Personality Disorders: So how do we decide who's normal?

Forums: Relationships, Psychology, Personality Disorders, Normalcy, Dsm-Iv
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I'm posting this thread in Relationships because the biggest reason I want to explore this and I guess why this topic really matters is because we have to deal with all sorts of personality disordered individuals in our relationships.

So how do you decide if someone's just ambitious and focused rather than a narcissist, or if the guy you have a crush on (because I have) just a happy-go-lucky type charmer or a real HPD (Histrionic Personality Disoder)?

We all have our flaws: we get angry; we will manipulate others sometime; we'll even be hypocrites at times. But how do you know when you're just not normal?

--
ETA: Here's a good place to get a briefing on the personality disorders: http://www.mayoclinic.com/health/personality-disorders/DS00562

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[+3] - ebrown p - 12/04/2008Personality disorders have to be considered in the context of a society. In our society... hearing voices means you are delusional. In other cultures, it means you are able to contact spirits...

@spidergal,

Basically, I think that it is a matter of degree. For instance, people are manipulative or histrionic etc. sometimes, but is this the predominant way that the person behaves?

Another thing is how the person relates to the rest of society. Does the person function well in school, or on the job? Does his personality quirk impact negatively in his relationships with other people?

Personality disorders cannot be evaluated quantitively. One must evaluate a person in the context of his entire personality.

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@spidergal,

The criteria for the various disorders are put forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Wikipedia has this to say about how the criteria are established:

http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders

Quote:

DSM-IV sourcebooks

The DSM-IV doesn't specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses and field trials.[16][17][18][19] The Sourcebooks have been said to provide important insights into the character and quality of the decisions that led to the production of DSM-IV, and hence the scientific credibility of contemporary psychiatric classification.[20][21]

Here's what American Psychiatric Publishing, Inc. has to say about the sourcebooks:

http://www.appi.org/book.cfm?id=2065

Quote:

DSM-IV® Sourcebook, Volume 1

American Psychiatric Association

For over six years the DSM-IV Task Force and members of the DSM-IV Work Groups have participated in a comprehensive effort of empirical review leading to the publication of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This first volume of the DSM-IV Sourcebook chronicles these efforts and their results, documenting the rationale and empirical support for the text and criteria sets presented in DSM-IV. From a total of five volumes, the first three contain the DSM-IV literature reviews and summarize the DSM-IV Work Group efforts that led to the publication of the DSM-IV Options Book.

This, the first volume, presents the reviews for substance use disorders; delirium, dementia, and amnestic and other cognitive disorders; psychotic disorders; medication-induced movement disorders; and sleep disorders.

Each review contains the following six sections:

# Statement of the issueexplicitly outlines the issues addressed in the review.
# Significance of the issue"frames the importance of each issue and discusses its clinical and empirical significance.
# Method"documents the extent to which the reviews were systematic and comprehensive in their coverage of the literature.
# Results"provides an objective and thorough summary of the findings most relevant to each issue.
# Discussion"addresses the implications of the clinical research findings for DSM-IV.
# Recommendations"recommendations for DSM-IV based on the review of the literature.

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I'll also add this in regard to laypeople attempting to use the DSM-IV-TR:

Quote:

Cautions

The DSM-IV-TR states, because it is produced for the completion of Federal legislative mandates, its use by people without clinical training can lead to inappropriate application of its contents. Appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.[15] The APA notes diagnostic labels are primarily for use as a “convenient shorthand” among professionals. The DSM advises laypersons should consult the DSM only to obtain information, not to make diagnoses, and people who may have a mental disorder should be referred to psychiatric counseling or treatment. Further, a shared diagnosis/label may have different etiologies (causes) or require different treatments; the DSM contains no information regarding treatment or cause for this reason. The range of the DSM represents an extensive scope of psychiatric and psychological issues or conditions, and it is not exclusive to what may be considered “illnesses”.

I definitely consider myself a layperson.

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@DrewDad,

I agree, Drew Dad. It is very seductive for a lay person to pin a diagnosis on someone. But unless he has the training, and the experience to evaluate a person's personality, the "diagnosis" that he comes up with may be way off the mark.

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I agree with others that no competent psychologist or psychiatrist would presume to diagnose a personality disorder in somebody they have not clinically evaluated, and certainly none of us without such expertise are qualified to do so.

