Personality Disorders

Abstract depiction of personality disorders

Everyone has a personality that is unique to them. Whether you’re an introvert or extrovert, personality helps you interact with others and function as a social being. But this isn’t always the case, as some traits are seen as unfavorable or unhelpful. Personality traits that create distress or a negative influence on others can obstruct the building of meaningful relationships and managing emotions. In athletes, a negative or dysfunctional personality can risk their performance, career, and relationships with their teammates. This article will explore what personality disorders are, their effect on athletes, and potential treatment, whether through a therapist or at home.

Image depicting the three expressions of personality

Background:

The term ‘personality’ may sound familiar to many. However, it is helpful to consider what defines it and its characteristics. So, what is a personality? It’s a set of behaviors, thoughts, and emotions that make an individual unique and shape who they are. Alternatively, people experiencing a personality disorder create extreme difficulties in how they relate or express themselves to others. These disorders cause inflexible, disruptive, and enduring behavior patterns that impair their personal, professional, and social lives. It can range from harmless displays of narcissism to an extreme lack of empathy for others, like psychopaths or sociopaths.

Image portraying various factors contributing to childhood trauma

Causes:

From genetics to childhood abuse, there are a variety of factors that can cause the development of personality disorders. Researchers categorize these causes into three groups:

• Environment/social situations:

  • Unstable/ abusive household:

    • EX: Parents dealing with alcohol or substance abuse in the household.

    • EX: Parents dealing with mental health issues such as depression.

  • Little to no support from parent(s)/guardian(s) creates a sense of self-unimportance, especially after a traumatic experience

  • Lack of support from a wide community

    • Bullied or excluded in school

  • Poverty or discrimination

• Early life experiences:

  • Childhood neglect

  • Losing a loved one/parent(s)

  • Emotional, physical, or sexual abuse

  • Involved in traumatic/heavy situations that leave emotional scars

• Genetic factors:

  • Born with different temperaments:

    • Babies vary in their activeness, attention span, or how they adapt to change.

  • Some researchers identified a ‘malfunctioning gene’ that could be a contributing factor to OCD/OPCD.

    • This malfunction is said to be caused by serotonin transporter missense mutation. For further interest: https://www.nature.com/articles/4001365.

Graph showing the types of personality disorders

Types of Personality Disorders & Their Symptoms:

Personality characteristics have been examined for thousands of years. However, the idea of personality disorders is new. Created by psychiatrist Kurt Schneider, modern classifications of personality disorders use a system of diagnosis that sorts out ten types of personality disorders into three clusters.

A. Odd/ Eccentric characteristics:

Paranoid personality disorder:

1. Cold, distant; unable to form close relationships with friends, family, and others

2. Projecting feelings as anger onto others

3. Difficulty trusting others; belief that others will manipulate you

4. Difficulty relaxing

5. Analyzing threats and danger from casual remarks or looks.

Schizoid personality disorder:

1. Sense of indifference to others

2. Difficulty relating/ acts cold

3. No interest in relationships

4. Preferred to be alone with their thoughts & daydream

5. Little interest in intimacy

6. Few emotional responses

Schizotypal personality disorder:

1. Cold and distant

2. Fear of intimacy and closeness

3. Difficulty forming close relationships

4. Shows disoriented thinking, perspectives, and ineffective communication skills.

   1. EX: Using unusual words and phrases

5. Belief to have a sense to ‘read minds’

6. Anxious with others who don’t relate to these beliefs

7. Experiencing anxiety or paranoia in social situations

B. Dramatic/Emotional/Impulsive characteristics:

Narcissistic personality disorder:

1. Selfish and dismissive of others’ needs

2. High feelings of self-worth, grandiose, and superiority

3. Putting yourself before others and demanding them to do too

4. Feeling upset if people chose to ignore or not treat the way you want them to

5. Reliance on others to recognize your worth

6. Overly sensitive to criticism and judgment

Histrionic personality disorder:

