Updated: 14 October 2018, by Marc Woodard

Personality disorders (PD) are long-term chronic patterns of erratic behavior that will likely require a lifetime of care. Often this is a result of people who don’t seek behavioral therapy and drug intervention early on.

Or are misdiagnosed and treated irrelevantly. Or don’t comply with prescribed treatment program(s).

Chronic PD behaviors are also known to lead to homelessness. Especially when the individual is drug addicted and believes self-medication is the solution to their problems. This connection is further explained in review of the 10 personality disorders as defined below.

Chronic and complex personality disorders make it more likely alcohol and drug abuse will exponentially escalate abnormal behavior and lead to self-harm, homelessness and jail time.The complexity of abnormal behaviors further challenges medical providers to assess an accurate diagnosis and treatment prescription program. Especially when mental health protocols are not followed.

There aren’t any drugs approved for the treatment of personality disorders. However, certain types of prescription medications might be helpful in reducing various personality disorder symptoms (Carey 2012).

PD Behavioral Characteristics

It appears this disorder has a connection to child abuse and neglect.  But abuse need not occur to develop a behavioral disorder as a child or homeless adult.

People with PD’s are often unaware their thoughts and behaviors are not normal and inappropriate. And once confronted a problem exists – generally little responsibility is taken for it.

The avoidance of seeking medical treatment for a personality disorder eventually results in negative impacts on relationships, social environment and holding a job.

This is because PD mood swings cause behavior to become unstable and irrational. Where relationships tend to be like a roller coaster ride and feelings swing from love to hate, or trust to distrust, or rational to irrational rather abruptly. These feelings are often connected to real or imaged abandonment situations that cause an avoidance of letting someone get too close. And that distancing causes antisocial, obsessive, detached, hostile or needy behaviors.

During personal crisis such as feelings of abandonment, harmful behaviors may ensue, e.g., wrist cutting, over dose, binge eating, uncalled for and inappropriate anger, impulse buying, substance abuse, shoplifting, unable to cope with being alone, unhealthy sexual relationships, emptiness and boredom coupled with anxiety and depression.

Currently there are ten classified Personality Disorder Types within 3 clusters:

Cluster A_PD (Type: Odd and Eccentric Behavior)

Paranoid Personality Disorder (PPD)

Distrust and suspicious perceptions prevail over trust of others. Those who encounter this personality type may communicate innocently enough with them. However the paranoid personality often interprets others intention and environment or events incorrectly. This incorrect read is often taken as a personal threat and harmful to relationships. It causes them to hold grudges, distrust people and become hostile to people who don’t deserve the cold shoulder. Close friendships are uncommon and a cold disposition in attitude is the norm. Early childhood trauma may be a cause, and is more common in males (Martel 2015).

Schizoid Personality Disorder (SPD)

They are detached from close relationships and lack motivation and drive to be with others or build relationships. They have a limited range of emotions and require little to no approval or attention from others. For the most part they have a persistent indifference of interests that make relationship building near impossible. Since the social skills are lacking a secretive lifestyle preference to remain in solitude and away from others seems to be the norm (Glunk 2015).

Schizotypal Personality Disorder (STPD)

An eccentric personality type with severe anxieties in a social sense and lacks an emotional response. They display paranoia and anxiety around people and have unusual beliefs outside of conventional norms. They are somewhat a loner and feel more comfortable living in solitude.  At times may appear to others as delusional due to strange thoughts and behavior. The mannerisms are often bizarre by-way of socially nervous tendencies with atypical communicative speech patterns. Which include talking to themselves and hard to follow rambling and complicated speech patterns. While STPD is on the schizophrenia spectrum, people with STPD don’t usually experience psychosis (Martel 2015). Psychosis is defined as a loss of contact with reality.

Cluster B Personality Disorder (Type Dramatic and Erratic)

Antisocial Personality Disorder (APD, or ASPD) 

The APD characteristics display manipulative behavior, lack of conscience and care for others and adept at manipulation. To be charming is a ruse to get what they want to self-gratify and feel no guilt over the deceit. While statistics indicate that 50%-80% of incarcerated individuals have been found to have antisocial personality disorder, only 15% of those convicted criminals have been shown to have the more severe antisocial personality disorder type of psychopathy (Dryden-Edwards and Stoppler 2016).

Borderline Personality Disorder (BPD)

Behavioral irregularities are often displayed by abrupt and unpredictable mood changes and outbursts. Self-image issues and high fear sensitivities to rejection and abandonment make it difficult to maintain relationships. Destructive behaviors such as suicide threats and attempts are often associated with this disorder. The diagnosis of BPD is frequently missed and a misdiagnosis of BPD has been shown to delay and/or prevent recovery. Bipolar disorder is one example of a misdiagnosis as it also includes mood instability. There are important differences between these conditions but both involve unstable moods. For the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and can even occur within the day (NEA 2016).

