How common are real personality disorders?

Huge strides have been made in building awareness among the public of the importance of good mental health, and the language of mental health is increasingly passing into common parlance.

All of us know or have met others we suspect may be a narcissist, paranoid, antisocial, suffer from OCD, or even be psychopathic; but how common are these kinds of pathologies in reality, and are the general public too quick to assign others an amateur diagnoses, when really the people they’re talking about are not sick?

When people use these kinds of phrases, they’re generally not talking about milder forms of mental health problem – instead they’re talking about full-blown psychiatric disorders, or, in the case of autism, a disability.

But how prevalent are actual cases like these in Ireland?

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"The first thing to say is that there isn't a person on the planet who doesn't have character traits that, when taken to an extreme, could be part of a personality disorder," says Dr Caragh Behan, consultant psychiatrist at the College of Psychiatrists of Ireland. "We've all got them but they only become a problem when they escalate into a disorder, which we would define as a condition that impairs someone's ability to function in their personal or work life."

Classic case

A classic case is that of obsessive compulsive disorder, or OCD, a term often used casually by people about themselves or others when what they really mean is they like things neat and tidy or clean. “Obsessive compulsive disorder is actually an illness rather than a personality disorder, and usually people with this have recurrent intrusive thoughts that are most usually to do with germs or sex, although they tend to keep that to themselves because it’s embarrassing,” says Dr Behan.

An anankastic personality is someone who typically is very organised and lives according to lists and schedules

“The compulsion part of it is that they feel that they have to do something and, if they don’t, something terrible is going to happen. It’s actually highly treatable with cognitive behavioural therapy [CBT] and, for severe cases, SSRI-type anti-depressant medication can also help a lot.”

According to Dr Behan, the character trait the general public is referring to when they use the label OCD is anankastic behaviour. An anankastic personality is someone who typically is very organised and lives according to lists and schedules. “They enjoy order and actually it can be really useful. For example, many people with this leaning make excellent accountants and can turn this to their advantage. It’s only a problem if it becomes an illness when it becomes OCD.”

This is also true of narcissism. Dr Behan says everyone has some narcissistic traits, but it’s not considered a problem unless that aspect of someone’s personality causes them problems. “Everyone needs a little bit of narcissism in order to self-care and have healthy self-esteem. If you didn’t, you’d spread yourself too thin, be constantly helping other people and be so empathic that you’d be swallowed up by life,” she says. “It only becomes pathological when someone becomes so narcissistic that they cannot see anyone else’s point of view and their regard is completely taken up with themselves.”

‘Very vulnerable’

Narcissistic personality disorder (NPD) is a real condition, but it’s rare for someone with this to present for treatment as a result of the disorder itself. “People with strong narcissistic traits are unpleasant and not nice to be around, but they rarely need intervention. Most don’t need help unless and until their extremely healthy self-esteem is punctured by some negative occurrence, such as a business going bankrupt or some other kind of failure,” said Dr Behan. “They can be very vulnerable when this happens and can end up with clinical depression, which can be severe.”

One of the labels most stigmatised in mental health is that of psychopathy, or as it is more usually referred to outside of the United States, sociopathy. People with this disorder have very little or no empathy, exhibit antisocial behaviour, have no remorse and exhibit strongly egotistical behaviour. Professionals who work in mental health only really come into contact with sociopaths when they end up in the criminal justice system.

Sociopathic traits

“They’re very difficult to treat because they usually don’t have much insight into their condition. When psychiatrists end up treating them, it’s usually because they’ve fallen foul of the law and a court has ordered them to seek treatment, so almost by definition, they’re not there because they think they have a problem,” said Dr Behan. “In reality, it’s a very, very rare condition and there are lots and lots of people with sociopathic traits who never end up needing help with them, but it’s understandable that some people with this condition end up in trouble with the law.”

Sociopathic people have a lack of empathy for others and no understanding that other people might have feelings too. Ironically, some sociopathic traits are regularly found in highly successful people in lots of different fields. “These traits help people in business or in situations where it can help to be a little bit indifferent to others in order to get ahead. Again, everyone has these traits to some degree or another – it’s not unhealthy unless they become a problem and dominate someone’s character.”