An Overview of Mixed Personality Disorder

Definition, Diagnosis, and Criteria

psychiatrist and patient
Alain SHRODER/ONOKY/Getty Images

Mixed personality disorder refers to a type of personality disorder that does not fall into the ten recognized personality disorders. It is possible for people to have traits or symptoms of more than one personality disorder at the same time, while not meeting the criteria for any single one of them. In DSM-IV, this was referred to as "Personality Disorder Not Otherwise Specified (NOS). This has been replaced in the DSM-5 by Personality Disorder—Trait Specified (PD-TS).

and the traits are listed out.

PD-TS is not a surprising category as there is significant overlap between the symptoms of several of the personality disorders. Though we don't understand all of the causes of personality disorders, there are causes as well which likely underlie more than one of these disorders. Since this is in a way a "catch all" category for people with some symptoms of many different personality disorders, there is a wide range of symptoms among people carrying this diagnosis.

What Are Personality Disorders?

Most people have a fairly flexible personality that allows them to adapt to a variety of circumstances, people and events. People with personality disorders, instead, get stuck in fairly rigid ways of relating to people and events. These rigid thoughts may affect how they think about themselves and the world around them, how they experience emotion, how they function socially, and how well they can control their impulses.

How Are Personality Disorders Diagnosed?

In order to be diagnosed with a personality disorder, an individual must exhibit symptoms that meet the diagnostic criteria established in the DSM-5, including:

  • These patterns of behavior must be chronic and pervasive, affecting many different aspects of the individual’s life, including social functioning, work, school and close relationships.
  • The individual must exhibit symptoms that affect two or more of the following four areas:
    1. Thoughts
    2. Emotions
    3. Interpersonal functioning
    4. Impulse control
  • The pattern of behaviors must be stable across time and have an onset that can be traced back to adolescence or early adulthood.
  • These behaviors cannot be explained by any other mental disorders, substance abuse or medical conditions.

While the DSM-5 retained the DSM-IV's categorical approach to diagnosing personality disorders, it developed an alternate model, which is suggests could be an area for future study. Using this alternate, hybrid model, clinicians would assess personality and diagnose a personality disorder based on a combination of specific difficulties in personal functioning, as well as the general patterns of pathological personality traits.

Types of Personality Disorders

A personality disorder is defined as a chronic and pervasive mental disorder that affects thoughts, behaviors and interpersonal functioning. The DSM-5 recognizes ten distinct personality disorders, which are arranged into three clusters:

Cluster A: Odd, Eccentric Disorders

  • Paranoid Personality Disorder—Paranoid personality disorder is marked by a chronic fear and distrust of other people combined with a belief that others are deceiving or exploiting them. It occurs in one to two percent of the population and overlaps in some ways with schizophrenia.
  • Schizoid Personality Disorder—Schizoid personality disorder is marked by an indifference to other people. Those with this disorder often have very little interest in forming close relationships with other people.
  • Schizotypal Personality Disorder—Schizotypal personality disorder, a condition which affects around three percent of the population, is marked by eccentric thoughts and behaviors. People with the disorder often engage in magical thinking, for example, believing they can read the future. and suffer from tremendous social anxiety as well.

    Cluster B: Dramatic, Emotional, or Erratic Disorders

    • Antisocial Personality Disorder—It's thought that 7.6 million Americans suffer from antisocial personality disorder, a disorder in which people may intentionally harm others and are indifferent to the pain experienced by anyone other than themselves. A lack of empathy (lack of concern for others) combined with a lack of remorse (little conscience about their cruel activities) often contributes to criminal behaviors.
    • Borderline Personality Disorder—Borderline personality disorder often leads to unstable and intense relationships due to anger and aggression towards others combined with a deep fear of abandonment. These people often engage in risky behaviors, and may engage in self harming behaviors.
    • Histrionic Personality Disorder—Histrionic personality disorder affects around 1.8 percent of the population and involves a combination of shallow emotions combined with attention seeking and manipulative behaviors. Suicide gestures are commonly not related to depression, but rather as a way to manipulate others.
    • Narcissistic Personality Disorder (NPD)—Narcissistic personality disorder is characterized by extreme self-centeredness, an exaggerated sense of their own importance, and a lack of empathy or concern for others. The disorder is often recognized first not in the person who has the disorder, but through the emotional damage which occurs to those people with whom the person with NPD relates.

    Cluster C: Anxious or Fearful Disorders

    • Avoidant Personality Disorder—Avoidant personality disorder is characterized by extreme shyness and sensitivity to criticism from others. It is often associated with other mental health conditions such as anxiety disorders and social phobia.
    • Dependent Personality Disorder—Dependent personality disorder is characterized by an intense fear and inability to make decisions. This disorder is the ultimate in the need to be a "people pleaser" and can result in near paralysis and inability to make the daily decisions (without the input of others) necessary for functioning well in the outside world.
    • Obsessive-Compulsive Personality Disorder—Around 2.5 percent of the population is expected to suffer from obsessive compulsive personality disorder at some point in their life. It is characterized by obsessions which are dealt with in turn by compulsions. Obsessions are often an irrational fear, perhaps the fear of disease, which are dealt with by compulsions, such as repeated hand washing to the point in which the compulsion causes inability to live normally.

    Differential Diagnosis of Mixed Personality Disorder

    Before a clinician can diagnose a personality disorder, she must rule out other disorders or medical conditions that may be causing the symptoms. This is very important, but can be difficult as the symptoms that characterize personality disorders are often similar to those of other disorders and illnesses. Personality disorders also commonly co-occur with other illnesses.

    The following are potential differentials that must be ruled out before diagnosing an individual with a personality disorder:

    Living With and Treatment for Mixed Personality Disorder

    Since the symptoms and characteristics of mixed personality disorder span a wide range, there is not one specific treatment which is helpful to all people with PD-TS. The particular symptoms present are often treated as if a person did meet the criteria of one of the personality disorders described above.

    For example, if a person meets some, but not all of the criteria for borderline personality disorder, treatments for borderline personality disorder such as psychotherapy may be pursued. In general, the treatment of personality disorders is difficult, and requires the person with the disorder wishing very much to pursue therapy. Psychotherapy is often more effective than medications.

    Sources:

    Clark, L., Vanderbleek, E., Shapiro, J. et al. The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity. Psychopathology Review. 2015. 2(1):52-82.

    Continue Reading