I’ve been writing a lot lately about personality disorders.

Linda F had an excellent comment, part of which I’ve reprinted below (the rest will be shared in a later post). She correctly notes that not all the personality disorders as listed in the DSM-IV share the characteristics I’ve been describing.

I appreciate that you have written on the “pain” one suffers, as well as friends and family, when they have a Personality Disorder (PD), however, the way you have written your article lumps “all” Personality Disorders into one all-identifying group; Personality Disorders cannot be so clearly delineated.

While I agree that “some” PD’s do comprise your definition, “People with PD have twisted, maladapted experiences of who they are,” I ardently disagree that ALL PD’s exhibit such traits.

Then, Laura L. Smith,  fellow PsychCentral blogger, wrote about the changes proposed for the DSM-V, coming out in 2013, including dramatic changes in the categories and diagnostic descriptions for personality disorders. Dependent, histrionic, and narcissistic personality disorders, among others, will be reconceptualized.

And to throw a bit of history into the mix, personality disorders used to be called “character disorders.” Ouch! I sure am glad they abandoned that name. But, clearly, the whole concept of personality disorder has always been problematic and continues to be poorly understood.

Linda F’s comment made me realize that, in an attempt to get a handle on the slippery concept of “personality disorder,” I’ve been spotlighting the ego-syntonic personality disorders. They’re the ones that have grabbed my attention throughout my personal and professional experience.

These are the PDs  where people are unaware and/or in heavy denial of having them. Individuals with ego-syntonic personality disorders have distorted experiences of themselves and the world around them, but they don’t seem able to realize this. They experience their disorder as consistent with their identities, as part of who they are.

There are other disorders, such as anorexia, which are also ego-syntonic. The emaciated anorexic looks in the mirror and sees a fat person.

Asperger’s, as well as certain people’s depression, may also be experienced as ego-syntonic, as inherent parts of the individual’s Self. They feel that This is the way I am, this is how the world is.

In contrast, anxiety, depression in many people, OCD, dissociative identity (multiple personality) disorder (Linda F has DID), and many other disorders, are ego-dystonic. The person experiences their disorder as an illness or affliction, something separate from themselves that they would like to be relieved of. Their sense is that I don’t feel like I should, something has gone wrong. These people are much more likely to seek help and to work actively towards their own improvement.

Linda F is not the first person I’ve known with DID. My experience has been with individuals who have learned effective coping skills and who, like Linda F, lead vibrant, successful lives. I interact every day with students and adults with various psychotic conditions and other serious disorders, who are stable, happy and productive, thanks to appropriate interventions and their own continued hard work. I must admit, these folks are not really on my radar as I worry about mental disorders, because they’re living such healthy, normal, well-adjusted lives.

It’s the ego-syntonic personality disorders that I notice and that I find heartbreaking. Sufferers don’t get the help they need, because they don’t realize they are ill, and because we who care about them don’t fully understand what’s wrong or how to help.

Photo taken in Provincetown, Cape Cod, MA

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From Psych Central's website:
PsychCentral (March 4, 2010)

Mahastee (March 5, 2010)

    Last reviewed: 4 Mar 2010