It is a much different thing, but one of the few areas in which I can claim a moderate expertise is in temperament evaluation which does not measure personality or deviancy, but does provide a fairly reliable guide in how a person uses information in decision making and the broad underlying motivation that drives him or her; i.e. special appreciation for order or excellence or competence or effectiveness or dependability etc. Understanding some of these concepts is especially useful to understand and accept or even learn to appreciate certain traits in our loved ones that would otherwise be annoying or frustrating. It is not useful, however, in evaluating a person's integrity or ability to have a healthy relationship.

But one thing is for sure. If your gut tells you that the relationship is off kilter or strange or unhealthy or not quite right, it is a very good idea to listen to it. Most of us have our quirks and eccentricities, but these will not override love, caring, courtesy, and respect that is necessary for a relationship to be healthy and endure.

If your boyfriend is occasionally rude, insensitive, inattentive, or disrespectful to you, this is highly unlikely to change over time. And it isn't only how he treats you but how he treats his friends, parents, relates to others, etc. that gives you important clues. If he thinks insulting and making fun of people is appropriate or clever or funny, etc., you could be in for a really miserable time over the long haul. If he lies to them or fails to follow through on promises, be prepared to be often disappointed. If he puts more importance on booze or drugs or hanging out with his friends more than anything else, this is likely to only become more and more the case. Physical attraction is great and important too, but it is no substitute for other qualities that are necessary for a healthy relationship.

We are all endowed with ability to reason, good judgment, and common sense. We are much more likely to find happiness when we exercise it.

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In school disorders (personality, learning, emotional, etc) are considered dibilitating if they negatively impact a person's life. At least that's how we (in a nut shell) define a disabled person. Working in special education we constantly ask ourselves, "..... but, is it a disability....?"

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Personality disorders have to be considered in the context of a society.

In our society... hearing voices means you are delusional. In other cultures, it means you are able to contact spirits (i.e. gifted). Traits such as "rudeness" or aggressiveness or taking control of people around you are desirable/undesirable depending on the society you are in.

Any definition that I would accept would have to do with living a "functional" life within the society you find yourself in. Any trait that keeps you from being successful within your culture is, by definition, a disorder.

Respect for women is a Personality Disorder if one happens to be a Viking pillager.

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there are studies that claim that huge numbers of people seem to meet the standard for being diagnosed, though most never are. Re relationships: I learned long ago from being in the childhood sexual abuse community that it is almost always a bad Idea to assign pathologies to ones spouse or other loved one. The first result is an almost glee of having a name to put on the dysfunction in the relationship, but long term thinking along these lines almost always destroys the relationship.

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@ebrown p,

ebrown p wrote:

Personality disorders have to be considered in the context of a society.

In our society... hearing voices means you are delusional. In other cultures, it means you are able to contact spirits (i.e. gifted). Traits such as "rudeness" or aggressiveness or taking control of people around you are desirable/undesirable depending on the society you are in.

Any definition that I would accept would have to do with living a "functional" life within the society you find yourself in. Any trait that keeps you from being successful within your culture is, by definition, a disorder.

Respect for women is a Personality Disorder if one happens to be a Viking pillager.

I believe the above makes a lot of sense. I will be more emphatic - it is correct.

Now since the profile of the original poster states India as the "location," I would add that hand analysis might be an approach. In India, I believe, hand analysis is an ancient tradition that goes back to the Dravidians, that supposedly worked it out as a science (before the Aryans invaded and burnt the libraries - according to the history I have read).

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Forget all the psycho-babble - personality disorders are the new catch-all for just being an a$$hole.

They are not treatable and counselors don't like them since they don't respond well to therapy.

Most people who I suspect are like that (and I won't label them as PD's) don't have any real, long term friends and are unable to really show concern for anyone but themselves. They make awful spouses and terribly emotionally-removed parents. They demonstrate only a capacity for selfish love.

They just are not acting out enough to get another diagnosis. But god knows what would set them off. Usually not getting their way.

I stay away from folks like that if I get an inkling.

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@Foofie,

Are you kidding? It's never worked itself out as a science among the scientific community. For most of us, it's still plain old astrology which has little or no bearing on
life's consequences.

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@sullyfish6,

I keep hearing that -- personality disorders are not treatable. But I can't seem to buy into that proposition. After all, these disorders represent traits that have been internalized over time. In other words, they have been "learned". So it should be possible to "unlearn" them. It wouldn't be easy, but not impossible either.

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I thought most human traits can be reduced to a bellcurve, implying there is only a mathematical average (aka normal). Mental health practitioners would likely believe that certain traits make for easier relationships; however, Jung did define the existence of introverts and extraverts. In my opinion, this implies there is no "normal" per se, just a range of personalities that we either find to our liking, or not to our liking.

