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Great Article - Am I Normal?
My name is Sonya and this is my first post. I just received a great article from Psychology Today in the mail and want to share with every one. It's a bit long winded, so make yourself a coffee, sit down and enjoy. It made me feel better, maybe it will to you as well.
Am I Normal?
They call him "the Shark."
Bill, a 26-year-old lawyer, is proud of his nickname and the ruthlessness that inspired it. Confident and
charming, he can also be arrogant, manipulative and deceptive—though he
sees nothing wrong with these qualities, useful as they are in winning
cases and attracting women. Lately, however, Bill's character has been
landing him in trouble. He's begun abusing cocaine. He can't resist the temptations of strip clubs and casinos. He's already been married and divorced twice. Even his successful career
has been endangered by his habit of propositioning female coworkers.
Bill is bothered enough that he pays a visit to a psychologist's
office. There he's told that he has an "antisocial" personality:
He consistently, and often unscrupulously, places his own interests
above those of others. Bill's antisocial tendencies pervade his entire
way of being—just as someone with a narcissistic personality
can't see past his own grandiosity or someone with an
obsessive-compulsive personality can't lift her eyes from her
meticulous, exacting tasks.
person's actions—has been around a long time. But it is gaining new
momentum. For one thing, it gives us a high-definition picture of human
character and its variety. It also encourages renewed appreciation for
the diversity of influences on behavior, from genes
to lifestyles. As a result, the new view of personality heralds a
revolution in how we view disorder, marking a shift away from rigid
categories of pathology to a more organic sense of the way individuals
fit in their world. After all, aren't lawyers supposed to be
aggressive? Aren't, say, actors almost universally narcissistic? Aren't
accountants and copy editors rewarded for their compulsive attention to
detail?
For many years, serious problems of character and personality were believed to be relatively rare. What's more, they were
regarded as virtually untreatable—and bereft of any benefit or utility.
Personality disorders were sequestered on their own island of pathology.
But a flood of new theories, surveys and techniques is sweeping aside the
old assumptions about problematic personalities. Dysfunctional
personalities actually appear to be quite common, affecting more than
30 million Americans—about one person in seven. This increased
awareness of the prevalence of personality problems is stimulating
breakthroughs in understanding and treating them, as well as a dawning
realization that what we call mental illness might once have had, and
may still serve, highly adaptive functions. Most surprising of all,
researchers are accumulating evidence that the line between normal and
abnormal personality is much more subtle than anyone imagined. Which
may mean that our conception of mental illness is due for a
revision—and that we "normal" people are all just a little bit crazy.
From Quirk to Quagmire Central to the emerging perspective is a
distinction between personality styles and personality disorders. Any
specific pattern of thinking and feeling may be expressed as a healthy,
though perhaps quirky, personality style, or it may be expressed more
floridly as a clinically diagnosable personality disorder.
Psychologists recognize 10 different personality types that, when
manifest in intense form, represent 10 distinct personality disorders.
People with an avoidant personality, for example, may be homebodies who like routine and cherish a few intimates, or they may shun people for fear of rejection and avoid risk-taking or new activities for fear of the humiliation of failure. The former have an avoidant personality style, the latter
an avoidant personality disorder. Likewise, people with a histrionic
personality may merely enjoy attention and be entertainingly dramatic,
although able to cede the stage to others when appropriate. Those with histrionic personality disorder
insist on being the center of attention and have emotional problems as
well; their feelings are shallow and ever-shifting, and they may have
difficulty intimately connecting with others.
So what's the difference between a personality disorder and a personality style? One
gauge is, simply, extremity: The personality disordered think, feel and
act in ways that are at the outer edge of what most people experience.
A second guideline is inflexibility. Says Randolph Nesse, a
psychiatrist at the University of Michigan: "Most of us are angry
sometimes and loving sometimes, nice sometimes and mean sometimes. But
people with personality disorders keep doing the same things over and
over again.
