- Mental Health
Difficult People and Personality Disorder
From a cranky two year old to an irritable spouse, to people who are chronically jerks, we have all had experiences in life with ‘difficult’ people. In most cases, the difficulty is a passing thing that is time limited; once the person’s mood changes or they get some sleep or a bit of caffeine in them, all is remedied and you may not see the same presentation for quite a while. We have even been difficult with others ourselves, and likely feel at least a bit guilty when we figure out we have been being difficult with others.
Temporary, or transient sour moods in which people express discontent or are uncooperative are not at all unusual. Believe it or not, most average people have mood changes about every twenty to thirty minutes. Not that these mood changes are drastic, in fact, they are usually quite subtle, but they do happen. Most of us are able to ‘reign in’ our mood a bit so that we do not impose our bad moods on others. Or, if we do express discontent in a strong fashion, know we have hurt someone and make attempts to mend the fences.
Chronically difficult people have much more demonstrative and intense expressions of their discontents, and develop a working style that is often very unapologetic and in-your-face. They have essentially learned the values of being verbally aggressive and intimidating as a means to get what they want, or just to enjoy the reactions of those around them. Basically, difficult people culture an approach to life that makes others think of them as assholes.
There is a very gray area between the difficult person and what the mental health field calls ‘Personality Disorder’ (PD). This gray area begins the description of a spectrum of personality issues that are both difficult to pin down as they are to treat or the damage they do to innocent victims. This is to say that not everyone who is 'difficult' is personality disordered. The PD spectrum ranges from benign quirky and eccentric people, through jerks and all the way to psychopaths. Through the hundred plus years of psychology as a field of study, there have been many descriptions, designations, and classification methods to understand this spectrum. Terms such as: ‘character disorder’, ‘megalomaniac’, ‘narcissist’, ‘sociopath’ and ‘psychopath’ are but a few older terms, and the reader likely already has many slang expressions for such difficult people.
Charlie Harper is a Narcissistic Personality Disorder
Personality Disorders are a classification of mental illness that are separate category from more familiar mental health issues like depression, anxieties, and psychosis. PD is different in that it does not manifest due to a problem with brain chemistry that can respond to medications, like, say, depression can. A valid theory is that PD is a genetic issue, as in: if your parent has it, you have a good chance of having it as well. But like addiction, you may have the gene, but that does not mean you will become a PD. If someone with the PD gene is not raised by an active PD, their chances of becoming a PD themselves is much lower. Remember though, this is just one theory of why PD exists and how a person develops into a PD.
The other difference between PD and other mental illnesses is that the person with PD is actually choosing to be the way they are. In fact, if a person is PD, they cannot use ‘insanity’ as a defense in the courtroom, like a person with schizophrenia might be able to do. Interviews with individuals with PD reveal that they know exactly what they are doing, and even why they are doing it.
Estimates for the prevalence of PD is between 9.1% and 13.4% of the population, or about nine to thirteen people out of one hundred. Much of the time, PD is not diagnosed, as many people with PD do not perceive that they have any problem at all, but it is the world and people around them that are difficult and odd, not themselves. Thus, they often do not seek or get treatment, so the estimated rates may be in fact a bit low. It is not uncommon for people with PD to also have ‘co-morbid’ mental health disorders, meaning other issues like depression or anxiety, for example, for which they do seek treatment.
There are nine major classifications or types of PD, but they all have some striking commonalities that are worth noting, and serve as the fundamental diagnostic tool for mental health professionals. It is important to note that while laymen may be able to identify people with personality disorder, it really does take a professional in mental health to accurately diagnose the disorder(s).
Characteristics common to most of the PD’s are: and ‘enduring pattern’ of symptoms, meaning that the symptoms are often life-long from childhood or at least adolescence, and continue without any real remission. The behaviors are pervasive, and present in all environments and aspects of life. There is a pattern of thinking about themselves, others, and events that is very inflexible. The affect (expressed emotions) of a person with a personality disorder often tends to be very intense or ‘over the top’, and the emotions are labile (meaning they change directions quickly and often). Their social and interpersonal responses to people and situations are often slightly off-center and odd; this affects their interpersonal functioning (making them ‘difficult’). There is also often a great deal of impulsive, or erratic behaviors. The entire behavior set is not otherwise explained by other mental conditions or substance abuse.
Specific Types of Personality Disorder
The specific types of PD are broken into four different groupings that have related types in each grouping. The first subset includes paranoid, schizoid, and schizotypal personality disorders. Despite how they sound, none of these types mean that the person is schizophrenic, as in schizophrenia there are active hallucinations of different kinds, and these types of PD do not have that symptom set, though they have characteristics that resemble a full blown psychosis like schizophrenia. These individuals usually present as eccentric, or ‘oddballs’ and are not particularly offensive to others. They tend to self-isolate and quietly sit on the fringes of society.
The second grouping of PD’s include antisocial, borderline, histrionic, and narcissistic personality disorders. This type of PD can be very annoying, damaging, and even dangerous. People with these types of PD range from petty thieves and over-dramatic divas to nasty, difficult, devious, and downright evil killers. They tend to be predators and either fill our prisons, or are so bright and clever to never get caught in their crimes. They often have no conscience.
The third grouping is comprised of avoidant, dependent, and obsessive-compulsive personality disorders. The latter, obsessive-compulsive PD, is not to be confused with obsessive-compulsive disorder, which is an anxiety disorder. The major difference between the two is the source of the behaviors; in the former is based in personality, while true “OCD” is a neuro-chemical issue in the brain. People with these PD’s tend to be fairly quiet, but intensely annoying to others, making them very difficult to be in community with at home or in working situations.
The last grouping is for PD’s that do not fit clearly into any of the above types, though they have multiple general and some specific characteristics.
Most PD’s do not get official diagnosis, let alone treatment. Most PD’s in the second grouping have intense and public interpersonal problems that often lead to jail or other social service agency interventions, but these routinely fail to make much of a positive impact. PD’s in the other groupings do show up for treatment, but it is often for other mental health disorders that go alongside the basic PD.
Many mental health professionals avoid treating PD’s because of the relatively low success rate in treatment. Many PD’s often drop out of treatment when it gets too challenging, or treatment presses them to address their central issues. Other clinicians will only treat certain types of PD, and avoid other types. The second grouping, in particular, that can include individuals with intensely anti-social behaviors are often avoided by clinicians, because of the tendencies for these people to be highly manipulative and conscienceless; it can be downright dangerous to interact with psychopaths. (Think: ‘Silence of the Lambs’).
When treatment is honestly engaged by the PD, they often struggle to accept that the problems they experience are their problems, and not a result of the world around them. It may take years of clinical treatment sessions a few times a week for the individual to begin to recover and change their behaviors, and even then, progress and success is usually very limited.
Coping With PD's
Family members and associates of people with PD are often very frustrated and exhausted in trying to cope with the behavior sets that the PD presents. In many cases, families try for decades to get help for the PD and themselves, but cannot find adequate or meaningful progress (due to the reasons cited above about treatment). Long term exposure to certain types of PD can cause collateral damages and create mental health issues for those in relationship with the PD. For example, a narcissistic male may induce intense dependency on a female partner. Qualified clinical counseling help with a counselor who is well versed in PD and PD victims can genuinely make a positive difference in the family member’s or victim’s life, allowing them to find some relief, serenity and satisfaction, but often the PD would never 'allow' the family member/victim to get such assistance.