10 Things People Misunderstand About Personality Disorders
©2021 Bill Eddy, LCSW, Esq. Personality Disorders—An Enduring Pattern of Dysfunctional Interpersonal Behavior The term personality disorder has been familiar to mental health professionals for over forty years. However, most other professionals and the general public know little about the meaning of such disorders and often operate with misconceptions about their patterns of dysfunctional behavior. Personality disorders are officially a category in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and used throughout the world. The current version of this manual is the fifth edition, which was published in 2013 and is known as the DSM-5. I was first trained in the DSM-3 when it was published in 1980, the year I was in a field placement at the San Diego Child Guidance Clinic during my master’s in social work (MSW) degree program. This was when personality disorders were first clearly included as a category of specifically defined disorders, each with its own list of criteria. Over the next forty years I have learned a lot more about personality disorders that I now take for granted, but I still find that most people know little about them. In short, personality disorders are an enduring pattern of dysfunctional interpersonal behavior. The following are some of the most common misunderstandings: #1: Personality disorders are rare. No. In fact, the DSM-5 refers to a study that indicates that 15% of adults in the United States have one. Other studies indicate 10-13%. This is equal to or more common than the percent of people with a substance use disorder (addictions), yet most people know little about personality disorders and they are not talked about much in public. In many ways, society is treating personality disorders like it used to treat addictions fifty years ago, as hush-hush. Now there is widespread public awareness and discussion, court-ordered drunk driving programs, hospital treatment programs, insurance funding for treatment, and many families and companies can push their loved ones and employees into substance abuse treatment with “interventions.” We are just starting to see some of this awareness beginning in regard to personality disorders. #2: Personality disorders are obvious. No. Personality disorders are generally hidden disorders. There is a full range of severity of these disorders. Some people with personality disorders can function well in their jobs and communities but have serious problems in close relationships (such as families), while others cannot even work because they are so dysfunctional. People with these disorders are often not obvious to people who are dating them until they have known them for six to twelve months, or people who hire them, who often do not know until they are settled deeply into the job. They can get by in many settings for a long time. They look like everyone else on the surface. #3: Someone would know if they had a personality disorder. Usually not. Most people who have one do not know they have it. Personality disorders are enduring patterns of behavior that develop before adulthood, most commonly in early childhood. They lack self-awareness of their own disorders and of the impact of their own behavior on those around them. When they get feedback for their negative behavior, they tend to become highly defensive rather than having insight into their part in the problem, which is often substantial. This is a big part of why they have an enduring pattern of dysfunctional behavior; it seems normal and necessary to them. But it does not work, and they often are unhappy. #4: Personality disorders can never change. Not necessarily. Historically, many people (including therapists) thought that personality disorders were unchangeable and therefore therapy was pointless. However, over the past 2-3 decades there have been breakthrough treatments that have succeeded at improving the behavior of some people with personality disorders. For example, there is a fairly successful treatment approach for borderline personality disorder called Dialectical Behavior Therapy, or DBT, which has helped many people overcome the diagnosis with improved self-awareness and self-control. Also, some people with other personality disorders (there are ten) have made some progress in therapy, such as some of those with narcissistic personality disorder. However, the vast majority of people with personality disorders do not seek or get treatment and remain stuck in dysfunction. #5: People with personality disorders know they are acting inappropriately. Usually not. This is one of the hardest things to accept about personality disorders. But they really, truly lack self-awareness of their part in their problems. They honestly believe that others have treated them unfairly for no good reason when others are usually reacting to their behavior or trying to set limits on their behavior. Since they cannot see their own part in their own problems, they are always searching for other explanations. Some blame life in general or the universe, while others blame specific people (these are the ones with high conflict personalities, who are preoccupied with targets of blame). #6: People with personality disorders could change if they just wanted to. Unlikely. Remember, a personality disorder is an “enduring pattern” of dysfunctional behavior. They cannot see their part in their problems and conflicts. In many ways, this problem is like that of alcoholics and addicts, who cannot see the connection of their own behavior to their problems in life. Only it’s even harder with personality disorders because the person has experienced their own patterns of behavior usually since early childhood as normal and necessary. There is no obvious cause of their difficulties, so people assume their behavior is knowingly bad and intentional. In reality, this is the problem: they cannot connect the dots from their own behavior to how others respond, and how they could change. #7: You should try to give them insight into their own behavior. Do not do this! Since they lack self-awareness and have an enduring pattern of behavior that they rarely change, feedback—even “constructive” feedback—feels like a personal attack to them. Not only do they not benefit from the feedback, but it
Cancel Culture: Setting Limits or Going Too Far?
