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 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.