I’ve been writing about ego-syntonic mental illnesses, the kinds where people don’t generally perceive themselves as ill. They experience their disorder as a part of their identity.

Many of the personality disorders fit this description.

I’ve often wondered, in this kind of disorder, who feels the pain?

If an ego-syntonically disordered person truly cannot understand that they have a problem, then do they suffer? Or is the suffering just transferred onto the people who love them?

Bonnie B has the same concern:

I think a major diagnostic flaw in the DSM contributes to our culture’s difficulty with clearly defining the difference between mental health and mental illness.  The diagnosis of many disorders relies upon the individual’s subjective experience of significant distress, and for many ego-syntonic personality disorders, the distress is felt not so much by the individual, but by those who are close to him.  Personality disorders commonly wreak havoc in the lives of family members, friends, and employers, but a diagnosis cannot be made unless the individual feels distressed.  Perhaps instead of relying only upon the individual’s subjective experience of distress, the criteria should be changed so that it includes significant distress in the lives of others as well.

An example of this is the diagnostic criteria for pedophilia.  Their behavior is extremely destructive, but most pedophiles see nothing wrong with their behavior and show no remorse or distress, so it was truly insane to include their subjective experience as the basis for diagnosis.  If that were the case, the vast majority would still be classified as normal!

One proposed change for the DSM-V is to include the category of relational disorders; maybe this is a step in the right direction, towards acknowledging the fact that disorders affect not only the individual but everyone who cares about them.

Finally, this excerpt from a comment from Heather (more will appear in a later post):

After a lifetime of suffering from major depressive disorder, I’ve recently been diagnosed as suffering from Borderline Personality Disorder.

Of course, I’ve been trying to do a lot of research online to learn more about BPD. I have to say it is truly depressing me and causing me great shame.

I identify with the criteria for BPD listed in the DSM IV. Then I read blogs and articles about people with personality disorders and they are all so negative – practically attacking those with a PD.

…Am I misunderstanding these blogs and articles? Am I being overly sensitive? Am I being paranoid in thinking these articles suggest people with PDs are essentially bad people?

Clearly Heather does “feel the pain.” She is aware of her disorder and  is actively working to understand and deal with it, and as she does so, she encounters constant vilification. How horribly unfair and hurtful!

I do want to talk more about this in future posts.

People with personality disorders are not “bad” or “wrong.”

We need to stop confusing mental illness with morality!

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From Psych Central's website:
PsychCentral (March 7, 2010)

Your type really can't change? - Page 4 - PersonalityCafe (June 9, 2010)

    Last reviewed: 7 Mar 2010