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WHEN ALARM BELLS SHOULD RING:
Recognizing Personality Disorders
By
Susan Schwartz Senstad, M.A., M.F.T., M.F.A.
About the author
Susan Schwartz Senstad holds an M.A. in Psychology and a current
California Marriage and Family Therapy (M.F.T.) license. From 1977
to 2000, she provided psychotherapy in California, Rome and, then,
Oslo. In 1986, she introduced Voice Dialogue to Norway. Until 2000,
in addition to using Voice Dialogue in business consulting, she
trained the entire first generation of VD practitioners and teachers
now working in Norway. Some of these have gone on to teach others
and now a second and even third generation are developing.
In 1995, she received a Master’s Degree (M.F.A.). in Creative
Writing and in 2000 closed her practice in order to write full-time.
On February 24, 2006, BBC Radio 4 will broadcast a one hour radio
dramatization of her prize-winning first novel, Music for the Third
Ear. (Go to www.bbc.co.uk/radio4/ then look for the “Friday”
play.) She is now at work on her second novel, under the working
title of Mother Tongue, Inc. See also Senstad’s other Voice
Dialogue-related articles: “Voice Dialogue: From a User's
Manual for the Human Being at Work” (http://www.delos-inc.com/Reading_Room/Articles/6/6.html
) and “The Wisdom of Vulnerability” (http://www.delos-inc.com/Reading_Room/Articles/18/18.html).
Appendix 1:
References and Useful Books & Websites
For lay people:
• To learn ways to assist people in relationship to someone
with what they call a Borderline Personality Disorder but which
actually includes other kinds of Personality Disorders, explore
the website http://www.bpd411.org/
• Book best suited to the U.S. legal system, but covers important
issues to consider anywhere if divorcing a Personality Disordered
partner, particularly when children are involved:
Eddy, William A. Splitting:Protecting Yourself While Divorcing a
Borderline or Narcissist. Eggshells Press, Wisconsin, 2004.
• Not limited to Personality Disorders but good:
Forward, Susan & Craig, Buck. Toxic Parents: Overcoming Their
Hurtful Legacy and Reclaiming Your Life. Bantam, 1989.
• An eloquent portrait of Narcissistic Personality Disordered
behavior. The solutions the author suggests seem to me to indicate
that she hasn’t quite resolved her own issues with her own
Narcissistic parent. She describes the disorder very well:
Golomb, Elan. Trapped in the Mirror. Harper Paperbacks, 1991.
• The best book I’ve found for people with a Personality
Disordered parent. Though the book focuses on disturbed mothers
it has proved useful regarding disturbed fathers as well. It also
clarifies various styles of Borderline Personality Disorder:
Lawson, Christine Ann. Understanding the Borderline Mother: Helping
Her Children Transcend the Intense, Unpredictable, and Volatile
Relationship. Jason Aronson, Inc.: N.J. 2000.
• The ‘bible’ for anyone in a relationship with
someone suffering from various Personality Disorders:
Mason, Paul T. & Kreger, Randi. Stop Walking on Eggshells: Taking
Your Life Back When Someone You Care About Has Borderline Personality
Disorder. New Harbinger Publications, Inc.: Oakland, California,
1998.
• Covers much of the same ground as Walking on Eggshells,
and also includes a moving personal story:
Tinman, Ozzie. One Way Ticket to Kansas: Caring about Someone with
Borderline Personality Disorder and Finding a Healthy You. Bebes
& Gregory Publications. 2005.
For Psychology Professionals:
• The psychiatric diagnostic manual:
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition
(DSM-IV), published by the American Psychiatric Association, Washington
D.C., 1994
• A well-written aid to professionals offering therapy to
people with Borderline and other Personality Disorders. Fits in
beautifully with the Stone’s concepts regarding Bonding Patterns:
Gabbard, Glen O. & Wilkenson, Sallye M. Management of Countertransference
with Borderline Patients. Jason Aronson Inc., American Psychiatric
Press, Inc., Northvale: 2000.
• Excellent overview:
Gunderson, John G. Borderline Personality Disorders. Psychiatric
Press, Inc., New York, 1986.
