SNAP!. Gary Small

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      Major Personality Disorders

      The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (fifth edition) lists the following personality disorders that cause social and professional impairment:

       • Antisocial. People with this disorder lack empathy, cannot distinguish right from wrong, persistently lie and exploit others, and use their charm to manipulate others for personal gain. They often have legal problems, take unnecessary risks, and engage in abusive relationships.

       • Avoidant. These individuals suffer from feelings of social inadequacy and inhibition; they are extremely sensitive to any criticism or rejection and have major difficulties interacting with others and maintaining relationships.

       • Borderline. These patients live in a world that borders between typical neurotic behavior and full-blown psychosis wherein they lose touch with reality. They have a disturbed sense of identity and are sensitive to real or imagined abandonment. They are impulsive and have intense, uncontrollable emotional outbursts. Their relationships are chaotic, and they often suffer from depression, psychosis, substance abuse, and suicidal behavior.

       • Obsessive-compulsive. People with an obsessive-compulsive disorder are preoccupied by rules and details. Extreme perfectionists, they become distressed when they fall short of their ideals. They try to control others and have trouble delegating tasks. They are rigid, stubborn, and have trouble letting go of worthless objects.

       • Narcissistic. These self-centered individuals often have unrealistic fantasies about the extent of their power, success, and attractiveness. They come off as arrogant, lack empathy, and frequently take advantage of others. They exaggerate their own achievements and seek constant praise and admiration.

       • Schizotypal. These patients usually appear peculiar in their dress, thinking, beliefs, and behavior. They may hear voices whispering to them and experience other odd perceptions. Many engage in “magical thinking,” wherein they believe that their inner feelings, thoughts, or desires can affect the external world. They are often uncomfortable with close relationships and can be suspicious of others.

      The Slow Lane of Personality Change

      Thankfully, less than 10 percent of the population suffers from a true personality disorder that debilitates their lives. However, the other 90 percent of us are not necessarily happy with each and every aspect of our own personalities. Many of the patients I see believe that one or more of their character traits are holding them back from reaching their professional goals, forming satisfying and supportive relationships, and remaining mentally and physically healthy. And for the longest time, there didn’t seem like much we could do about it, outside of the slow and laborious changes that can sometimes be achieved through psychoanalysis.

      Psychoanalysis is a branch of psychiatry and psychology that has been successful in helping some patients with personality traits that disrupt their lives. It involves intensive, long-term treatment approaches and can also help some patients with borderline, narcissistic, or other personality disorders. In Freudian psychoanalysis, a patient with problems or mental symptoms verbalizes their free associations, fantasies, and dreams to the analyst. The analyst then interprets the unconscious conflicts that are thought to cause the patient’s issues. Once the patient gains insight from the analyst’s interpretations, the symptoms often improve, but it can take years of nearly daily treatment, which is expensive and obviously very time consuming. Also, controlled systematic trials proving the effectiveness of psychoanalysis in altering personality traits are limited.

      New Research Turns Personality Science Upside Down

      If you’ve known someone for a long time, you may have noticed that certain aspects of his personality have gotten mellower with age. Real-life experiences and milestones—like becoming a first-time parent—may have altered his perspective and made him more conscientious in order to meet his new responsibilities. Perhaps with age he began to worry less about peer pressure or future events going wrong. Studies have shown that these gradual and modest changes happen throughout life. Whether they occur in young adulthood, middle age, or even late in life, they tend to soften us. Over time, we do gradually become more agreeable, confident, conscientious, and stable. And although this can be an upside of aging, the degree of change is very modest and it takes decades to occur.

      How Do You Perceive Your Own Personality?

      Place a number between 1 (strongly disagree) and 10 (strongly agree) for each of the following statements to quickly see how you rate your own personality on the Big Five Inventory. The higher your score, the stronger your personality trait.

Personality Domain	Statement	Your Score
Extraversion	I am outgoing and assertive.
Openness	I am creative and adventurous.
Emotional stability	I am self-confident and easygoing.
Agreeableness	I am supportive and cooperative.
Conscientiousness	I am organized and focused.

      In a 40-year study, investigators assessed personality traits in elementary school students and then reassessed those volunteers four decades later. They found remarkable consistency in the volunteers’ personalities: impulsive kids remained impetuous as adults, and agreeable youngsters were still cooperative decades later. A limitation of this and many other studies was that researchers were tracking personality traits in people who never received any psychological treatment or used any self-help strategies.

      Based on all available research to date, most psychiatrists, including myself, have been trained to operate under the assumption that true core personality traits are fundamentally set by early childhood. In therapy, we could help patients change specific behaviors but not necessarily the basics of their personalities.

      But now, startling new research contradicts that long-held tenet. The latest science points to a new conclusion that has literally reversed our assumptions about how—and how rapidly—personality can change. To explore whether it’s possible for personality traits to change quickly through interventions like therapy and just how rapidly such change could occur, psychologist Brent Roberts and his coworkers at the University of Illinois did an in-depth assessment of hundreds of studies looking at assorted types of treatments.

      This approach to answering a scientific question is called meta-analysis, which uses statistical methods to combine the results of multiple scientific studies. The statistical methods pool estimates from the various studies to reach a conclusion that is valid. Many investigators consider meta-analysis to be one of the most robust forms of scientific evidence, but it is essential for the investigators to choose the right studies to include.

      Did You Know?

       • Although firstborn children tend to score higher on intelligence tests, birth order has no influence on self-reported personality traits.

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