Emotional Regulation Disorder

Emotional Regulation Disorder (ERD) is an alternate name for Borderline Personality Disorder (BPD)

There are a number of different names used around the world for Borderline Personality Disorder:

  • Borderline Personality Disorder (BPD)
  • Emotional Regulation Disorder (ERD)
  • Emotional Dysregulation Disorder
  • Emotional Intensity Disorder (EID)
  • Emotionally Unstable Personality Disorder (EUPD)
  • Emotion-Impulse Regulation Disorder (EIRD)
  • Impulsive Personality Disorder (IPD)

Continue to Borderline Personality Disorder Description

 

Personality Disorders DSM-IV to DSM-V

Summary

In 2013, The American Psychiatric Association (APA) voted down proposed changes in the way Personality Disorders will be classified and diagnosed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5 or DSM-V). As a result, the DSM-IV definitions of Personality Disorders have been retained in the DSM-V.

Background

The DSM is sometimes referred to as the "bible" of all mental illnesses and is used by clinicians, mental healthcare providers and insurance companies as a diagnosis guide.

Personality Disorders are broken into 10 separate diagnoses in the 4th edition - DSM-IV. However, the DSM-IV diagnoses are often criticized for being subjective and vague and there is so much overlap (known as comorbidity) between the definitions that many patients are diagnosed with more than one personality disorder while others are given the catch-all diagnosis Personality Disorder - Not Otherwise Specified (PD-NOS)

A working group developing new definitions for the DSM-V tried to resolve this by eliminating some diagnoses and developing a scale of traits. However the new system was criticized as being too complex for practical everyday use. The early decision to drop Narcissistic Personality Disorder (NPD) from the list of disorders led to so much criticism that NPD was later added back in. However, the controversy did not subside and the changes were dropped.

At issue is the problem that the neurological causes for personality disorders is not well understood. Rather than having an objective test, such as a blood test for HIV or an ECG for a heart condition, personality disorders are instead described by groups of symptoms - or behavioral traits - which are often viewed as subjective and vague. Some clues to the root causes for personality disorders have been seen by researchers using functional magnetic resonance imaging (fMRI) but this is not settled science or widely available today.

It is for this reason that Out of the FOG first published a combined list of personality disorder traits - our list of Top 100 Traits of Personality Disorders. There appears to be a great deal of overlap in personality disorders and no single set of traits that applies to everyone. There is also still a healthy debate on the nature vs nurture question - whether a person is born with biological propensity to develop a personality disorder in their DNA or whether a personality disorder develops during developmental years as a result of environmental stresses - such as child abuse.

However, the lack of a clear clinical definition of personality disorders in the DSM-V is clearly a setback for millions who suffer from these disorders and for families and loved ones. Clearly we have a lot of work left to do. 

Proposed & Rejected DSM-V Personality Disorder Definitions

Here are the proposed personality disorder classifications which were rejected by the APA:

  • Borderline Personality Disorder (BPD)
  • Obsessive-Compulsive Personality Disorder (OCPD) 
  • Avoidant Personality Disorder (AVPD)
  • Schizotypal Personality Disorder (STPD)
  • Antisocial Personality Disorder (ASPD)
  • Narcissistic Personality Disorder (NPD)

Other:

  • General Criteria for a Personality Disorder
  • Personality Disorder Trait Specified (PDTS)

Source: American Psychiatric Association DSM-V

Rejected mapping from the DSM-IV to the DSM-V

Here is a table showing the proposed (rejected) mapping from the DSM-IV-TR to the DSM-V. 

