Personality disorders

The term “Personality Disorder” implies there is something not-quite-right about someone’s personality. However, the term “personality disorder” simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. There are many subset of personalities, all identifiable by their patterns. Personality disorders in particular are subsets that use maladaptive patterns of functioning, causing distress or problems integrating into society. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.


To be diagnosed with a “personality disorder” does not mean that someone’s personality is fatally flawed. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).


Many types of disorders are evidenced by a complete and total deviation from normal and healthy functioning (e.g., epilepsy). However, personality disorders cannot be understood independently from healthy personalities.  Since everyone has a personality (but not everyone has epileptic seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle. Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.


Personality Disorders: Crash Course Psychology #34

Social Anxiety disorder

Social anxiety, also known as social phobia, is a fear, anxiety and avoidance surrounding normal social situations. This is different from shyness, as there is an intense fear that cannot be controlled rather than discomfort. Symptoms of social anxiety include: anxiety or fear surrounding social interactions, being observed, and performing in front of others; fear that anxiety will be apparent to others; social situations almost always provoke fear or anxiety; situations are avoided or endured with intense anxiety; anxiety or fear is disproportionate to the actual threat posed by the situation. This must cause significant distress that lasts six months or longer without being attributable to any other substance or mental disorder. It is estimated that about 7% of Americans suffer from social anxiety at any one time. Treatment involves typically a combination of psychotherapy and medication. Psychotherapy can be in the form of cognitive-behavioral therapy or group therapy. Medications like anti-anxiety, antidepressants, and beta-blockers can be helpful in reducing symptoms. Beta-blockers, instead of targeting the brain, target the physical symptoms that appear while anxious. This may help sufferers with panicking about being anxious or panicking that others can see they are anxious.


Much of the college experience is about navigating differing social situations. Someone with social anxiety has almost an inability to do this. They have such intense fear and anxiety surrounding the situation that they cannot enjoy the interaction or take anything away from it. Going to class, speaking up in class, and doing presentations cause so much fear and anxiety that they are avoided, which can cause academic decline. Social situations like going out with friends or even meeting new people are difficult. College is all about thriving in these interactions and getting the most out of these experiences, and someone with social anxiety will try to avoid all of that even if it would be beneficial to them. Some people will attempt to use drugs or alcohol to cope with the anxiety, which can lead to a substance abuse problem and does not actually relieve the anxiety. The best thing for someone with social anxiety is to go to therapy and/or take medication. This will help them navigate social situations better and lead a more fulfilling life.


Panic disorder

Panic disorder is characterized by recurrent panic attacks. These panic attacks cannot be explained by any other means (like PTSD, drugs, etc.) and are follow by a period of at least a month where the individual performs behaviors to prevent panic attacks or is generally intensely afraid of having another panic attack. Panic attacks consist of sudden feelings of fear or dread, an overactive fight or flight response when there is no reasonable risk. Panic attacks, along with the intense emotions, have many physical symptoms like shortness of breath, chest pain, shaking, feelings of numbness, or sensations of unreality. Because panic attacks do not typically have a specific cause, they can happen at any time. This simply perpetuates the fear around even having a panic attack or having someone see you have a panic attack. Intensity and frequency can vary by person. About 2-3% of the US population has panic disorder, and it is 2x more prevalent in women than men. Treatments include psychotherapy, like cognitive behavioral therapy, and medications, like antidepressants and beta-blockers.


As stated previously, panic attacks can happen at any time. This makes life very difficult for a college student with panic disorder. They live in constant fear of having another attack or having someone witness an attack. This avoidance gets in the way of what you’re really supposed to be doing: school. Many school environments cause lots of anxiety for any student, but a student with panic disorder is more likely to have a panic attack when already anxious or stressed. Avoiding that stress can simply look like avoiding school in general. Sometimes it can be so debilitating that sufferers prefer to stay locked inside rather than go out. Students miss out on college experiences. Those with panic disorder have a higher risk for drug or alcohol abuse. It’s hard to achieve when you are afraid of something you have no control over. But therapy and medications can help dramatically. Medications can lessen the load while going through therapy, or may be used long term. Therapy works by training your brain to react to stress in healthy ways, recognize panic attacks and stop them before they can fully develop, and be able to enter into situations where panic attacks have previously happened. It can become completely manageable with treatment.


Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) consists of excessive worry around a variety of situations and functions. Most people are worried about something, but the worry of GAD is extreme and unwarranted by the specific situation. Normal worries may escalate to something beyond the individual’s control. These excessive worries must last most days for the 6 months and be around a variety of activities. There also has to be three or more physical symptoms, such as sleep disturbances, restlessness, and irritability, along with the anxiety. These symptoms cause significant distress and cannot be explained by any substance or other mental illness. GAD affects about 3.1% of Americans. Treatments for GAD involve medication and psychotherapy, usually in tandem. Medications can target the feelings of anxiety as well as the physical symptoms. Psychotherapy works on the behaviors and thinking surrounding the anxiety, developing new habits around the anxiety. This can help in coping with the anxiety and reduce its effect.