©2021 Bill Eddy, LCSW, Esq. & Megan Hunter, MBA What Does Cancel Culture Mean? Although there is no single definition of cancel culture, it is about groups of people applying pressure to punish a person or group for what is perceived as a wrong opinion. It happens in the workplace, on social media, and in the celebrity community. Professors are boycotted for attending pro-police rallies. Authors’ publishing contracts are terminated for their opinions on other matters. Sports teams are under threat of elimination from tournaments because of religious beliefs. Journalists and others are losing jobs for decades-old social media posts or repeating an offensive word in conversation to clarify what’s being said. What is behind it? It seems we are in the age of offendedness and the age of tolerance and common sense are a distant memory. Applying pressure to reach a desired result is not a new concept. What is different is the new mob mentality mixed with an all-or-nothing judge-and-jury mentality. Loud voices of the offended attract the like-minded, strengthening the group bond and the volume. They are collectively emboldened and utilize the power and speed of social media to spread the message and add to the ranks. They apply pressure to someone with authority who, these days, usually caves to the pressure, firing the person, canceling the book, or, fill in the blank. Is it High Conflict Behavior? At the High Conflict Institute, we teach and write about high conflict behavior all the time. This behavior includes: Preoccupation with blaming others Lots of all-or-nothing thinking Unmanaged emotions and Extreme behavior or threats. Some people engage in a persistent pattern of high conflict behavior, so we think of them as high conflict people who need different methods of management beyond logical persuasion and criticism. So the questions are: (1) Do people who engage in cancel culture present a pattern of high conflict behavior? (2) Is cancel culture, by nature, high conflict? We can be fairly certain that at least some who engage in cancel culture fit the high conflict pattern. Cancel culture opens the door wide open to someone with a: preoccupation with blaming others (you don’t agree with me—you are my target of blame) all-or-nothing thinking (the target is all bad and must be eliminated; I’m right, you’re wrong) unmanaged emotions (I don’t agree with the target of blame, so I’m really mad) extreme behaviors or threats (public shaming on social media and outright calls for cancellation) While we won’t go so far as calling cancel culture high conflict, it is ripe for drifting into that territory in an unchecked society. It isn’t all bad, but it isn’t all good either, and put in the hands of someone with a high conflict personality can be downright devastating. Setting Limits on High Conflict Behavior Some people engage in a persistent pattern of high conflict behavior, so we think of them as high conflict people who need different methods of management beyond logical persuasion and criticism. In short, high conflict people need limits because they cannot stop themselves. We encourage people to set limits with three basic steps (see article on Setting Limits: Setting Limits with EAR™ ): State what behavior is acceptable and what behavior is not. Let others know what the consequences will be if they engage in the behavior that is unacceptable. If the unacceptable behavior occurs or persists, then impose the consequences. Generally, the consequences in daily life are those that a person can impose primarily by no longer providing their own benefits to the violator of the limits. In some cases, this means ending the relationship, such as getting divorced, firing an employee, or quitting a job. Words Matter In some cases, the issue is one of words. One of the big issues around words today is values and politics: freedom of expression versus words that hurt people. In the United States, we have the Bill of Rights, also known as the first ten Amendments to the Constitution. The First Amendment says the following: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. But this doesn’t mean total freedom of speech, as interpreted many times by the United States Supreme Court. For example, yelling “Fire!” in a crowded theater when there is no fire is not allowed—it’s not protected by the constitution. Who Decides? Twitter has a policy since March 2019 that says: You may not threaten violence against an individual or a group of people. We also prohibit the glorification of violence. Healthy conversation is only possible when people feel safe from abuse and don’t resort to using violent language. For this reason, we have a policy against threatening violence on Twitter. We define violent threats as statements of an intent to kill or inflict serious physical harm on a specific person or group of people. Based on this policy, Twitter permanently banned President Trump. One of his sons has stated that this was inappropriate “canceling” of his father. Was it? And who decides? In the case of Twitter, a private company, it is allowed to set its own policies and follow them. However, even German Chancellor, Angela Merkel, who is no fan of the prior president, has expressed concern about this: “The right to freedom of opinion is of fundamental importance. Given that, the chancellor considers it problematic that the president’s accounts have been permanently suspended,” her spokesman said. He added that governments, not private companies, should decide on any limitations to freedom of speech. Germany has restrictions against disseminating “untrue facts” and “abusive criticism,” as well as denial of the Holocaust. Applying the policy fairly and evenly across the social media platform is a daunting challenge and one no platform will ever get completely right, whether because of sheer mass or internal bias. Setting
Personality Disorders Gaining Importance in Recent Legal Cases
