Personality disorders are not the result of any type of pharmaceutical or chemical substance, nor are they the result of another medical condition. Personality disorders are a medically unique subset of mental disorders. According to the DSM-5, personality disorders are defined as;
- “An enduring and inflexible pattern of behavior which significantly harms the person with the disorder”.
Personality Disorder Clusters
In order to better assist doctors in providing diagnosis and treatment for their patients, the DSM-5 has grouped the 10 known personality disorders into 3 distinct types (A,B,C) or clusters. These disorders, they are grouped as follows:
Cluster A – Odd or Eccentric
- Schizoid personality disorder – Disinterest or detachment from social relationships and difficulty expressing emotions
- Schizotypal personality disorder – Characterized by beliefs in the unusual, sometimes even paranormal, sufferers of this disorder tend towards extreme eccentricity and have great difficulty engaging in social interactions
- Paranoid personality disorder – A deep and constant distrust and assigning of malignant motives to even the most benign actions
Cluster B – Dramatic, Emotional, or Erratic
- Borderline personality disorder – People who routinely experience dramatic mood swings that lead to self destructive behavior
- Narcissistic personality disorder – Individuals that experience an acute need for admiration and attention, often coupled with a near complete lack of empathy for others
- Antisocial personality disorder – A complete disregard for the rights and feelings of others and often characterized by highly manipulative behavior
- Histrionic personality disorder – Similar to narcissistic personality disorder in need for attention, but characterized more by a willingness to do anything, even engage in reckless sexual behavior, to enjoy that attention, rather than obtaining attention at a cost to others
Cluster C – Anxious or Fearful
- Obsessive compulsive personality disorder – An unbending conformity to rules and structures, usually created by the person suffering from the disorder, at the cost of normal relationships and comfortable living
- Dependent personality disorder – An abiding need to be nurtured or supported by other people
- Avoidant personality disorder – A complete fear of any type of negative evaluation or social rejection that results in avoidance of most social interactions
Personality disorders can be found in approximately 10% of the population, with a particularly high prevalence among the homeless, though the causal relationship is almost certainly that personality disorders often result in homelessness, not vice versa. While there is a strong genetic component that increases the likelihood of blood relatives having the same personality disorders, few other factors seem to consistently influence the existence of these disorders. The single exception is that six of the disorders are more likely in males while three of the disorders are more likely in females and one disorder is split evenly among the genders.
Medical professionals test for personality disorder using a combination of techniques. Psychiatric evaluation is usually the most effective testing. Both psychiatrists and traditional doctors will ask specific questions to evoke emotional and behavioral responses. By comparing those responses to the symptoms of a specific disorder, as detailed in the DSM-5, doctors are able to pinpoint specific personality disorders. In some cases physical examinations may also be helpful, especially in order to rule out substance abuse as a cause for observed symptoms. Usually such examinations are performed in a controlled setting like a doctor’s office, but when attempting to diagnose younger children, or in other special cases, a doctor may perform such tests “in the wild.”
There are more unique treatment options for personality disorders than there are unique personality disorders. This variety of treatment options makes it difficult to discuss common treatments. A few generalities do apply, however.
- First, less than half of personality disorders meaningfully respond to pharmaceutical treatment. Pharmaceuticals are often prescribed for co-morbid depression or anxiety, but usually do little for the underlying problem.
- Second, most personality disorders are also highly resistant to traditional forms of psychiatric treatment or counseling (individual or group). Personality disorders are biological in nature and rarely can be resolved through simple discussion.
More often than not, treatment involves getting the patient to acknowledge their personality disorder and then training the patient to recognize symptoms, so as to minimize their impact on themself and others.
This is somewhat akin to putting a band-aid on a wound when it really needs stitches, but it is one of the most effective options. This particular approach does not represent a single treatment option, however, but instead represents numerous specific approaches and philosophies of treatment throughout the field.
Obsessive Compulsive Disorder – OCD Defined
Obsessive compulsive disorder (OCD) is a debilitating mental disorder that results in obsessive behavior. Once thought to be a variation of an anxiety disorder, the medical field now recognizes it as a unique disorder, while it does involve anxiety, is biologically distinct and results in different symptoms.
Medlineplus defines OCD as “Obsessive-compulsive disorder (OCD) is a mental disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), and behaviors that drive them to do something over and over compulsions.”
Often the person carries out the behaviors to get rid of the obsessive thoughts. But this only provides short-term relief. Not doing the obsessive rituals can cause great anxiety and distress. The “obsessive” part of OCD concerns the inability of the person to get rid of unwanted thoughts, no matter how hard they try to stop thinking about washing their hands or counting tables in a restaurant. Acting on these obsessive thoughts is the “compulsive” aspect of OCD.
- OCD is a severe disorder involving compulsions to perform the same actions repeatedly, such as washing hands 20 times a day or counting items over and over again.
- Unless someone with OCD is permitted to act on their obsessions, they experience severe anxiety, agitation and panic.
- Over two million adults in the U.S. have obsessive-compulsive disorder. However, since many people with OCD may never receive a clinical diagnosis, that number could be substantially higher than reported.
