Personality Disorders
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection the chapter on Personality Disorders in the DSM-5. I have included my reflection below.
Personality Disorders
This week, I continued my reading of the DSM, this time in the DSM-5-TR, and read the section on Personality Disorders. This section describes a personality disorder as an individual's enduring pattern of behavior that differs extensively from the norms of a society such that it causes considerable impairment. It also typically occurs in early adulthood and is usually pervasive throughout the individual's life. Ten particular kinds of personality disorders were identified and grouped into clusters. Cluster A represents odd or eccentric personalities, which include schizoid, schizotypal, and paranoid. Cluster B represents dramatic and erratic personalities and includes antisocial, borderline, histrionic, and narcissistic. Cluster C represents fearful and anxious personalities and includes avoidant, dependant, and obsessive-compulsive.
My initial reaction to reading this chapter was that it was quite riveting. I have not done an undergraduate course in psychology, so this is really my first proper time looking into personality disorders and trying to understand what they are. I had yet to consider them before. This reading really took me by surprise. I was shocked, saddened, and even frightened. I had not considered that people with these kinds of conditions were out there in the world. I tend to be friendly with everyone I meet and try to think the best of them. This chapter left me feeling fearful and definitely made me want to be more cautious of people I have met and will meet; it also made me feel sad because I do not want to be fearful of people I have met and will meet.
My next reaction after the initial shock, fright, and sadness was a feeling of wanting to reject these classifications. I felt that it is wrong to give someone a label like this, for example, saying you are antisocial or you are borderline; it is like telling someone they are a criminal. The label may get absorbed into their entire identity, and indeed, many others will judge a person tarnished with any of these labels. The way the DSM frames these definitions gives the impression that once the DSM assigns a label to someone, it essentially taints them for life, leaving no way to escape. The DSM seems to write them off as a lesser kind of human being, doomed to always harm society and never be saved. I want to reject that viewpoint. Also, an absence of any real etiology, with the exception of some genetic and environmental information, could leave the reader with the impression that the individual is just born this way or chooses to be this way, and it may leave the blame on the person with the condition.
I heard mention in the chapter of an alternative way to look at these personality disorders, by a dimensional model. I have not yet had a chance to read this part of the DSM, but when I heard there was another way of looking at things, it made me hopeful. The way I would prefer to look at things is that any individual who develops a personality disorder does so as a coping mechanism for trauma, either trauma met in their lifetime or multigenerational trauma passed on in their genes and environment. I would also prefer to look at these as spectrums rather than categories, for example, a narcissistic coping spectrum or a dependent coping spectrum. I also would prefer to reframe these as behaviors that could be unlearned by the individual, with the support of personal development, society, new skills, and technologies. I imagine a group of very anxious and scared scientists sitting in a room, making categories of all the people they are afraid of in the world and how to spot them; this is how I see this part of the DSM written, as coming from fear and rejection and objectification, I do not like that.
As a result of reading this, I immediately began going through people I've met in my life. I started labeling them. I now think one of my friends, who is emotionally flat and a loner, could be a schizoid, another person who talks about a paranormal activity I now see as schizotypal, and my other acquaintance who believes in conspiracy theories as paranoid. I then wondered if some of my friends in business were antisocial or narcissistic. I then started wondering if my partners have been borderline, histrionic, avoidant, or dependent. I even worried, am I narcissistic? Am I obsessive-compulsive? Because I have a history of competitive performance and type-A behavior in the business world. Or am I schizotypal because I sometimes ponder synchronistic connections between events? Then I realized that this labeling of people has to stop. We can all see a small quantity of ourselves in these categories; I cannot go around labeling myself or others; it is a form of critical judgment, and I do not want to occupy my headspace with such negativity. I really wish we had a better way of describing these behaviors.
In my practice as a counselor, I do not want to adopt the medical model of labeling people. I want to see people beyond classification, each person in a class of their own with their dignity and their own path to find a place in the world no matter who they are, Hannibal Lecter or the bunny boiler in Fatal Attraction. I hope we can devise a new way of articulating personality disorders to move from a disorder and permanent category to a coping mechanism for trauma and a flexible spectrum. If all the world's a stage and we are merely players, as Shakespeare says, then we need people to play all sorts of roles for the play to go on and trying to brand someone as permanently broken with a personality disorder diagnosis seems wrong to me.