©2020 Bill Eddy, LCSW, Esq Personality Disorders Should be Considered in More Legal Cases A landmark case in Australia and a study in California both reached the same conclusions in the last month: personality disorders should be considered in more legal cases. This is what we have been saying with High Conflict Institute since our founding in 2008. Our readers may find this interesting, because most of us are used to considering personality disorders as a form of mental illness because they are included in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association, 2013, currently the “DSM-5.” In reality, personality disorders are interpersonal disorders, yet they can also be hidden disorders. In Criminal Cases In Australia, on August 25, 2020, the Court of Appeal of the State of Victoria (highest court in the state, which includes the major city of Melbourne) ruled that “personality disorders can be considered a mitigating factor in the same way a judge or magistrate can find mental illness reduces an offender’s moral culpability…. Whether and to what extent the offender’s mental functioning is (or was) relevantly impaired should be determined on the basis of expert evidence rigorously scrutinised by the sentencing court.” (Cooper, A. “Landmark ruling gives judges power to consider personality disorders,” The Age, August 25, 2020.) This decision is important because legal systems in the United States, Australia and probably most other countries have considered that personality disorders are not a mental illness and should not be considered in criminal cases as a reason to alter anything—up to now. For example, in the high-profile case of the kidnapper of 14-year-old Elizabeth Smart in the United States in 2002, a federal court of appeal considered the question: “Is he competent to stand trial or does he have a severe-enough mental illness that prevents him from understanding the proceedings and his role in it?” (Eddy, B. High Conflict People in Legal Disputes, 2nd Ed., 2016, 122.) The court found that the kidnapper did not have a mental illness, such as schizophrenia, but instead had a narcissistic personality disorder and an antisocial personality disorder and therefore was not mentally ill and could competently stand trial. They essentially found that he was a con artist and knew what he was doing. This appears to be the current standard across the United States. In this case, this made sense. However, in the Australian case of Daylia Brown, she was a teenager (17) when she went on a fire-starting spree in several stores in Melbourne (fortunately, no injuries). She was found guilty of her crimes and sent to an adult prison, but the judge believed that her severe personality disorder should be taken into account in reducing her sentence and getting her some help. At the time, the governing standard said that personality disorders could not be considered as a mitigating factor, because they were not a mental illness under the law. The prior case was that of Michael O’Neill, who murdered his partner and also had a severe personality disorder. But in that case “the Court of Appeal ruled personality disorders do not impair mental functioning,” based on long-standing decisions. The judge in Daylia Brown’s case asked that her lawyers appeal his required ruling, because he thought that her personality disorder (including a history of personality change since she was 8 years old, cutting on herself as a teenager and suicidal thoughts) should be considered as a mitigating factor in getting her sentence reduced. It was noted that in some cases a personality disorder can cause more impairment than other mental illnesses. (Cooper, A. “Judge urges appeal as teen with personality disorder jailed over arson,” The Age, March 3, 2020.) In this case considering her personality disorder appears appropriate, as the judge himself said. However, a personality disorder is not a get-out-of-jail free card. It totally depends on the facts of the case. The impact of a personality disorder on sentencing should be based on the testimony of a mental health professional, as the Court of Appeal stated. They do not expect that this will change the sentence in most cases. I am very interested in these cases, as my law students in Australia (4-day intensive courses at Monash University and Newcastle University every September/October) have written about this issue in some of their research essays. In Family Law On September 1, 2020, an article reported on a study by the Santa Clara University School of Law on the significance of personality disorders in family law. The study included interviews with family lawyers, judges, and a custody evaluator. They specifically found that narcissists “fundamentally thrive on conflict.” Also, the “narcissist’s perceived sense of infallibility and accompanying resistance to settle is amplified by the traditional civil process.” Of the approximately 10% of family law disputes that go to trial, many are conflict-fueled separations. While most divorce cases are settled out-of-court in less than two years, high-conflict cases typically last two to five years and can involve scores of filings, endless delays, tens and hundreds of thousands of dollars in legal fees, and a high rate of attorney turnover. Worst of all, children become collateral damage and often wind up developing a wide range of mental-health issues. Rarely are formal diagnoses made in family court. Thus, attorneys unequipped to recognize NPD traits struggle to meet their ethical obligations to serve as zealous advocates for clients taking untenable and unreasonable positions. (Rosenfeld, E. “Opinion: Dealing with narcissists in the family law courtroom,” Mercury News, September 1, 2020.) What Should be Done? Their recommendations include attorneys becoming “educated about personality disorders such as NPD.” Also: “the State Bar should develop continuing legal education courses addressing how to recognize – and deal with – high-conflict personalities.” We are glad to hear this and ready help, as we with High Conflict Institute and our trainers have been educating lawyers, judges, mediators and court-involved therapists for the past thirteen years about personality disorders and high-conflict personalities. We have