Old DSM-IV-TR Personality Disorder

New DSM-5 Personality Disorder Type

Prominent Personality Traits/(Domains)

Paranoid

PD Trait Specified (PDTS)

Suspiciousness (NA)

Hostility (A)

Unusual beliefs & experiences (P)

Intimacy avoidance (DT)

Schizoid

PDTS

Withdrawal (DT)

Intimacy avoidance (DT)

Restricted affectivity (DT)

Anhedonia (DT)

Schizotypal

Schizotypal

Eccentricity (P)

Cognitive & perceptual dysregulation (P)

Unusual beliefs & experiences (P)

Restricted affectivity (DT)

Withdrawal (DT)

Suspiciousness (NA)

Antisocial

Antisocial

Manipulativeness (A)

Deceitfulness (A)

Callousness (A)

Hostility (A)

Irresponsibility (DS)

Impulsivity (DS)

Risk taking (DS)

Borderline

Borderline

Emotional lability (NA)

Anxiousness (NA)

Separation insecurity (NA)

Depressivity (NA)

Impulsivity (DS)

Risk taking (DS)

Hostility (A)

Histrionic

PDTS

Emotional lability (NA)

Manipulativeness (A)

Attention seeking (A)

Narcissistic

Narcissistic

Grandiosity (A)

Attention seeking (A)

Avoidant

Avoidant

Withdrawal (DT)

Intimacy avoidance (DT)

Anhedonia (DT)

Anxiousness (NA)

Dependent

PDTS

Submissiveness (NA)

Anxiousness (NA)

Separation insecurity (NA)

Obsessive-Compulsive

Obsessive-Compulsive

Rigid perfectionism (C)

Perseveration (NA)

Depressive

PDTS

Depressivity (NA)

Anxiousness (NA)

Anhedonia (DT)

Passive-Aggressive

PDTS

Hostility (A)

Depressivity (NA)

PD Not Otherwise Specified (PDNOS)

PDTS

Individual trait profile

Notes: 

  • NA = Negative Affectivity
  • DT = Detachment
  • A = Antagonism
  • DS vs. C = Disinhibition vs. Compulsivity
  • P = Psychoticism

A recent empirical project reduced the number of facet traits from 37 to 25, reduced the number of domains from 6 to 5, and provided provisional mappings of traits onto domains. Please see the rationale for the B criteria for further information.

Whenever a patient’s impairments in personality functioning are sufficiently severe to warrant a PD diagnosis, but the combinations of impairments and pathological personality traits do not meet criteria for one or more of the six specific personality disorder types, a diagnosis of PD Trait Specified (PDTS) is made. 

Source: American Psychiatric Association DSM-V

Rejected DSM-V General Criteria for a Personality Disorder

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains or trait facets.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). 

Rejected DSM-V Criteria for Antisocial Personality Disorder (ASPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.

b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:

a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one„s ends.

b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one„s actions on others; aggression; sadism.

d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

2. Disinhibition, characterized by:

a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.

b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one„s limitations and denial of the reality of personal danger.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

F. The individual is at least age 18 years.

Rejected DSM-V Criteria for Avoidant Personality Disorder (AVPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose avoidant personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Low self-esteem associated with self-appraisal socially inept, personally unappealing, or inferior; excessive feelings of shame or inadequacy.

b. Self-direction: Unrealistic standards for behavior associated with reluctance to pursue goals, take personal risks, or engage in new activities involving interpersonal contact.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Preoccupation with, and sensitivity to, criticism or rejection, associated with distorted inference of others‟ perspectives as negative.

b. Intimacy: Reluctance to get involved with people unless being certain of being liked; diminished mutuality within intimate relationships because of fear of being shamed or ridiculed.

B. Pathological personality traits in the following domains:

1. Detachment, characterized by:

a. Withdrawal: Reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.

b. Intimacy avoidance: Avoidance of close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

c. Anhedonia: Lack of enjoyment from, engagement in, or energy for life‟s experiences; deficits in the capacity to feel pleasure or take interest in things.

2. Negative Affectivity, characterized by:

a. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of embarrassment.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Borderline Personality Disorder (BPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. 

b. Self-direction: Instability in goals, aspirations, values, or career plans.