1. Has an urge to entertain others

2. Shows expressions that are seen as superficial/exaggerated

3. Overly conscious of physical appearance

4. Dependent on approval from others

5. Makes reckless decisions

6. Easily influenced by others

7. Desire to be the center of attention

8. Dressing or behaving provocatively to receive attention

9. Taking dangerous risks and potentially use suicidal gestures to receive attention.

Borderline personality disorder (BPD):

1. Anxious/ fear of abandonment

   1. Does anything to prevent this from happening

   2. Or push others away

2. Inconsistent emotions

3. Low sense of who you are what you want to achieve in life

4. Difficulty making and keeping stable relationships

5. Impulsive actions that can be harmful (ex. binge eating or substance abuse)

6. Having suicidal thoughts

7. Thinking or doing self-harm

8. Feeling empty and lonely often

9. Difficulty controlling anger

10. Struggle to trust others

11. Experiencing other mental health issues like:

    1. Anxiety

    2. Depression

    3. Eating Disorders

    4. PTSD

12. When feeling excessively stressed, you might experience:

    1. Paranoia

    2. Psychotic experiences (seeing/hearing things others don’t, numbness and emptiness, dissociation)

Antisocial personality disorder:

1. Putting yourself in risky situations, often without the intent of consequences.

2. Behaving dangerously/illegally

3. Behaving ways uncomfortable to others

4. Feeling easily bored

5. Acts on impulse

6. Acts aggressively and easily get into fights without regret/guilt

7. Hurting others to get what you want

8. Difficulty empathizing with others

9. Diagnosis of conduct disorder before age 15

*These diagnoses include psychopathy and sociopathy.

**Cluster B disorders can sometimes result in hospitalization.

C. Anxious/Fearful Characteristics:

1. Anxious/Avoidant personality disorder:

2. Avoiding work and socialization

3. Sensitive towards disapproval and criticism

4. Constant worry of rejection, disapproval, and criticism

5. Avoiding relationships, friendships, and intimacy

6. Feeling lonely and inferior

7. Reluctance to try new activities in case of embarrassment

Obsessive-compulsive personality disorder (OCPD):

1. Obsession with order; bothered if routine disrupted

2. Setting unrealistic expectations for oneself

3. Difficulty maintaining relationships

4. Worry about making mistakes or when others make mistakes

   1. Can cause difficulty in completing tasks and making decisions

5. Thinking oneself is the best solution to doing things

6. Heavy focus on perfectionism

Dependent personality disorder:

1. Unable to make decisions or function without the help of others

2. Can’t take proper care of oneself

3. Lack of confidence and esteem

4. Agreeing even suggested things are wrong to do

5. Fear of abandonment

Researchers have argued that some conditions can overlap with each other so much that it can be impossible to differentiate them. Meeting certain criteria for more than one type of personality disorder can result in mixed personality disorder. For example, narcissistic and histrionic personality disorders have traits that overlap one another. Because of this “gray area,” personality disorders are commonly diagnosed as “personality disorders not otherwise specified” or PD-NOS. This suggests that while a personality disorder can be identified, figuring out its details can be confusing.

Instead of being categorized into a specific type of personality disorder, a proposed alternative is used. The Dimensional Model replaces discrete disorders with a range of personality traits/symptoms. For example, the Dimensional Model could rank someone higher on narcissism and avoidance than just narcissism or just avoidance.

Importance:

Feelings and behaviors associated with personality disorders can be very difficult to live with. It can cause disturbances in day-to-day life. Some of these disturbances include difficulty understanding feelings and tolerating distress. Impulsive acts can make it difficult to relate to others, affecting one’s family life, social activities, work, school, sports, and overall quality of life.

Various factors leading to personality disorders in athletes

Impact on Athletes:

There has been considerable research that links sports and personality traits. As games become more competitive or challenging, competitive stress can cause perfectionism (OCPD) and aggression (cluster B disorders).

