Introduction to Personality Disorders
Authors' comments: This document, Understanding Personality Disorders, has been about two years in the making. Over time, and many drafts later, it has grown in size and scope beyond the original core document authored by Dr. Hoermann. Additional contributions by Drs. Zupanick and Dombeck were added as we collectively sought to provide readers a deeper and truly meaningful understanding of personality disorders to include an understanding of the complicated theoretical frameworks that support contemporary and effective treatments. The scope and magnitude of these many revisions resulted in Drs. Zupanick and Dombeck becoming co-authors rather than editors, though this was certainly not our original intention. New research developments will continue to improve our understanding of these very troubling disorders and so we consider this a living document that will continue to be revised and expanded. A new diagnostic manual will be published in a few years (DSM-V) and it is expected there will be significant changes with respect to personality disorder diagnoses. Although we recognize we have not done justice to the entirety of this subject matter, we felt it was time for it to be published. As always, we welcome our readers' feedback and suggestions for future expansion and revision.
What is a Personality Disorder?
The term "Personality Disorder" implies there is something not-quite-right about someone's personality. However, the term "personality disorder" simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.
To be diagnosed with a "personality disorder" does not mean that someone's personality is fatally flawed or that they represent some freak of nature. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed with these disorders. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).
Unlike many types of disorders that are indicated by symptoms that are not usually found in the general population (e.g., seizures), personality disorders cannot be understood independently from healthy personalities. Since everyone has a personality (but not everyone has seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle. Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.