Their emotional palette isn't varied; it's monochromatic." They get stuck, unable to respond fluidly to changing
circumstances. Their daily functioning is also impaired. A clinician
evaluating someone for a personality disorder would ask two key
questions: Has the patient's personality contributed to a loss of
relationships? Has it contributed to career failure? Thomas Widiger, a
University of Kentucky psychologist who diagnosed Bill the Shark, adds
a subjective measure: How much distress is a person feeling as a result
of his personality problems? If these distinctions seem less
black-and-white than shades of gray, they are. And in fact, many
psychologists are shifting from the old you-have-it-or-you-don't
perspective on personality disorders (the
"categorical" model) to the more nuanced "dimensional" model. In it,
personality is located along a continuum, with healthy personality
traits at one end, personality disorders at the other—and innumerable
gradations in between.
recognize one at all. "I don't think it is useful to draw a line,"
declares Johns Hopkins University psychiatrist Gerald Neustadt. "What
is the purpose of having a diagnosis? Ultimately, it's to treat people,
to help them. So when someone comes to you with a problem in the personality
domain, you try to understand his traits and how they are getting him
into trouble." What counts most is recognizing that the patient's
difficulty does indeed lie within the "personality domain," says
Neustadt. Problems of personality are different in nature from other
kinds of mental disorder, such as a sudden onset of depression or anxiety.
Character disorders are more deeply rooted, broader and more
encompassing—and more intractable, because they are so intimately
related to a person's very self.
But the implications of the new work on personality disorders go far beyond parochial diagnostic matters. It represents a sea of change in
how we view psychological health and illness. As Thomas Widiger says,
"The patterns found in personality disorders really are traits that are
distributed throughout the population, and we all have them to greater
or lesser degree." The new research suggests that psychopathology is
not alien and unfamiliar but rather recognizably human, an extension of
what we all experience. That could soften the stigma that still
attaches to mental illness.
Just as we may see something of ourselves in the volatile diva or the misanthropic recluse, we may also
embrace the extreme, the flagrant, the florid in our own characters.
The new work on personality disorders might allow us to rescue an array
of traits and behaviors—the high spirits of a borderline personality,
the single-minded intensity of an obsessive-compulsive—from the
"pathological" category in which they've been deposited and reclaim
them as rich additions to healthy human variety.
Context, Context, Context
Personality disorders contribute an important insight to reformulated ideas of
mental health: Context is everything. Behavior that creates havoc in
one situation may be celebrated in another, and finding the right niche
may mean—for any one of us—the difference between psychological health
and sickness. From this perspective, personality problems are not
burdens we carry wherever we go but latent vulnerabilities that are
exacerbated by specific environments. They are also potential assets.
Randolph Nesse offers an example. "Imagine a very dramatic woman—in DSM
language, a 'histrionic' individual. If she goes to work for an
accounting company, chances are she'll have lots of trouble, because
she's more interested in impressions than details and because she's
likely to be more impulsive
and more emotionally expressive than the others who work there. She
gets thrown out of the job, gets really depressed and shows up at the
office of a therapist, who says, 'It's your personality that's the
problem; you have a personality disorder.' Now imagine that same woman
in the artistic world, where her attributes are actually an advantage.
She'd be doing beautifully, would not show up at a psychologist's
office and would not be diagnosed with a personality disorder. Yet this
is the same person with the same constellation of traits—just two
different contexts." The importance of specialized niches turns up
again in investigations of the origins of personality disorders. One
provocative notion emerging from evolutionary psychology
is that many of the behaviors found in personality disorders—perverse
as they may appear to us now—originated as adaptations necessary for
survival.
And in fact, looking closely, it's not hard to see the germ of something useful in what on the surface appear to be
self-defeating patterns of behavior. Avoidant personality disorder,
for example, may be a holdover from a time when strangers posed a very
real danger. "The insecurity and nervousness avoidant people feel about
approaching others was in some contexts very adaptive," says Widiger.
"It helped them develop a sense of caution about entering risky
situations and risky relationships." Likewise, obsessive-compulsive
personality disorder may be an exaggerated version of the directed and
diligent efforts that helped some of our human ancestors thrive. The perfectionism, productivity and skinflint approach to money that characterizes this disorder may be remnants of organizing and hoarding behaviors that prepared communities for times of scarcity, Nesse speculates.
Conversely, some personality patterns may have rewarded the individual at a cost to
the larger community. Stealing, cheating and manipulating got for some
people what they couldn't obtain by more legitimate means, which may
explain why researchers have found a small but stable population of
individuals with antisocial personality disorder
in societies all over the world. Such personality quirks have persisted
because extreme behavior can still work to an individual's advantage.
"One of the features of narcissism is enormous confidence and self-esteem,"
observes Widiger. "It takes a degree of narcissism to continue despite
failures and setbacks, and narcissists quite often have very successful
careers." People with dependent personality disorder
may suffer for their exquisite sensitivity to relationships, says
Nesse, "but I bet they make really good friends" and have stronger
social networks as a result.