The nature of GAD is that worry is about anything and everything, and most likely the sufferer knows that it is. But they have no control over what they have anxiety around or how great it is. And sometimes this can prevent the individual from performing tasks, sleeping, and drain all energy. Part of college is to be efficient with time and energy, and anxiety makes it very hard to do that. The college environment in general is stressful, which exacerbates the problem. The majority of those with GAD have other mental illnesses as well, compounding the difficulty. They are more likely to have substance abuse problems. Someone with GAD in college can contact the disabilities office to set up accommodations that may aide in reducing anxiety and fostering success. This may include more time on exams, changes in housing, and more flexibility in course work. Medications and therapy are effective as well as likely essential. When untreated, GAD can lead to many other health problems, so it is important to address it. However, it is completely treatable and success in college is very possible.


Obsessive Compulsive Disorder

Obsessive compulsive disorder, or OCD, is characterized by disruptive obsession and compulsions. Obsessions are recurrent and persistent thoughts that are both unwanted and cause distress. The individual attempts to neutralize them by performing an action. Compulsions are repetitive behaviors or mental acts that the individual feels compelled to complete. These acts aim to reduce anxiety and distress, even though they may only be loosely related to the cause of distress or are excessive. The individual may even be aware that the thoughts and actions used to reduce them are unreasonable and unlikely, but they have no power over them. Obsessions and compulsions usually occur together, though only one may be present in some individuals. These obsessions are time consuming or cause significant distress and impairment in several areas of functioning. Obsessions can take up anywhere between 1-3 hours per day in more mild cases, and in more severe  cases consuming most of the day. Symptoms cannot be associated with substance use, medications, or be better explained by another mental illness. About 1.2% of Americans have OCD. Treatment consists of typically a combination of medication and psychotherapy, though medication will not work for all cases. Medications for OCD are most commonly antidepressants in high doses. Psychotherapy focuses on reducing anxiety surrounding obsessions and reducing compulsive behaviors. Eventually, after managing the anxiety, the individual will feel less and less anxiety around the obsessions.


Depending on the obsessions and compulsions, OCD can be very disruptive in a lot of different areas. But specific functioning differs between sufferers. Some have problems with relationships because they obsess over losing or hurting loved ones. Some have rituals that make completing school-related tasks difficult or time consuming, such as needing to read each page a certain number of times or anxiety surrounding a task becoming so overwhelming that the task is avoided altogether. Those without OCD have a hard time understanding that these are not made up, that someone with OCD cannot control what they obsess over or what compulsions are needed to reduce anxiety. And because these thoughts can pop up at any time, it is difficult to predict what the student will need to succeed. Many of the more common accommodations are of no use to a student with OCD. Students are encouraged to seek help in managing their symptoms, as this will aide them in the long run for reducing stress. While in college, it may be helpful to contact the disabilities office and set up specific accommodations for what the individual needs to function in college while being treated. Not all accommodations will look the same from one OCD student to the next. This illness is completely manageable, and success in a college environment is very possible.


Anorexia [nervosa]

Anorexia nervosa, or simply anorexia, is an eating disorder characterized by an individual restricting their diet because of an intense fear of gaining weight. This fear of gaining weight is usually founded in personal insecurities, and not necessarily a vain attempt to be thin. Anorexic individuals restrict their energy intake, relative to their individual requirements, which leads to significantly low body weight. They will continue to take weight loss measures, such as excessive exercise or laxative use, even though they are at a significantly low weight already. Anorexia also involves a skewed vision of the individual’s body, undue influence of body weight or shape on self-evaluation, or a consistent lack of recognition of seriousness of current low body weight. About 0.3-0.4% of women and 0.1% of men in America have anorexia. Treatment consists primarily of psychotherapy, though medications can be used to treat underlying conditions such as depression. If not treated, anorexia can lead to anemia, heart problems, bone loss, gastrointestinal problems, kidney problems, death, and other issues.


Anorexia tends to take over the individual’s life. And stressful life events can trigger disordered eating, so college is no exception. College is used as an excuse. “I didn’t have time to eat.” “I could only grab something small on the go.” Drowning in responsibilities can be an excellent reason not to eat properly or at all. But it can also lead to avoiding going out with friends, especially when social interactions in college frequently surround a meal. If the individual ends up participating in meals with friends, they spend their time counting calories, hiding food, and worrying about weight gain rather than enjoying the experience. Functioning is possible, as this does not directly interfere with the ability to finish assignments, study, or get to class. However, anorexia is not sustainable considering other health problems that develop and thought patterns that are self-destructive. Other mental illnesses may occur along with anorexia, and those also need to be treated in tandem. Psychiatric services and counseling support may be helpful throughout this process. In some cases, taking a semester off to visit a treatment facility can do more for the individual than traditional counseling. It is possible to reach remission and return to normal college life.