- Nearly 25 percent of substance abusers seeking treatment are ultimately diagnosed with obsessive- compulsive disorder
- Studies indicate that people with OCD often share common obsessions and compulsions, such as obsessions about checking and re-checking things (if doors are locked, ovens turned off), repositioning things so they are symmetrical, cleaning/washing rituals and hoarding.
- Signs of OCD typically begin in childhood and worsen with age if treatment isn’t initiated.
- Six out of 10 people with OCD respond positively to antidepressants and psychotherapy. However, symptoms may return if they stop taking SSRI medications.
Research suggests that there is a genetic component, and possibly an environmental component, but no specific sources have been identified.
- The medical community has been unable to identify any specific causes of OCD
- As with most anxiety and mood disorders, obsessive-compulsive disorder seems to emerge when insufficient serotonin levels exist in the brain.
It is known that OCD can, and often does, develop at a young age and that it usually lasts for a lifetime. Research also suggests that biologically, the symptoms of OCD are caused by problems in the pathways in the brain between the areas that filter messages about body movement and the areas that involve judgment and decision making. However, the exact problems have yet to be identified and there is no permanent solution to repair such problems.
A neurotransmitter responsible for regulating impulsivity, mood, sleep, pain sensitivity and appetite, serotonin is also implicated in depression, panic disorder and phobias. Genetics may also support development of OCD but genes specifically linked to obsessive-compulsive disorder have yet to be discovered.
The symptoms of OCD are nearly universally some form of repetitive behavior that the person suffering OCD is physically and psychologically unable to stop performing.
This behavior is performed in response to extreme anxiety. Individuals with OCD engage in specific actions (rituals) that help decrease the feeling of anxiety. The actual action does not directly counter the anxiety, but the ritualistic act of performing it, often for hours at a time, helps to assuage the anxiety. Common symptoms include, but aren’t limited to:
- Repeatedly bathing some or all of the body
- Refusal to touch specific objects or other people
- Compulsive counting of objects or actions performed
- Constant need to check and re-check things like whether doors are locked
- The need to arrange objects in a precise pattern
- Performing actions in a precise order
- Insistence on performing actions a specific number of times
Most Common Objects
These compulsive symptoms are commonly related to the specific anxiety of the patient, like refusing to touch other people for fear of germs. However, that connection is not always clear and sometimes there is no obvious connection. Whatever the obsessive action performed. The most common objects of OCD;
- Germs and dirt
- Making a mistake
- Causing harm
- Social interactions
- Chaos and disorder
- Evil or sinful thoughts
Certain risk factors have been identified that may trigger OCD symptoms, such as having grandparents, parents or siblings with OCD or experiencing traumatic events that, for unknown reasons, provoke obsessive thoughts and compulsions. In many cases, substance abuse may lead to significantly reducing or increasing brain chemicals implicated in development of OCD and other mental illnesses.
In the mildest cases, OCD results in numerous delays in completing activities. In the worst cases, it produces effective paralysis that can prevent the person suffering from it from eating, sleeping, working, leaving the home, or even going to the bathroom. In all but the least debilitating cases, people suffering from OCD are unlikely to be able to maintain a job, residence, and lifestyle without some form of assistance.
- It is quite common for people suffering from OCD to abuse drugs.
- The consequences of OCD are extreme difficulty performing everyday activities.
- If OCD is not properly treated, an individual is likely to develop other behavioral disorders.
The compulsive behavior that identifies OCD is engaged in specifically to help relieve anxiety. This behavior, however, does not always provide the level of relief that someone experiencing extreme anxiety requires. As a result, it is common for someone suffering from OCD to resort to drugs or alcohol in order to relieve that anxiety. And since they are already prone to compulsive behavior, taking those drugs compulsively is very likely.
Eating disorders and sleeping disorders are particularly common, not for the usual reasons, but rather because they directly result from OCD symptoms. Treatment for these disorders, and the previously mentioned substance addictions, can only be successful when the underlying OCD is treated first or in addition to the resulting disorders.
Here is a list of some movies with OCD in them;
- The Aviator
- The Odd Couple
- Conspiracy Theory
- As Good AS It Gets
- What About Bob
- Rain Man
- Mommie Dearest
- Matchstick Men
Here is a list of some famous people who have OCD;
- Leonardo DiCaprio
- Cameron Diaz
- Howard Hughes
- Woody Allen
- Alec Baldwin
- Donald Trump
- Justin Timberlake
- Katy Perry
- Howie Mandel
Treatment for OCD
Before obsessive-compulsive disorder can be addressed in addicts. The addiction must be treated with medical detoxification, psychotherapy, counseling and medication, if applicable. Sometimes, OCD symptoms diminish as the addict recovers from substance abuse and learns to live with drugs or alcohol. If they persist, then the recovering addict will need to undergo behavioral therapy called ERP exposure and response prevention.
With the assistance of a trained psychotherapist, OCD patients are exposed to things or situations that cause them fear and anxiety. They are then gently but firmly prevented from following through with rituals to relieve their anxiety. For example, someone being treated with ERP who feels compelled to wash their hands every time they touch a door handle is led to touch a door handle by the psychotherapist but not allowed to wash their hands. It is the goal of ERP to show people with OCD that nothing catastrophic will happen if they don’t wash their hands.
Obsessive-compulsive disorder is manageable in both non-addicts and addicts but does require medication and ongoing therapy to maintain control of symptoms.