• Otto Kernberg did the seminal psychoanalytic work on identifying
Borderline Conditions. Early classic text:
Kernberg, Otto. Borderline Conditions and Pathological Narcissism,
New York: Jason Aronson, Inc., New York, 1975.
• Especially good for understanding Kernberg’s theories
about “object relations”:
Kernberg, Otto. Object Relations Theory and Clinical Psychoanalysis,
Jason Aronson, Inc., New York, 1976.
• An important article clarifying distinctions between deficit-based
and conflict-based issues:
Killingmo, B. International Journal of Psychoanalysis. “Conflict
and deficit: implications for technique.” 1989;70 (Pt 1):65-79.
Appendix 2:
DSM IV – Personality Disorders
(Hyperlinks to http://www.psyweb.com)
Borderline: Borderline Personality Disorder is
characterized by a lack of ones own identity, with rapid changes
in mood, intense unstable interpersonal relationships, marked impulsively,
instability in affect, and instability in self image.
A. Going to about any lengths to avoid real or imagined abandonment.
B. Intense unstable interpersonal relationships characterized by
changing between idealization and devaluation the relationship.
C. Lack of ones own identity. A marked instability of self image
or the sense of self.
D. Impulsivity in two or more areas that are self damaging. These
may included abuse, sex, spending, eating, driving recklessly, etc.
E. Recurrent self-destructive gestures, self-mutilation, suicidal
behavior, or threats.
F. Instability in affect.
G. Marked feelings of emptiness.
H. Frequent displays of anger due to a difficulty in control.
I. Dissociative or paranoid.
Narcissistic: Narcissistic Personality Disorder
is characterized by behavior or a fantasy of grandiosity, a lack
of empathy and a need to be admired by others. Narcissistic personality
has a pathological unrealistic or inflated sense of self-importance,
has an inability to see the viewpoints of others, and is hypersensitive
to the opinions of others.
A. Grandiose sense of self-importance.
B. Fantasies of and preoccupation with beauty, brilliance, ideal
love, power, or unlimited success.
C. A belief of being special and unique and can only be understood
or a need to associate with people of high status.
D. A need for excessive admiration.
E. An unreasonable expectation of being treated with favor or expecting
an automatic compliance to her / his wishes.
F. Will use others to achieve her / his goals.
G. Lacks empathy.
H. Believes others are envious of her / him or is envious of others.
I. Contemptuous or haughty attitudes / behaviors.
Histrionic: Histrionic Personality Disorder is
primarily characterized by exaggerated displays of emotional reactions,
approaching theatricality, in everyday behavior. Emotions are expressed
with extreme and often inappropriate exaggeration. Persons with
this disorder are prone to sudden and rapidly shifting emotional
expressions.
A. Uncomfortable if not the center of attention.
B. Interaction with others in an inappropriately provocative or
seductive manner.
C. Shallow and rapid changing of emotion.
D. Uses appearance to draw attention.
E. Speech that lacks in detail and excessively impressionistic.
G. Theatrical, self dramatization, or disproportionate expression
of emotion.
H. Easily influenced, suggestible.
I. Feels even a sociable relationship is intimate.
Schizotypal: Schizotypal Personality Disorder
is primarily characterized by peculiarities of thinking, odd beliefs,
and eccentricities of appearance, behavior, interpersonal style,
and thought. Persons with this disorder may have peculiar ideas:
belief in psychic phenomena or magical thinking.
A. Ideas of reference.
B. Magical thinking or odd beliefs, that are not consistent with
the culture’s norms and which influence behavior.
C. Odd perceptual experiences.
D. Odd thinking or speech.
E. Suspicious or paranoid.
G. Narrowed or inappropriate affect.
H. Eccentric, odd, or peculiar behavior / appearance.
I. Few or no close friends or confidants, not including first-degree
relatives.
J. Excessive social anxiety.
Paranoid: Paranoid Personality Disorder is characterized
by a marked distrust of others, as indicated by at least four of
the following:
A. Believes without reason that others are exploiting, harming,
or trying to deceive her / him.
B. Unjustified doubts about a friend’s / associate’s
loyalty or trustworthiness.
C. Believes without reason that if she / he confides in others,
this information will somehow be used against her / him.