Bulimia [nervosa]

Bulimia nervosa, or simply bulimia, is an eating disorder characterized by purging following a binge eating episode. During binge eating, the individual eats more than what an average person would eat in the same amount of time under the same circumstances. They feel a lack of control over eating, often unable to stop once started and may enter into a trance while eating. After eating, they use inappropriate behaviors to compensate for overeating. This may include vomiting, laxative use, diuretic use, excessive exercising, or other ways of purging. Binging and purging cycles happen at least once a week for three months or more. Self-evaluation is unduly influenced by body weight and shape. None of these symptoms occur during periods of anorexia nervosa. About 1.1%-4.6% of females and 0.1%-0.5% of males will have bulimia. Treatment consists primarily of psychotherapy and medications to treat underlying conditions. Psychotherapy aims to interrupt the binge/purge cycle, address negative thought about self and body image, and resolve emotional issues related to the disorder. Bulimia frequently occurs with other mental illnesses, such as depression and alcohol abuse.


Bulimia, like anorexia, takes over the individual’s life. Life becomes about staying thin, taking steps to lose weight, and trying to hid how much food you consume. Some people will spend upwards of three hours a day exercising. Health problems related to the eating disorder can get in the way of school work. But generally bulimia doesn’t interfere with the individuals ability to complete school work, study, get to class, or keep appointments. Bulimia is not, however, a sustainable habit. Severe health complications arise, other mental illnesses can develop, and even death can occur. Specifically, bulimia can cause dehydration, kidney failure, heart problems, severe tooth decay and gum disease, digestive problems, alcohol or drug use, and possibly suicide. Balanced living is a large part of the college life, and bulimia disrupts that. Treatment is the best option for restoring balance and recovering. Sometimes campus psychiatry and support services can be enough. Sometimes taking a semester off and going to a recovery facility may be more effective. It depends on the individual, but recovery is always possible.


Binge Eating Disorder

Binge eating disorder, or BED, is an eating disorder characterized by binge eating episodes that result in feelings of shame, guilt, or depression. Eating more than someone else in similar circumstances during a specified period of time, as well as feeling a lack of control over food consumption during that time, is considered binge eating. Three or more physical symptoms are also present during this time, such as eating more rapidly than normal or eating when not feeling hungry. The individual has marked distress from their binge eating. Binge eating occurs at least once per week for three months and does not occur during anorexia nervosa or bulimia nervosa. There is also no inappropriate use of compensatory actions for the amount eaten, such as laxative use or inducing vomiting. Prevalence in the United States is about 1.6% of females and 0.8% of males. About 0.2%-3.5% of all females and 0.9%-2.0% of all males will develop BED. Treatment consists of mostly psychotherapy and nutrition counseling. Medications can help to treat underlying conditions that frequently come along with BED. The goal of therapy is to work though issues that lead to eating disorder and develop a better relationship with food consumption.


BED, like other eating disorders, affects mostly the social side of college life. Eating in and of itself does not affect academic performance, unless it takes up more than its allotted time per day. However, much of college life revolves around eating. Social outings typically revolve around a shared meal. But someone with BED has severe shame around these situations, and will often avoid them. Or they will binge eat and have guilt around people seeing them that way. College also comes with complete control over what, when, and how much you eat. Late night studying is often fueled by food. Students don’t have time to make food and dining options typically aren’t healthy. Anxiety and stress over school and other obligations can be hard to handle, for anyone. But for those who already have an eating disorder or are already predisposed to it, the stress can fuel the disease. The best course of action is treatment. Throughout treatment, the individual learns to handle food and themselves better, which will help in getting through social situations involving food. Without treatment, BED can lead to many health issues related to obesity. Enjoying college while maintaining academic status is the goal, and is completely possible with an eating disorder.


Gender Dysphoria

Gender dysphoria stems from a innate feeling of one’s assigned gender or gender characteristics being different from their experience or expressed gender. All babies are assigned a gender when they are born. Typically this is just “male” or “female” and based exclusively on what genitalia can be seen. But gender isn’t necessarily experienced from sex organs, and sometimes sex organs do not develop properly or do not regulate hormones in the way healthy organs do. Society also creates how we look at gender and what we expect from different genders. In these and many other ways, we experience gender. Gender dysphoria happens when the person feels as though their experience of gender (for example: male, female, or non-binary constructs) and their body characteristics do not match up with the typical sex characteristics(for example: penis, vulva, ovaries, testicles) of the gender they experience. Because of this feeling, they also have a strong desire to rid themselves of their primary and/or secondary sex characteristics, be of a different gender, and be treated like another gender. Gender dysphoria creates a strong sense that one has the typical feelings and reactions of the gender that they prefer. All of this produces clinically significant distress and disruption of functioning. Treatment consists of psychotherapy, hormone treatments, sex reassignment surgery, or a combination of those. The course of treatment primarily depends on the individual’s needs, gender identity, and personal identity.