I have been googling “mental illnnes vs. personality disorder” but didn’t manage to find any satisfactory answer. How is a mood disorder (say, generalized anxiety disorder) different from a personality disorder? One sense that I get is that in a mood disorder, the affected person knows what he is going through is atypical while the latter usually is sure that he doesn’t have any problems.
Is mood disorder just brain chemical imbalance and personality disorder a ‘wrong’ way of thinking?
Both may have genetic, chemical, and environmental factors. A mood disorder is something that affects affect, e.g. depression, bipolar. Personality disorders do not necessarily affect someone’s mood. PDs include 10 specific disorders (in DSM-IV), and fall upon three domains: odd or eccentric, dramatic, emotional, or erratic, and anxious or fearful. Seems like you are comparing mood disorders to the second group only.
Personality disorders are way more pervasive. In the DSM, mood disorders are on Axis I with most disorders. Axis II contains only personality disorders and mental retardation, i.e mostly incurable symptoms.
It is essentially about the difference between one’s personality, and one’s mood.
Your personality is moulded by your experiences and determines how you cope with stress and life events. A personality disorder is when the mechanisms you have learnt throughout your childhood to cope with life events are so maladaptive that they cause major problems in your life through impulsivity, aggression or various other manifestations.
Your mood (or affect) is overlaid onto this.
So- Bill may be a sunny, happy-go-lucky man with a stable job. He loses his job and is very sad…but underneath that sadness will still be sunny, happy-go-lucky Bill, and he’ll use healthy coping skills to get over his redundancy and cope with unemployment.
Joanne finds it difficult to make friends because they find her emotionally exhausting to be around. People describe her as an emotional vampire and a drama queen. She wins the lottery and is super happy- but underneath her happiness she is still the same Joanne and will still find it difficult to connect with other people.
The ICD-10 (European version of DSM-V) explain very nicely what a personality disorder is.
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Personality disorder are notoriously difficult to treat, because you basically have to change not only how you think about the world, but how you respond to those thoughts both on a conscious and subconscious level.
People with personality disorder, by definition do not lead happy, well-adjusted, successful lives. They know something isn’t right, but are often powerless to fix it.
Think about men with Anti-Social Personality disorder- otherwise known as sociopaths or psychopaths. They are often that way as a result of serious childhood trauma (c’mon, you watch CSI and Law and Order, you know this stuff), which they cope with by turning their anger outwards and feeling little empathy for others. being numb and angry is a good way to survive a horrible childhood- it just doesn’t translate well to adulthood.
You can have a personality disorder and an affective disorder (depression, mania) or they can exist independently.
In some ways the answer can simply be ‘thats just the way it ended up being classified’.
Some of these classifications came from where we had groups of symptoms but not clear causes for these groups of symptoms. In practise we’re finding that the differences arent necessarily as clearcut as thought, eg that there are debates over whether borderline personality disorder is ‘complex trauma’ more akin to post-traumatic stress disorder, which is a mental illness.
The main common aspect with PD diagnoses is a general set of beliefs about the world, eg that you cant trust anyone with borderline PD, or that people must like and respect you with narcissistic PD, to a point far out of the norm for their culture.
They are often overdiagnosed, because people tend to thing any tendency towards these traits count as a ‘PD’, when a true diagnosis requires it to be very stable and ‘pervasive’ over time and to be negatively impacting very heavily on their life in a wide range of areas in their lives.
Otara
Sometimes it is not clear. For instance, it is speculated that borderline personality disorder is just very rapid-cycling bipolar disorder–which is an affective disorder.
A personality disorder can have traits that increase the likelihood of having a mood disorder. Peope with PDs tend to have problems with identity and connecting effectively with others, as well as controlling their emotions, so it’s no wonder that many of them also suffer from depression. But the depression is harder to treat, because it’s of the existential type rather than the endogenous variety that drugs can treat effectively.
PDs aren’t all shaped soley by environment. There’s some evidence (sorry, don’t have time right now to look up the cites) that BPD, schizotypal and schizoid, as well as avoidant PD have physiological and genetic linkages. Not sure about BPD, but I know the others in this list are correlated with the development of schizophrenia (I wouldn’t be surprised if BPD is as well, because extreme cases are known to experience delusions and magical thinking). So not everyone with a PD is a victim of abuse or horrible childhoods. Some of them are suffering from chemical imbalances just like you find in Axis I disorders, except that they are so pervasive and lifelong that they have shaped their personalities in a hard to repair way.
The DSM-V will be doing away with personality disorders as separate categories, if I’m not mistaken, and replacing them with a list of traits that a practioner can check off. So a person can have a little of column A, B, C, etc., allowing them to get a more “wholistic” rather than cookie cutter diagnosis.
What is the relevance of this story? It does not seem to involve any sort of mental disorder at all.
Do you intend to imply that only males can can be sociopaths or psychopaths?
That’s true, but it bears a little further explanation.
The purpose of creating the Antisocial Personality Disorder (ASPD) diagnosis in the DSM was to sort of codify what had been known as both psychopathy and sociopathy, and the current DSM-IV-TR states that they’re all synonymous: “(ASPD) has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder.” However, most criminal and forensic psychlogists and psychiatrists will tell you that the ASPD model and what’s called the Hare/Cleckley psychopathic model aren’t exactly the same thing. The problem is “construct drift”: the ASPD model describes a general pattern of criminal behavior that isn’t necessarily the result of a completely psychopathic mind.