Narcissistic Personality Disorder (NPD)

This personality type feels a need to be center of attention, lacks empathy, and displays an egocentric behavior and feels full of self-importance. Also sees themselves above others in appearance or intellectual endowment [whether true or not] has a grandiose sense of entitlement and believes he/she is special, or falls into a high class or status of people. Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year (Bressert 2016).

Grandiosity is closely associated with NPD. It is considered a personality disorder. Where one feels entitled, is self-absorbed and lacks empathy for others. Grandiosity occurs when a person has an inflated self-esteem, believe they have special powers, spiritual connections, or religious relationships.  When grandiosity is severe, the person may be delusional about his or her capabilities (Droogendijk 2009).

He/she has an unrealistic sense of superiority and are often referred to as narcissist, or Bipolar and seem boastful and rude. They feel a sense of uniqueness which can only be matched intellectually and understood by a handful of people. And since they feel superior to everyone else they have disdain for those they see inferior to them. In the American Psychiatric Association’s Diagnostic and Statistical Manual, the presence of grandiosity is used in combination with several other symptoms to confirm a diagnosis of bipolar. This symptom also occurs in children with early onset bipolar disorder (Purse 2016).

Histrionic Personality Disorder (HPD)

This type of personal disorder is obsessed with appearance and acts sexually provocative with excessive attention seeking tendencies. They desire to be at center stage to get reassurance and approval. And are overly sensitive to criticism and disapproval which causes inappropriate and unwanted behavior. Such as an over the top melodramatic outburst and manipulative behaviors which push people away. The outbursts are coupled with a consistent flood of emotional storms that reap havoc on romantic, social and for that matter, inability to solidify any meaningful and long term personal commitments and relationships.

Since this personality type has a low tolerance toward delayed gratification, they often blame others for their shortcomings. Although negative attention may seem shallow to others, it is better than no attention at all for this person. Histrionic personality disorder can improve with talk therapy and sometimes medicines. Left untreated, it can cause problems in people’s personal lives and prevent them doing their best at work (Berger 2014).

Cluster C (Personality Disorder: Type Anxious and Fearful)

Obsessive-Compulsive Personality Disorder (OCPD)

This disorder is displayed by orderly perfection and preoccupation to detail that causes a lack of flexibility with regard to healthy lifestyle and time balance. The disorder is also a contributor of workaholic tendencies. Fears of losing control over orderly perfection is the compulsion which causes the irrational obsession to continue its course. And this interferes with getting things done that matter.

Most professionals subscribe to a bio-psycho-social model of causation that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress) (Bressert 2016).

Avoidant Personality Disorder (APD)

Fears rejections and feeling of inadequacy in front of others, but wants desperately to be accepted. Very self-conscious and avoids social group settings and situations when possible. Jobs with little human interaction are preferred. Avoidant personality disorder (APD) is usually first noticed in early adulthood and is present in a variety of situations. APD is treated in much the same way as social anxiety disorder.

Cognitive-behavioral therapy, social skills training, group therapy, and medication have all been shown to have some impact on the disorder. However, it is sometimes difficult for people with APD to trust their therapist enough to complete treatment (Cuncic 2016).

Dependent Personality Disorder (DPD)

The need to be taken care of to meet emotional and physical needs and fear of abandonment and being alone causes clinginess. The reliance on others to make important life decisions is needed for advice and reassurance. If relational trusts are broken, suicidal tendencies and acts increase.

Mental Health Treatment and Homelessness Connection

A combination of mental health and drug prescription [psychotherapy] treatment plan includes exploration of inappropriate behavioral causation that triggers out-of-control feelings and thoughts.

Once childhood or adult abuse-history connects to current social, or environmental, or personal stress-triggers that cause erratic and undesirable behavior; a relative diagnosis and treatment plan is prescribed to manage it.

However there are caveats to this approach. Success of treatment is dependent on accurate diagnosis and wiliness of patient to opt-in, trust their medical care provider and follow the treatment plan.

For instance, the treatment that’s best for you depends on your particular personality disorder, its severity and your lifestyle situation. Often, a team approach is needed to make sure all of your psychiatric, medical and social needs are met. Because personality disorders are long-standing, treatment may require months or years (MayoClinc 2016). In severe cases when someone can’t care for themselves, or present harm to others, admittance to psychiatric care is the process towards stabilization. Thereafter may lead to successful outpatient treatment.

Recall, I stated the individual has to opt-in to receive mental health resources and follow the treatment plan.

Unfortunately for too many, the inability to take responsibility for a personality disorder problem causes a revolving door that does not adequately help a chronic mental health condition especially when connected to drug addiction. For those who choose to self-medicate and deal with a chronic personality disorder; many of those people are homeless.