AND 

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.

b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

B. Pathological personality traits in the following domains:

1. Negative Affectivity, characterized by:

a. Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

c. Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

2. Disinhibition, characterized by:

a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger. 

3. Antagonism, characterized by:

a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V elimination of Dependent Personality Disorder (DPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: Submissiveness, Anxiousness, Separation Insecurity

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with DPD will be diagnosed with other personality disorders which share a common set of traits, including Borderline Personality Disorder, Avoidant Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V elimination of Histrionic Personality Disorder (HPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: Histrionism, Emotional lability

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with HPD will be diagnosed with other personality disorders which share a common set of traits, including Narcissistic Personality Disorder, Borderline Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V Criteria for Narcissistic Personality Disorder (NPD)

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.

B. Pathological personality traits in the following domain:

1. Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Obsessive-Compulsive Personality Disorder (OCPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose obsessive-compulsive personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions.

b. Self-direction: Difficulty completing tasks and realizing goals associated with rigid and unreasonably high and inflexible internal standards of behavior; overly conscientious and moralistic attitudes.

AND

2. Impairments in Interpersonal functioning (a or b):

a. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behaviors of others.

b. Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others.

B. Pathological personality traits in the following domains:

1. Compulsivity, characterized by:

a. Rigid perfectionism: Rigid insistence on everything being flawless, perfect, without errors or faults, including one's own and others' performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order.

2. Negative Affectivity, characterized by:

a. Perseveration: Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Personality Disorder - Trait Specified (PD-TS) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

A. Significant impairments (i.e., mild impairment or greater) in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains OR specific trait facets within domains, considering ALL of the following domains.

1. Negative Affectivity

2. Detachment

3. Antagonism

4. Disinhibition vs. Compulsivity

5. Psychoticism

NOTE: Trait domain or one or more trait facets MUST be rated as “mildly descriptive or greater. If trait domain is rated as “mildly descriptive” then one or more of the associated trait facets MUST be rated as “moderately descriptive” or greater.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V elimination of Paranoid Personality Disorder (PPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: 

Suspiciousness, Intimacy avoidance, Hostility, Unusual Beliefs

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with PPD will be diagnosed with other personality disorders which share a common set of traits.

Rejected DSM-V elimination of Schizoid Personality Disorder (SPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: 

Social withdrawal, Social detachment, Intimacy avoidance, Restricted affectivity, Anhedonia

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with SPD will be diagnosed with other personality disorders which share a common set of traits, including Avoidant Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V Criteria for Schizotypal Personality Disorder (STPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose schizotypal personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning:

a. Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context or internal experience.

b. Self-direction: Unrealistic or incoherent goals; no clear set of internal standards.

2. Impairments in interpersonal functioning:

a. Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent misinterpretations of others‟ motivations and behaviors.

b. Intimacy: Marked impairments in developing close relationships, associated with mistrust and anxiety.

B. Pathological personality traits in the following domains:

1. Psychoticism, characterized by:

a. Eccentricity: Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things.

b. Cognitive and perceptual dysregulation: Odd or unusual thought processes; vague, circumstantial, metaphorical, over-elaborate, or stereotyped thought or speech; odd sensations in various sensory modalities.

c. Unusual beliefs and experiences: Thought content and views of reality that are viewed by others as bizarre or idiosyncratic; unusual experiences of reality.

2. Detachment, characterized by:

a. Restricted affectivity: Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness.

b. Withdrawal: Preference for being alone to being with others; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.

3. Negative Affectivity, characterized by:

a. Suspiciousness: Expectations of – and heightened sensitivity to – signs of interpersonal ill-intent or harm; doubts about loyalty and fidelity of others; feelings of persecution.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Personality Disorder Trait Specified (PDTS)

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a trait specified personality disorder, the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains OR specific trait facets within domains, considering ALL of the following domains:

1. Negative Affectivity

2. Detachment

3. Antagonism

4. Disinhibition vs. Compulsivity

5. Psychoticism

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Bipolar Disorder

Introduction

The primary characteristic of Bipolar Disorder is cycles of elevated and depressed moods lasting several months at a time. Bipolar Disorder is sometimes referred to by it's old name: manic depressive disorder.

