Mental health articles

characteristics of personality disorder Personality disorders diff er from other mental disorders in that they are traits
and features of personality and not a transient state of being. Recognizing this
diff erence, the American Psychiatric Association (1980) created a separate
axis for personality disorders distinct from other mental disorders in the DSM
third edition. Whether personality disorders actually are distinct from Axis 1
disorders is still questioned, but such a separation remains (Livesley, 2001).
Currently, the DSM-IV-TR defi nition of a personality disorder is “an
enduring pattern of inner experience and behavior that deviates markedly
from the expectations of the individual’s culture, is pervasive and infl exible,
has an onset in adolescence or early adulthood, is stable over time, and leads
to distress and impairment” (American Psychiatric Association, 2000). In
practice, diagnosing can be complicated, with many college counselors also
being ambivalent about labeling students due to the stigma and seriousness of
personality disorder diagnoses.

Personality disorders may fi rst emerge and be recognized when students
are in college. Th us, it may be diffi cult to establish the “enduring pattern”
criterion. What one might see, however, is the beginning of a set pattern in
which dysfunctional behaviors or experiences persist across environments.
Frequently, students will say that they expected things to change when they
came to college, only to continue to have the same pattern of life experiences.
With college students, it is usually best to focus on dysfunctional patterns
of behavior and experiences. Th e clinician may have to look for such maladaptive
responses as extremely inaccurate perceptions and interpretations of
the self, others, and events; inappropriate and/or extreme rage, intensity, and
lability of emotional response; and very poor interpersonal functioning and
impulse control (Livesley, 2001). In supervision of clinicians, I have oft en used
the term “wired wrong” for students with personality disorders; how the student
responds is not what you would expect from the typical college student.
Cultural context is a particularly important consideration in a multicultural
setting such as a college. Students with personality disorders respond
signifi cantly diff erently from what one would expect in their culture.Th e level of distress and impairment is revealing. Kernberg (1984) refers to
personality disorders as “constellations of abnormal or pathological characteristic
traits of suffi cient intensity to imply signifi cant disturbance in intrapsychic
and/or interpersonal functioning” (p. 77). Th ese personality traits
are viewed as personality disorders when they are not just maladaptive and
infl exible but also signifi cantly impair social and occupational functioning
or cause tremendous subjective distress (Maxmen & Ward, 1995). Whereas
students with neurotic conditions may react inappropriately to the situation at
hand, students with personality disorders respond so inappropriately time and
time again that they have diffi culty progressing academically, vocationally, or
socially. Lacking adequate social skills, the ability to form solid relationships,
and a clear sense of self, they have diffi culty achieving the developmental tasks
of college.
Th e prevalence of personality disorders in a college counseling population
has been little studied. Th e average percentage of clients diagnosed at one Midwestern
college counseling center was 7.23 for the years 1996 until 2001 (Benton,
Robertson, Tseng, Newton, & Benton, 2003). Lewinsohn, Rohde, Seeley, and
Klein (1997) found only a 3.3% rate of prevalence of personality disorders in
young adults. Ranges for prevalence of at least one personality disorder in
clinical settings were 10% to 35.9%, with borderline personality disorder the
most frequently diagnosed personality disorder at 12% and substance use disorders
the most common comorbid Axis I diagnosis (Koeningberg, Kaplan,
Gilmore, & Cooper, 1985; Torgersen, Kringlen, & Cramer, 2001; Weissman,
1993). Nearly 75% of all patients diagnosed with a personality disorder also
present with an Axis I disorder (Dolan-Sewell, Krueger, & Shea, 2001).
Th ere are various models, including biopsychosocial systems, to explain
the etiology of personality disorders. Frequently discussed developmental factors
include genetic predisposition, disturbed attachment experiences, exposure
to trauma, temperament issues, family psychopathology, and, to some
degree, sociocultural and political forces such as socioeconomic levels and
gender (Magnavita, 2004).
In summary, personality disorders manifest in adolescence but oft en are
fi rst diagnosed in young adults. Th eir maladaptive behaviors include an inability
to reach personal goals or successfully complete the developmental tasks of
college. Students with a personality disorder oft en justify and rationalize dysfunctional
behaviors and long-standing patterns. Since they do not see any reason
to change, their maladaptive behaviors continue, resulting in disturbances
in the emotional, social, academic, and career domains of their lives.

Tags: disorder, Personality Disorder