Friday Counseling Issues: The Personality Disorders

Today:  Obsessive-Compulsive Personality Disorder.

 

   

First, there is a difference between Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder.  Here is a quick summary of the differences:

Difference #1: Insight

Folks with OCD usually know that their thoughts are not exactly reasonable (“Did I turn off the stove?  I’d better check,” or “If I wear unmatched socks, something bad will happen to my brother.”)

By contrast, individuals with OCPD believe their sky-high standards and work ethic are not only reasonable, but the only way to get things done.

Difference #2: Distress

In OCD, the obsessions and compulsions are stressful and unpleasant. For instance, feeling convinced you just drove over someone and circling back dozens of times to check for a body turns one’s stomach into knots. By contrast, for those with OCPD, the rigid schedules and rules of the condition are often comforting and feel right.

Difference #3: Guilt

In OCD, individuals can, but not always, feel guilty about asking others to conform to their rituals (for example, “I know it’s a hassle to put on shoe covers whenever you come inside, but I really, really need you to do that.  I’m so sorry.”)  On the flip side, those with OCPD think others should conform to their methods and firmly believe they’d be better off for it.

Difference #4: Anxiety

With OCD, compulsions – the actions someone with OCD can’t resist doing, like checking, counting, or washing – are performed to reduce anxiety.  For instance, an individual with OCD might review her schedule for the day over and over again because she’s  terrified she’s forgotten to include all her appointments.

By contrast, someone with OCPD might make and review a detailed schedule in order to be comprehensive and efficient.  Anxiety isn’t part of the picture.

Difference #5: Time

By definition, OCD takes more than an hour a day.  That’s right – part of an OCD diagnosis can be the fact that the obsessions, plus the compulsions to neutralize the obsessions, suck up a lot of time. OCPD, on the other hand, is more tightly interwoven to one’s personality. Rather than being an activity unto itself, the perfectionism and control of OCPD is more of a trait, not a time suck.

Quick Tip: Think of the one-letter difference between the two acronyms: OCPD has a “p” in it, which you can pretend stands for “perfectionism,” the defining feature of the disorder.

Any way you slice it, these disorders are tough to live with.  The good news?  They’re also treatable, particularly OCD.  With work and practice, the only difference you’ll think about is what a difference good treatment makes.

(taken from: http://www.quickanddirtytips.com/health-fitness/mental-health/ocd-vs-ocpd-5-differences)

As with all the personality disorders, the person who has one thinks it is everyone else who is odd, wrong, strange, unreasonable, and needs help.  People who have OCD, as opposed to OCPD, are willing and often eager to seek help. On the contrary, OCPD people don’t think they need any help.  If only everyone else were as organized, scheduled, meticulous, PERFECT as they are, the world would be a better place.

Both of these disorders used to be classed under anxiety disorders. The new Diagnostic and Statistical Manual, however, has given OCD a place of its own, while OCPD is still under Personality Disorders.

Confused?  Think of it this way. OCPD people many not have the counting rituals, the constant handwashing, checking and rechecking of OCD, but they are absolutely convinced that their way is the ONLY right way, and they don’t mind imposing their standards on everyone else.

If you have an OCPD boss, that person will demand absolute obedience to every rule in the book, and he knows them all by heart.  He probably wrote them.  He simply doesn’t understand a cluttered desk, and will insist that his employees have prisitine  desktops. He doesn’t understand at all that some of us just don’t see the clutter, and we actually work more efficiently and productively if things are not antiseptically clean.

I knew someone who always did her wash on Monday, no matter what. No exceptions. She hung her laundry outside, even in the coldest weather, because the sun and fresh air helped kill bacteria that her boiling hot water and bleach may have overlooked.  If it rained or snowed on wash day, the clothes were hung on lines in the basement, but she worried incessantly that the clothes just weren’t as clean as if she’d been able to hang them out.

It messed up her whole week.  She could hardly wait until the following Monday.

That’s OCPD. To her, it was just normal, and she simply didn’t understand why Monday washday was not sacred to me. It bothered her. A lot.

She also ironed and mended on Tuesday, baked on Wednesday, shopped on Thursday, cleaned on Friday, and did yard work or major deep cleaning on Saturday.  Like clockwork.

OCPD people can find it difficult to make time for an unscheduled lunch date, or just taking an hour off to read or nap. Being off-schedule is intolerable.  Rules of etiquette are strictly observed, and there isn’t much spontaneous humor.

