245 Introduction to the Personality Disorders
Basic Concept of a Personality Disorder
Personality disorders (PDs) tend to be pervasive, life long disorders. People with PDs carry with them destructive patterns of thinking, feeling, and behaving as their way of being and interacting with the world and others. In order to be classified as a personality disorder the personality traits must be inflexible, be maladaptive and cause functional impairment or subjective distress. Onset begins in adolescence or early adulthood and is generally stable over time. They tend to be incredibly difficult to treat, in no small part because people with personality disorders often do not view themselves as actually having a problem, and they tend to frame reality in terms of their needs and perceptions, and are unable to understand the perspectives of others. For instance, most people with Narcissistic personality disorder are actually convinced they are as wonderful as they profess themselves to be. Similarly, people who suffer from schizophrenia see no problem with the fact that they do not like people, this to them is not a disorder, only a character trait. A person with antisocial personality disorder might resist treatment because they see the psychologist as trying to gain dominance over them, viewing it as if the psychologist is trying to change them to be submissive, weak and pathetic like the way they view the psychologist has. On the other hand they may even think that the psychologist really is trying to help, but is simply confused about the harsh and cruel nature of reality. Another reason for why they are difficult to treat include their limited ability to receive, accept, or benefit from corrective feedback. Another difficulty during treatment is the strong counter-transference clinicians have while working with them.
People with PDs are also often fully mentally functional. Though their views of reality may be distorted or odd, this is not due to impairment in mental function. Many people at the top of corporations, for example the CEOs of Enron, could easily be diagnosed with antisocial PD. In this way, the PDs tend to be seen somewhat differently than the other ‘mental disorders’ instead is seen as a deficit. Those with PDs, it is quite literally a change in the nature of the cognition, rather than a reduction in the potency thereof, and due to this, treatment can be difficult. It is also different from those with mood disorders where the person is usually not as resistant to treatment. People with PD often have strong wills and ideas, and the intelligence to back up what they experience and rationalize it.
Also due to these traits, people do not often bring themselves in for treatment for personality disorders. People with personality disorders tend to be either court-ordered to attend therapy, as is often the case with antisocial personality disorder or borderline personality disorder. Those who are treated may be pushed into it by family and fri