Bipolar Disorder is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR) as an Axis I Mood Disorder.

There are four different types of Bipolar Disorder specified in the DSM-IV-TR as follows:

  1. Bipolar I Disorder
  2. Bipolar II Disorder
  3. Cyclothymia
  4. Bipolar Disorder NOS (Not Otherwise Specified)

Bipolar I Disorder

Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes.

Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder.

In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  1. inflated self-esteem or grandiosity 
  2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
  3. more talkative than usual or pressure to keep talking 
  4. flight of ideas or subjective experience that thoughts are racing 
  5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
  6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 
  7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Mixed Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either:

  1. depressed mood or
  2. loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood. 
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
  4. Insomnia or hypersomnia nearly every day 
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
  6. Fatigue or loss of energy nearly every day 
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

B. The symptoms do not meet the criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Bipolar II Disorder

Bipolar II Disorder is defined as a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.

Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode.

Episodes of Substance- Induced Mood Disorder (due to the direct effects of medication, drug abuse, or toxin exposure) or Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar II Disorder.

In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either:

  1. depressed mood or
  2. loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood. 
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
  4. Insomnia or hypersomnia nearly every day 
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
  6. Fatigue or loss of energy nearly every day 
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

B. The symptoms do not meet the criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Hypomanic Episode

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  1. inflated self-esteem or grandiosity 
  2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
  3. more talkative than usual or pressure to keep talking 
  4. flight of ideas or subjective experience that thoughts are racing 
  5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
  6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

Cyclothymia

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

Note: In children and adolescents, the duration must be at least 1 year.

B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed)

D.The symptoms in Criterion are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

F) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar Disorder NOS (Not Otherwise Specified)

Bipolar Disorder NOS (Not Otherwise Specified is a form of "catch-all" diagnosis for people who meet some of the criteria for Bipolar Disorders - Bipolar I Disorder, Bipolar II Disorder or Cyclothymia but do not fit neatly or exactly into any of these diagnoses.

Examples of Bipolar Disorder NOS (Not Otherwise Specified):

  • Manic episodes with little or no major depressive episodes
  • Rapid cycling between manic and major depressive episodes
  • Other disorders present with symptoms of Bipolar disorder

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Dissociative Identity Disorder

Introduction

Dissociative Identity Disorder (DID) is also known by it's former label of Multiple Personality Disorder (MPD) in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM)

Dissociative Identity Disorder is the condition in which a person displays more than one unique identity or personality, each with its own pattern of behaviors.

The diagnosis of Dissociative Identity Disorder requires that at least two personalities routinely take control of a person's behavior. This is accompanied by an associated memory loss that goes beyond normal forgetfulness. Each personality is unaware, or unfamiliar with the others.

Additionally, for a valid DID diagnosis, the symptoms cannot be explained by substance abuse or another medical condition.

Earlier versions of the DSM named the condition Multiple personality disorder (MPD) and the term is still commonly used.

DID is a controversial diagnosis. There is argument about its validity, existence, causes, and epidemiology.

DID Characteristics - The DSM-IV Criteria

Diagnostic criteria for 300.14 Dissociative Identity Disorder (formerly known as Multiple Personality Disorder)

A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). 

B. At least two of these identities or personality states recurrently take control of the person's behavior. 

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. 

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

Controversy 

DID/MPD is a controversial diagnosis. There are a number of influential voices who do not recognize it as a legitimate diagnosis and are advocating for its removal from the DSM.

 

The Amygdala and it's Link to BPD

The Amygdala is a small region of the brain which plays a key role in emotional regulation, emotional memory and responses to emotional stimuli.

