PERSONALITY DISORDERS It may seem presumptuous to classify someone's personality as "disordered" on some arbitrary basis, and indeed any such categorization can be considered judgmental. What is ideal to one may be obnoxious to another, and it is not the purpose of this discussion, nor of mental health professionals to deal with this aspect of human variation. Rather, it is recognized that there are individuals who despite being productive, successful, and accepted members of society have certain attributes to their personality which either make them unhappy with themselves most of the time, interfere with interpersonal relationships to a profound and consistent extent, or otherwise obstruct the attainment of important or desired life goals which would otherwise be reasonable to expect. To this extent, such people define their own personality as being maladaptive in some regard by seeking professional help. Rather than approach the topic in a formal and clinical fashion, this article will provide a descriptive overview of such traits. Virtually every person has elements of these symptoms intermittently, or mild awareness of some of these traits most of the time. Only when the individual perceives the problems as overwhelming does the professional enter the picture. Freud might have called some of these syndromes "neuroses" although this term has vague and inappropriately negative connotations to some. Representative Types OBSESSIVE-COMPULSIVE Such an individual may be driven to such a high degree of orderliness, perfectionism, and conscientiousness that expectations are unattainably high, or energy to meet the needs is so great that other activities and emotions suffer. The appearance of these people may be meticulous, and their surroundings will match. Blind loyalty and a high dependence on the praise of superiors is common. He or she may surround themself with regulations and rules to an extreme degree. Others see them as logical and reliable, but formal, inhibited, inflexible, and stubborn. Routines become an important part of such an individual's life, even if they are inconvenient or downright inappropriate. Fiscal "tightness" is the rule. Inability to relegate responsibility to others is noted, and an increasing coldness is described by family members. Analysts hypothesize that such traits stem from exaggerated parental insistence on discipline and behavior in early childhood, such as early toilet training and suppression of emotional expression. Normal aggression and defiance are not allowed, and thus suppressed. HYSTERIA Despite the somewhat sexist overtones of the above term, there is no more suitable description of this personality style. It is acknowledged that this is a more common maladjustment in women. There occurs a preoccupation with physical appearance, even in situations where it is inappropriate. The need to draw attention to himself or herself is great. The extremes of emotion may be manifest within minutes, such that one may see exaggerated cheerfulness and friendliness quickly replaced with hostility or aloofness. Tears and laughter come readily, such that an observer may question the genuineness of the emotions being displayed. There may be a history of failed relationships as premature plunges into unwarranted intimacy give way to the realities of a sharing and compromising relationship which the patient is unable to sustain. A stylish, even attractive appearance is common, with either a "macho" or "seductive" look being common. Personality theorists have indicated that such a style stems from a need to be dependent, with associated feelings of inner inadequacy and lack of confidence. The tendency is thus to trust or become intimate too readily, with the stage set for disappointment. The patient's reaction is then typically immature or dramatic, and reminiscent of a child. Dramatic and sometimes even ludicrous "hysterical" symptoms with no basis in physical disease are sometimes seen in such patients. It has been stated that between the ages of 3 and 6 years these patients may have had difficulty in reconciling the ambivalence of their affection for the parent of the opposite sex, with the love and guilt never coming to terms. It is not clear to what extent such theories are valid. PARANOIA This use of the term is not to be confused with paranoid schizophrenia. People with paranoid personality disturbance are those who are overly defensive about every comment or suggestion, suspicious of others' motives without cause, and unexpressive of emotion to an extreme degree. Heightened cynicism, hostility in general, and "grumpiness" are common. Self-sufficiency and independence may assume unusual importance, as may secretiveness. Small arguments with others become crusades to these people. Their perceived sense of self- importance often outpaces the little respect which they receive from others. Humor, kindness, warmth and vulnerability are character traits which are absent. Analysts tell us that such traits may come from families where parental anger is dominant, conspicuous, and comes to be expected even when unjustified. The cycle may easily be seen to perpetuate itself generation after generation. BORDERLINE PERSONALITIES This disorder has only recently become widely understood, and is, indeed, a clinical diagnosis. It refers to people whose personalities intermittently approach loss of reality awareness almost to the point of a truly psychotic patient, often mixed with any number of other traits of personality disorder, such as phobias (see the section on anxiety), hysteria, etc. At baseline the patients are frequently perceived as highly immature, unhappy, and have short tempers. They display poor judgment in life decisions, in a manner which may seem almost intentional or self-destructive. They tend to see the world's population as good or bad with little in between. In some cases only during extreme stress and on careful evaluation do the near-psychotic proportions of their thinking process become recognized. Some theorists have said that this personality comes from difficulties in the separation process from the mother at around 18 to 24 months of age. Any type of separation as an adult thus leaves such patients feeling highly vulnerable and threatened. TREATMENT and PROGNOSIS It is probably in this area of psychiatry where analytic therapy and strictly personality-based approaches have been the least challenged. The subtleties of the intricate interaction which goes on are beyond the scope of a written discussion. In summary, the therapist will attempt to know the patient sufficiently well through listening, probing, testing, and eliciting reactions that eventually some insights into the precipitating events in early life will be made. The patient may then be guided to understand these events in a new way and can begin to reconstruct those elements of the personality which are of concern. Such therapy is not usually available, affordable, or agreeable to many patients, and understanding by those around him or her becomes important. Many people simply make their way, however unhappily, through life and only come to professional attention through some crisis. Any professional who deals with large numbers of people in a helping role will encounter many variations of maladaptive personalities. Peers, colleagues and family members can also benefit from recognizing some of the traits as being reflective of such problems as those described above, thereby enabling a more sensitive, patient but firm, and adaptive attitude toward the affected individual.