Personality or Bipolar: Who Is Really Doing the Talking?

John McManamy Health Guide
  • Last year at this time, here at Bipolar Connect, we were engaging in a series of very productive discussions on illness vs personality. For instance:

    • Is it depression, or just thinking deep?
    • Is it hypomania, or just exuberance?
    • Is it our bipolar that is holding us back, or do we have other stuff going on?

    It’s easy to fall into the trap of thinking that our illness is responsible for all our behavior. It’s as if the surreal twists and turns of crazy lives demand a one-word explanation. That one word - bipolar - certainly accounts for a lot, but strip away the illness and we’re still left with personality, lots of it.

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    In February this year, the American Psychiatric Association issued its draft of the DSM-5, due for publication in 2013. The 2013 version of mood disorders, including bipolar, will look very much like the 1994 version (DSM-IV), which will in turn look like the 1987 version (DSM-III-R), which will in turn look like the 1980 version (DSM-III). By contrast, personality disorders will get a complete makeover.

    In my other blog, Knowledge is Necessity, I am running a series on the new and improved DSM personality disorders, but I do caution: "Diagnostic psychiatry can no more explain the reality of personality than theology can explain God."

    Personality is way too complex and subtle for easy descriptions, even those put together by experts. In the final analysis, we are our own best judges. But before we look inside, it pays to look outside. We may not have a personality disorder, but we all have our personality quirks, and where you find a quirk you are likely to find an amplified version of that quirk in the form of a disorder. Read about the disorder, and insights into the quirks follow.

    With me, so far?

    One of the problems with the current DSM is there are too many personality disorders to  choose from, ten in all, neither of them fitting neatly into their preassigned categories. Is someone who comes across as weird, for instance, “schizoid” or “schizotypal”? The DSM-5 has made things easier by folding one into the other. A bit more folding and winnowing later and we are left with five disorders, renamed types. Thus:

    • Antisocial/psychotic
    • Avoidant
    • Borderline
    • Obsessive-Compulsive
    • Schizotypal

    Conspicuously absent is narcissism, which got folded (with considerable controversy) into antisocial/psychotic. We can argue till our lips fall off which illnesses deserved to make the cut and what to call them and how to define them, but for the first time it appears that personality now has a clear navigational system, with five distinct pointer stars. Underpinning the new DSM personality constellation is this clear statement:

    Personality disorders represent the failure to develop a sense of self-identity and the capacity for interpersonal functioning that are adaptive in the context of the individual’s cultural norms and expectations.

    The DSM-5, in essence, is asking us to consider personality disorder as a failure to adapt to our surroundings. What we’re looking at is a breakdown in perception, both in regard to our sense of self and sense of others. Many of us go through life viewing the world as hostile. We respond with too much emotion or not enough emotion. Our thoughts and feelings and behavior lose all relation to events around us. In a Knowledge is Necessity piece, I put it this way:

  • Do we, for instance, try to dominate those around us? (Antisocial.) Or do we freak out and lose it? (Borderline.) Or do we withdraw into a comforting cocoon? (Avoidant.) Maybe we look for order where none exists. (Obsessive-compulsive.) Perhaps we harbor unusual perceptions of reality. (Schizotypal.)

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    If you’re looking for a further breakdown, the DSM-5 has kindly provided a list of six “trait facets,” including negative emotionality, introversion, antagonism, disinhibition, compulsivity, and schizotypy. The new version of borderline, for instance is heavy on the negative emotionality (six altogether, such as emotional lability), while the new antisocial/psychotic is tempered with six degrees of antagonism (such as hostility and aggression).

    Maybe you don’t fit into a category. Maybe you see a bit of yourself in a number of categories. That’s okay. The new DSM, for the first time, recognizes it may be more productive to look at personality “dimensionally,” without pinning categorical labels onto behavior, which drives home our point:

    Whether or not we have a full-blown personality disorder, we all have personality in various combinations, a little bit of this, a little bit of that. Remove bipolar from the equation and we are still left with the daunting prospect of negotiating our way through an often mystifying and challenging world. Try to recall, for instance, your thoughts and feelings the last time you walked into a room full of strangers and how you handled yourself. Was it really your bipolar doing the talking or was it something else?

    Only you can answer that question.

Published On: December 18, 2010