Recent technological advances have given neurologists two new ways to create 3-D images of the brain. These techniques are known as Positron Emission Tomography (PET Scanning) and functional Magnetic Resonance Imaging (fMRI). By scanning a person's brain while prompting them to think in a certain way, scientists are unlocking clues as to which regions of the brain are responsible for different kinds of thought.

Much of this work has focused on the amygdala - a small region deep in the brain shown below. There is one amygdala the right side of the brain and one on the left.

The Amygdala, courtesy The Brain From Top To Bottom @ http://thebrain.mcgill.ca/

The Amygdala's Role in Emotional Reactions

It is believed that the amygdala has an important rule in producing lightning-fast emotional responses to events, whenever a person recognizes an event with a strong emotional element (good or bad) such as events that results in fear, anger or rage or events that result in delight, joy or excitement.

The amygdala is believed to be part of our fast, instinctive and reactive brains. Not much conscious thought is involved if an object is hurled towards us and we instinctively duck. This ability to react instinctively to danger is thought to have historically played a critical function in survival of most species. Similarly, witness the reaction of a crowd whenever a sports team scores a goal. There is a universal instant response of throwing hands in the air, widening the eyes, leaping into the air etc, without much thought given. When you see these instinctive reactions occur, the amygdala is at work.

The Amygdala and Memory

The amygdala has also been shown to have an important function in enhancing memory functions by releasing stress hormones, such as adrenaline. It has been shown experimentally that rats, who have had their amygdala disabled lose their fear of cats. It has also been shown that increasing stress hormones improves memory of an event. This helps explain why people can remember stressful moments in great detail - such as times of disasters or crises, when adrenaline is released and yet can easily forget long periods when nothing significant seems to have happened.

Gender Differences in the Way the Amygdala is Connected

Another interesting finding resulted from a study comparing amygdala activity in males and females. When shown images containing strong emotionally arousing content, it was found that the amygdala on the right side of the brain was the most active in men, while the amygdala on the left side of the brain was most active in women.

Other experiments with people who are relaxing have shown that in men, the right amygdala is more closely connected to the rest of the brain than the left, while women show a stronger connectivity between the left amygdala and the rest of the brain. Additionally, in men the right amygdala seems to be strongly connected to regions of the brain normally associated with interactions with the external environment while in women, the left amygdala seems to be strongly connected to regions of the brain normally associated with more internal thought. This suggests that in an emotional context, men are biased toward thoughts about the external environment and women toward thoughts about the internal environment.

Source: Human Brain Imaging Studies of Emotional Memory: Uncovering Influences of Sex and Hemisphere by Larry Cahill.

The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder

In a famous experiment at Yale University, 15 people diagnosed with BPD and 15 people with no BPD diagnosis were shown photographs of faces with neutral, happy, sad, and fearful facial expressions while mapping the activity in the brain using fMRI. It was found that there is a lot more activity in the left amygdala of people who had been diagnosed with Borderline Personality Disorder when exposed to an emotional stimulus than there is for most other people.

Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.

High-Functioning and Low-Functioning

A High-Functioning Personality-Disordered Individual is one who is able to conceal their dysfunctional behavior in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members behind closed doors. A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

Description:

Contrary to a popular myth, personality disorders have little correlation with intelligence. People who suffer from personality disorders span the spectrum of IQ from the lowest to the highest.

High-Functioning Personality-Disordered Individuals are those who are able to keep up appearances outside of the home and participate in society convincingly in the workplace, in social groups, in churches and organizations. Some high functioning personality-disordered individuals are leaders in their field of work, politicians, CEO's, teachers, church elders, police officers, judges etc. However, they may exhibit a very different set of behaviors behind closed doors.

Living with a High-Functioning Personality-Disordered Individual can be frustrating because there may be little support and validation from people outside the home, who may assume that what they see on the outside is a reflection of what goes on behind closed doors.High-Functioning Personality-Disordered Individuals may use their success in the public world as a way to bolster the opinion that there is nothing wrong with them and that any conflict within the home cannot be their fault. You may find yourself thinking "Everybody thinks I'm so lucky but nobody knows what this is really like." In reality there are many people who do know what it is like, but it's not the kind of thing that many people are willing to talk about openly in public.