Rising Tide
That personality disorders once had their uses could explain why they are so prevalent today. The first survey of such
conditions conducted in this country concluded that about one in ten
Americans suffers from a personality
disorder. A much larger survey, based on interviews of more than 43,000
people, released by the National Institutes of Health, put the number
at 15 percent—or almost one-sixth of the population.
Obsessive-compulsive personality disorder is the most common, affecting
about 8 percent of all adults; next come paranoid personality disorder at 4.4 percent and antisocial personality disorder at 3.6 percent. Just 0.5 percent was diagnosed with dependent personality disorder, in which a person needs excessive reassurance from others and fears functioning on his or her own.
Personality disorders may afflict 50 percent or more of people currently receiving treatment for any mental health condition. "Most
patients who seek assistance are suffering from the difficulties of
long-standing maladaptive attitudes and coping styles, essentially what
have come to be labeled personality disorders," notes personality
researcher-clinician Theodore Millon. "Dysfunctions of personality have
become omnipresent" in therapy practices, he says. Millon thinks personality disorders "will outstrip all other areas of psychological and psychiatric practice in the coming decade."
Chipping Away at Disorder
Not long ago, diagnosis of a personality disorder carried a grim outlook.
By and large, the only treatment available was long-term psychoanalysis.
To eliminate troublesome behaviors, it was believed, you needed to
change the underlying traits on which the very structure of personality
had been built, day in and day out, through a person's countless
interactions with the world. The few who qualified for such demanding
therapy didn't necessarily benefit from it. Therapists' general
attitude toward these illnesses, says psychiatrist Len Sperry of the
Medical College of Wisconsin, was one of "dread and hopelessness."
Gone, along with that approach to treatment, is the Freudian view that inner conflicts arising in childhood are the sole cause. The emerging perspective acknowledges that
personality, both normal and abnormal, is a complex interaction of
forces inside and outside the individual—biological, psychological and
social.
The antisocial personality of Bill the Shark, for example, may have originated in a genetic predisposition to
aggressiveness expressed biochemically in low levels of the
neurotransmitter serotonin. This inborn temperament might have been
aggravated by hostile or irresponsible parenting
manifest as Bill was growing up. Bill's antisocial tendencies may have
reached full expression and reinforcement in social
environments—casinos, strip clubs, law firms—that permitted and even
encouraged combative behavior.
New treatments chip away at each element of the biopsychosocial roots of personality disorders. Drugs like selective serotonin reuptake inhibitors may act on the biochemical
imbalances. Interpersonal and psychodynamic therapies take on the
psychological component of the disorder, encouraging the individual to
reflect on his past experiences to help release their hold on current
behavior. Cognitive-behavioral and dialectical exercises (in which the
person learns to challenge his own impulses) seek to shift the pattern
of external rewards and punishments in favor of more controlled and
constructive conduct. The new integrative paradigm, Sperry reports, has
transformed clinicians' attitudes from hopelessness to optimism.
From the start, Bill the Shark's antisocial personality traits
presented special challenges. He "had little desire for psychological
growth or moral
self-improvement," Widiger notes, and his glib cockiness made genuine
rapport difficult to achieve. Widiger instead took advantage of Bill's
ambitious and competitive nature by challenging him to come up with
ways to limit his drug use and his gambling. Using approaches borrowed
from cognitive-behavioral therapy,
psychologist and patient devised personal mantras that Bill would
repeat to himself when faced with a temptation. "These mantras might
have sounded superficial to others," Widiger acknowledges, but to Bill
"they were effective, meaningful, even inspirational."
Widiger made a concerted effort not to react with judgment or disapproval when
Bill regaled him with tales of his unsavory exploits. As Bill grew more
comfortable, he was able to examine the roots of his behavior, coming
to terms with his parents' failings and considering ways to rectify his
own. Though still far from sensitive or empathetic, Bill began to
recognize how hurtful his actions were to himself and to others. His
essential nature was not changed by therapy, says Widiger, but he was
able to smooth "the rougher edges of his personality."
Len Sperry uses an identical metaphor to describe the treatment of patients
like Bill. "The clinician working with personality-disordered
individuals is not a carpenter who rebuilds a structure," he notes,
"but is rather like a cabinetmaker who sands down and takes the rough
edges off." Ultimately, he adds, the goal is to turn a personality
disorder into a personality style—to help the personality-disordered
patient become a functioning, healthy human being, with quirks and
idiosyncrasies intact. A person, that is, a lot like you and me.
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