The treatment protocol for the mentally unstable homeless person who is a public nuisance and is drug addicted and breaks the law doesn’t receive the mental health resources they need. Although homelessness is not a crime and not all homeless people commit crimes, personality disorders are found within a large sector of the homeless population. Many have all the signs and symptoms of PDs. That is they have fears and anxieties and paranoia associated with anti-social lifestyle which leads to obsessions and depression and illegal self-medication habits.  These behavioral habits amplify the PD stress-triggers which cause inappropriate behavior.

When the mentally-ill are caught for inappropriate behavior or breaking the law to sustain their habits, short-term jail time or out-patient psychiatric care is served. Jail time release is often conditional on probation agreements which are almost always broken by those with complex personality disorders and drug abuse.

Homeless people with a complex PD and drug addiction history don’t have the mental faculties or resources to comply with orderly and civil penalty processes like the rest of us. So the sequence is repeated costing tax payers dearly as the revolving door to the homeless is a reactive civil penalty process as opposed to a proactive mental health treatment program.

There is no good answer for the homeless that suffer with personality disorders and/or drug addiction. Not until society determines they want to foot the solution. And that solution must provide the comprehensive mental health treatment, public transportation and sheltered resources, etc., needed to get on with their lives. I regress, moving.

Medications may include stabilizers to help balance mood swings and impulses, or anti-depression medications to help reduce feelings of hopelessness and irritability.

If a patient has lost touch with reality then anti-psychotic drugs are prescribed. Anti-anxiety medications are to help reduce anxieties. But for some these drugs can lead to impulsive behavior. For this reason their avoided when diagnosed with other types of personality disorders.

Recommendation if a PD disorder is suspect – Get diagnosed and treated by a medical professional if you, or a friend or loved one suffers from a personality disorder that now causes out-of-control behavior, drug addiction and homelessness.

Common treatment programs for any one of the 10 diagnosed personality disorders listed above may require a combination of the following types of therapy treatment by a behavioral therapist and/or phycologist, etc., : On-going Group, one-on-one psychotherapy [includes mental health and prescription protocol], behavioral-social and drug addiction therapy, etc.

References,

Berger, Fred K., MD. “Histrionic Personality Disorder: MedlinePlus Medical Encyclopedia.” MedlinePlus Medical Encyclopedia. NIH U.S. National Library of Medicine, 10 Oct. 2014. Web. 23 Nov. 2016.

Bressert, Steve, Ph.D. “Obsessive-Compulsive Personality Disorder Symptoms | Psych Central.” Psych Central. Psych Central, 17 July 2016. Web. 21 Nov. 2016.

Bressert, Steve, Ph.D. “Narcissistic Personality Disorder: Symptoms & Treatment | Psych Central.” Psych Central. Psych Central, 18 Nov. 2016. Web. 21 Nov. 2016.

Carey, Elea. “Personality Disorder.” AARP. HealthReferenceLibrary, 31 July 2012. Web. 21 Nov. 2016.

Cuncic, Arlin. “Avoidant Personality Disorder and Social Anxiety Disorder: Shared Genetics.” Verywell. About, Inc., 27 July 2016. Web. 21 Nov. 2016.

Droogendijk, Daniel, RPN. “Bipolar Mania Symptoms.” Grandiosity – Bipolar Disorder Symptoms. Daniel Droogendijk, 4 Feb. 2009. Web. 23 Nov. 2016.

Dryden-Edwards, Roxanne, MD, and Melissa Conrad Stoppler, MD. “Antisocial Personality Disorder Symptoms, Treatment, Causes – What Is the Difference between Antisocial Personality Disorder and Psychopathy? – MedicineNet.” MedicineNet. MedicineNet, Inc., 16 Feb. 2016. Web. 21 Nov. 2016.

Gluck, Samantha. “What Is Schizoid Personality Disorder?” HealthyPlace. HealthyPlace.com, Inc., 20 Oct. 2015. Web. 23 Nov. 2016.

Martel, Janelle. “Paranoid Personality Disorder.” Healthline. Healthline Media, 17 Dec. 2015. Web. 23 Nov. 2016.

Mayo Clinic Staff Print. “Personality Disorders.” Treatment – Personality Disorders – Mayo Clinic. MayoClinic.org, 23 Sept. 2016. Web. 21 Nov. 2016

Moore DP, Jefferson JW. Borderline personality disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry.  2nd ed. Philadelphia, PA: Mosby Elsevier; 2004: chap 138.

Montandon M, Feldman MD. Borderline personality disorder. In: Ferri FF, ed. Ferri’s Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008.

Purse, Marcia. “Grandiosity in Bipolar Disorder: Definition and Stories.” Verywell. About, Inc., 14 July 2016. Web. 23 Nov. 2016.

NEA. “BPD Overview – Borderline Personality Disorder.” Borderline Personality Disorder. NEA.BPD, 2016. Web. 21 Nov. 2016.

Author: Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2018 Copyright.  All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.org, Sign up for FREE Monthly eNewsletter.