Most psychopaths will qualify for the criteria of ASPD due to repeated run ins with the law, but not all individuals who qualify for the criteria of ASPD will be psychopaths - about 80% of the prison population will meet the criteria for ASPD, while about 20% would qualify as a prototypical psychopath. In a way it’s sort of a continuum; an individual with ASPD might suffer from a deficit of conscience, but to a psychopath a conscience is more like an alien concept. Dr. Robert Hare wrote an excellent article contrasting the two:
(emphasis in original). The whole thing is a good, not overly technical read:
Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion
The term “sociopathy” is even more problematic, because it’s used by some to describe both the DSM diagnosis for ASPD, and by others as a synonym for the Hare/Cleckley psychopathic model (Dr. Martha Stout’s book The Sociopath Next Door is an example of the latter). The trend in academia is to avoid the use of “sociopathy” in favor of either ASPD or psychopathy.
My point, njtt, was to try and highlight the difference between affect and personality.
In my (admittedly crappy) examples Bill is a sad but well adjusted optimist without a personality disorder, and Joanne is a happy woman with Borderline PD.
I know women can have ASPD, but the reason men, specifically, develop ASPD is as a result of childhood trauma- women with the same childhood trauma are more likely to develop Borderline PD (where the anger is turned inwards instead of outwards and the dominant maladaption is distrust).
I’ll freely admit I didn’t enjoy treating patents with PD. They pushed my buttons.
Schizophrenics, depressives, manic patients, drug induced psychosis, PTSD- all much, much preferable to PD patients.
According to my supervisor Borderline PD patients are sort of psychic transmitters- they have the ability to make those around them feel the way they feel. I do not like to feel powerless, angry and frustrated, and those were generally the overwhelming emotions I experienced after any encounter with a PD patient.
I can only imagine how awful it must be to have PD and feel like that 24/7.
Do you really believe the etiology of these disorders is so clear-cut and so definitively linked to life experiences?
That contradicts most of my recent reading on the topic, which hypothesizes a significant genetic component. MRI studies tend to show that psychopaths use their brains differently, and one implication is that their brains be have been genetically programmed (at least in part) to develop that way.
I know it isn’t that simple, but I have yet to meet a person with a personality disorder who didn’t have a childhood that was traumatic. I mean “sold into prostitution at the age of 11 by your mother” or “witnessing your father kill your mother and then raised by maternal grandparents who beat you daily for causing your mother’s death” traumatic.
I’m sure there are people whose PD has a solely genetic basis and who had perfectly lovely childhoods- I think that they’re probably in the minority though.
I think a helpful framework here is the diathesis-stress model which posits that those who develop these disorders have a genetic pre-disposition or risk factor that is triggered by environmental conditions. This might explain why some people can have horrific childhoods and later become productive, healthy human beings, whereas others go just batshit nuts.
In the case of BPD, while the vast majority of clients do have a history of childhood trauma, some don’t (estimates of BPDs with non-traumatic histories range up to 25%), so we can’t accurately state that BPD is caused by childhood trauma. It does suggest, however, that certain people may have a psychological vulnerability to childhood trauma that others don’t.
There are more personality disorders than BPD and AsPD, and most of them are not associated with great trauma. I know those two seem to be the factor of discussion, but I don’t think that the etiology of PDs in general can be found. Perhaps it’s a problem with terminology, which DMS-V seems to be fixing, but I don’t know the details yet.
Some people are uncomfortable with genetic links to such scary disorders. As olives suggests, these genetic factors seem to confer a predisposition. Someone with an amazing childhood may develop a serious disorder, while someone else with a traumatic childhood may turn out (relatively) normal. However, if you have the genetic factors, then you are more more susceptible to environmental trauma and thus developing the disorder.
I know anecdote != data, but a tendency toward depression and/or bipolar disorder seems to trickle through the women in our family for no apparent reason. None of us knows of any environmental cause, and there is absolutely no abuse in our childhoods. Mom, her sister, me, my sister, and one of my daughters. I’m guessing there were others in earlier generations but of course nobody talked about such things then.
I’ve felt both the genetic predisposition (which is apparent through my mother father’s and father’s mother’s lines) and the traumatic experience (“dying” at 16 months and the trauma of cold-turkey benzo withdrawal.)
I could see how either would be sufficient to cause a disorder in and of itself.
Another factor to consider in etiology of personality disorders, particularly with ASPD and psychopathy: a lot of our understanding of the impact of traumatic childhoods comes from their own self report, and from the self report of criminal offenders in particular. You’re looking at the self report of individuals who are untruthful and manipulative pretty much by definition, so it’s probably best to to maintain at least some skepticism. There’s a pretty strong motivation among offenders to blame current bad behavior on bad childhoods, and on top of that a truly psychopathic individual will often lie about anything at all just for the sheer joy of it, even when it make no sense to do so. Bad childhoods and poverty can and do lead to criminality and ASPD, but many full blown psychopaths appear to be just wired that way from childhood on, without any evidence of maltreatment whatsoever.