Low-Functioning Personality-Disordered Individuals are at the opposite end of the spectrum, unable to hide their behaviors from public view. Examples include people who are reclusive, long-term unemployed, chronically depressed, people who are institutionalized in psychiatric facilities, people with alcohol & drug addictions or people who are repeatedly in trouble with law enforcement. Note that none of these conditions is necessary or sufficient for the diagnosis of a personality disorder, but someone who has been diagnosed with a personality disorder and also exhibits one of these traits might be considered "low-functioning".

Living with a Low-Functioning Personality-Disordered Individual can be frustrating because you may feel that you are being taken advantage of and you are doing all the hard work while the person with the personality disorder complains and puts demands on you while doing nothing to improve their own situation. You may also suffer from depression yourself as you torture yourself with the thought "How did I get stuck with such a loser?" In reality what sometimes keeps us stuck is our own sense of FOG- Fear Obligation & Guilt - in which we convince ourselves that we can't afford to make the changes necessary to unstick ourselves.

It is not unusual for some people with personality disorders to flip between periods of high-functioning and low-functioning behavior. This is very similar to people who suffer from Bipolar Disorder and may in some cases be indicative of Bipolar Disorder. Another common occurrence is for a personality-disordered individual to live with a kind of "split-personality" where in certain environments or situations they behave in a high-functioning manner and in others in a low-functioning manner. See our pages on Selective Competence and Selective Memory for more Information.

Acting In

Definition:

Acting In behavior refers to a subset of personality disorder traits that are more self-destructive than outwardly-destructive.

Description:

Personality-Disordered Individuals often behave in ways that are destructive to themselves and to those around them. When a behavior or trait is more self-destructive than outwardly-destructive, that behavior or trait is sometimes referred to as "acting-in".

People who suffer from Cluster A (odd or eccentric) personality disorders Paranoid personality disorder (PPD) Schizoid personality disorder (SPD) & Schizotypal personality disorder (STPD) more typically engage in "acting-in" behaviors.

People who suffer from Cluster B (dramatic, emotional, or erratic) disorders - Antisocial personality disorder (ASPD) Borderline personality disorder (BPD), Histrionic personality disorder (HPD) & Narcissistic personality disorder (NPD) more typically engage in "acting-out" behaviors.

People who suffer from Cluster C (anxious or fearful disorders) - Avoidant personality disorder (AVPD) Dependent personality disorder (DPD) Obsessive-compulsive personality disorder (OCPD) more typically engage in "acting-in" behaviors.

Examples of Acting-In Behaviors

Avoidance - The practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.

Catastrophizing - The habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Cognitive Dissonance - A psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values. People who suffer from personality disorders often experience cognitive dissonance when they are confronted with evidence that their actions have hurt others or have contradicted their stated morals.

"Control-Me" Syndrome - This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.

Dependency - An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression - People who suffer from personality disorders are often also diagnosed with symptoms of depression.

Dissociation- A psychological term used to describe a mental departure from reality.

Escape To Fantasy - Taking an imaginary excursion to a happier, more hopeful place.

Fear of Abandonment - An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Identity Disturbance - A psychological term used to describe a distorted or inconsistent self-view

Low-Functioning - A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

Low Self-Esteem - A common name for a negatively-distorted self-view which is inconsistent with reality.

Mirroring - Imitating or copying another person's characteristics, behaviors or traits.

Panic Attacks - Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Perfectionism - The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.

Selective Memory and Selective Amnesia - The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Selective Competence - Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Harm - Any form of deliberate, premeditated injury, such as cutting, poisoning or overdosing, inflicted on oneself.

Self-Loathing - An extreme hatred of one's own self, actions or one's ethnic or demographic background.

