Personality Disorders

You can find heaps of information online about Personality Disorders – a broad term referring to the Category of Mental Disorder where unwise and self-sabotaging decision-making and immature, inflexible and a limited range  coping skills frequently occurs. Most of this online information is a regurgitation of symptoms from the classification ‘bible’ DSM-5, which lists the features of different diagnoses like the ingredients of a cookbook! Despite these ‘descriptions’ being easily available, all the publicity about how common ‘personality disorder’ has has led to any tendency towards poor decision-making and Coping Skills as being perceived as a homogenous condition – as if there is just one type of ‘personality disorder’.  A big reason for how dissatisfied many people are with the quality of information available about personality disorders is that the DSM-5 classification system does not provide any ‘explanations’ or ‘causes’ and hence there is a lack of education about causes to the general public. Even we psychiatrists have not categorised causes in a way that is easily understood by the public, beyond using the term ‘biopsychosocial’ amongst ourselves, which refers to the biological, psychological and social factors contributing to any individual case of disorder. Because we have failed to adequately educate the public about these causes, I have ‘given a go’ to fill this gap in my eLearning education program!
 

In fact, there are 9 different ‘types’ of ‘Poor coping’ that we psychiatrists diagnose to help treat our patients. And an individual with ‘Poor coping’ might have a mixture of more than one cause. Hence, those with more severe types of Poor coping often get the best outcomes from combinations of approaches – a management package – sometimes by more than one type of Help-Provider. Despite this, the treatment approach many people receive is too often dictated by the setting where the person goes for help or the type of Help-Provider a person seeks help from: some Help-Providers only offer medication, others only psychotherapy, some only life coaching, some only positive lifestyle factors. Whilst in many cases that may be adequate, what if it doesn’t adequately facilitate  recovery? Because each type of Poor coping tends to have a dominant cause, I’ve gone ‘Beyond DSM-5’ to divide all the common 6 Categories of Disorder (Mood, Anxiety, Personality, Psychotic, Substance Use and Eating Disorders) into 3 Explanatory SubTypes that reflects how most psychiatrists conceptualise mental health problems. 

For Personality Disorders, I have placed each of the 16 different types of ‘Poor coping’ into 1 of their 3 causative subtypes:

1.     The Mind subtype due to an underdeveloped or immature capacity for decision-making and coping skills and unhelpful scripts. This tends to explain 6 Personality diagnoses: (1) Borderline Personality Disorder (PD) (AKA affect dysregulation, borderline traits, bipolar 2 disorder, complex PTSD, emotionally unstable disorder) (2) Obsessive PD (AKA obsessive compulsive PD, OCPD) (3) Narcissistic PD (AKA passive aggressive, grandiose, psychopathic traits, antisocial personality) (4) Avoidant PD (AKA extreme shyness, anxious traits) (5) Impulse Control Disorder (AKA addictive personality, behavioural addictions) (6) Gender Dysphoria-Mind Subtype (a.k.a. gender identity disorder) 
2.     The Body subtype is due to ‘runaway feedback loops’ causing physical distress due to anxiety, pain, fatigue or nausea. This covers 5 diagnoses: (7) Chronic Fatigue Disorder (a.k.a. chronic fatigue syndrome, CFS, myalgic encephalomyelitis)  (8) Chronic Pain Disorder (a.k.a. chronic pain syndrome) (9) Conversion Disorder (a.k.a. functional neurological disorder, somatisation disorder) (10) Body Dysmorphic Disorder (a.k.a. BDD, body dysmorphia, dysmorphophobia) (11) Gender Dysphoria-Body Subtype (a.k.a. gender identity disorder) 
3.     The Brain subtype is due to malfunctions, injuries & glitches. This explains 5 diagnoses: (12) Attention Deficit Hyperactivity Disorder (a.k.a. ADD, ADHD) (13) Autism Spectrum Disorder  (a.k.a. ASD, Asperger’s syndrome, high functioning autism) ) (14) Dementia (a.k.a. progressive cognitive decline) (15) Intellectual Disability (16) Gender Dysphoria-Brain Subtype (a.k.a. gender identity disorder) 

 

Ok, but what is the common mechanism that leads poor coping? Well, you cannot cope when either critical parts of your mind are underdeveloped or overall there is poor integration (connectivity between the critical parts) or you have adopted unhelpful scripts to guide you. This may activate one of three compensatory mechanisms: overactive (or underactive) Rational, Emotional or Wise Mind. I have depicted all of this information pictorially, conversationally and pragmatically in eLearning.
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