The other day, at work, I’d been doing some research during a free hour.  My desk was cluttered with several books, a legal pad full of notes, and the usual collection of pens, tissue box, and so on. It was a mess.  Didn’t bother me a bit;  it was work in progress.

When my client, a very nice lady who was seeing me for some marital help, came into my office, she stopped cold and stared at my desk. “Would you like me to help you clean that up before we start?”  she asked.

I could see that the mess would distract her completely, so I quickly gathered up, straightend up, and put things in my desk drawers. It was a pain for me, because I would have to get it out all over again. For her, it was intolerable and she wouldn’t have been able to focus on anything but my messy desk.

Treatment is helpful only when the person realizes she needs it. People with OCD respond well to cognitive behavioral therapy and treatment for anxiety.  People with OCPD  have to be persuaded that they need any help at all.

Today’s post concludes our study of the personality disorders.  I hope it’s been interesting for you, and even better, perhaps it’s been helpful.

 

Friday Counseling Issues: The Personality Disorders

Today, we’re looking at Dependent Personality Disorder. Keeping in mind that in this cluster of disorders, all the disorders are based on fear/anxiety, what seems irrational to a person who does not struggle with any of them is completely rational to those who do. As a therapist, I’ve had to sort of rewire my own brain in order to empathize and have compassion with dependent people, because the truth is that this disorder irritates the fire out of me.  I am so NOT dependent that it’s very hard for me to understand how anyone can function  when they so desperately need the help/approval of others.

Years ago, I was given the leadership position of a ministry in my church.  I took “leader” to mean that I was to make decisions and implement them. It wasn’t long before I discovered that I was wrong. What was expected of me was to put any ideas or decisions that needed to be made across the desk of my pastor, and HE would tell me what to do. This created a problem between us until I realized that most people in leadership ministries expected the pastor to do their thinking for them.  I couldn’t understand that. It all ended well because the pastor was a wise man, and I was willing to meet him more than halfway. I share this because I want you to understand how  difficult it is for me to truly understand dependent people.  It’s just not the way I roll.

The core feature of the Dependent Personality Disorder* is a strong need to be taken care of by other people. This need to be taken care of, and the associated fear of losing the support of others, often leads people with Dependent Personality Disorder to behave in a “clingy” manner; to submit to the desires of other people. In order to avoid conflict, they may have great difficulty standing up for themselves. The intense fear of losing a relationship makes them vulnerable to manipulation and abuse. They find it difficult to express disagreement or make independent decisions, and are challenged to begin a task when nobody is available to assist them. Being alone is extremely hard for them. When someone with Dependent Personality Disorder finds that a relationship they depend on has ended, they will immediately seek another source of support.

https://www.mentalhelp.net/articles/dsm-5-the-ten-personality-disorders-cluster-c/

The person with Dependent Personality Disorder (DPD) will hear, throughout the course of his life, that is is “needy,”  “clingy,” and “can’t stand on his own two feet”  His need for the approval and support of someone else is overwhelming, and when he loses that support he flounders around until he finds someone else who will fill the role for him. He really can’t stand to be alone. He will follow someone all over the house, keeping up a conversation of little or no interest to the other person, just to keep contact.  His need for obvious approval is unrelenting, and it wears out the other people in his life.

This is the high school girl who asks her best friend every single day, “Do I look okay?  Makeup?  Hair?  Outfit?  How about my shoes? How do I look from the back? Is this color good for me?”  She will then gather up her books from her locker and stick like a woodtick to her friend’s side as they walk to their first class.  If they don’t share the same class, she will say, “Okay, see you after class.  Can we meet at my locker?  Will you sit with me at lunch?  I’ll miss you!”

Her confidence and ability to function depends on her knowledge that her friend will always be available to her, no matter what.

In order to get a diagnosis of DPD, these traits have to be inflexible. All of us, especially during our teen years, tend to have a best friend that we rely on for support.  DPD goes way beyond the normal teen behavior. These traits cause functional impairment, and visible anxiety in the person who has them.  The traits create a problem in functioning well in normal society, and in interpersonal relationships.  Most important, the person who has DPD is miserably unhappy with her own behaviors, but is unable to break the pattern.