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@Foofie,

But, Foofie, this is not just about liking or disliking. PDIs (Personality Disordered Individuals) are highly manipulative and "use" people for their selfish ends. That renders them highly inappropriate for any kind of healthy long-term relationship (and we're not just talking romantic relationships here).

I will have to agree with some of the posters above that we're no ones to be diagnosing others. Who knows what they're going through. Maybe it's just a phase in their life, but I think it helps to be vary if you see a lot of symptoms of a personality disorder in someone.

I'm beginning to believe that people who crave and feed on negative attention (as in any attention is better than no attention) often have self-esteem problems, and it's a good indication that something is wrong there. The two people I find histrionic in class both fit that bill. They're very uncomfortable when others receive attention, and they proudly bask in any negative attention. They've both lied to me on occasion also. The lies had to do with making them look better in my eyes (clear manipulation there). One of them, a guy, will suddenly become very friendly when he needs help with test preparation and notes. He tries hard to make me feel like we're both really good friends and keeps saying he looks up to me for all my good qualities, though I always have a feeling he's just playing around. He tries to sound weak in my presence as if he is going through some crisis and I am the redeemer he's looking for. I've always been the leader type, the kind who goes around guiding people, so I kind of fell into that "I-am-weak-you-are-strong-guide-me-please" trap of his initially, but I am more cautious now. There were a lot of discrepancies in his behavior, and it was all quite confusing. So I decided to be on my guard.

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@sullyfish6,

Quote:

Forget all the psycho-babble - personality disorders are the new catch-all for just being an a$$hole.

They are not treatable and counselors don't like them since they don't respond well to therapy.

Most people who I suspect are like that (and I won't label them as PD's) don't have any real, long term friends and are unable to really show concern for anyone but themselves. They make awful spouses and terribly emotionally-removed parents. They demonstrate only a capacity for selfish love.

They just are not acting out enough to get another diagnosis. But god knows what would set them off. Usually not getting their way.

I stay away from folks like that if I get an inkling.

What's your point?

Inability to have real long term friends; Inability to show concern for others; Lacking the skills to do normal things in our society like being a good spouse or parent.

This sounds like a "disorder" to me.

Whether it is treatable or not seems irrelevant (although "not treatable" implies "not a choice" which sounds even more like a "disorder" to me).

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Spidergal - something is telling you that these people are using you. Something's just not right . . .

That's a compliment to you that you can see them for what they are. Listen to your gut feelings.

Now your task is to not let them into your life or into any situation where they can hurt your feelings.

Move AWAY and move on . . and do it with a smile.

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@spidergal,

spidergal wrote:

But, Foofie, this is not just about liking or disliking. PDIs (Personality Disordered Individuals) are highly manipulative and "use" people for their selfish ends. That renders them highly inappropriate for any kind of healthy long-term relationship (and we're not just talking romantic relationships here).

There is nothing for me to discuss here; I do not make judgements about anyone. I just explained my belief about normalcy being an abstract concept that one can subscribe to or not. I was not thinking, or talking, about the term PDI. That is outside the scope of my comments.

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@spidergal,

My 2 cents would be to look at:

1. physical attributes - athletic, strength, beauty, ugly, fat, slow,uncoordinated, agility
2. mental attributes - smart, stupid, quick to learn, analytic, good long memory, bad short term memory, poor memory
3. station in life - born to rich society, poor society, professionals, beggars
4. training and upbringing - professional skills, etiquette, ethics
5. social upbringing - in a Viking settlement it is okay to pillage and rape women
6. self control - is the person spontaneous, cool headed, calculating
7. personal behavior - blabber mouth, taciturn
8. ambition - end game i.e what are the person's goal - to be filthy rich, to enjoy life, to see the world, to be loved by all, to make society a better place, to bring law and order to the world, etc.

All these these factors will help determine a person's behavior and the route he takes to achieve his/her end goal. It changes with his/her age and status. The mores are the society standards one grows up with be it religious or ethnic. The family might have a great influence on motivation with the father or mother being the motivator for moral guidance. Peer pressure and celebrity or sports figures, military or professional heroes may also provide as an idol for a young impressionable teen. You have to check his her background to see what motivates a person and what the goals are. If there was a war and his/her parents were murdered it can be easily deduced that he/she would seek revenge thus the conflicts in the Balkans.

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Personality Disorders: So how do we decide who's normal?

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