Self-Victimization - Casting oneself in the role of a victim.

Acting Out

Definition:

Acting Out behavior refers to a subset of personality disorder traits that are more outwardly-destructive than self-destructive.

Description:

Personality-Disordered Individuals often behave in ways that are destructive to themselves and to those around them. When a behavior or trait is more destructive towards others than self- destructive, that behavior or trait is sometimes referred to as "acting-out".

People who suffer from Cluster A (odd or eccentric) personality disorders Paranoid personality disorder (PPD) Schizoid personality disorder (SPD) & Schizotypal personality disorder (STPD) more typically engage in "acting-in" behaviors.

People who suffer from Cluster B (dramatic, emotional, or erratic) disorders - Antisocial personality disorder (ASPD) Borderline personality disorder (BPD), Histrionic personality disorder (HPD) & Narcissistic personality disorder (NPD) more typically engage in "acting-out" behaviors.

People who suffer from Cluster C (anxious or fearful disorders) - Avoidant personality disorder (AVPD) Dependent personality disorder (DPD) Obsessive-compulsive personality disorder (OCPD) more typically engage in "acting-in" behaviors.

Examples of Acting-Out Behaviors

Alienation - The act of cutting off or interfering with an individual's relationships with others.

Baiting - A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Blaming - The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Bullying - Any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.

Chaos Manufacture - Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Cheating - Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations - Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Domestic Theft - Consuming or taking control of a resource or asset belonging to (or shared with) a family member, partner or spouse without first obtaining their approval.

Emotional Blackmail - A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment - An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

False Accusations - Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism - Favoritism is the practice of systematically giving positive, preferential treatment to one child, subordinate or associate among a family or group of peers.

Frivolous Litigation - The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Gaslighting - The practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term “Gaslighting” is based on the 1944 MGM movie “Gaslight”.

Harassment - Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

Holiday Triggers - Mood Swings in Personality-Disordered individuals are often triggered or amplified by emotional events such as family holidays, significant anniversaries and events which trigger emotional memories.

Hoovers & Hoovering - A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Relationship Hyper Vigilance - Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Hysteria - An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Impulsiveness - The tendency to act or speak based on current feelings rather than logical reasoning.

Infantilization - Treating a child as if they are much younger than their actual age.

Imposed Isolation - When abuse results in a person becoming isolated from their support network, including friends and family.

Narcissism - A set of behaviors characterized by a pattern of grandiosity, self-centered focus, need for admiration, self-serving attitude and a lack of empathy or consideration for others.

No-Win Scenarios - When you are manipulated into choosing between two bad options

Objectification - The practice of treating a person or a group of people like an object.

Parental Alienation Syndrome - When a separated parent convinces their child that the other parent is bad, evil or worthless.

Passive-Aggressive Behavior - Expressing negative feelings in an unassertive, passive way.

Pathological Lying - Persistent deception by an individual to serve their own interests and needs with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.

Projection - The act of attributing one's own feelings or traits to another person and imagining or believing that the other person has those same feelings or traits.

Proxy Recruitment - A way of controlling or abusing another person by manipulating other people into unwittingly backing “doing the dirty work”

Push-Pull - A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression - Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Sabotage - The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Scapegoating - Singling out one child, employee or member of a group of peers for unmerited negative treatment or blame.

Shaming - The difference between blaming and shaming is that in blaming someone tells you that you didsomething bad, in shaming someone tells you that youare something bad.

Splitting - The practice of regarding people and situations as either completely "good" or completely "bad".

Stalking - Any pervasive and unwelcome pattern of pursuing contact with another individual.

Testing - Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing - Any process of trying to question, control, or unduly influence another person's thoughts or feelings.

Threats - Inappropriate, intentional warnings of destructive actions or consequences.

Cognitive Dissonance

A  psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values.

Uncomfortable Realities:

Cognitive Dissonance occurs whenever a person is confronted with information which conflicts with their own world view. For someone with a Personality Disorder, this includes evidence their actions have hurt others or have contradicted their stated morals.

