If there is one learning point to take from this chapter above all others, it is the 3 P’s – the need for personality disorder to be Problematic, Persistent and Pervasive.
It’s not PD unless the symptoms are…
Problematic – unusual and causing distress to self or others
Persistent – starting in adolescence and continuing into adulthood
Pervasive – affecting a number of different areas in the person’s life
Before defining personality disorder, it may be helpful to consider what is meant by the term personality. Personality consists of the characteristic patterns in perceiving, thinking, experiencing and expressing emotions and relating to others, which define us as individuals. Personality disorders are best understood as unusual or extreme personality types, which cause suffering to the individual or others and hinder interpersonal functioning. The symptoms of personality disorder should be understood as problematic aspects of personality attributes which also exist in the general population. Although there is not yet a consensus about the definitive structure of personality, most modern theories of personality suggest that it comprises of a number of broad domains (such as agreeableness or conscientiousness), with each of these domains comprising a number of specific traits. An example of the relationship between domains and traits is presented below with reference to the domain of agreeableness and it’s polar opposite antagonism.
It will be noted that some of these traits are adaptive and socially desirable and others less so. While we all possess a range of both adaptive and maladaptive traits to varying degrees, individuals with personality disorder are likely to possess higher numbers of problematic personality traits and experience them to more extreme degrees. For example, an individual with a narcissistic personality disorder may be unusually arrogant and exploitative, while an individual with an antisocial personality disorder may be extremely aggressive and deceitful. Personality disorders are categorised into different disorders, which would suggest that a sharp distinction exists between normal and abnormal personality and also between the different types. However, the clinical reality is more complex and the severity of personality dysfunction varies greatly from person to person. While some individuals may possess only a few problematic traits, others may meet the criteria for several different personality disorders (this is sometimes called co-morbidity). It may therefore be helpful to think of personality difficulties as existing along a continuum, with adaptive personality functioning at one end and personality disorder at the other end, as illustrated below.