Treatment is in learning to confront anxiety; to tell oneself the truth; and to develop a set of personal goals that involve learning to become less dependent on others. As with all personality disorders, it’s not easy.  Good talk therapy with a patient, understanding counselor is important. The counselor needs to know how to draw the boundary so that the client doesn’t become dependent on her.  It’s a fine line to walk, and takes some experience  and compassion.

Friday Counseling Issues: Cluster C, Fearful/Anxious

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

Avoidant Personality Disorder can easily become a self-fulfilling prophecy.  The person who has this disorder has probably always felt inadequate, socially shy, and is certain that everyone sees him as a loser.  He’s always picked last when kids are choosing up sides to play a game. It seems as if no one even sees him or notices when he quietly backs away and leaves. People forget his name, or just refer to him as “that round-headed kid.”

We’ve all fallen in love with Charlie Brown.  He mirrors how we feel about our own perceived inadequacies, and we can identify with him easily—unless we’re narcissistic 🙂

The biggest problem here is with the person’s own perception of himself.  Our perceptions become our realities, and it’s no different for the Charlie Browns out there.  Here’s a good comprehensive list of symptoms:

• Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
• Is unwilling to get involved with people unless certain of being liked
• Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
• Is preoccupied with being criticized or rejected in social situations
• Is inhibited in new interpersonal situations because of feelings of inadequacy
• Views themself as socially inept, personally unappealing, or inferior to others
• Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

What we believe to be the truth motivates our emotions, words, and behaviors. The more convinced we become that no one likes/wants/appreciates us, the more likely it is that we will behave in such a way that avoids people altogether.We become so self-effacing that we are actually self-erasing.

Treatment can include good talk therapy with a counselor who understand that this is more than just being a little bit shy.  Sometimes an anti-anxiety medication is helpful in the early stages of counseling because it helps the person be more objective about his situation.

I have found that it is very helpful to talk with a client who has this diorder about his own worth and value to the God Who created  him.  Changing his beliefs about himself will start him on the road to understanding how God sees him, and will help him to realize that part of his problem is not so much  a lack of self-esteem as it is a conviction that other people don’t esteem him appropriately.

Friday Counseling Issues: The Personality Disorders

“He/she  is such a narcissist!”

Such a statement has become quite common, and applied like a coat of varnish over anyone who seems even a tiny bit more self-involved than we like.  It’s usually a major overstatement of the situation, but like lots of other psychological terms, it is applied freely  when it really doesn’t apply at all.  We need to be careful with our words.  Words mean things, and contrary to the old “sticks and stone” jingle, they DO hurt.  They hurt, and they remain in the human psyche for a very long time.

The legend from which we derive the name for this disorder is, briefly, that a very handsome  young god named Narcissus saw his reflection for the first time in a pool of water.  He fell in love with himself at first sight, and eventually fell into the water and drowned.  Narcissus flowers sprang up  in the place where he died.

The moral of the story is that being totally consume with oneself leads to nothing good.

The person who has true Narcissistic Personality Disorder goes way beyond being just a little vain. These people truly believe that they a special, set aside for some glorious destiny in which the whole world will acknowledge their unique qualities, and they will finally receive the glory and honor they deserve.

Their envy of others  goes way beyond reason, and in some cases can lead  them to commit crimes against the object of their jealousy.  They are capable of murder, believing they have done the world a favor.  Of course, as with any other disorder, there is a huge degree of difference among narcissists.  Not all of them are sociopaths!

They often present an arrogant, haughty attitude because they alone understand how wonderful they are.  The rest of the world needs to catch up.  They can be quite charming, lulling another person into believing that they are truly interested.  Their only real interest, however, is in self-promotion.  They take praise and adulation as their due.

They are often innately dishonest,  exxagerating their accomplishments in order to achieve whatever status they desire. They are certainly capable of abuse, although most of the time it is not visible.  They are master manipulators,  seeming to know exactly where to put the knife of sarcasm, belittlement, and criticism  to do the most harm.  When they are confronted with their nasty behavior, they will raise their eyebrows in shock and claim that you simply must have misunderstood them.

They are never wrong. Ever. They don’t apologize for anything unless doing so will further their cause.  You can’t win an argument with a narcissist.  You can’t reason with an unreasonable person.

There is no specific treatment.  Talk therapy can help IF the person acknowledges he actually has a problem.

Friday Counseling Issues: The Personality Disorders

Histrionic Personality Disorder.  The name seems to cover it, but there are some nuances that separate this one from Borderline, which it closely resembles.

