prohibitive towards one’s ability to function – particularly in relationships and in the workplace.

There are three essential groups of personality disorders.
“Cluster A” covers Paranoid, Schizoid and Schizotypal personality disorders. While different in many ways from one another, they share some common traits. Typically characterized as “odd,” “bizarre” or “eccentric,” people with these disorders are often (mis)judged for their thinking and behavior – and stigmatized or shunned as a result.

The personality disorders in “Cluster B” include Antisocial, Borderline, Histrionic and Narcissistic. This is the “dramatic” and “erratic” group.

“Cluster C” disorders are Avoidant, Dependent, and OCD. These are often perceived or thought of as the “anxious” or “fearful” people.
What causes personality disorders? This can vary from person to person. Factors include:

• Genetics
• Childhood trauma
• Verbal abuse
• High sensitivity (to light, sound, texture, etc.)
• Life experiences (with peers, relatives, teachers, et al)

In therapy or counselling, it’s worth exploring these causes. Especially in the case of trauma or abuse, there would likely be other emotional issues that need to be addressed.

Let’s take a look at some specific personality disorders.

Narcissistic Personality Disorder (NPD)

A certain White House occupant has brought attention to Narcissistic Personality Disorder as of late. It’s not at all clear whether Donald Trump has NPD, of course, since none of us can accurately diagnose some simply by reading his Tweets and watching his public appearances. What’s caused the stir? What is it about the US president that makes some believe he may have this condition?

Narcissistic Personality Disorder is essentially an inflated sense of self-importance, combined with an inability to empathize with others. Common traits are:

• grandiose self-image
• filled with delusions and fantasies
• seen by others as arrogant, egotistical, self-centered and self-absorbed
• feeling of superiority and entitlement
• needs to have constant admiration and attention from others
• believe that everyone else envies them – and simultaneously envies others
• lacks empathy towards others, cannot relate
• left unchecked, will take advantage of others

You might know someone like this in your life. They might have NPD, though it’s worth bearing in mind that the presence of some of these traits doesn’t necessarily equate to a personality disorder. Proper diagnosis can only come from a trained professional (not an online “test” or other superficial assessment). The majority of NPD-diagnosed individuals are male – as many as two in three.

Treatment for NPD is hardly simple or straightforward. People with inflated egos tend to be defensive when anything resembling criticism is directed their way. Their likelihood of acknowledging a problem, let alone seeking help, is significantly less than for someone with, say, depression or anxiety issues. Group therapy can be helpful here, setting up an environment with fellow NPD patients. Talk therapy has also proven to be effective. Capital Choice Counselling can direct you to the right therapists who specialize in treating narcissistic personality disorder in Ottawa.

Avoidant Personality Disorder

Nope, contrary to what it might sounds like, people diagnosed with avoidant personality disorder aren’t lazy or inept. They suffer from an inability to confront challenging or difficult situations in life, including things that most people might take for granted. Although only 2% of the population suffer from AvPD, its effects can be harsh and wide ranging. What are signs to look for?

• tends to magnify challenges into mammoth hurdles
• highly risk-averse
• reluctant to engage in social situations
• socially awkward
• avoiding confrontation or conflict
• easily offended by criticism
• few or no close friends

Having said this, we should be careful not to ‘over-diagnose’ AvPD or jump to conculsions about someone simply because they’re extremely shy or don’t like confrontation. Like other personality disorders, one needs to meet several criteria on a list of symptoms, and proper diagnosis can only come after sessions with a professional. Is avoidant personality disorder a genetic phenomenon, or one caused by environment? We don’t yet know. Antidepressant medication has been helpful in the treatment of avoidant personality disorder, along with psychotherapy (particularly CBT or cognitive behavioural therapy).

Obsessive Compulsive Disorder (OCD)

OCD has become a popular in our lexicon, but one that is often misused. The actual condition is one that’s quite serious and life-altering. But it’s become popular to say things like “I’m a little OCD” when someone has a slight obsession with a way of doing things, or who shows shades of compulsiveness about having life in a certain order. Such people can lead fully successful lives, and their slight tendencies are seen as “adorable quirks” more than something limiting or off-putting.

People legitimately diagnosed with OCD lead a life that’s marked with great suffering and limitation. They obsess terribly about many things in life, most things even, with repeated thoughts, urges or mental images that are hyperfocused on a singular subject or aspect – often leading to anxiety. These thoughts can have a tendency to run in a seemingly endless loop, preventing the OCD individual from functioning effectively in day-to-day life, work, relationships, etc. Some obsessive thoughts and patterns include:

• Perceived as having aggression – or aggressive thoughts – towards other people and/or themselves
• Needing life to be symmetrical and in ‘proper’ order
• Fear of germs (germophobia)
• Taboo or forbidden thoughts about violence, sex, etc.

Compulsions are the things that a person with OCD feels the urge to do, often repeatedly in patterns, as an anxiety-based response to the obsessive thoughts that triggered them. Some more common compulsive behaviours include:

• Counting
• Excessive cleaning (tidying, cleaning their environment, washing hands, etc.)
• Repeating mundane tasks (e.g. turning off the stove, checking to make sure the door is locked, etc.)
• Having physical or tangible items lined up or arranged in a very specific order, one which cannot be disturbed

Again, if you or someone you know shows one or two of these symptoms, that in and of itself doesn’t necessarily equate to OCD. We all have something we need to be in some semblance of order, and from time to time we all have an obsessive thought or take a compulsive action. It’s the repeated pattern of these, over and over, to the point where it becomes a limitation (in life, work, school, relationships, etc.) – that’s when a diagnosis can be made. Treatment includes psychotherapy (particularly CBT or cognitive behavioural therapy), as well as medication (e.g. SSRIs) in some cases.

How and Where to Get Help

If you or someone you know is afflicted with a personality disorder, or are showing signs of one, it’s important to seek help. Life’s too short to suffer with limitations. You don’t have to suffer in silence. At Capital Choice Counselling in Ottawa, we have trained therapists and counsellors with expertise and experience in various personality disorders. We encourage you to contact us today, and get started on the road to recovery.