D. Finds hidden demeaning or threatening meanings in harmless remarks
or events.
E. Unforgiving and bears grudges.
F. Believes without reason that people are out to attack his / her
character or reputation and is quick to react with anger.
H. Believes without reason in the infidelity of their sexual partner.
Antisocial: Antisocial Personality Disorder is
characterized by a lack of regard for the moral or legal standards
in the local culture. There is a marked inability to get along with
others or abide by societal rules. Individuals with this disorder
are sometimes called psychopaths or sociopaths.
A. Repeated acts that could lead to arrest.
B. Conning for pleasure or profit, repeated lying, or the use of
aliases.
C. Failure to plan ahead or being impulsive.
D. Repeated assaults on others.
E. Reckless when it comes to their own or others’ safety.
F. Poor work behavior or failure to honor financial obligations.
G. Rationalizing the pain they inflict on others.
Avoidant: Avoidant Personality Disorder is characterized
by marked social inhibition, feelings of inadequacy, and extremely
sensitive to criticism. Individuals wish for but are fearful of
any involvement with others. They are terrified by the thought of
being embarrassed in front of others. They avoid situations that
give them social discomfort which in many cases leads to social
withdrawal.
A. Avoids activities that involve interpersonal contact.
B. Avoids getting involved due to a fear of not being liked by others.
C. Restraint in intimate relationships due to a fear of shame or
ridicule.
D. Marked preoccupation of being rejected or criticized by others.
E. Stays away from new interpersonal situations due to feelings
of inadequacy.
F. Views oneself as inferior, socially inept, or personally unappealing.
G. Takes few if any personal risks in the engagement of new activities
for a fear of being embarrassed.
Dependent: Dependent Personality Disorder is primarily
characterized by an extreme need of other people to a point where
the person is unable to make any decisions or take an independent
stand on their own. There is a fear of separation, clinging, and
submissive behavior. They have a marked lack of decisiveness, self-confidence,
and self-denigration.
A. Has a hard time in making everyday decisions without getting
reassurance and advice from others.
B. Has others assume the responsibility for the major areas of their
life.
C. Can not show disagreement with others for fear of being rejected.
D. Difficulty in doing things on their own.
E. Will do almost anything to get the support of others.
G. When alone, a feeling of discomfort or helplessness in being
unable to care for themselves.
H. When one caring or support relationship ends they are compelled
to seek another.
I. A preoccupation with and unrealistic fear of being left alone
to care for themselves.
Obsessive-Compulsive: Obsessive-Compulsive Personality
Disorder is characterized by perfectionism and inflexibility. A
person with an Obsessive-Compulsive Personality becomes preoccupied
with uncontrollable patterns of thought and action. Symptoms may
cause extreme distress and interfere with a person's occupational
and social functioning.
A. Marked preoccupation with details, lists, order, organization,
rules, or schedules.
B. Marked perfectionism that interferes with the completion of the
task.
C. Excessive devotion to work.
D. Excessive devotion and inflexibility when it comes to ethics,
morals, or values.
E. Can not throw out worn-out, useless, or worthless objects, with
no sentimental value.
F. Insist others work or do tasks exactly as they would.
G. View money as something to be hoarded.
H. Stubborn and rigid
Schizoid: Schizoid Personality Disorder is primarily
characterized by a very limited range of emotion, both in expression
and experiencing. Persons with this disorder are indifferent to
social relationships and display flattened affect.
A. Wishes not to have or to enjoy close relationships, family included.
B. Prefers solitary activities and life.
C. Has little or no interest in sex with other people.
D. Has little or no pleasure when doing activities.
E. Few if any close friends, other than first-degree relatives.
G. Indifferent to criticism or praise.
H. Displays flattened affect, emotional coldness, or detachment.
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Table of Contents
Aims of this article
What is ‘normal’?
What is ‘abnormal’
Warning signs that a potential client/student
may suffer from a Personality Disorder
What to do – but first, what NOT to
do
Working with a client/student whose parent
and/or partner suffers from a Personality Disorder
Doing Bonding Pattern work with a client/student
with a Personality Disordered parent and/or partner
About the author
Appendix 1: References and Useful Books
& Websites
Appendix 2: DSM IV – Personality
Disorders
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