Examples of Cognitive Dissonance:

  • If a person holds the view "mother's know what is best for their children" they may experience conflict when presented with evidence that a mother has acted in a violent, unkind or abusive way towards one of her children.
  • If a person holds the view "all believers of a particular faith will go to heaven" they may feel cognitive dissonance when they witness a believer actingin a cruel or depraved manner.
  • If a person holds the belief "I am a good person" they may experience cognitive dissonance whenever it is obvious their words or actions have hurt others.

Confronted by evidence which contradicts their values or beliefs, a person is forced to make an uncomfortable choice:

  1. To hold to their belief and disregard the data they have been presented with or
  2. To modify their beliefs and risk having to re-evaluate their world view, their choices and their character.

What it feels like:

People who are experiencing cognitive dissonance may adopt a pattern of denial, diversion and defensiveness to control their discomfort. They may also alternate between periods of denial and periods of admission when they try to compensate or make amends.

Non personality-disordered (Non-PD) individuals often experience cognitive dissonance when they are confronted with evidence that their partner, spouse, parent, sibling or child is not behaving in a loving way toward them. This may contradict their belief or desire that their family is healthy or "normal".

Non-PD's may also experience cognitive dissonance when they discover that their own reactions or responses to challenging behavior on the part of a family member do not reveal their best side. They may display occasional angry outbursts, actions of deception or retribution, such as violence, shouting, name calling, sabotage, affairs, gossip and slander. Following such actions they may feel shameful, worthless or powerless. They may feel regret that they have handed justification for bad behavior to the abusive person in their home. They may even blame themselves for contributing to the abuse and dysfunction in the home.

What NOT to do:

If you experience cognitive dissonance as a Non-PD:

  • Don't blame yourself or shame yourself for having had contradictory thoughts or assumptions. Everybody has them. They are an important part of growth and learning.
  • Don't assume that because you have been wrong or mistaken about one thing that you are wrong and mistaken about everything. Accept your errors for what they are and learn from them.
  • Don't consider yourself worthless, useless or powerless.
  • Don't try to over-compensate for your weaknesses by over steering in the direction of your strengths. Try to love and accept the whole you.
  • Don't go into denial about things which are plain facts. Try to accept the truth and learn from it.
  • Don't make any big announcements, dramatic gestures or life decisions while you are feeling emotional. Wait until you have had time to think and consider your options.

If a Personality-Disordered person in your life experiences cognitive dissonance:

  • Don't take advantage of them by preaching, pontificating or nagging. Nobody likes that.
  • Don't mock, ridicule, shame or criticize another person who is struggling, no matter how much you may feel they deserve it.
  • Don't be surprised if they engage in denial, desperately seek an "out" or rationalize away flawed thinking, poor choices or unkind behavior.
  • Don't blame yourself for another person's behaviors, words or beliefs. That's their stuff.
  • Don't condone abusive behavior or speech. Protect yourself and children.
  • Don't engage in circular arguments or thought policing.

What TO do:

If you experience cognitive dissonance as a Non-PD:

  • Forgive yourself. Nobody is perfect. Everybody makes mistakes. It's not wrong to be wrong. Everyone who has ever lived has personal struggles.
  • Take advantage of the opportunity for growth that comes from learning something new about yourself.
  • Open your mind. Take advantage of the opportunity to see things from a totally different perspective.
  • Get support. Talk to trusted friends, family and professionals who can help you work it out.

If a personality-disordered person in your life experiences cognitive dissonance:

  • Give them space to explore their own thoughts.
  • Encourage, support and validate them where appropriate.
  • Accept that they have a right to have their own thoughts and feelings, even if you think they are "wrong".
  • Find a supportive environment where you will independently feel validated and nurtured.
  • Take care of yourself, regardless of what level of encouragement the personality-disordered individual gives you.