 

It wasn’t hard at all to find images that describe Histrionic Personality Disorder (HPD).  The disorder is fascinating, but it wears you out–whether you have it, or you’re close to someone who does.

It takes a lot of energy to keep up the kind of drama that characterizes HPD.  The person who has it is demanding, needy, and convinced that the things that happen to her have never happened to anyone else, and that the whole world is fascinated by her experiences. She loves to talk about herself, and takes or makes every opportunity to do so. She rarely sees the distaste or the boredom in the eyes of her captive audience, because she is consumed with her performance and has very little awareness of other people.

You go ahead and try to have a normal conversation with  a person who has HPD.  Good luck. Your first sentence will likely prompt him to go off on one of his own stories, totally taking the stage and derailing what you were trying to say.  Everything is about him, all the time.

Here’s a good list of diagnostic symptoms, taken from psychcentral.com :

• Is uncomfortable in situations in which he or she is not the center of attention
• Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
• Displays rapidly shifting and shallow expression of emotions
• Consistently uses physical appearance to draw attentionto themself (my sharp-eyed son caught this egregious grammatical error.  Himself, not “themself.”  Oy.)
• Has a style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is highly suggestible, i.e., easily influenced by others or circumstances
• Considers relationships to be more intimate than they actually are

HPD cannot be cured, but as with all personality disorders, it can be mitigated with good therapy.  Sometimes, medication can be helpful in calming the extreme attention-seeking and impulsive behaviors.

As with all the personality disorders, a biblical approach is often the most effective therapy.  When a person truly comes to Christ, it changes him.

 

 

Friday Counseling Issues: The Personality Disorders

Borderline Personality Disorder (BPD) is fascinating to the clinician, but a pure misery for the one who has it and those who love the one who has it.

Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood.

Most people who have BPD suffer from:

• Problems regulating their emotions and thoughts
• Impulsive and sometimes reckless behavior
• Unstable relationships

Incidence

• BPD affects 5.9% of adults (about 14 million Americans) at some time in their life

• BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%).

• BPD affects 20% of patients admitted to psychiatric hospitals

• BPD affects 10% of people in outpatient mental health treatment

• (taken from  http://www.borderlinepersonalitydisorder.com/what-is-bpd/bpd-overview/)

The gold-standard treatment for DBT has become Dialectic Behavior Therapy, which is an offshoot of Cognitive Behavioral Therapy.  Therapists who work with BPD usually study DBT in order to be most effective (please forgive the acronyms.  I don’t usually resort to them, but all these psychobabble labels are a real pain to type out all the time!)

My personal experience with BPD is limited.  I’ve had a couple of clients who had it, and after two or three sessions I sent them both to a specialist in the disorder.  Group therapy is very important and helpful, because  it gives the client the opportunity to interact with people in a controlled atmosphere while they learn skills that will help them function normally.

If you or someone you love has BPD, you know that there’s a lot of drama.  It can wear you out and shut you down. Borderlines crave close relationships, yet they continually destroy those relationships with their endless demands for complete closeness. They often feel that others dislike them, are keeping secrets from them,  or have abandoned them. Romantic relationship often go sour because the Borderline person is so possessive and jealous of the object of her affection.

While BPD can’t be permanently cured, it CAN be treated and kept in check with good therapy and family support. The person’s need for constant reassurance is wearying for the family. Boundaries are important in a relationship, lines that cannot be crossed without serious consequences.

There’s lots of good information out there in cyberspace.  As I’ve scanned through many different articles, I’ve found almost everything to be accurate. Of course, I use trustworthy sources like  the National Insititue for Mental Health (NIMH) when I go looking for information.  Check your sources carefully.  Not everyone who writes about these things has the training, authority, and experience to do so.

Friday Counsling Issues: The Personality Disorders

Today we’ll take a look at  Cluster B (Dramatic, erratic) personality disorders, which include Antisocial, Borderline, Histrionic, and Narcissistic personality disorders. In fact, I think we’lll just talk about the first one. We’ll see how it goes 🙂

It’s very important to understand  that this is a serious maladaptive pattern of behavior.  It is NOT typical of someone who just prefers to be alone.  We are far to quick to slap labels on people who walk a little different path than we do.