An athlete with perfectionist traits will set and chase extremely unrealistic goals as well as be overly critical of themselves. Although there is some evidence that proves perfectionism improves athletic performance, its psychological effects outweigh the good. Perfectionism -not only in sports- can lead to anxiety, burnout, depression, and eating disorders (anorexia/bulimia). However, it is important to understand that there are two degrees of perfectionism: 1) normal and adaptive perfectionism, which positively drives achievement, and 2) unhealthy perfectionism, which comes from the fear of failing others and oneself. Negative perfectionism can come from pressure from parents or coaches who set unrealistic goals for them. Perfectionism can also lead to the risk of overtraining, further mental health deterioration, and overall sports performance.

Moreover, aggression tends to be seen as a good trait when it comes to sports, such as tackling your rival during a football match or pressing your competitor during a water polo game. However, it can manifest into risky behavior, including rule-breaking that can cause penalties and losses in matches, as well as injuring someone that results in a call for clinical attention. Some ways aggression is caused is by taking anabolic steroids and using drugs and alcohol. Mental illnesses such as depression, bipolar disorder, and ADHD can also be associated with aggression.

To prevent the development of personality disorders in athletes, coaches, families, or sporting organizations should all aim to find a comfortable position for athletes to balance their sports and personal lives that can limit achievement and prevent overpressure. Other ways include treatment.

Artistic depiction of psychotherapy

Treatment:

Personality disorders are complex and can be difficult to treat. Determined by your healthcare provider, treatments will vary based on your age, health, and medical history. Treatment may include:

• Medicine: Has limited effectiveness and should not be the only use of treatment. However, it can reduce some symptoms:

  • Antidepressants can reduce anxiety

  • Mood stabilizing medication to reduce aggression:

    • Sodium valproate

    • Lamotrigine

    • Lithium

*Medication should only be prescribed by a mental healthcare provider/ specialist.

Psychological treatments:

• Dialectical behavior therapy - Offered often over one year, this therapy involves individual and group sessions. It can help adapt those who experience intense emotions.

• Cognitive behavioral therapy - Offering often up to 20 weekly sessions, which involve individual and group sessions. It can help link thoughts and feelings and alter distorted thinking.

• Cognitive analytical therapy- Offered often weekly for 8-24 weeks, this therapy is individual sessions. It is used to help identify and adapt unhealthy behavior in relationships.

• Dynamic psychotherapy- Offered often over a year or more, this therapy helps individuals identify how their past experiences have an impact on their current behavior.

• Interpersonal therapy- Offering often 8-16 sessions, this therapy focuses on relationships and their impact on mental health.

Conclusion:

Our personality shapes and colors us for who we are, making each and every one of us unique from another. Although personalities help us connect with others and build a social network, those who suffer from personality disorders can hinder building meaningful relations in day-to-day life. Personality disorders arise from a mix of genetic, environmental, and early psychological experiences that lead to dysfunctional behavior. It is crucial to start treatment early, either through psychotherapy, medication, or support networks from a wider community. This can help those who suffer from personality disorders to navigate their causes, how to deal with them, and, as a result, to live a better life. So if you live or know someone dealing with personality disorders, try to talk to them rather than dismiss them, make them feel known and comfortable, and especially provide them with the professional help and treatment they need.

Sources:

Crash Course. 2014. “Personality Disorders: Crash Course Psychology #34.” YouTube Video. YouTube. https://www.youtube.com/watch?v=4E1JiDFxFGk.

American Psychological Association. 2010. “What Causes Personality Disorders?” Apa.org. 2010. https://www.apa.org/topics/personality-disorders/causes.

Mind. 2020. “Types of Personality Disorder | Mind, the Mental Health Charity - Help for Mental Health Problems.” Mind.org.uk. January 2020. https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/.

“Personality Disorders.” 2020. Johns Hopkins Medicine. 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/personality-disorders.

Owen, Bruce. 2016. “The Athletic Personality and Personality Disorders.” Oxford University Press EBooks, March, 97–106. https://doi.org/10.1093/med/9780198734628.003.0007.

Heba M. Fakher M. Hendawy, and Ezzat. 2013. “Personality and Personality Disorders in Athletes,” April, 53–64. https://doi.org/10.1002/9781118404904.ch6.

“Personality Disorders - Symptoms and Causes.” 2023. Mayo Clinic. July 14, 2023. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463#:~:text=People%20with%20personality%20disorders%20often.