Someone who has Antisocial Personality Disorder may disguise it well, depending on basic temperament, but typically this person really doesn’t care too much how he is perceived. Lying is his primary MO, and he feels no remorse whatsoever in lying.  If he is confronted, he will either charm his way out of it or he will shrug and walk away.  His philosophy is that other people exist to  help him get what he wants; to take care of him, and to make no demands on him whatsoever.  He cannot truly love.

As a matter of fact, this person could easily be considered sociopathic. There is just no concern at all about the effects of his behavior.  He was probably a very difficult child, angry and maybe violent. This is a young person who will not hesitate to physically attack a parent or a sibling, and he can be a bully with his peers if he is strong enough to pull it off.  He has very little fear.

Some refer to this disorder as The Cold and Callous Man.  Not that all people with Antisocial PD are men, but it does seem that there are more men than women who fall into this category.

Treatment is difficult. There is no permanent cure, although if the person can be reached with the gospel, there can be a huge improvement. If the person will agree to treatment, there are several approaches that can be tried.  You can go here for a comprehensive article about treatment for ASPD.  Sadly, the person most often refuses treatment, blaming everyone else but never himself for the situations his behavior creates.

Next week: The very interesting Borderline Personality Disorder.

Friday Counseling Issues: The Personality Disorders

First, we need to define our terms.  A personality disorder  is a deeply ingrained and maladaptive pattern of behavior of a specified kind, typically manifest by the time one reaches adolescence and causing long-term difficulties in personal relationships or in functioning in society.

By contrast, depression and Bipolar Disorder are categorized as mood disorders.  Other problems fall under the label of anxiety disorders, such as obssessive-compulsive disorder. More serious issues, such as schizophrenia, are true mental illnesses requiring close medical attention.

A personality disorder cannot be “cured” in the sense that it will ever completely disappear.  It can, however, be treated to a certain extent if the person who has the disorder is willing to be treated. Sadly, much of the time there is no recognition by the afflicted person that there is a problem, except with everyone else.

The DSM-5, which is used by clinicians to identify specific conditions, lists ten personality disorders, grouped into three clusters,  as follows:

 

Cluster A (Odd, bizarre, eccentric)

Paranoid PD, Schizoid PD, Schizotypal PD

Cluster B (Dramatic, erratic)

Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD

Cluster C (Anxious, fearful)

Avoidant PD, Dependent PD, Obsessive-compulsive PD

As I’ve said many times before, it is difficult to diagnose oneself or someone else by looking up symptoms on the internet.  In fact, I beg my clients not to do it.  It generally leads to increased fear and often a strong misunderstanding of what is really going on. So this and the following posts on this subject are not intended to diagnose you or anyone else; rather, they are for general information.  If you or someone close to you seems to be suffering with symptoms you will find here, the best thing to do is to start by going to your primary care physician, who will refer you as necessary for further medical evaluation and then perhaps to a therapist like me.

Cluster A

I’m not going to spend a great deal of time here, because I am not experienced in this set of personality disorders.  I have a standing rule:  If you have been diagnosed with any  of the three conditions in this cluster, you MUST see a psychiatrist for medical treatment before I will accept you as a client.  My experience has been that people  dealing with these conditions are not going to benefit from counseling if they are not staying faithful to their medication.

Some quick definitions:

Paranoia: Characterized by a pervasive distrust of others, including even friends, family, and partner.The true paranoid is constantly on guard, looking for clues that he is being spied upon, followed, harrassed, wrongly accused and/or gossiped against by everyone he knows. He will not hesitate to call law enforcement if he believes the car he just saw passing his house is following him.  He lives caged in fear and suspicion.

Schizoid Personality Disorder: The term ‘schizoid’ designates a natural tendency to direct attention toward one’s inner life and away from the external world. A person with schizoid PD is detached and aloof and prone to introspection and fantasy. They tend to avoid social interaction, seeming to be content with their own life in their own space.

Schizotypal Disorder: Schizotypal PD is characterized by oddities of appearance, behaviour, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia. These latter can include odd beliefs, magical thinking (for instance, thinking that speaking of the devil can make him appear), suspiciousness, and obsessive ruminations.

There is more, much more, to these three disorders in the first cluster. Again, this is not an area of expertise for me and I in no way want you to think that what I have written here is the complete, substantive description of these three disorders.

And again, if you or someone close to you suffers from these symptoms, your medical doctor is the best starting place in your quest to find help.